Private Ambulance Services

[L1tilr]

In 1987 our city fathers turned over ambulance service to a local private company as a move to stick it to our union. Today, after a number of new owners, one of them a well known national service, it is destined to be sold again. Costs for services have risen 500% in the last 13 years, on top of the tax that was never reduced. The only losers in this have been the citizens of our city. I believed then and still do that any medical facility's first priority is to care not cost. A municipal service provided everyone with low cost professional service payed for within the tax base. You be the judge.

[Lieutenant Gonzo]

I agree 100%. A fire based ems system answers to its citizens, a private ambulance company answers to its stockholders!!! The company in question must be AMR.

My community is serviced by AMR, and although I have heard some horror stories, the crews working in Marlborough are pretty good. We have always had a private ambulance service, it went from a local mom and pop to a regional company, then bought out by ASA, then AMR , then Laidlaw. Its the little fish getting eaten by the big fish syndrome...now the big fish has financial indige$tion and wants to barf their EMS responsibilities. They are making money on 911 transports here, it'a probably the only reason the're staying. My department is looking into getting into the amulance services. Two of our support vehicles are classified as class 5 ambulance, so our foot is in the door. We do first response EMS and most of the department's personnel are EMT-Basic or EMT-D, and at a call do 90% of the work with triage and treatment! AMR passes go and collects the $$$, we get a thank you!

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Take care and stay safe...Lt. Gonzo

[Newt]

I disagree w/your views on private EMS vs fire. I've worked in the Cleveland area as a medic for 8 yrs now, yes at a private. For the last 4 yrs have worked in 2 west side suburbs w/a call volume of 39,000+. Yes we have to work for a profit to keep the co. a float but all the money goes back into the co. and we have a close working relationship w/the FD's. This co. has been doing EMS for the cities for about 12 yrs now and both cities have been very happy w/our performances and if they weren't they have had plenty of contract negotiations to jump ship. Contracted third services EMS works for these cities. I also have part time status at a local FD that has a fire based EMS service and it works for that community. I am not saying that it works one way better than the other, I guess that you just need to see what works for your community. I just get tired of always hearing privates get slammed for doing there job, the job of saving lifes.

[ems40]

I've worked the EMS field for 40 years. Pretty much worked my way up from the bottom.

I've always worked private. I have to say that the people I've worked shoulder to shoulder with, on the streets, in the office, and in all other areas, for the most part showed as much dedication to the job and the patients as any public service, be it third service or fire.

It bothers me very much to see privates, lumped into one batch and slammed so regularly.

I agree that the national consolidation of services is a bad idea, that's why the two largest are failing, but we've see some bad ideas fail in the fire service too.

The key to the issue is the committment of the people, private or public, we're there to serve.

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[fireguypara]

I think 911 ems belongs on the fire side of public safety. In this dept we are looked upon very highly as a positive service to the city. People in this community have fought to keep the dept fully staffed because we have EMS. We are able to to keep the over all cost of an ambulance call very reasonable with fire based EMS. What a service to community with ff/medics. Another positive side is our response times (less than 3-4min). With this combination of ff/medic we are very active with city promoting fire and life safety to the people young and old.

[engineone2611]

Our county has just went through a major problem with private service EMS. Our FD runs 911 but the private co. in town also had one 911 zone to cover. It started out with two but quickly gave one up because it was not profitable. The company that left town was the 2nd largest on the country. RM for short. The zoning comittee for the region opened up zoning for our county and gave it all back to the frie department as sole 911 provider. After this R/M got upset and packed its bags and went home. Leaving the hospital as well as our dept taxed for resources because we were given 72 hrs notification. In the time that R/M was there there was a noticeable difference in standard of care for pts with us and them. Their squads were unorganizedand usually raggedy. Their people were sloppy for the most part and did not inspire trust that the community needed in an EMS provider. Not to mention the fact that the taxbase never changed when they took over their zones or when they left it. Then there is the billing question. What we charge as a nominal 265.00 flat fee regardless people in their zone were getting bills of 1000.00 to 1200.00 for simple "ALS" care. It was all "ALS" for them. I have heard of private services doing well in some communities but these arew just some of the problems noticed in our system. If it works great but personally I think we should keep it Fire based EMS for the citizens sake.

[RyanEMVFD]

I work for a private EMS service myself and have seen the reasons why pt care slips or the rates rise. In my opinion if there is any one thing to blame it should be insurance companies. They want their clients to pay for insurance but not pay for when the people need it. Also the federal gov't should be pointed at also for doing the Medicare/Medicaid cut backs. Those are the main two insurance companies and they are very particular about what they will pay to ambulance services.

[txdefib]

I agree with most of you. I think EMS should be left to the municipalities and not private services. It seems to never work. My city has a third party EMS through the city health dept. We have a very close working relationship with the FD and are housed with the fire dept. at 1 station. It works there is no doubt and it is very cost effective to the city and citizens.

13 years ago a private service packed up and left over night with no warning. That is one of the risk you take when private services are involved.


Take care and stay safe.

[Resqmedic]

I have worked both sides of the fence my self, and I have to admit, by in large private services do have some major problems. I have seen 911 calls hang for 10 min before being dispatched because the services always seem to be running on a skeleton crew. There are some very noteable exceptions, but by enlarge private services don't have to resourses to respond when the fit hits the shan. The county EMS Rescue service I work always have staffed trucks to respond to any emergency, even some major MCI's we have had in the past couple of years. We pride our selves on never having a call wait for a rig. Our county based EMS service in fact bails the private hospital based services out on a regular basis.

[4trauma]

I work for a private ambulance company in Milwaukee, Wisconsin. We have a contract with Milwaukee FD and run 911 calls. I feel we do a great job. The problem I encounter is lazy and prejudice MFD Paramedics that think they are paraGODS. By there own protoccals we have to call a med unit for PNB's, certain gun shot wounds, mva's with vehicle penetration of 12" or more and cocaine chest pain to name a few. When we do call them in per there own protoccals they give us an attitude. They even go as low as to make fun and put the patient down. These patients are mostly black or hispanic and live in the so called "hood". In a system with lazy and racist fire ems personnel such as this one the private companies do a better job because we treat our patients with respect and dignity. Something that every person is entitled to. Fire ems can be a great thing but we have to get rid of the "cowboys".

[SargeCo.69]

I dont neccesarily agree with the private EMS systems. What we do in my community is more of a combination. We have both paid and volunteer members at our station (which is strictly EMS and rescue). This system allows each different company do be its own corporation and all of the proceeds we gain come from either fundraisers or from our county governemt. This works very well, we rarely miss a call and if we do we have mutual agreements with all of the other medic companies in our area to cover for us. This system works very well.

[JHall26]

Privates are good for interfacility transports. Otherwise....
How 'bout this question...should EMS be considered primarily an element of public safety or healthcare? I think that may be relevant to the answer of this question.

[ridingbackwards]

There may be some good private services out there but I haven't seen them yet. I would paint houses or something before I would put my carrer in the hands of some accountants. I feel for the employees but have no use for the employer. they can GET OUT of my chosen profession that I have put years into!

[kghemtp]

A certain 3-letter private service was booted from the hospital transfer contract as the hospital made financial arrangements with a municipal department known for their precedented ALS service.

There are providers who don't wish to be affiliated with the fire service and certainly want nothing to do with being a firefighter. That's ok in my book. I tend to think privates are more equipped for interfacility transports. In many cases, we're looking at different fire & ambulance dispatch centers, so extra communication is necessary. With the two agencies working together, it seems there is more conflict because one is non-profit and the other is for-profit. I notice tension around such systems.

[ffemt1361]

Originally posted by engineone2611
In the time that R/M was there there was a noticeable difference in standard of care for pts with us and them. Their squads were unorganizedand usually raggedy. Their people were sloppy for the most part and did not inspire trust that the community needed in an EMS provider. Not to mention the fact that the taxbase never changed when they took over their zones or when they left it. Then there is the billing question. What we charge as a nominal 265.00 flat fee regardless people in their zone were getting bills of 1000.00 to 1200.00 for simple "ALS" care. It was all "ALS" for them. I have heard of private services doing well in some communities but these arew just some of the problems noticed in our system. If it works great but personally I think we should keep it Fire based EMS for the citizens sake.

I would have to agree with keeping EMS Fire Based. Even though I havent worked for a Public FD I have worked for RM. The above quote says alot. They will come into a city expecting to take over a 911 contract. They tried to do that with Baltimore City and failed. Instead they bought out several mom and pop companies that had merged. So RM got stuck doing interfacility transports and critical care transports. All RM,AMR and Laidlaw are out for is money, money, money. With that the quality of care the patient receives becomes lackluster. Any EMT can get a job at a private company. Some places dont screen their employees. Any way I could go on and on about the Private vs Public EMS issue. In my opinion when a private company takes over, they tend to ruin the service instead of making it better. Take care and stay safe everyone.

[Toering]

I help run a private service. In all honesty, We have no problems. I've added to this type of thread before and have said the same thing. There is nothing to bitch about here, the pay is great, hours are great, the people are great. No one has any problems with reciving a bill for services they recived. We accept no payment from any tax base, or subsidy. We have the best equipment money can buy. And most importantly... The folks that live, work, play, and visit here are reciving some of the best perhospital care in the area. In fact, other services are looking for our help when they can't get there act together. I belive that is something to be said about our private service. I think that the fire guys are just ripping on us privates just because they have nothing to do when they sit around waitng for the big fire. Please tell me what the difference is in pt. care on a 911 call vs. interhospital transport? None, so why is it that some think privates are only good for interhospital transports and not 911, Same level of care is being given, right?
Anyways... is there a better thread to debate in???

[mstclair190]

There is a difference between providing care on a 911 call and on an interfacility transfer. In theory the care actually provided should be the same. From what I've seen and experienced, the difference lays mainly in the providers. Some people are just not able to handle the stress and quick pace of your more critical 911 calls (i.e. shootings, arrests, bad mvas, etc.). They are "in the weeds" from the initial dispatch in some cases. They are not able to focus on the tasks needing to be handled and therefore patient care suffers as a result.

I've worked directly with some medics that if I could have, I'd have kicked them out the back doors during the call. Their inability to deal with the stress, did compromise patient care! I can only do so much on my own at the same time. Some people are better suited for the lower stress, more leisurely pace of most interfacility or non-emergent ambulance tranports.

There are quality providers and poor providers on both sides of the fence. In this area, the better ones tend to be with the 911 services that are recognized as being the top agencies. The poorer ones or atleast those not necessarily ready for 911 service tend to work for the private services that do mostly non-emergency trips.

One of the local privates does "911" services for 4 communities. They operate outside the 911 system. The calls go to the regional 911 center for that area, then are transferred to their internal dispatch center. After that initial notification, 911 has no control over what happens with that call until they call back and say they don't have a unit available. They aren't held to the same response time standards that other services are. I've seen them sit on emergencies waiting for a unit that just arrived at a hospital out of that area to clear and take the call instead of giving it away to a neighboring service that could respond much quicker. How is that good for patient care or even on the same level?

If your situation is working as great as you say, then great for you and your community. I have no ill feeling towards you just because your a private service. I do have a problem with the services that aren't performing on the level that they should be. Unfortunately, AMR and RM appears to have left a sour taste in most peoples mouth when it comes to privates.