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This USA Today investigation finds that emergency medical systems in most of the nation's 50 largest cities are fragmented, inconsistent, and slow. The found three major reasons that emergency services in most U.S. cities are saving so few people in life-or-death situations. Many cities' emergency services are undermined by their culture...disagreements and turf wars between fire departments and ambulance services cause deadly delays. Most cities don't measure their performance effectively..if at all. So they can't determine how many lives they're losing, and therefore can't find ways to increase survival rates. Finally, many cities lack the strong leadership needed to improve emergency medical services.