| County | Population | Area (mi²) | Units (curr / desert) | Baseline Cost | Baseline Gap | Per-Capita Cost | Index Score |
|---|
Cost Parameters
Unit cost: Jonk et al. (2023) consensus panel establishes $1.04M–$2.25M per rural staffed ambulance unit annually. Inflation-adjusted to 2025 at 3.5%: $1.077M (low-volume), $1.76M (mid), $2.33M (high). Unit cost tier is determined by calls per unit.
Revenue: RAND/CMS GADCS (Dec 2024) mean revenue per transport across all payers = $1,147.
Jonk et al., Maine Rural Health Research Center, 2023 | RAND/CMS GADCS Report, Dec 2024
Units Required (Binding Constraint)
Geographic: One ambulance unit per 300 sq mi based on 25-minute response radius (Jonk 2023 minimum access standard). This is the binding constraint for all frontier and most rural counties.
Volume: One crew per 1,500 annual transports. Appropriate for rural and frontier systems. In high-volume urban counties this rate may overstate unit requirements — a designation-adjusted refinement is planned for v2.0 pending validation against actual urban agency financials. Geography-bound counties are unaffected — their coverage requirement exceeds the volume calculation.
Terrain multiplier: Applied to base cost based on CMS designation (Urban/Rural/Frontier) and mean county elevation. Range: 1.00×–1.42×.
CMS designation per GADCS | Elevation: U.S. Census / Wikipedia county data
Data Sources & Limitations
Call volume: Colorado EMS Data Repository (ESO/CDPHE), 2023–2024 scene response transports by county.
Population: U.S. Census Bureau Vintage 2024 county estimates.
Hospital access: Average transport time (ESO 2023–24) used as proxy for hospital access gap. GIS isochrone analysis by hospital capability (OB/ICU/surgery/pediatric) will replace this in a future version.
⚠ Limitations: Does not include census block population distribution weighting; hospital capability proximity is approximated by transport time; volunteer labor subsidy not reflected in revenue estimate.
Note on Agency Count
Call volume data is drawn from the CDPHE ePCR dataset (2023–24 ground 911 scene transports), organized at the county level. Agency counts shown in the detail panel reflect agencies active in each county in the ESO/CDPHE system as of April 2025. The current CDPHE licensed count is 242 agencies statewide (March 2025). That figure includes agencies that hold a license but do not perform transports. Non-transporting agencies do not generate billing revenue. The CCECBI structural cost model derives minimum staffed-unit requirements from geographic coverage area and call volume — neither input uses individual agency counts, so non-transporting agencies do not affect cost calculations. ePCR call volume totals are filtered to transported patients at the record level (scene disposition = transported), confirming the county call counts reflect actual ground transports only. The transporting vs. non-transporting distinction does not directly affect index scores in this version. It will be a relevant factor in any future version that incorporates agency-level cost reporting.
Model Assumptions
- Minimum staffed ambulance unit requirement: 1 ambulance unit per 300 sq mi, based on the 25-minute radius standard (Jonk et al., 2023 — Maine Rural Health Research Center)
- Unit cost tiers (inflation-adjusted to 2025 at 3.5%): low-volume $1.077M, mid-volume $1.76M, high-volume $2.33M — from Jonk et al. 2023 consensus panel
- Revenue per transport: $1,147 (RAND/CMS GADCS report, December 2024 — mean across all payers and agency types)
- Binding constraint: maximum of geographic unit requirement and volume-based crew requirement (1 crew per 1,500 annual transports (rural/frontier appropriate; see limitations))
- Terrain multiplier applied to base cost by CMS designation (Urban/Rural/Frontier) and mean county elevation; range 1.00×–1.42×
- Hospital access adjustment: average transport time (ESO/CDPHE 2023–24) used as proxy for hospital capability gap; adjustment capped at 3.0×
- Population: U.S. Census Bureau Vintage 2024 county estimates; area and mean elevation from U.S. Census / Wikipedia county data
Limitations
- Hospital access proxy (known limitation): Average transport time is used as a proxy for hospital capability deficit. A future upgrade will replace this with GIS 25-minute isochrone analysis by hospital capability level (OB, ICU, surgery, pediatric) — which may materially change scores for affected counties
- Census block-level population distribution weighting is not incorporated; a county with dispersed population centers may require more posts than the geographic formula indicates
- Seasonal population variation (ski season, hunting season, summer tourism) is not reflected; permanent resident population is used throughout
- Volunteer labor subsidy is not reflected in revenue or cost estimates; counties with significant volunteer capacity will show structural gaps that partially exist on paper only
- Agency counts in the detail panel reflect licensed ground transporting agencies only (ePCR Agency_Info, filtered to 911 Response with Transport Capability, Medical Transport, and Critical Care Ground)
- Index score is relative to the statewide population-weighted mean — it is not an absolute cost standard and should not be used to compare Colorado counties to national benchmarks
- Lake County data estimated from ePCR dataset; not sourced from agency cost reporting
- Hospital count correction (identified March 2026): Four counties were incorrectly coded as having no in-county hospital — Alamosa, Chaffee, Grand, and Huerfano. This does not affect CCECBI structural cost scores (hospital access uses transport-time proxy, not facility count) but does affect IFT revenue modeling in Model 04. Will be corrected in CCECBI v2.0. County structural costs include per-capita share of $25M underfunded mandates ($4.20/resident/yr)..