EMS Cost Analysis Project (EMSCAP)

The EMS Cost Analysis Project is a collaboration between the National Association of State EMS Officials (NASEMSO) and E. Brooke Lerner, Graham Nichol, Daniel Spaite, Herbert Garrison, and Ronald Maio). It is a continuation of the Emergency Medical Services Outcomes Project (EMSOP), a recently completed, 5 year National Highway Safety Administration (NHTSA) project (DTNH22-96-H-05245) intended to support and facilitate emergency medical services (EMS) outcomes research and evaluation.


The objective of the EMS Cost Analysis Project is to create a comprehensive framework that would allow users to determine the cost of providing pre-hospital emergency care from a societal prospective.


The project goals are:

  • To synthesize the state of the art/science of economic evaluation and it’s relevance to EMS research by completing a systematic review of literature in regard to EMS economic evaluation studies.
  • To develop a conceptual framework for applying cost analysis in EMS research.
  • To develop a cost workbook that could be used by communities to calculate the cost of EMS in their community.


  • The results from the literature search were presented in oral format at the International Interdisciplinary Conference on Emergencies held June 26-30, 2005, in Montreal, Canada.
  • A paper on the literature search was published in Annals of Emergency Medicine.

Lerner EB, Maio RF, Garrison HG, Spaite DW, Nichol G: Economic Value of Prehospital Emergency Care: A Structured Literature Review. Annals of Emergency Medicine 2006; 47 (6): 515-2.

  • A cost framework was developed and presented along with general EMSOP information at the 11th International Conference on Emergency Medicine, held June  3-7, 2006 in Halifax, Nova Scotia, Canada
  • A paper on the cost framework was published in the Annals of Emergency Medicine.

Lerner EB, Nichol G, Spaite DW, Garrison HG, Maio RF: A Comprehensive Framework for Determining the Cost of an Emergency Medical Services System.  Annals of Emergency Medicine; Ann Emerg Med. 2007;49:304-313.

EMSCAP Workbook

The workbook was pilot-tested in Oshkosh, Wisconsin; Richmond, Virginia; and Livingston County, New York and is now available for download below. Final version of workbook guide posted 09/19/11.