Highlights:

Net revenue was $637.3 million, an increase of 11.6% compared to the second quarter of 2008;

Net income was $29.0 million, an increase of 58.3% compared to the second quarter of 2008; Adjusted EBITDA was $73.0 million, an increase of 31.4% compared to the second quarter of 2008;

Diluted EPS was $0.67, an increase of 57.1% compared to the second quarter of 2008;

Cash provided by operating activities was $99.0 million compared to $58.2 million in the second quarter of 2008; Free cash flow was $70.9 million in the quarter compared to $65.4 million for the same quarter last year; and

Increases 2009 diluted EPS guidance from $2.05 - $2.15 to an expected range of $2.38 - $2.48. and Adjusted EBITDA guidance from $248 million to $255 million to an expected range of $268 million to $275 million.

Emergency Medical Services Corporation (NYSE: EMS) (EMSC or the Company) today announces results for the second quarter ended June 30, 2009.

William A. Sanger, Chairman and Chief Executive Officer, said, "We are particularly pleased with our second quarter results. EMSC continues to deliver strong performance, with consecutive quarters of year over year revenue and earnings growth, from signing new contracts, selective acquisitions and improved resource utilization at both segments. We are encouraged by the continued demand for our core services and our expanded service lines, and with our strong balance sheet, believe we are well positioned to capitalize on market opportunities."

Results of Operations for the Second Quarter 2009

For the quarter ended June 30, 2009, EMSC generated net revenue of $637.3million, an increase of 11.6% compared to the quarter ended June 30, 2008. EMSC generated net income of $29.0 million, or $0.67 per diluted share, for the second quarter of 2009, compared to net income of $18.3 million, or $0.43 per diluted share, in the second quarter of 2008, an increase of 57.1%. Adjusted EBITDA was $73.0 million, an increase of 31.4% compared to the same quarter last year. The increase in earnings is attributable primarily to the net impact of increased volume from net new contracts, higher rates and volumes from existing contracts, improvement in compensation and benefits expenses as a percentage of net revenue and lower fuel costs, offset by an increase in insurance expense. A description of the non-GAAP measures, Adjusted EBITDA and Free Cash Flow, and a reconciliation of non-GAAP to GAAP financial measures are included in this news release.

Cash provided by operating activities was $99.0 million in the second quarter of 2009, compared to cash provided by operating activities of $58.2 million for the same quarter last year. Accounts payable and accrued liabilities increased $20.1 million in the second quarter of 2009 compared to $3.1 million in the same period last year due primarily to the timing of payroll related disbursements. Accounts receivable decreased $3.5 million during the second quarter of 2009 compared to a decrease of $12.6 million in the second quarter of 2008. EMSC's Days Sales Outstanding (DSO) decreased 3 days in the second quarter of 2009. Free cash flow was $70.9 million in the second quarter of 2009 compared to $65.4 million in the same quarter last year.

Net cash used in investing activities was $28.2 million for the quarter ended June 30, 2009, compared to cash provided by investing activities of $0.5 million for the same period in 2008. The quarter was impacted by an increase in insurance collateral of $15.2 million compared to a decrease of $12.7 million in insurance collateral in the same period last year.

For the quarter ended June 30, 2009, net cash provided by financing activities was $2.2 million compared to net cash used in financing activities of $1.8 million for the same quarter last year. At June 30, 2009, there were no amounts outstanding under our revolving credit facility.

Results of Operations for the Six Months Ended June 30, 2009

EMSC's net revenue was $1.25 billion for the six months ended June 30, 2009, an increase of 10.0% compared to the same period last year. EMSC's net income for the six months ended June 30, 2009 was $53.1 million, or $1.23 per diluted share, compared to net income of $35.4 million or $0.82 per diluted share, an increase of 49.6% over the same period last year. Adjusted EBITDA was $138.5 million, an increase of 26.0% compared to the same period last year. The increase in earnings is attributable primarily to the net impact of increased volume from net new contracts, higher rates and volumes on existing contracts, improvement in compensation and benefits expenses as a percentage of net revenue and lower fuel costs, offset by an increase in insurance expense.

Cash provided by operating activities for the six months ended June 30, 2009 was $140.9 million compared to $55.4 million for the same period in 2008. The increase in operating cash flows relates primarily to an increase in net income, a reduction in DSO, and changes in accounts payable and accrued liabilities, including insurance accruals. Changes in accounts payable and accrued liabilities increased $11.6 million during the six months ended June 30, 2009 compared to a decrease of $10.3 million during the same period in 2008. The change is due primarily to the timing of payroll related disbursements. EMSC's DSO decreased 7 days during the six months ended June 30, 2009. Free cash flow was $118.3 million for the six months ended June 30, 2009, an increase of $55.4 million over the six months ended June 30, 2008.

Net cash used in investing activities was $22.7 million for the six months ended June 30, 2009 compared to $12.4 million for the same period in 2008. The increase in cash flows used in investing activities relates to additional insurance collateral of $1.9 million during 2009 compared to a reduction in cash required for insurance collateral of $14.9 million during the 2008 period. Net capital expenditures were $20.0 million during the six months ended June 30, 2009 compared to $10.0 million during the same period in 2008 due primarily to the timing of capital purchases. The quarter ended June 30, 2008 included $20.0 million used in the acquisition of businesses.

For the six months ended June 30, 2009 net cash provided by financing activities was $2.8 million compared to $1.2 million for the six months ended June 30, 2008.

Segment Results

EMSC operates two business segments: American Medical Response, Inc. (AMR), the Company's healthcare transportation services segment, and EmCare Holdings Inc. (EmCare), the Company's outsourced hospital-based physician services segment.

American Medical Response (AMR)

For the quarter ended June 30, 2009, AMR generated net revenue of $335.5 million, an increase of 3.7% compared to the same quarter last year. The increase in net revenue was from an improvement in revenue per transport and growth in our managed transportation business, offset by lower transports primarily from our exit of underperforming markets. Adjusted EBITDA was $32.4 million, an increase of 24.8% compared to the same quarter last year. The increase in Adjusted EBITDA is attributable to the impact of revenue growth coupled with improvements in our resource utilization and lower fuel costs, offset by higher insurance expense. The increase in insurance expense is primarily attributable to an unfavorable prior period insurance adjustment of $1.3 million in the quarter ended June 30, 2009 compared to a favorable prior period adjustment of $1.7 million in the same period last year. Income from operations was $19.7 million, an increase of 76.7% compared to the same quarter in 2008 resulting from an increase in Adjusted EBTIDA and a reduction in depreciation and amortization expense.

For the six months ended June 30, 2009, AMR's net revenue was $672.0 million, an increase of 3.4% compared to the same period last year. Adjusted EBITDA was $66.3 million, an increase of 22.0% compared to the same period last year. Insurance expense in the six months ended June 30, 2009 included an unfavorable prior period adjustment of $2.0 million compared to a favorable prior period adjustment of $3.6 million in the same period last year. Income from operations was $40.4 million, an increase of 64.8% compared to the same period in 2008.

EmCare

For the quarter ended June 30, 2009, EmCare generated net revenue of $301.8 million, an increase of 22.0% compared to the same quarter last year. The increase in revenue is attributable primarily to the addition of 98 net new contracts since March 31, 2008 (of which 45 were a part of our acquisition of Clinical Partners in August 2008 with related management fee revenue of $2.0 million during the quarter) and revenue increases at existing contracts. Adjusted EBITDA was $40.5 million for the quarter compared to $29.5 million last year, an increase of 37.2%. The increase in Adjusted EBITDA is driven primarily by revenue increases and a reduction of compensation and benefits expenses as a percentage of net revenue, offset by higher insurance expense. The increase in insurance expense is primarily attributable to an unfavorable prior period insurance adjustment of $3.1 million in the quarter ended June 30, 2009 compared to a favorable prior period adjustment of $1.7 million in the same period last year. Income from operations was $35.9 million, an increase of 42.9% over the same period in 2008 resulting from increased Adjusted EBITDA.

For the six months ended June 30, 2009, EmCare's net revenue was $578.4 million, an increase of 18.8% compared to the same period last year. Adjusted EBITDA was $72.2 million compared to $55.6 million, an increase of 30.0% compared to the same period last year. Insurance expense in the six months ended June 30, 2009 included an unfavorable prior period adjustment of $3.2 million compared to a favorable prior period adjustment of $2.6 million in the same period last year. Income from operations was $62.8 million, an increase of 34.3% over the same period in 2008.

Guidance

EPS guidance is increased to an expected range of $2.38 - $2.48 per diluted share from previously announced guidance of $2.05 - $2.15 per diluted share, and Adjusted EBITDA guidance is increased to an expected range of $268 million to $275 million from previously announced guidance of $248 million to $255 million.

Conference Call

EMSC management will host a conference call and live audio webcast on Tuesday, August 4, 2009, at 11:00 a.m. EDT, to discuss the Company's financial results. A 30-day online replay will be available approximately one hour following the conclusion of the live broadcast. A link to the live broadcast and online replay is available on the Investor Relations section of the Company's website at www.emsc.net.

About Emergency Medical Services Corporation

Emergency Medical Services Corporation (EMSC) is a leading provider of emergency medical services in the United States. EMSC operates two business segments: American Medical Response, Inc. (AMR), the Company's healthcare transportation services segment, and EmCare Holdings Inc. (EmCare), the Company's outsourced hospital-based physician services segment. AMR is the leading provider of ambulance services in the United States. EmCare is a leading provider of outsourced emergency department and hospital-based physician services. In 2008, EMSC provided services to 11.4 million patients in nearly 2,100 communities nationwide. EMSC is headquartered in Greenwood Village, Colorado. For additional information visit www.emsc.net.

Forward-Looking Statements

Certain statements and information herein may be deemed to be "forward-looking statements" within the meaning of the Federal Private Securities Litigation Reform Act of 1995.