Fire based EMS

[flip418]

I would like to know if there is any department out there who recently was charged with providing EMS service to their community after a stint with a private provider. My department is in a position to possibly get the EMS dumped in thier laps after several years of a private/for profit entity providing the EMS. What are the pro's/con's of fire based EMS and what were the initial problems encountered?

[swrr88]

I have to say that since you are using the term "dumped" to describe EMS that things in your area are starting off wonderfully.

If the majority of your department feels that way then I feel for the guys and gals that will be working your ambulances in the future.

EMS and Fire don't always mix, sometimes they do. However, it takes both sides being committed to the process and seeing each other as equals. I don't feel that's the case in your city.

You are a paramedic-firefighter? But you have no intention of riding in an ambulance, correct?

You department has enjoyed their ALS companies....the runs, the equipment, the salaries, and most importantly the funding. Now, you are looking actually having to do EMS...which you never wanted to do, right?

Why so harsh? You ask.....been on the ems side of the equation and maybe I am a little cyanical now.

[kghemtp]

Fire-based EMS:
Pro - 1 chief for the whole service, fire & medical
Pro - increased call volume to support more money at budget time
Pro - job security & potential for more hiring
Pro - continuous contact with your ALS transport service (it's your own FD)
Pro - less costly overall with less management

Many more advantages... these hit a few of them.


~Kevin
FF/Paramedic

[rekeith]

I agree with kghemtp; however, the one CON that I can think of (and it's a big one) is EMS billing. If you all bill for your service then you'll need to hire someone with experience in EMS billing, not just medical billing because there is a difference. This person will ultimately have to estalish your department with insurance companies, Medicare, and Medicaid. My department uses one EMS billing clerk (we average about 2-3 EMS transports a day) and she is part-time; if no billing is needed then she assists with general administrive duties. Hope this helps...

[medic2k3]

Kevin and I have the same billing company...the hospital. Our area has a pretty good system for fire department billing services. We transport the patients to the hospital and make a copy of the run report and submit it into a box. The forms are then brought to the billing department. The billing office is based in the hospital. As they are well versed in both medicare and medicaid billing it isn't an issue. Also in the event a patient doesn't pay or have the ability to pay the collection action is handled by the billing service. At the end of the month our department recieves a check for monies collected. I hope this helps.:cool:

[nisler]

I work for a large department in South Florida. We run Approx 100,000 calls a year we have about 300 transports per day. We are a Fire based EMS system and from my expierience the PRO's are limitless for why EMS should reside in the Fire Departments. Remember that when you think about why EMS should be in the Fire Service think about it from a citixens perspective first and an employees second. The Fire departments are best tuited to provide consistant levels of service and the city or county governement that has a fire based system will take much more pride in their service if they are providing it themselves instead of contracting this service out. Remember also that privates (at least in my area)bill based on level of care ALS/BLS, Mileage, and for ALL suplies. They charge for band aids. As a tax funded agency we are not able to bill by FL statute for any supplies we only bill for ALS/BLS base rate plus mileage. This is due to the fact that taxes are used to purchase all of the supplies on your rig and you cannot double tax. Things to think about.

[LouisianaMedic]

The old bash the private service bit.. Private vs Public.. The debate will continue for years, which is better.. Either one depending on your area, and provider.. Both have advantages both have disadvantages.. If there is a strong tax base and the Fire departments want to run EMS - go for it. I have worked for both, depending on the area, one is no better than the other one.. Yes Private is geared for profit - but you also can't run a public service based on losses either.. must at least break even.. I seen public services want out of EMS transport because of all the BS calls, and losing money, because cost to maintain a service is too high and personnel burned out being dually trained.. Also some areas of the country need a private service to come in because it takes to long to get an ambulance out because they are still relying on volunteers to man the ambulance. May have to wait an hour or longer to get an ambulance especially during the day time when most people are at work.

If Fire/EMS works better in your area use it, If private works better use that.. but don't put all private services down because of several bad companies...

Instead of bashing the private services - work with local government officials in your area to ensure that you are getting the best service for your money. Set up certian ordiances or rules regarding ambulance services in your area... Remember is cost over 250,000 per unit a day to staff 24/7 more if you staff it with 2 paramedics or more than 2 people, just a point to remember...

[kghemtp]

I think the suggestion of Fire-based EMS was very civil, and information offered were the advantages of municipal services. I think SOMEONE hasn't been playing well with fire departments and got a little punchy here. If this was a post about anti-private, I'd be writing all about not liking them. Since this isn't, how about simply sharing your ideas and not taking this personally toward your department? Just a thought!

[hwoods]

With a title like LouisanaMedic you might work for Acadian, probably the best private EMS operation on the face of the earth, an outfit that I admire. However, I do disagree with saying that public must return a break even or better cost recovery. We (Prince Georges County, Maryland) are a combination career and Volunteer Fire Department, with a huge EMS call volume. With equipment operating from 48 Fire/Rescue stations in 2001, (I don't have 2002 numbers handy) the 12 ALS units ran 43,304 and the 51 BLS units had 100,878 responses. (Units are Ambulances) plus the BLS support provided by a Heavy Rescue or a Engine Company. (with us, you need help, you get the closest thing, immediately, in addition to whatever transport level you need) Is this cost effective? Of course not, and we don't give a damn. Our purpose is to provide care, not worry about the bottom line, and it shows in the quality of our service. Every year, the Washington Post newspaper runs a poll on local government services, which jurisdiction provides the best, and how do residents rate the service that they receive. Our operation tops that poll so often that it embarrasses us. Funding is from the County Government budget, with additional support from Volunteer Fire Department Fund Raising events. (Volunteer organizations own a lot of the equipment and stations) We're not cost effective and proud of it. Stay Safe....

[expvol]

My department isnt having that problem but a few neighboring departmens are taking over the ambulance service, and they need to do. The private company allededly doctored their call logs to show faster response times!!

[bigJ164019]

Originally posted by LouisianaMedic
The old bash the private service bit.. Private vs Public.. The debate will continue for years, which is better.. Either one depending on your area, and provider.. Both have advantages both have disadvantages.. If there is a strong tax base and the Fire departments want to run EMS - go for it. I have worked for both, depending on the area, one is no better than the other one.. Yes Private is geared for profit - but you also can't run a public service based on losses either.. must at least break even.. I seen public services want out of EMS transport because of all the BS calls, and losing money, because cost to maintain a service is too high and personnel burned out being dually trained.. Also some areas of the country need a private service to come in because it takes to long to get an ambulance out because they are still relying on volunteers to man the ambulance. May have to wait an hour or longer to get an ambulance especially during the day time when most people are at work.

If Fire/EMS works better in your area use it, If private works better use that.. but don't put all private services down because of several bad companies...

Instead of bashing the private services - work with local government officials in your area to ensure that you are getting the best service for your money. Set up certian ordiances or rules regarding ambulance services in your area... Remember is cost over 250,000 per unit a day to staff 24/7 more if you staff it with 2 paramedics or more than 2 people, just a point to remember...


I must agree with LouisianaMedic on this one. It really breaks down to your individual area and financing sources.

[Truck74Hooligan]

The debate of government run or private run is just a tricky as fire based or non fire based ems. It is like talking about religion, it is hard to tell who is wrong and who is right, plus it will always start a fight. But the truth is that 80% of ems is delivered by fire departments, and according to a prominent ems periodical the quality of service has grown by leaps and bounds since the entry of fire departments into the ems arena, if for the only fact that there are more fire stations than ambulance stations in most parts of the country so in effect a fire apparatus can get there quicker and care can be initiated quicker. All in All it depends on how the services are run, how a merger happens and what type of mentality is held by the upper echelon of the f.d. command structure. I happen to work fo a dept. that the merger between the two is not working so well. It is only a couple years old so who knows. Now for private becoming run by an f.d. same rules apply. It all depends how this venture is approached and how everyone's attitude toward the whole thing is. All I can say is research, research, research.....than act. Before i get crucified by some of non-believers I want to say that although I have been in the fire service for 10 years and only been involved with ems for 5 years I like both equally and like spending time on the medic unit. You see some weird stuff and it is a good way to keep my skills up.

[hageremtp]

There are many combined rural ambulance and fire services. Most have their own staffing, and few are cross trained (in this state). There is only one dept in the state that is paid that runs both full time EMS and Fire. They have had alot of problems with it. The city has been attempting to sell the service for some time now but with little luck. Most of the problems come from the fire Chief. He is old school, and struggled to obtain is EMT-B. Combine that with a lack of respect from some of his limited staff, and you have lots of problems. To add to the mess, the city is what I call a dead end city (its near nothing, with only 15,000 people) and not alot of activity goes on there. By activity I mean, people moving in, econ devlopment, etc.

[IAMedic]

bump

[Toering]

Hey, if billing is a big problem, try a billing service. Ya, it might be kinda spendy but it's a sweet deal once you start using the service. Hageremtp could help with this topic... RIGHT HAGER??? Hager, e-mail me and tell me what city you speak of!!!

[kghemtp]

The thing about billing & billing services is that unless someone is completely versed in all of the rules for health insurances & medicare, a great percentage of what we do for service can be denied or overlooked and not paid. Billing services do this all the time, and from what I understand the service isn't incredibly expensive. Could be worth the extra money that is collected!

[hageremtp]

We use our own billing service, which currently bills for over 70 ambulance services. Our staff has attended many conferances on Medicare and other private insurance companies. They are all EMT-s (paramedics and basics) who understand EMS and billing. Look at our website and see if we could help you Golden Heart Services (http://www.hamc.com/htmls/ambulancebilling.htm)

[smurfe]

With a title like LouisanaMedic you might work for Acadian, probably the best private EMS operation on the face of the earth, an outfit that I admire.

Don't let their great PR department fool you. They ain't all that and YES, I have worked there and NO, I didn't leave disgruntled.

The Municipal department I work for exists because of their un-scrupulous business tactics.

Smurfe:D