Who's patient care is better?

[EMT_yea_you_know_me]

I'm an EMT-B trying to go to Paramedic school and I'm working on a debate for Private vs. Public EMS and one of the key issues is who's patient care is better? And within that, who's cost is better? I don't have much experience on either side of the coin so I'd really like some input, on both sides if possible. Thanks for any help you can offer.

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Never eat more that you can lift.

[TFDminnow]

I believe, and statistics show, that FD EMS provides better Pt care than private ambulance, not sure about privates but an ALS run in my Dept costs $500, BLS is $250. The fact that Firefighters like to be at work and the majority of Private ambulance Medics don't has a big impact on Pt care, also the quality of equipment that a FD has is better.

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Will Caruso
Firefighter/Paramedic
Taylor FD
Taylor, MI
Local 1252

[munson]

My own personal opinion is neither is really better than the other. Working for a private ambulance co. is a good way to practice all your pt. assessment skills. Its easier to get a medical hx on someone going for dialysis or for a dr.'s appointment than someone having trouble breathing. The amount of non emergency interfacility transfers will (hopefully) improve your report writing skills. And lastly show you how to trust your partner, because usually its just the two of you. Depending on where you work you may not get many EMS calls on the public side and that's not bad, but your skills may not be up to par. It may take longer to feel comfortable with some one not breathing. Better care falls on the person giving it, a FD medic is not any better than a private medic. If your ignorant, pt. care will always suffer.

If by cost you mean the difference in pay? Then that also varies on where you live. And finally having better equipment falls on both sides. There are public systems that have more money than others as does private systems.

Hopefully this helps.

I worked for a private on and off of a 1 year and a half, and am currently a paid on call ff/emt for two years

[This message has been edited by munson (edited 11-21-2000).]

[greendrum872]

Now I am not and EMT or anything, but I was just browsing the forums and this caught my eye. In my area (South Chicago Suburbs) many cities are being flooded with medic runs due to the aging community. Many towns are also small and can't afford the high cost of running the ambulances. My town started it's paramedic program in the mid-70's by door-to-door donations. The village would be devistated if we switched. I also feel as previously stated, that the FD medics enjoy thier job better the the Private medics. Go for your town. Hell, if Chicago can do it, so can you.

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These are not the opinions of my department.~;)

[Turk II]

If you have plans on attending Medic school and working as a Medic then consider this...

Most private EMS services have contracts throughout a state or throughout a region. If you have to "relocate" during your life, this might be easier for you to do if you worked for a company such as AMR compared to a public EMS service working out of only one or two stations.

[engineone2611]

I am a FF/EMT for a paid dept. We will run 7500 EMS calls before the end of the year. We had a big company in here that left a bitter taste in our mouths when they up and left. I worked, as did quite a few of our people, for them PT. The level of care is dependant upon the particular caregiver. But as a general oversight here, the FD tends to give better care. We have numerous times seen the private srevice bring in patients from Nsg homes who had fallen and bruised and broken themselves and no kind of Cspine precautions are taken. They also run as a backup 911 provider if needed. They have brought many pts in who should have been given breathing treatments and werent or who should have been on a monitor and werent and general things like that. As a norm FD based EMS is more rigid in its standard of care because of the discpline instilled in their people. Private service is usually a more relaxed type that is less regulated and in the case of big companies are supervisd from far away. The boss at our particular site couldnt have cared less about what we did. There was no kind of QA in the company and the employees ran with the knowledge that a complaiht would probably be covered up before it reached anyone important anyway. As stated earlier it depends on the caregiver but the discipline and pride instilled in Fire based ems usually lends itself to batter care.

The opinoins here are mine and mine soley and in no way reflect an official comment or opinoin of my department.

[FCDave]

The quality of patient care is based on the EMT-B,I,or P that is in charge.
Many of you are correct. Most fire dept. medics like their jobs. However, what about the firemedics that JUST want to fight fire? There are many FF/medics that are only medics, because they want to get a job. Just because the fire dept. shows up at your house, doesn't mean that patient care is any better than a private company.

[douch91]

Like most I have worked both sides and can say with all honesty that working as a firefighter/medic is the best of the two. This in know way means I think I provide better care than those in private industry.I think we all do the best we can for our patients.I think as a firefighter/medic I am lucky to have the security of my position and that is why we like going to work more than privates. This does not make us better or give better care . It just lets us enjoy our profession . We all should be proud of what we do and who we are not what someone else is not.

[SteamTrain]

In relation to deciding on public vs. private EMS, you have to consider 2 options. Here aroung the metro Atlanta area we have several Fire Dept.s that transport. We also have a couple of "3rd service" type public EMS. Both of these systems (IMHO) tend to provide better care in general. They do have their problems. I'm in s Fire Svc. that provides 1st responder/non-transport ALS. We have a pvt. svc. for transport.
I have this theory about why there is so much conflict in these issues. Consider this: How is an EMT & Paramedic student trained? Individually or ar a member of a team? How is a recruit F/F trained? Individually or as a member of a team?
EMS is based entirly on individual skills. Firefighting is a team skill. I think this has a significant impact on who provides better pt. care. Our pvt. svc. we run with is a mixed bag. We have some crews that provide excellent care and then some are complete duds.
ANYHOOO, back to your original questions. Go with the public svc. Around here the pay is usually better and job security is much better. Then study computer programming for when you get burned out, you'll have a decent job skill.

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GOD is my Fire Chief, JESUS is my Incident Commander!

[sgtdave2002]

The problem with many Private Ambulance Companies come into a area as a friend..working well with the local fire departments, but as the run volumes increase, so does the greed, how much the company can milk the community.. the privates get in the back pockets of the local Fire Chiefs "kissing thier ***". We have a problem like that in our neighboring community, the chief is not to keen on the idea of having his department run on medical calls and even allows the private company to respond to medical calls without toning his fire fighters, a few of the private company empoyees are on the fire department staff, even in supervisory positions inside the private company.. so the old story of money talks fits in, if the chief does not have to send out his troops, he save on his budget, the community residents get a bill for hundreds to thousands of dollars (thier insurance usually gets this but many times much may not be covered), they are sometimes being treated like third class citizens and this is allowed.. all in the name of staying inside the budget and not willing to improve your own.. Lord hope nothing happens to his family and he has to get a bill as well as being trated like they are wasting the privates time.. Fire based EMS provides compassion as well as a moral builder of the fire service members and the community..

[ourfamilyhelpingyours]

As someone who has worked in both private and public sectors, for Professional Fire Fighters and for private services, there can be a lot of difference or none. It depends on the service. There are some great private services. A very few have a great relationship with the public fire dept. they work with. Most privates fail at this because the private ambu medics become "paragods" rather than paramedics. The fault lies with the management of their service.

I have read alot on Lincoln, Nebr., and how they dropped Rural-Metro ambu after several years and now the FF do both emergency and GT stuff. I understand most of the private providers went to work for the city FD based on what I read.

There are union people in private ambu services, some as the same union as the FF (IAFF). Maybe the union helps their professionalism and ability to get along.

The private sector has long been the training ground for the public sector. I know of only one or two guys that have retired from the private ambu. business. In fact, most of the ambu providers have not been in business long enough to have people retire.

And there are public "third services" like Denver Paramedics.

It is about relationships. And those relationships are guided by the managers and owners of the ambu companies. I think most FD's, their people and chiefs would value a good working relationship in the field. When it gets competitive, history has proven that the FF will eventually win any public policy battle. Look at Phoenix. They have had the ambu's since 1984, right in the middle of a right wind Republican state.

There are private ambu companies who can do it right. There are public agencies who don't have a clue, too.

If you read any of Alan Brunacinni's books, it is about customer service. I think people will vote you the resources if you provide them the service.

It is about your person professionalism. From there, you will find a home. After all, there are only so many ways to do a needle stick or defib a pt. If you don't learn teamwork, private or public, you need to reconsider what that looks like to the patient, their family and anyone else who is watching.

And people do watch. Good luck!

[tlfd600]

Well personally, I am an EMT-B for a hospital based EMS service that does the transport for the community and a first responder/FF for a volunteer fire department. From my observations and input from others, if you have a contracted EMS service they are there only to deliver EMS and need to do a good job to keep their contract. If you have a fire department running the transport then several of the guys just want to fight fires but needed to become paramedics to get a job and also many times if there is a big fire their ambulances start to shut down as more fire fighters are needed at a fire. I know one local department shuts down its ambulance when there is a working structure fire and on good word another department used to basically end EMS for a town of about 50,000 when there was a large fire that pulled multiple alarms. I don't think either service delivers better patient care, I have seen ausome paramedics that I would love to work on my family from both sides and others that I would rather crawl to the hospital than let them work on me. It basically depends on the person not their employeer.

[oldE6man]

The big issue is not which medic provides the better care, but which system provides a better overall service to the customer. The privates always come in with a drastically lower bid to provide the 'same' service, but historically their service delivery does not match their proposal.

When a city that has been providing EMS transport accepts a bid from the privates, they obviously stop purchasing equipment, apparatus, and supplies. This is the most compelling reason to outsource this service. But when the provider fails to live up to the terms of the contract, the city is faced with two options: they can live with the reduced service or face a huge startup investment to rebuild a transport fleet.

If it seems as though I favor fire-based EMS, then I have made my argument. The lack of control over EMS is the greatest threat to the fire service. We must embrace EMS and treat it as the critical component of our operation that it is.

[HR314]

I have been employed with a private ambulance service, located 45 miles north of me, a little over a year and First Respond for a hospital based ambulance service that is located in my hometown. I have come up with the conclusion that neither service is better than the other, they use very similar if not the same equipment, yet I also believe that there is only one thing that compromises PT. care in the rig and that is THE MEDIC. Services have very little impacted on Pt. care if they meet standards, codes and regulations. When the paramedic is not thoroughly trained or incompetent in his/her skills, that is when the Pt. suffers. I personally recommend that you choose what type of company you will feel comfortable in and one that will help you during your learning phase.

Good luck!!

[steven1534]

I live in Fairfax County, right outside of DC in VA. We have an excellent Fire and Rescue Department. Some private companies wont respond because the patient wont pay. Where I live, I would prefer to be helped by the public dept because it is massive, paramedics on all of the 34 engine companies, 21 medic uits and 18 ambulance units. Public EMS is best, in my opinion, because they will respond, even if they cant be paid, and in fairfax they do not get paid to respond, all services provided are free of charge and funded by taxes. I am gonna become a Junior Volunteer (Fairfax has a combo paid/volunteer dept, all front line units are fully staffed by paid personell, and have additional staffing by volunnteers) as soon as I turn 16 because I think that Fire/EMS stuff is cool.

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--Steven Jacobson
steven@episodeguides.com

[buzzmedic]

What a great topic! I'm going to jump on the coattail of all the other FF/medics who responded. I myself have to work for a private ambulance service part time. My fire dept. runs first responder only with no ALS. There is a huge personality gap between our departments. We (the fire dept.)have attempted on several occasions to invite the EMS people to train with us so we can learn together, ie.extrication. And so the ff can learn what the medics are looking for and need on a scene. This has been met with great resistence. The EMS management won't pay overtime for this opportunity. As for the patient care. Many factors come in to play in my opinion. First is pay. A private company will pay peanuts to medics to work. And as long a fresh medics out of school continue to except peanuts to work, the private industry will continue to farm peanuts. Secondly, looking at the current trend of EMS, the private companies finally realizing that the interfacility transfers are the bread and butter, and beginning to shut down thier 911 operations in favor of BLS only transfer services. Something to think about if your looking for a job!
ff/emt-p Buzz

[WFDFFEMTI]

I, like many have worked both sides. As far as who gives better care, well, that depends on where, call volume, management, educational opportunities, etc, it's going to be different everywhere.
In Maine there are good and bad private and good/ bad fire based. I have to agree that fire based services do seem to enjoy the work more.
It does need to be considered however, that where I am from, and my guess many other places, a number of private services have several who also work full time for a fire based service( myself included). Which makes it very hard to say one is better then the other. After all does the uniform relect the level of care that I give?

[A52zLT]

Ah, the age old question. Public vs. Private? You could write a doctoral thesis on this topic and not have any better understanding. In the end, you will develop an opinion based on your personal belief, situation, and (yes) bias.

Like most on the list here, I currently work for both. My full time is with public, PT private and first responder.

You have 2 basic models with some variation: 1. Public (FD based,division of,3rd city service,or volunteer).
2. Private (generally a for-profit company, some hospital based).

The individual provider is the most important link. If he/she is a positive, intelligent, competent, and compassionate individual, it won't matter what uniform they are wearing. This is what really matters. We all have our bad moments in the ditch at 3a.m. when it's cold, raining, and you are dealing with a drunk, belligerent patient. We try our best.

System wise, who is managing your system is important. All too often, a private service will focus on the bottom line, the profit in making decisions. Public must deal with a budget funded by taxes and collection rates.

You can find positive and negative examples on both sides of the fence. My personal, unscientific opinion is that the public systems tend to fare much better than the private. I know of only two fire based systems that have laid off staff vs. nearly daily reports of the large private companies being sold, having cancelled contracts, etc.

Public systems tend to pay better and offer better benefits. These tend to be "career" positions. Most require cross-training as a Firefighter. Private systems typically are "stepping stones" to fire systems or other allied health positions such as nursing or medical school for example. Private systems change hands or management frequently.

The numbers are there. Do the research with the systems that are in your immediate area. Talk to the employees. What works? This topic usually is good for stirring up emotions. I am glad to see that this thread has prompted nothing but rational thought and discussion.

Good luck on your research. Of course, my opinion is only based on my own observations being in the business for ten years.

Do your best for the patient and family no matter who you work for and what your situation is. They are always someone's mother/father/sister/brother/grandfather/grandmother/wife/husband and such. Above all, Be careful out there!