Citations
Theory and economics, the evidence base, analogs, and the source corpus for SSM and the PUM.
Theory and economics#
- Holmström, B., and Milgrom, P. Multitask Principal-Agent Analyses: Incentive Contracts, Asset Ownership, and Job Design. Journal of Law, Economics, & Organization, 1991. (The multitask principal-agent result behind the surrogate-shaving argument.)
- Eggleston, K. Multitasking and mixed systems for provider payment. J. Health Econ., 2005. (Application to provider payment.)
- Porter, M. Competitive Advantage, 1985. (The value chain, as adapted by ODS.)
Evidence base#
- Eisenberg, M. S., Bergner, L., and Hallstrom, A. Cardiac resuscitation in the community: importance of rapid provision and implications for program planning. JAMA 241(18):1905–1907, 1979. (Origin of the eight-minute figure. Both intervals start at the patient's collapse: collapse to initiation of CPR and collapse to provision of definitive care. CPR within four minutes and definitive care within eight: 43% survival. Nontraumatic cardiac arrest only.)
- Fitch, J. Response Times: Myths, Measurement and Management. JEMS, 2005. (Early-1970s Seattle work by Alvarez and Cobb behind the eight-minute figure; the 59 seconds as a punch-clock accommodation.)
- Hansen, P. M. et al. Association of ambulance and helicopter response times with patient survival: A systematic literature review and meta-analysis. PLOS One, 2025. (Weak and contested basis for the specific 8:59 threshold. The evidence is thin and contested; it does not show that "response time is irrelevant.")
- Fatigue science (the published literature ODS benchmarks shift design against): NASA alertness-management guidance (Rosekind et al., Crew Factors in Flight Operations, NASA TM 2001-211385); Borbely (1982) on the two-process model; Van Dongen et al. (2003) and Belenky et al. (2003) on cumulative sleep debt and recovery; Folkard & Tucker (2003) on risk by hours-on-shift and successive shifts.
Analogs#
- Joskow, P. Capacity Payments in Imperfect Electricity Markets: Need and Design. Utilities Policy, 2008. (Capacity markets pay for availability separately from output; the analog for buying unit hours.)
- Cabinet Office (UK). The Sourcing Playbook, 2023, and Risk Allocation and Pricing Approaches guidance note. (Risk belongs with the party best placed to manage it; over-transfer loads a risk premium into the price and shifts supplier focus to cost cutting.)
Source corpus: SSM and the PUM#
- Jack Stout, JEMS, 1980–1989: the Public Utility Model series (1980), "System Status Management" (1983-05), "Performance Security" (1983-09), the "PUM Revisited" series (1985), "Ambulance System Designs" (1986-01), and related columns. The 1986 antitrust series is guest-authored by attorney George E. Leonard and is attributed to Leonard, not Stout.
System frameworks#
- Emergency Medical Services Systems Act of 1973, Pub. L. 93-154. (Fifteen components of an EMS system.)
- National Highway Traffic Safety Administration. Statewide EMS Technical Assessment Program. (Ten component standards.)
- National Highway Traffic Safety Administration. Emergency Medical Services Agenda for the Future. 1996. (Fourteen attributes.)
Agency guidance#
- Centers for Medicare & Medicaid Services. EMTALA "Parking" of Emergency Medical Service Patients in Hospitals. Survey and Certification memorandum S&C-06-21, July 13, 2006. (A hospital's obligation begins when the patient presents, and leaving the patient on the ambulance stretcher does not delay it.)
Public procurement in practice#
- City of San Diego, Office of the Independent Budget Analyst. Report 23-19, Proposed Transition to Alliance Model for EMS Delivery. July 26, 2023. (The city purchases ambulance unit hours from private producers at hourly rates and contracts separately for billing and collections. The producers own and staff the ambulances.)
- Lamorinda Weekly. "Supervisors Award ConFire County Ambulance Contract." 2015. (The Contra Costa County Fire Protection District holds the county contract from January 2016, with a private producer as its subcontractor.)
The Public Utility Model record#
- JEMS. "Kansas City Places MAST Under Fire Department Control." 2010. (The Metropolitan Ambulance Services Trust became a bureau of the Kansas City Fire Department on April 25, 2010.)
- KERA News. "Fire department swears in 600 MedStar employees as Fort Worth's EMS transition solidifies." June 3, 2025. (The City of Fort Worth became the licensed EMS provider on July 1, 2025.)
- U.S. Department of Justice. Press release on the False Claims Act settlements with Paramedics Plus, its parent companies, and the Emergency Medical Services Authority. 2018. (Paramedics Plus and its parents, $20.649 million; EMSA, $300,000.)