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How Ambulances Work

What Happens When Someone Calls 911?

ambulance emergency
An ambulance speeds to an emergency in London. Leo Patrizi/Getty Images

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When there is a medical emergency and someone calls 911 for help, they talk to a 911 dispatcher. He or she typically will ask questions from a standardized script, and type the answers into the 911 center's computer system. Sometimes, the system will automatically pick the response, though there's always a human involved in the decision as well, according to Buchle.

But who actually answers the call depends upon where the caller is. Big cities and suburban counties have their own government-run EMS systems (supported by taxpayers), while other communities may have a mix of hospital-based, private for-profit, and private non-profit ambulance companies that have contracts to handle emergency care in those places. For instance, in one city, a fire department might respond to critical cases, while a private company might handle non-life-threatening issues. In addition, many municipalities have mutual aid agreements with other nearby communities, who can send their ambulances to fill in if needed. But it's not a case of various ambulances competing for the same business. Counties contract with just one company to handle their ambulance needs or if there are more than one, each one would handle a specific need or region.

The National Association of Emergency Medical Technicians broke down the makeup of the ambulance system in the U.S. in 2017 as follows [source: Calams]:

  • Fire Departments with EMS personnel: 49 percent
  • Government: 14.5 percent
  • Private company: 18 percent
  • Hospital-based: 7 percent
  • Police: 1.5 percent
  • Other: 10 percent

According to a study published in 2017 in the journal JAMA Surgery, across the U.S. there's an average interval of seven minutes between a 911 call and an ambulance arriving on the scene. But that wait averages 13 minutes in rural areas, and in some isolated places, it can be up to 30 minutes before help arrives [source: American College of Emergency Physicians].

This delay has been a problem in some counties and states. For instance, in Dekalb County in Atlanta, Georgia, ambulances in 2018 had routinely exceeded the county goal of nine minutes by several minutes. This caused the county to threaten to pull the ambulance contract from the private company that had it. The service blamed the delays on long waits at hospitals for a bed to free up where the patient could be placed from the ambulance. To remedy the situation (and keep its contract), the ambulance service agreed to add more vehicles to fire stations and to have more paramedics on board [source: Berard].

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