The first study was conducted in 1997 and published in 1998 at the request of the Metropolitan Ambulances Services Trust (MAST) and the City of Kansas City, Missouri.  A Public Utility Model (PUM), MAST was deciding whether it would be more advantageous to negotiate a contract extension with its current operations contractor or to proceed with a competitive procurement process.  Recognizing the eventuality of such a decision, the City Council of Kansas City previously enacted as part of the Kansas City Code, a “procedure for securing operations contractor,” provision, which allowed for a “study of market conditions,” to be conducted “to determine whether competitive bidding or a negotiated process is more likely to ensure better services for lower cost.  The Director of Health approached AIMHI, then known as the National Association of Public Utility Models (NAPUM) about conducting such a study.  This was accomplished using a survey of all AIMHI members.

With the success of the first study published in 1998, AIMHI members decided to conduct the study on regular intervals, beginning in 2000.  Studies have since been conducted in 2002, 2004, 2005, 2006 and again in 2010. Those involved in the operations and research of other EMS system designs also expressed interest in the study, and the survey was expanded in 2002 to test the applicability for capturing data from a diversity of system designs, both in North America and abroad. The AIMHI Market Studies have since become the only referenced, evidenced-based studies to share clinical, response-time and economic data across diverse EMS systems.

The objectives of the AIMHI studies are to:

  • Provide outcomes from which an High Performance EMS (HPEMS) system can compare clinical capability, response-time reliability and economic effectiveness with another HPEMS system or a similar design, and
  • Establish a framework that allows for the comparison of different EMS system designs, providing a foundation for out-of-hospital systems’ research.



Benchmarking is the art and science of comparing a system or system component with the best measured performance or performance criteria.  Accurate benchmarking requires standardized definitions, reliable data, accurate reporting and a common measurement methodology.  All HPEMS systems share common characteristics, including fractile response-time measurement, all-Advanced Life Support (ALS) staffing, medical dispatch triage, and exclusivity in the market for both emergency and non-emergency transports, establishes a commonality of components that allows for basic benchmarking.

The survey instrument has evolved considerably since it was first released.  With the success of the initial Market Study, the survey was again revised and distributed in 1999.  By this time, AIMIHI membership had expanded, which allowed for the first comparison among different HPEMS system designs and the results are provided in the Market Study 2000.

Following the 2000 study, AIMHI members decided to expand future Market Studies to capture additional information, especially in the area of system revenue sources.  Specific questions used to establish comparability and to measure and calculate economic performance remained unchanged to ensure a consistent reporting of results.  Using the testing methodology used in previous surveys, AIMHI again revised and distributed the survey, which became Market Study 2002.  The survey was then further refined to include additional questions on cardiac arrest and clinical innovation before being distributed once more in 2004.  That version remained unchanged and was used to generate data for 2004, 2005 and 2006 benchmarking projects.  It was divided into five areas:  General Information, Response-Time Reliability, Clinical Capabilities, Economic Efficiency and Revenue.  Also in 2004, AIMHI published, for the first time, The International EMS Benchmarking Study:  A Comparison of System Design and Performance.  This publication was unique, in that it presented a longitudinal analysis of core performance indicators with the AIMHI systems using data analysis from the surveys conducted from 2000 through 2004.  This publication also included data from a variety of HPEMS systems across Europe as well as systems in New Zealand and Qatar.

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