Risks Associated With Municipally Operated Ambulance Services

Oklahoma law authorizes municipalities to either contract out ambulance services or to regulate and control ambulance services pursuant to a duly enacted ordinance or regulation.[i] There are risks associated with operating an ambulance service.  Because of those risks, liability and workers compensation insurance is required by law.  The Oklahoma Governmental Tort Claims Act[ii]  and the Oklahoma Administrative Workers Compensation Act provides certain levels of coverage. If the municipality chooses to contract out the services, then the contractor is required to provide the liability coverage in a sum of not less than the Oklahoma Governmental Tort Claims limits and workers compensation insurance. 

There are many liability issues when assessing the risks associated with a municipality operating an ambulance service.  Municipalities running an Emergency Management Service (EMS), such as an ambulance service, have a responsibility, or duty, to serve their communities in a timely and competent manner.  This responsibility begins when a call for assistance comes into the dispatch center and generally ends with transfer of care to the receiving facility. The citizens who call EMS for assistance expect that each step in the process will be handled quickly, safely and appropriately.  When calls for assistance are not handled properly, it can lead to liability.  The areas of liability fall into three general categories:  general liability stemming from injuries that occur as a result of the negligence by an EMS employee, automobile accidents, including property damage and bodily injury, and workers compensation for the employees.


Some of the most critical treatment a patient receives occurs in the minutes after an injury or acute health crisis.  The treatment can either positively or negatively affect the patient’s outcome. The most frequent claims involve delay in ambulance arrival, ambulance collisions, poor patient assessment/treatment and refusals of care, negligence associated with loading and unloading a patient, and improper training and supervision of personnel. As a result, patients may be entitled to monetary compensation for injuries caused by careless acts of EMS providers.  If a patient can prove that the medical provider breached a standard duty of care, the municipality can be held liable, as well as, the employee in certain circumstances.

Municipalities can also be sued for the negligent hiring, training and supervision of the emergency medical providers.  It is important when hiring an emergency medical professional that municipalities verify credentials and licenses, education requirements, contact references, and complete background checks.  It is also imperative that the emergency medical professional receive the appropriate training, whether a refresher course or training on new equipment.  Further, Oklahoma law requires that EMS personnel work under the direct supervision of others licensed or certified to undertake such activities. The lack of appropriate supervision can lead to exclusion of insurance coverage for municipalities and the EMS personnel.[iii]


Auto accidents involving ambulances pose a serious risk to the crew, patients and third parties causing property damage and personal injuries. The most recent National Fire Protection Association (NFPA) crash report[iv] indicates that in Oklahoma between 2001 and 2010, there were nearly 845 crashes involving ambulances resulting in 351 injuries and 7 fatalities and 485 property damage claims.  

State law requires all vehicles on the road to carry auto liability insurance. Auto liability insurance protects you in two critical areas: bodily injury and property damages. Vehicle accidents cause a wide-array of bodily injuries, from minor scrapes and bruises, to permanent disability and death.  Damages resulting from bodily injury claims include physician and hospital payments, home health care, permanent disability, and pain and suffering.  Often times, the bodily injury damages are more costly than the property damages.

An ambulance is a mobile triage unit.  Not only should you insure the vehicle itself, but also the equipment and supplies in the ambulance.  The medical equipment on the ambulance, such as oxygen tanks, ventilation and airway equipment, monitoring and defibrillation equipment, backboard, gurney, and mobile communication equipment, can be very costly to replace.

In addition to bodily injury and property coverage, there are other types of coverages a municipality may want to consider, like medical payment, physical damage, specified peril, towing, rental, and accessories.


EMS workers have a hazardous job.  On a daily basis, they are lifting patients and equipment, treating patients with infectious illnesses, handling hazardous chemical and body substances, and participating in the emergency transport of patients. These duties create an inherent risk for EMS worker occupational injuries and illnesses.[v] Data from the Department of Labor show that EMS personnel have a rate of injury that is about three times the national average for all occupations. The majority of non-fatal injuries involves sprains and strains, mostly to the hands, fingers and lower back.  Another common injury is exposure to harmful substances including to bodily fluids.[vi] Assaults are also identified as a significant cause of fatality.[vii]


There are risks associated with running an ambulance service.  Municipalities can carry that risk itself or shift the risk to a contractor.  If a municipality chooses to provide the service, it is suggested that the staff are appropriately and consistently trained.  Further, an attorney with this expertise should be involved to ensure that all state, federal and local laws are followed and the municipality is apprised of all the risks.

 If you would like information about OMAG’s coverages with regard to ambulance service, please contact Randy Stone or Dorie Spitler.


i 63 Okl.St.Ann. § 1-2515 and 11 Okl.St.Ann. § 23-105
iiThe Oklahoma Governmental Tort Claims Act limits are $25,000 for property and $125,000 (population less than 300,000) for any other loss arising out of a single act.  51 Okl.St.Ann. § 154
iiiVI. EXCLUSIONS  We have no obligation to pay nor do we have any obligation to defend any claim against a plan member on account of:
       5. Loss arising out of: 
         a. the rendering of or failure to render medical, surgical, dental, x-ray or other treatment;               any service or treatment conducive to health; or any cosmetic or tonsorial service or                   treatment; or
    b.  the furnishing or dispensing of drugs or medical, dental or surgical supplies or                            appliances; or
    c. the handling of or performing of autopsies. 
This exclusion does not apply to certified First Responders or licensed Emergency Medical Technician (EMT) services of or provided by a plan member. This exclusion does not apply to a plan member while the plan member is engaged as a student training to secure certification as a First Responder or an EMT license. The plan member who is engaged in such training must be under the direct supervision of others licensed or certified to undertake such activities in order to be covered under this agreement. Services of a certified First Responder or a licensed EMT include the transportation and immediate medical care provided to emergency patients prior to their arrival at a medical facility, as those terms are defined by 63 O.S. § 1-2503, as amended.
iv Analysis of Ambulance Crash Data: Final Report, Prepared by:  Casey C. Grant, P.E., and Brian Merrifield for The Fire Protection Research Foundation
v http://www.cdc.gov/niosh/topics/ems
vi http://www.jems.com/articles/print/volume-36/issue-11/health-and-safety/studies-show-dangers-working-ems.html
viiInjuries and fatalities among emergency medical technicians and paramedics in the United States, BJ Maguire, Department of Emergency Health Services, University of Maryland

Risks Associated With Municipally Operated Ambulance Service was written by Suzanne D. Paulson, OMAG Associate Counsel. You may contact the author at spaulson@omag.org. The information in this bulletin in intended solely for general informational purposes and should not be construed as or used as a substitute for legal advice or legal opinions with respect to specific situations, since such advice requires an evaluation of precise factual circumstances by an attorney. OMAG does not represent or endorse any group, site or product that may be mentioned in this article. 
                                                                                                                                                            September 2015  


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