New ESO Research Finds 3% of Patients Drive 16% of All 911 EMS Responses

Published in Health Affairs Scholar, the analysis of 9.5 million EMS encounters identifies frequent 911 use as a signal of structural barriers to care, calls for policy action

AUSTIN, Texas, July 07, 2026 (GLOBE NEWSWIRE) -- ESO Solutions, Inc. (“ESO”), a leading data services and software provider for EMS, fire departments, hospitals, and government agencies, today announced the publication of new research in Health Affairs Scholar analyzing patient-level EMS utilization across the U.S. The study of more than 9.5 million 911 encounters found that 3% of patients accounted for 16% of all responses, and that the most frequent callers returned to EMS within a median of 10 days. The research underscores multiple considerations for EMS leaders and policymakers, including exploring new incentive and reimbursement models.

The study, “A National Description of EMS Patient Utilization Patterns,” drew on 9,508,809 EMS encounters involving 6,604,938 unique patients using the 2024 ESO Data Collaborative, the industry’s largest integrated emergency outcome data asset. Using a novel patient-level linkage method, researchers tracked repeat 911 use across a full calendar year—a view that has been largely absent from U.S. health policy discussions because 911 EMS calls have historically been structured as one-time, encounter-level transport records.

“EMS practitioners have seen this in the field for years, and now this research quantifies their experience at a national scale: A concentrated group of people is turning to 911 again and again to access healthcare,” said Brent Myers, M.D., MPH, chief medical officer at ESO and a co-author of the study. “These data give the emergency care continuum an earlier, community-based signal for who those patients are and a chance to connect them to the right care in a patient-centered manner.”

Key findings from the article include:

• Three percent of patients accounted for 16% of all 911 responses. Patients with the highest utilization, defined as those with 12 or more encounters in a year, returned to EMS within a median of 10 days.
• Patients with very-high utilization were transported more often than single-encounter patients (83% vs. 75%) but were 40% less likely to be admitted to the hospital once they reached the emergency department.
• Frequent EMS use concentrated among Medicaid patients and residents of socioeconomically vulnerable communities. Medicaid patients showed three times higher odds of very-high utilization than commercially insured patients, and patients in the most socioeconomically vulnerable communities showed three times higher odds than those in the least vulnerable.
• Patients with diabetes were twice as likely to experience high EMS utilization, suggesting focused secondary prevention and patient education efforts may reduce this burden.

The findings carry direct implications for how systems triage and respond to lower-acuity calls. Prior outcomes research cited in the study indicates that only 6% to 12% of 911 calls require time-sensitive interventions, which the authors point to as support for alternative response pathways.

“Uniquely, we can now describe the socioeconomic and disease patterns that contribute to high EMS utilization,” Myers added. “With this focus on the patient rather than the single episode of care, we can navigate individuals to the right healthcare resource rather than defaulting every call to the same pathway.”

“This study furthers the evidence base the field has needed to meaningfully advance policy and reimbursement dialogue in the U.S.,” said Eric Beck, DO, MPH, chief executive officer at ESO and a co-author of the study. “Expanding EMS reimbursement beyond transport to an emergency department is hard to ignore, especially when care coordination programs that prevent the next 911 call and navigate low-acuity 911 callers to more appropriate resources are both better for the patient and lower cost. EMS reimbursement and incentive alignment that focuses on clinical care, quality and outcomes while reducing strain on the system—including prospective payment models—is a win-win-win for patients, providers and payers. EMS is already engaging with high utilizers in their community. The question is whether we align EMS reimbursement to do more than transport.”

The authors identify the EMS system and EMS data as underused population health assets and name several policy actions that warrant consideration, including accelerating alternative payment models for EMS that incentivize care coordination over transport volume; enhancing community paramedicine and mobile integrated healthcare; investing in data-sharing infrastructure so EMS has real-time access to patient history and care plans to facilitate care coordination; creating incentives for EMS integration with federally qualified health centers and broader payer networks, namely for Medicaid and Medicare populations; including EMS navigation and coordination roles in community health worker funding programs; and integrating EMS into broader population health strategies to proactively engage patients with high utilization and provide care coordination.

The ESO Data Collaborative includes more than 3,000 participating agencies. As an observational study drawn from a large but self-selected sample, the analysis describes patterns within the dataset rather than nationally representative estimates, and its design does not establish causation.

The full study is available in Health Affairs Scholar at academic.oup.com. To learn more about ESO’s research, visit www.eso.com/data-and-research.

About ESO
ESO’s mission is to improve community health and safety outcomes through the power of data. Founded and led by emergency responders and medical professionals since 2004, ESO advances the industry by combining deep domain expertise with innovative technology, impactful research and the industry’s largest integrated emergency outcome data asset. The company delivers the world's most trusted and connected emergency ecosystem—an open, interoperable platform that unites emergency medical response, fire, hospital and government stakeholders across the full emergency continuum through real-time data exchange and embedded intelligence in frontline workflows. ESO’s solutions deliver actionable insights to decision-makers, enable smarter coordination across the emergency continuum and uphold the highest standards of data security and patient privacy. The company helps customers around the world deliver measurable improvements in clinical, operational and financial outcomes with dedicated teams in the United States, Canada, United Kingdom, Denmark, Czech Republic, India and Costa Rica. For more information, visit www.eso.com. 

Media Contact:
For ESO,
Anika Grendell
Red Fan Communications
eso@redfancommunications.com

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