Rural and/or volunteer EMS organizations can leverage scale in the same way to improve training, purchasing and service delivery while being perceived as local. Many aspects of an EMS organization benefit from scale. Two very large volunteer organizations including the American Red Cross and the Boy Scouts of America, organizations likely active in your community, leverage the use of volunteers while maintaining a strong sense of local control.
Perhaps the most common application of EMS economy of scale in the United States is vertical integration. Vertical integration is best described as multiple elements of public services, emergency services or health care services working together under a common umbrella. Vertical integration exists in almost every EMS system that is described as “-based” such as county-based, fire-based or hospital-based EMS.
In vertically integrated operations the EMS organization shares oversight, support functions and/or facilities and staff as part of a larger organization. Support functions can include such items as training, human resources, finance, information technology, dispatch, vehicle maintenance or purchasing.
Other economies, such as shared staffing, either paid or volunteer may also exist. Shared staffing is probably most common in fire-based organizations when personnel are cross-trained to provide both firefighting and EMS. It is likely there are thousands of volunteer fire departments that provide fire and EMS in the United States, although there is currently no great method to count them.