A retrospective review of all claims brought against a large, metropolitan emergency medical services (EMS) system related to paramedic-patient encounters during the 12-year period from 1976 through 1987 was undertaken to review and describe the incidence and types of malpractice claims. During this period, EMS units responded to approximately 2 million calls and transported more than 1 million patients. Sixty claims occurred during the incidence study period (1976 through 1985). The overall litigation rate was one lawsuit per 27,371 paramedic-patient encounters and one lawsuit per 17,995 patient transports. While the total number of runs and transports did not change significantly during the study period, the data indicate a trend of increasing claims filed against the prehospital care provider. To date, 26 cases (38%) have been settled with the majority involving either no monetary awards or nominal out-of-court settlements.