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Public or Private?

Privatization of EMS is something that makes the IAFF’s skin crawl. Recently in Brook Park, OH, firefighters protested the mayor’s decision to examine a private provider providing EMS.

“Fire based EMS is the way to go…” was one quote from the article. It was following by more crying that it’s unsafe and unfair, blah blah blah. Basically the same scare phrases used all over the country by union leaders looking to preserve paramedic positions and fire chiefs to justify budgets.

To debate the article on it’s face is definitely unfair, it lacks the necessary information to be able to make a rational decision over which one would suit them best. Things I really want to know are along the lines of:

  • How fast the fire department responds to EMS calls? Do they meet the NFPA 1710 requirement? Are crews held to account for dragging on EMS calls but blistering the roadway going to fires?
  • What’s the clinical environment like? Do they provide good and accurate care? How well seasoned are their providers?
  • What does it cost to truly operate the system? Does it break even or is it more expensive to operate? What kind of subsidy would a private provider require and is that worth the cost?
  • What’s their equipment like? Do they send ambulance out for repairs a lot (which could indicate apathy on the account of the crews, trust me, it’s a good indicator)?

If there’s a lack of dedication to EMS by the fire department, and the majority of run volume is overshadowed by the minority, then perhaps a change is necessary. I work in such a system where once EMS was the red-headed step child of the fire department. It rose to prominence and is now in a straight drop because the “Powers That Be” have preconceived notions about the “place” of paramedics. Such systems need a systemic change in order to correct such errors, and perhaps a separation of EMS from fire is a necessary maneuver. It’s like a band aid, just rip it off, and we’ll all feel better.

In the end, however, I reject the IAFF’s position that fire-based EMS is an “end-all, be-all” to the issues municipalities and governing bodies face concerning EMS coverage for several reasons. I think that quality control is always an issue, government employees in general are very difficult to terminate especially with civil service protection and so it leads to a sense of invincibility. I’ve witnessed terrible providers slip through the cracks and they can’t be removed for non-performance because of the difficulty of termination. Private services lack this issue, since they’re in the business of “good care = good contracts” and customer service usually only the best providers, or least the average, are retained.

Another reason is that there is truly no “one size fits all” approach. Like in Memphis, straight 12 hour shifts and system status management would keep the workload even, instead of some locations getting the bulk of the work and others being left sitting. Here the positions would be constantly changing instead of static as they are now. I think it leads to a greater exposure and less provider fatigue. Very few fire departments operate with a fluid system, here the system is rigid and inflexible to meet demand and results in often extreme delays in ambulance arrival. I should mention that delays are offset by the ALS engine companies, but we’re not sure how long that’ll last.

In all, the debate is worth having. The argument that there’s only one way that government should operate EMS isn’t supported by many good metrics, and in many places private services will beat fire departments hands down. It’s up to the community leaders to decide what kind of service is best for them.