Office of Performance Evaluations

News Release: Governance of EMS Agencies in Idaho

November 30, 2010

(BOISE) Today the Legislature's independent, non-partisan evaluation office released its report to the Joint Legislative Oversight Committee on the governance of agencies responsible for delivering emergency medical services (EMS) in Idaho. The report concludes that Idaho lacks a coordinated and accountable EMS system and does not have a governing structure in place to ensure the delivery of quality emergency medical services. In the absence of a governing structure, the state cannot limit duplicated services, cannot eliminate gaps in coverage, and cannot mandate the coordination of EMS agencies. Governor Butch Otter, in his response to the report, said, "Key to our future success will be finding a system of governance that retains local autonomy and collaboration while also assuring accountability to the public and safety for patients."

The report identifies seven design attributes of a well-functioning EMS system from national literature and uses those attributes to evaluate Idaho's EMS system. A comparison of Idaho's current approach to delivering emergency medical services demonstrates that the state falls short of having the design attributes described in national EMS literature, which can negatively affect patient outcomes. The report attributes this shortfall to EMS statutes that are outdated, disjointed, and do not reflect contemporary EMS practices.

Both the director of the Department of Health and Welfare and the Governor support working with the Legislature to address these issues. In his response to the report, Director Armstrong said that the report depicts "the conditions present..., the issues that need to be addressed, and the array of improvements that could be realized through the report recommendations."

The legislative evaluators recommend that the state use comprehensive legislation to update those sections of Idaho Code that affect the delivery of emergency medical services to ensure patient needs rather than agency needs remain the system's priority. They advise the improvement of Idaho's EMS system using two underlying principles: the need to implement a governing authority and the need to allow all stakeholders to meaningfully participate in the system. The report has recommendations for the state to establish local EMS systems using county boundaries, to create a shared governance structure for local systems, to implement a mechanism providing uniform medical direction, to increase the role of the Department of Health and Welfare's EMS Bureau, and to consider reviewing the funding available for emergency medical services.

The report highlights the need for the Legislature to take the lead on this issue on behalf of taxpayers and those citizens who require emergency medical care in a prehospital setting. The report acknowledges that although the Legislature should carefully consider the many viewpoints of Idaho's EMS stakeholders, complete consensus among stakeholders is unlikely. The report identifies that stakeholders generally agree that statutory changes are necessary, but disagree about the specifics of how a governing structure should be designed—stakeholder compromise is a must to improve the state's EMS system.

The report contains formal responses from the Governor and the Department of Health and Welfare. The entire report is posted on the Office of Performance Evaluations' website at

Performance audits or evaluations are an essential function of legislative oversight to ensure that taxpayer dollars are spent efficiently and in accordance with Idaho law. At the end of 2010 legislative session, the Joint Legislative Oversight Committee unanimously voted to direct the Office of Performance Evaluations to conduct this study. The eight-member committee is equally divided between the two political parties and the two chambers of the Legislature. Senator Elliot Werk and Representative Clifford Bayer co-chair the committee.