High utilizers (patients with 5-11 EMS encounters) and very high utilizers (patients with 12 or more EMS encounters) made up 2.46% and 0.38% of the study population respectively. The very high utilizers, compared to other patients, were more likely to be enrolled in Medicaid, live in socioeconomically vulnerable communities and have chronic medical conditions. But the very high utilizers also had 40% reduced odds of hospital admission. Identify your very high EMS utilizersFilter your ePCRs to identify the number of patients who have 12 or more EMS encounters per year. Lean into this as you develop the program, begin to work with very high utilizers and transparently share the lessons learned, including successes and failures.