Demand For Emergency Medical Services Research Articles

Changes in the epidemiological characteristics of prehospital emergency services before and during the COVID-19 pandemic, Chengdu, 2016–2021

The coronavirus disease 2019 (COVID-19) brought a healthy crisis all around the world. It’s not only affected healthcare utilization, but also some disease’s incidence. We collected pre-hospital emergency data in Chengdu from January 2016 to December 2021, and studied the demand for emergency medical services (EMSs), emergency response times (ERTs), and the disease spectrum in the city proper of Chengdu as a whole. A total of 1,122,294 prehospital emergency medical service (EMS) instances met the inclusion criteria. Under the influence of COVID-19, notably in 2020, the epidemiological characteristics of prehospital emergency services in Chengdu were considerably altered. However, as the pandemic was brought under control, they returned to normal or even earlier in 2021.The COVID-19 pandemic had an effect on people's medical care-seeking behavior and the performance of prehospital emergency services. Although the indicators associated with prehospital emergency services eventually recovered as the epidemic was brought under control, they remained marginally different from before the outbreak.

Factors associated with demand for emergency medical services by people with hypertension and diabetes

RESUMO Objetivos: analisar a associação entre a recorrência de atendimentos nos serviços de emergência devido ao descontrole pressórico e/ou glicêmico com as variáveis sociodemográficas e cadastro da doença na Atenção Primária. Métodos: estudo quantitativo, que consultou prontuários de pessoas que compareceram duas ou mais vezes nesses serviços no período de 26 meses. Utilizaram-se estatística descritiva e modelos de regressão logística múltipla na análise. Resultados: a maioria das pessoas não possuía registro/cadastro de hipertensão e/ou diabetes no prontuário da Atenção Primária. A ausência desse cadastro foi mais frequente em pessoas do sexo masculino, com idade entre 18 e 59 anos, baixa escolaridade e descontrole pressórico. Observou-se associação entre número maior de procura desses serviços em um mesmo ano e não acompanhamento da condição crônica na assistência especializada. Conclusões: pessoas que não fazem acompanhamento da hipertensão e/ou diabetes na Atenção Primária estão mais sujeitas a necessitar de assistência por descontrole pressórico e/ou glicêmico.

Physician Discretion and Patient Pick-up: How Familiarity Encourages Multitasking in the Emergency Department

Patient demand for emergency medical services has never been greater. In the United States, as fewer people access medical care through a primary care provider, more people access care through the hospital emergency department (ED). Unlike other types of queuing systems, however, the ED allows physicians discretion in whom they serve. That is, ED queues do not operate solely under a policy of “first-come, first-served, by severity.” Therefore, we wanted to know: “What leads physicians to select which patients, and how many patients, they will treat?” We explore how familiarity between peer physicians affects patient selection and the chosen multitasking level, a process more commonly known in the ED as “patient pick-up.” We find greater familiarity leads to an increase in patient pick-up rate, observed multitasking, and shorter patient wait time, with no identifiable negative impact to patient processing time or length of stay.

Modular vehicle technology for emergency medical services

While advancements in vehicular and wireless communication technologies are shaping the future of our transportation system, emergency medical services (EMS) are not receiving enough research attention. Their operations are still plagued by response delays that can often be life-threatening. Dispatching and redeployment systems identify the best practices regarding the allocation of the resources to emergencies and stations. Yet, the existing systems are unfortunately insufficient, and there is a growing need to embrace new technological solutions. This research introduces a smart system for EMS by leveraging the modular vehicle technology initially developed for transit systems. The proposed system relies on the design of vehicular modules that can couple and decouple to transfer patients from one module to another during transport. A fleet of medical transport vehicles is deployed to cooperate with the life support vehicles by providing, for example, transport and hospital admission tasks, thus allowing life support vehicles to answer pending emergency calls earlier. This is especially useful when there is a large demand for EMS (e.g. under the COVID-19 pandemic or other disasters such as the recent explosion in Beirut). This paper introduces a mathematical programming model to determine the optimal assignment decisions in a deterministic setting. This work is a proof of concept that demonstrates the applicability of the modular vehicle technology to EMS, evaluating the upper bound EMS performance that can be ultimately reached. A sensitivity analysis is conducted to provide insights and recommendations that are useful when selecting the weighting coefficients for the optimization function, to ensure a more efficient implementation of the modular vehicle technology for EMS. Also, the results of a comparative analysis show that the proposed system can adapt and offer larger benefits, in terms of response times and times to hospital, as demand increases and/or resources become more limited.

Emergency Medical Services Demand: An Analysis of County-Level Social Determinants.

Variations in the demand for Emergency Medical Services (EMS) exist when observed at a local level. This unspecified heterogeneity leads to an investigation of social factors contributing to EMS demand. Data for this study were collected from publicly available EMS reports from Florida and Oklahoma for 2009 - 2015. Health and social data were gathered from County health rankings and roadmap reports. Data were combined into a single dataset, and pooled ordinary-least-squares models with time-fixed effects were utilized for tests of inference. EMS call volume was log-transformed to derive a semi-elasticity function. A total of 874 county-year observations were analyzed. Increases in poor/fair health (95% CI: 0.6% - 3.9%), binge drinking (95% CI: 1.6% - 3.5%), teen birth rate (95% CI: 1.1% - 5.2%), unemployment rate (95% CI: 0.5% - 3.9%), and violent crime rate (95% CI: 1.0% - 3.0%) were associated with an increase in the EMS demand rate. The data supports the notion that some community measures have an effect on EMS demand as counties with higher levels of poor health, binge drinking, teen births, unemployment, and violent crime saw higher EMS demand. These factors may have been treated as spurious, or overlooked by policy makers and EMS leadership.

A mathematical optimization model for location Emergency Medical Service (EMS) centers using contour lines

Despite extensive research and efforts to optimize Emergency Medical Service (EMS) during the last four decades, there are still critical and fundamental challenges to study. Operational problems experienced during implementation of the proposed models result in the emergence of new concerns and the development of other models. This research examines the optimal location of emergency medical centers in order to offer faster and more efficient care. The purpose of this study is to offer a mathematical model for locating emergency medical centers with the goal of increasing both the quantity and quality of demand coverage. Then, by defining numerical examples, the behavior of the model is analyzed. The model is first solved in small dimensions using GAMS, and due to the np-hard nature of the model, it is then studied in large dimensions using a meta-heuristic algorithm, which uses a Genetic Algorithm (GA) in this paper. Finally, the graphs’ results are compared to each other. Our findings indicate that as the dimensions of the problem increase, GAMS loses its ability to solve the problem and the solution time by GA decreases compared to GAMS. Ultimately, in a numerical example, we used contour lines to analyze the data. EMS potential points follow these lines and serve as demand points. Given the model’s accuracy has been proven with various parameters, the proposed model can be used to both meet demand for emergency medical services and determine the optimal location of emergency medical care facilities.

A Study on the Role of Public Health in Reducing the Abuse of Ambulance Services

Background Demand for emergency medical services or ambulance response is situated within the context of other healthcare and social welfare services. Worldwide ambulance providers have a wide variety of services available, but many services are struggling to meet service demand. Inappropriate use of ambulance services is one of the biggest concerns globally. The burden of using the ambulance services includes transporting non-critical patients to the hospital. Misuse of the ambulance services is a serious problem that must be addressed and solved. Objective The purpose of this study is to evaluate the public perception of appropriate usage of ambulance services and determine the applicable role of public health to reduce the inappropriate use of an ambulance. Methodology A cross-sectional study was conducted to collect data from the general public using an online survey. The survey contains 9 questions that evaluate the public awareness of appropriate ambulance use. Participants are people from the public within the age of 18 and above. Sample Size A total of N=97 of participants’ responses were used to analyze the data. Inclusion Criteria Complete surveys and answer data using the English language. Exclusion Criteria Uncompleted surveys, and answered with other languages. Results During the online survey, a total of n=97 participants enrolled voluntarily. The majority of the residents are aware of when to and whom to call in case of a medical emergency. N=35 (36%) of the participants believe that ambulance services are misused. Conclusion The conducted study demonstrated that almost 36% of participants believed abuse of ambulance services, though there might be numerous reasons for calling ambulance unnecessary. Public health plays a vital role to reduce inappropriate ambulance calls when both ambulance services and public health are integrated into one system of care.

Laypeople's activity for seeking telephone number of EMS before and during the COVID-19 outbreak: An analysis of web search data.

ObjectiveTo explore trends and patterns of laypeople's activity for seeking telephone number of emergency medical services (EMS) based on analysis of online search traffic, including changes of the search activity with onset of the coronavirus disease 2019 (COVID-19) outbreak, in five countries – the United States of America (USA), India, Brazil, the United Kingdom (UK) and Russia.MethodsGoogle Trends (GT) country-level data on weekly relative search volumes (RSV) for top queries to seek EMS number were examined for January 2018–October 2021, including a comparison of RSVs between pre-COVID-19 period (January 2018–October 2019) and COVID-19 period (January 2020–October 2021), and evaluation of temporal associations of RSVs with weekly numbers of new COVID-19 cases.ResultsThe countries demonstrated diverse patterns of the search activity with significantly different mean RSVs (the USA 1.76, India 10.20, Brazil 2.51, the UK 6.42, Russia 56.79; p < 0.001). For all countries excepting the USA mean RSVs of the COVID-19 period were significantly higher compared with the pre-COVID-19 ones (India +74%, Brazil +148%, the UK +22%, Russia +9%; p ≤ 0.034), and exhibited positive correlations with numbers of new COVID-19 cases, more pronounced for 2021 (India rS = 0.538, Brazil 0.307, the UK 0.434, Russia 0.639; p ≤ 0.045).ConclusionLaypeople's activity for seeking EMS telephone number greatly varies between countries. It clearly responds to the spread of COVID-19 and could be reflective of public need for obtaining emergency help. Further studies are required to establish the role of GT for conducting real-time surveillance of population demand for EMS.

Study on the associated factors of turnover intention among emergency nurses in China and the relationship between major factors

BackgroundIn China, the demand for emergency medical services is increasing. However, there is a shortage of nurses and a high turnover rate. The study has three purposes: (1) to investigate the turnover intention of emergency nurses in China; (2) to analyze the associated factors of turnover intention; and (3) to clarify the relationship between work stress, job burnout, perceived organization support, job satisfaction and turnover intention. MethodsA cross-sectional study was conducted to investigate 56 hospitals with independent emergency departments in Chongqing. A total of 522 emergency nurses were included. Descriptive statistics, One-way analysis of variance, Pearson correlated analysis and a mediation regression analysis were used to analyze the turnover intention, associated factors, and the relationship between the major study variables. ResultsThe score of turnover intention was 2.38 ± 0.57, and the proportion of nurses with high turnover intention was 40.61%. Age, working years in emergency department (ED), marital status, employment forms, professional title, promotion opportunities, weekly working hours, monthly night shifts and exposure to workplace violence during the year influenced turnover intention of emergency nurses. Work stress and job burnout were positively correlated with turnover intention (r = 0.189, r = 0.391), while perceived organization support and job satisfaction were negatively correlated with turnover intention (r = − 0.349, r = − 0.485). perceived organization support plays a mediating role between work stress and job burnout, between work stress and job satisfaction, and between work stress and turnover intention. ConclusionWork stress, job burnout, perceived organization support and job satisfaction are important associated factors of emergency nurses' turnover intention in China. It is suggested to take intervention measures to reduce work stress and job burnout and to improve perceived organization support and job satisfaction.

A spatial queuing model for the location decision of emergency medical vehicles for pandemic outbreaks: the case of Za'atari refugee camp

PurposeRefugee camps can be severely struck by pandemics, like potential COVID-19 outbreaks, due to high population densities and often only base-level medical infrastructure. Fast responding medical systems can help to avoid spikes in infections and death rates as they allow the prompt isolation and treatment of patients. At the same time, the normal demand for emergency medical services has to be dealt with as well. The overall goal of this study is the design of an emergency service system that is appropriate for both types of demand.Design/methodology/approachA spatial hypercube queuing model (HQM) is developed that uses queuing-theory methods to determine locations for emergency medical vehicles (also called servers). Therefore, a general optimization approach is applied, and subsequently, virus outbreaks at various locations of the study areas are simulated to analyze and evaluate the solution proposed. The derived performance metrics offer insights into the behavior of the proposed emergency service system during pandemic outbreaks. The Za'atari refugee camp in Jordan is used as a case study.FindingsThe derived locations of the emergency medical system (EMS) can handle all non-virus-related emergency demands. If additional demand due to virus outbreaks is considered, the system becomes largely congested. The HQM shows that the actual congestion is highly dependent on the overall amount of outbreaks and the corresponding case numbers per outbreak. Multiple outbreaks are much harder to handle even if their cumulative average case number is lower than for one singular outbreak. Additional servers can mitigate the described effects and lead to enhanced resilience in the case of virus outbreaks and better values in all considered performance metrics.Research limitations/implicationsSome parameters that were assumed for simplification purposes as well as the overall model should be verified in future studies with the relevant designers of EMSs in refugee camps. Moreover, from a practitioners perspective, the application of the model requires, at least some, training and knowledge in the overall field of optimization and queuing theory.Practical implicationsThe model can be applied to different data sets, e.g. refugee camps or temporary shelters. The optimization model, as well as the subsequent simulation, can be used collectively or independently. It can support decision-makers in the general location decision as well as for the simulation of stress-tests, like virus outbreaks in the camp area.Originality/valueThe study addresses the research gap in an optimization-based design of emergency service systems for refugee camps. The queuing theory-based approach allows the calculation of precise (expected) performance metrics for both the optimization process and the subsequent analysis of the system. Applied to pandemic outbreaks, it allows for the simulation of the behavior of the system during stress-tests and adds a further tool for designing resilient emergency service systems.

Binary Programming Model for Rostering Ambulance Crew-Relevance for the Management and Business

The nature of health care services is very complex and specific, thus delays and organizational imperfections can cause serious and irreversible consequences, especially when dealing with emergency medical services. Therefore, constant improvements in various aspects of managing and organizing provision of emergency medical services are vital and unavoidable. The main goal of this paper is the development and application of a binary programming model to support decision making process, especially addressing scheduling workforce in organizations with stochastic demand. The necessary staffing levels and human resources allocation in health care organizations are often defined ad hoc, without empirical analysis and synchronization with the demand for emergency medical services. Thus, irrational allocation of resources can result in various negative impacts on the financial result, quality of medical services and satisfaction of both patients and employees. We start from the desired staffing levels determined in advance and try to find the optimal scheduling plan that satisfies all significant professional and regulatory constraints. In this paper a binary programming model has been developed and implemented in order to minimize costs, presented as the sum of required number of ambulance crews. The results were implemented for staff rostering process in the Ambulance Service Station in Subotica, Serbia. Compared to earlier scheduling done ad hoc at the station, the solution of the formulated model provides a better and equable engagement of crews. The developed model can be easily modified and applied to other organizations with the same, stochastic, nature of the demand.

Increased Emergency Calls during the COVID-19 Pandemic in Saudi Arabia: A National Retrospective Study.

The coronavirus 2019 (COVID-19) pandemic has a direct and indirect effect on the different healthcare systems around the world. In this study, we aim to describe the impact on the utilization of emergency medical services (EMS) in Saudi Arabia during the COVID-19 pandemic. We studied cumulative data from emergency calls collected from the SRCA. Data were separated into three periods: before COVID-19 (1 January–29 February 2020), during COVID-19 (1 March–23 April 2020), and during the Holy Month of Ramadan (24 April–23 May 2020). A marked increase of cases was handled during the COVID-19 period compared to the number before pandemic. Increases in all types of cases, except for those related to trauma, occurred during COVID-19, with all regions experiencing increased call volumes during COVID-19 compared with before pandemic. Demand for EMS significantly increased throughout Saudi Arabia during the pandemic period. Use of the mobile application ASAFNY to request an ambulance almost doubled during the pandemic but remained a small fraction of total calls. Altered weekly call patterns and increased call volume during the pandemic indicated not only a need for increased staff but an alteration in staffing patterns.

Introduction of emergency paramedic investigators in the context of the COVID-19 pandemic in the Berlin emergency medical service

HintergrundIm Rahmen der COVID-19-Pandemie zeigt sich wiederholt, dass sich eine Vielzahl von Patienten im Verlauf unbeobachtet akut verschlechtert. Dem gegenüber steht eine erhöhte Inanspruchnahme der Notfallrettung mit einer daraus folgenden Ressourcenknappheit, die es erfordert, die Notwendigkeit einer stationären Versorgung zu priorisieren oder entsprechend die Anbindung an eine geeignete ambulante Versorgung sicherzustellen. Bei der Berliner Feuerwehr wurden in dem Zusammenhang NotSan-Erkunder als zusätzliche Einsatzmittel eingeführt.MethodikAusgewertet wurden alle Einsätze, zu denen im Zeitraum 28.03.2020 bis 28.04.2020 NotSan-Erkunder der Berliner Notfallrettung entsendet wurden. Hierbei konnten in dem Zeitraum von 31 Tagen 341 Einsätze einbezogen werden. Neben den Daten aus dem Einsatzleitsystem wurde die Einsatzdokumentation ausgewertet.ErgebnisseIn 57 % wurden mNACA-II-Patienten (ambulante Behandlung) vorgefunden (NACA[National Advisory Committee for Aeronautics Scoringsystem]-Score), in 42 % mNACA-III- (stationäre Behandlung) und in 1 % mNACA-IV-Patienten (drohende Lebensgefahr). In 51 % erfolgte ein Transport in eine Klinik durch die Notfallrettung, in 49 % der Fälle konnte eine alternative Versorgung sichergestellt werden. Hierbei erfolgte in 28 % der Verweis an die hausärztliche Versorgung. In 11 % erfolgte der Verweis an den ärztlichen Bereitschaftsdienst der kassenärztlichen Vereinigung. In 4 % der Fälle wurde über die Leitstelle der Berliner Feuerwehr ein ein KV(Kassenärztliche Vereinigung)-ARE(Akute respiratorische Erkrankung)-Erkunder hinzugezogen.DiskussionDie Ergebnisse zeigen, dass einem zusätzlichen Einsatzmittel in einer Pandemielage eine wichtige Funktion im Sinne einer Ersteinschätzung und Lotsenfunktion zukommen kann. Hierdurch kann es zu einer Entlastung der Notfallrettung, aber auch von weiterführenden Versorgungseinrichtungen kommen. Die standardisierte Notrufabfrage ermöglicht auch hier die Anbindung an entsprechende Codes aus dem niedrigprioritären Einsatzspektrum, weiterhin bietet die Unterstützung durch den Telenotarzt eine erweiterte Handlungskompetenz für die Notfallsanitäter.

Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

BackgroundThere has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data.MethodsA descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test.ResultsOut of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women.ConclusionsFewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

Familiarity, Load, and Patient Pick-Up: The Positive and Negative Effects of Group Composition on Physician Behavior in the Emergency Department

Background: Patient demand for emergency medical services continues to rise from all-time highs. ED physicians generally respond to this rising demand by increasing their level of multitasking. Aim: What leads ED physicians to select which patients, and how many patients, they will treat? Queuing models frequently assume individual servers operate independently of other servers. In contrast, we consider how familiarity between peers affects a physician’s chosen multitasking level through patient selection, otherwise known as “patient pick-up. Methods: Using data from multiple EDs, we quantify the effect of familiarity on multitasking empirically, show this effect occurs due to changes in pick-up behavior, and explore the combined impact of familiarity and multitasking on other ED outcomes. Results: Among ED physicians, greater average familiarity leads to observed multitasking, an increase in patient pick-up rate, and shorter patient wait time -- all with no identifiable, negative impact to patient processing time or length of stay. Moreover, these effects intensify at the end of a physician’s shift and for patients in severe condition. Conclusion: Within more familiar groups, physicians appear willing to exert more effort. This study explicates how these benefits materialize and illustrates why researchers must consider server familiarity moving forward.

Emergency department visits during the 4/20 cannabis celebration

BackgroundAnnual ‘4/20’ cannabis festivals occur around the world on April 20 and often feature synchronised consumption of cannabis at 4:20 pm. The relationship between these events and demand for emergency...

Maximising the coverage of emergency medical services with time-dependent demand restrictions: a case study in Shanghai

In many Asian cities, periodic changes in the demand for emergency medical services are concerned, but few existing studies have discussed the time-dependent factor in delivering these services. This study proposes a formula for locating emergency medical services, in which factors of varying demand, time-dependence, cost and facility capacity are considered. A real case is investigated in order to understand the impact of time-dependence on decision making. The case study suggests different solutions depending on whether the design is service-oriented or cost-oriented. The analysis also indicates that the limitations on demand complicate the making of decisions to optimise service locations, e.g., more service stations are required. By creating a design for allocating service sites based on demand nodes in a real case, this study provides a framework for analysing the location problem when demand changes.

Repeated ambulance use is associated with chronic diseases - a population-based historic cohort study of patients\u2019 symptoms and diagnoses

BackgroundThere is a growing demand for emergency medical services (EMS) and patients are repeatedly transported by ambulance services. For many patients, especially those with chronic disease, there may be better ways of delivering care. We examined the symptom at time of emergency call and the hospital diagnosis for those ambulance users who repeatedly received an ambulance.MethodsPopulation-based historic cohort study of patients receiving an ambulance after an emergency call between 2011 and 2014: one-time users (i.e. one ambulance run in any 12 month period) were compared to two-time users (two runs in any 12 month period) and frequent users (>two runs). The presenting symptom according to the Danish Index for Emergency Care from the EMS calls and the hospital ICD-10 discharge diagnoses were obtained from patient records.ResultsWe included 52 533 patients (65 932 emergency ambulance runs). Repeated users constituted 16% of the patients (two-time users 11% and frequent users 5%) and one third of all ambulance runs. The symptoms showing the largest increase in frequency with increasing ambulance use were breathing difficulty (N = 3 905–15% were frequent users); seizure (N = 2 437–10% were frequent users), chest pain (N = 7 616–17% were frequent users), and alcohol intoxication (N = 1 998–5% were frequent users). The hospital diagnoses with a corresponding increase were respiratory diseases (N = 4 381) - 13% were frequent users), mental disorders (predominately abuse of alcohol) (N = 3 087–10% were frequent users) and neurological diseases (predominately epilepsy) (N = 2 207–6% were frequent users). 5% of one-time users, 12% of two-time users and 16% of frequent users had a Charlson Comorbidity Index > = 3.ConclusionRepeated use of ambulance services was common and associated with chronic health problems such as chronic respiratory diseases, epilepsy, mental disorders with alcohol abuse and comorbidity. Alternative methods of caring for many of these patients should be considered.Trial registrationNone.

Stormy weather: a retrospective analysis of demand for emergency medical services during epidemic thunderstorm asthma

ObjectivesTo describe the demand for emergency medical assistance during the largest outbreak of thunderstorm asthma reported globally, which occurred on 21 November 2016.DesignA time series analysis was conducted of emergency...

Exiting the Emergency Medical Services Profession and Characteristics Associated with Intent to Return to Practice

Objective: Inadequate staffing of agencies, increasing attrition rates, and frequent turnover of personnel make employee retention an ongoing concern for Emergency Medical Services (EMS). Faced with increasing demand for EMS, understanding the causes underlying turnover is critical. The objectives of this study were to describe the proportion of individuals that left EMS, likelihood of returning to the profession, and key factors contributing to the decision to leave EMS. Methods: This was a cross-sectional study of nationally-certified EMS professionals who left EMS. Respondents to a census survey who reported not practicing EMS were directed to a subsection of items regarding their choice to leave EMS. Demographic and employment characteristics, likelihood of returning to EMS, and factors influencing the decision to leave EMS were assessed. Descriptive and comparative statistics (Chi-square and nonparametric test of trend [p-trend]) and univariable odds ratios were calculated. Results: The overall response rate for the full survey was 10% (n = 32,114). A total of 1247 (4%) respondents reported leaving the profession and completed the exit survey. The majority (72%) reported that they will likely return to EMS. A stepwise decrease in the reported likelihood of returning was seen with increasing years of EMS experience (e.g., 2 or less years of experience: 83%; 16 or more years: 52%; p-trend < 0.001) and months away from EMS (e.g., 0–2 months: 89%; more than 12 months: 57%; p-trend < 0.001). The most common factors reported to influence the decision to leave EMS included desire for better pay/benefits (65%), decision to pursue further education (60%), dissatisfaction with organization's management (54.7%), and desire for career change (54.1%). Conclusion: This cross-sectional study found an attrition rate of approximately 4% among nationally certified EMS professionals; however, the majority reported that they intended to return to the EMS profession. Intention to return to EMS decreased as years of experience and months away from the profession increased. Important factors in the decision to leave EMS included a desire for better pay and benefits and the decision to pursue further education. Targeting the factors identified as important in this study should be a priority for key stakeholders in improving recruitment and retention of EMS professionals.