The goal of this section is to motivate our empirical analysis of emergency response systems through a description of the background and institutions of pre-hospital care. To do so, we review the operation of the emergency medical response system (in most communities, a 911 system), focusing in particular on potential productivity benefits. We further discuss the interaction between pre-hospital and in-hospital emergency care. Finally, we describe the factors which lead to heterogeneity in the adoption of 911.
Emergency Response Systems are a public service providing a standardized and integrated method for local communities to respond to emergencies. Until the late 1960’s, emergencies were reported to a telephone operator (whose training and equipment usually did not accomodate the efficient handling of emergency) or by directly contacting a particular public service agency (requiring individuals to find the 7-digit phone number for a particular agency and precluding integration among agencies). Under this ad-hoc system, emergency response was often inappropriate to the particular situation — overreaction to minor crises coexisted with frequent underreactions to critical emergencies (Gibson, 1977; Siler, 1988). Following a model developed in Europe after WWD (most particularly the 9-9-9 system in Great Britain), the first 911 systems were introduced into the US in 1968 (in Haleyville, Alabama and Nome, Alaska). Shortly thereafter, Federal legislation explicitly encouraged the development of 911 systems in local communities and ensured that the Bell System would reserve 911 for emergency service use (Pivetta, 1995). loans