911 and the area code from which you call: How to improve the disparity in California's Emergency Medical Services.

Thirty-three separate local emergency medical services (EMS) authority agencies serve the 58 counties in California. Each local emergency medical services agency dictates widely different treatment and trans-port protocols for its paramedics. Although previous research has established the problem of geographic EMS dis-parities, nothing definitively explains their cause. We analyze California's most recently available EMS performance-measure data to determine if there is still disparity in EMS patient care and patient outcomes in California. If there is a disparity, we determine whether the differences are accounted for by socioeconomic factors, geographical differences, or population size, by combin-ing California EMS data with other state and county level data. If none of these factors are significantly correlated, this supports the hypothesis that something different, such as system structure, could be a potential cause of Califor-nia's EMS disparities. As a secondary analysis, we attempt to replicate these types of analyses at national and inter-national levels, which could potentially permit a structural comparison as well. There is still disparity in EMS patient care and patient outcomes in California. Regression analyses did not identify a single factor to explain the disparity in performance measures. Most notably, the regression found that basic socioeconomic factors and geographical differences frequently speculated as common drivers for disparity of services, including median income, population density, and availability of specialty care facilities, did not account for the disparity in services. Unfortunately, the striking lack of performance-measure data-a data desert-for EMS throughout the United States meant that the secondary analyses were inconclusive. Based on these results, we propose three recommendations:(1) most importantly, the lack of data must be addressed. Data collection should be standardized and mandatory for all EMS providers. (2) Treatment protocols for the state should be standardized and based on the latest evidence-based research. Providers should be required to offer the same level of care, to all geographic re-gions. (3) It may be beneficial to consider restructuring the California EMS system. While the research is limited due to imperfect information, consolidated systems seem to perform better. An existing framework for this already exists.