Tri-State Ambulance Delivers  “High Performance” Emergency Medical Services to the Coulee Region

High Performance emergency medical services (EMS) is defined as[1], [2] the simultaneous achievement of:

  • Clinical Sophistication
  • Response Time Reliability
  • Economic Efficiency

Does Tri-State Ambulance meet the definition of a “High Performance” EMS provider?

Tri-State Ambulance meets or exceeds these criteria in the following ways:

Clinical Sophistication

  • Dual paramedic ambulances staffed by paramedics certified by the National Registry of EMTs, and the States of Wisconsin and Minnesota
  • Paramedic:Patient encounter ratio two times better than the national average
  • A cardiac arrest survival rate three times better than the national average
  • An average paramedic patient care experience level of 6,400 patient encounters
  • Paramedics are authorized to administer enhanced ALS procedures such as Rapid Sequence Induction for Airway Management, Nitroglycerine infusions and numerous controlled medications for pain management
  • Externally monitored skills proficiency levels are measured on both a procedural and outcome basis

Response Time Reliability

  • Response times measured and reported using “fractile” reliability standard at a 90% confidence interval
  • Urban and Suburban average response times are twice as fast as the national average
    • 4 minutes, 32 seconds for urban areas
    • 5 minutes, 8 seconds suburban
  • Response time results are published to all stakeholders and on Tri-State’s web site

Economic Efficiency

  • No taxpayer subsidy for any community serviced
  • An average net patient charge of $462.16 per transport

The following grid measures the clinical, operational and fiscal performance achieved by Tri-State Ambulance as compared to nationally published reports and studies, with attribution.

There is little published data comparing EMS systems of similar size serviced by Tri-State Ambulance.  Consequently, many of the clinical, operational and fiscal comparisons have been derived from the Journal of Emergency Medical Services (JEMS) survey of the 200 largest cities in the United States which is conducted and published annually in JEMS. 

[1] Kuehl, et. al.: Pre-Hospital Systems and Medical Oversight, National Association of EMS Physicians, Mosby Pub. 2006

[2] A Guide to Effective System Design; American Ambulance Association; 2005

 How Does Tri-State Ambulance Compare to National Standards?

Performance Criteria Tri-State Performance National Average Notes


Cardiac Arrest Survival Rate (to hospital discharge)







Tri-State’s cardiac arrest survival rate is nearly 3 times the national average


Cardiac Arrest Cases per Medic/yr







Tri-State’s cardiac arrest encounter rate per paramedic is nearly twice the national average



Endotracheal Intubation Success Rate






Tri-State’s intubation success rate is 20% higher than the national average



Two paramedics on every 9-1-1 ambulance







Most ambulance configurations are 1 EMT and 1 paramedic


Closest unit sent to every call






45% of top 200 cities in the U.S. do not send the closest unit to an EMS call



Average Response Time – Urban







Tri-State’s response times are nearly twice as fast as the national average



Average Response Time – Suburban






Tri-State’s response times are nearly twice as fast as the national average


Emergency Medical Dispatch available?




16% of the largest 200 cities do not offer EMD



Rapid Sequence Induction







Only 24% of the largest 200 cities allow medics to perform RSI



Surgical Cricothyrotomy







Only 32% of the largest 200 cities allow medics to perform Surgical Cricothyrotomy



Analgesics other than morphine







Only 45.8% of the largest 200 cities allow medics to administer analgesics other than Morphine



% of Budget from Public Subsidy






56% of governmental EMS agency’s budget comes from a public subsidy



Average Net Patient Charge







Tri-State’s net charges are 27% lower than the national average



Pen-Based electronic patient care reporting in the field






Less than 10% of the EMS systems in the largest 200 cities in country are using the technology Tri-State is using


[1] American Heart Association; Circulation. 2005;112:IV-1 – IV-5

[2] ACAD EMERG MED  May 2006, Vol. 13, No. 5, Suppl. 1

[3] Wang HE, Yealy DM. Out-of-hospital endotracheal intubation where are we? Ann Emerg Med 2006;47:532-41

[4] Jour Emerg Med Svcs Feb 2007, 200 City Survey


Freedom Honor Flight

In 2008 and 2009, Tri-State State Ambulance provided three fully equipped and seasoned paramedics to accompany three groups of U.S. veterans to Washington, D.C.  In 2010, Tri-State Ambulance paramedics will accompany three additional flights. The Freedom Honor Flight pays tribute to our American heroes by fully funding their trip to visit their war memorials.  Tri-State Ambulance is honored to contribute our skilled paramedics to this important event.  Please visit the Freedom Honor Flight website and join us in supporting this valuable program.

Community AED Loaner Program

Tri-State Ambulance is proud to announce the inception and creation of a valuable program that will aid our community in the treatment and survival of sudden cardiac arrest victims.(read more)