OBJECTIVES While much is known about EMS care in urban, suburban and rural settings, only limited national data describe EMS care in isolated and sparsely populated frontier regions. We sought to describe the national characteristics and outcomes of EMS care provided in frontier and remote (FAR) areas in the continental United States (US). METHODS We performed a cross-sectional analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) data set, encompassing EMS response data from 40 States. We linked the NEMSIS dataset with Economic Research Service-identified FAR areas, defined as a ZIP Code >60 minutes driving time to an urban center with >50,000 persons. We excluded EMS responses resulting in intercepts, standbys, inter-facility transports, and medical transports. Using odds ratios, t-tests and the Wilcoxon rank-sum test, we compared patient demographics, response characteristics (location type, level of care), clinical impressions and on-scene death between EMS responses in FAR and non-FAR areas. RESULTS There were 15,005,588 EMS responses, including 983,286 (7.0%) in FAR and 14,025,302 (93.0%) in non-FAR areas. FAR and non-FAR EMS events exhibited similar median response 5 [IQR 3–10] vs. 5 [3–8] min), scene (14 [10–20] vs 14 [10–20] min) and transport times (11 [5–24] vs 12 [7–19] min). Air medical (1.51% vs 0.42%; OR 4.15 [95% CI: 4.03–4.27]) and Advanced Life Support care (62.4% vs 57.9%; OR 1.25 [1.24–1.26]) were more common in FAR responses. FAR responses were more likely to be of American Indian or Alaska Native race (3.99% vs 0.70%; OR 5.04, 95% CI: 4.97–5.11). Age, ethnicity, location type, and clinical impressions were similar between FAR and Non-FAR responses. On-scene death was more likely in FAR than non-FAR responses (12.2 vs. 9.6 deaths/1,000 responses; OR 1.28, 95% CI: 1.25–1.30). CONCLUSIONS Approximately 1 in 15 EMS responses in the continental US occur in FAR areas. FAR EMS responses are more likely to involve air medical or ALS care as well as on-scene death. These data highlight the unique characteristics of FAR EMS responses in the continental US.

Conclusions: Current average wholesale pricing of intravenous opioids may contribute to the magnitude of controlled substance waste. Supply optimization could reduce waste by 60% and save approximately $13,422.20 across 3 EDs in one health system in one year. In addition, hospitals should consider indirect cost savings achieved by utilizing supply optimization, including the nursing time saved with the reduction in the number of instances of drug waste. With the continuing rise in opioid abuse and related overdose deaths it is important that health care systems recognize supply driven concerns and consider risk mitigation strategies in the broader opioid epidemic.