# Private EMS second class?



## jgw1981 (May 12, 2012)

I am a paramedic at a large private EMS company in metro Detroit.  In the past year or so, there have been several cities who have lost ALS transport and in at least one case lost the ENTIRE fire department due to lack of money in that city.  With private EMS taking over.  

Before I begin my rant and dive into the subject, I will say this.  I am a paramedic and very proud of it.  I have no interest in performing the duties of a fire fighter, never have, never will.  Furthermore I have an immense amount of respect for those who will run into somewhere that everyone is running out of.  I will be right there waiting to render any assistance to them or whoever they rescue.  With that said, as these departments have lost their transport abilities, meaning they lost men due to layoffs and positions not filled / eliminated due to attrition or retirement.  When this happens, it is like clockwork the fire department goes to the media and says that the city and its citizens are now going to be in danger because "professional" firefighters will not be responding to medical emergencies.  This is where I begin to see red.  It has been implicated that the quality of service from private EMS is sub-par.  It has been said that the individuals who are employed by these companies are all criminals and cannot do the job as well.  It has been said several times that because the private companies are not union, the quality of service is not what you will get from the fire department.  

My response to this is simple.  I have the same training.  I passed the same exam.  I hold the same license to practice.  I operate under the same protocols.  There are no special schools that fire fighter / paramedics  go to.  They go to fire school, which has little to no medical training involved (my wife is a fire fighter).  Then they go to paramedic school.  There are no special certifications, and there is nothing different between what I learned in medic school and what anyone on a fire department learned in medic school.  The difference.  I became a paramedic to be a paramedic.  How many firefighters became medics because it was a requirement of the job?

I will say in fairness there are differences.  Lets start with staffing.  When a private EMS firm shows up for 911 calls, it is just the two in the truck.  Some cities run fire as first responders, some run non transporting ALS, some just pick and choose what calls they want to go on.  Some don't show up at all.  Anyways... those 2 crew members will typically make $25k - $35k generally speaking.  There is no pension for those folks, the benifit packages are less, and depending on if it is a for profit or non profit, they have a 401-k or 403-b that do not cost the employer anywhere near the legacy costs of pensions / health benifits.  When a fire department shows up, typically speaking 3-4 firefighters pop out of the rescue, and an engine rolls up with another 2-3 guys.  Needless to say, those guys make more.

Next, lets talk about the trucks.  Most fire departments have medium duty ambulances with kneeling capabilities.  Some do use type III ambulances but a majority are the larger trucks.  The private companies generally speaking have type II van type ambulances with some using type III mods.  There is a cost difference there.  

I figure I probably outta bring this to a close.  I hate being told that because I am private, non union that my work is lower quality.  I take pride in what I do, as do many of those I work with and have met at other companies.  I love caring for the people, and do what I was trained to do to the best of my abilities.  This is not an example of private companies forcing out city workers, it is simple economics and numbers.  There are too many cities that simply cannot afford to run ALS transporting departments and the immediate as well as legacy cost involved.  The fact of the matter is that none of us want to see someone lose a job, especially a fellow medic.  Don't take it out on the folks on the ambulances.  If there is someone who needs to take the heat for job losses, take it to city hall.  The people there who have not seen anything cut out of their budgets, nor are their positions ever in danger are the ones to blame.  If you lost your job because of a situation like this, please, knock on our doors.  We will welcome you in with open arms.  Yes there are more rules, yes the pay is lower, yes we do IFT from time to time, but its better than unemployment.  Lets all just get along for god sakes!

** end of rant ** :wacko:


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## Frozennoodle (May 12, 2012)

From an employee standpoint, I think working for a private service is for the birds.  They put emphasis on all the wrong things.  My private service has a QA/QI department.  I have been QA'd one time in two years for treatment.  They wanted to know why I didn't put a hypotensive patient in trendelenberg.  I wrote them back explaining that trendelenberg was now contraindicated and the pathophysiology behind it.  They apologized and said they didn't know that and I have never heard from them again.  In that same amount of time I have been asked to change my reports, or lie, about 30 times for billing reasons.  

The pay and the equipment is substandard.  We're not talking about operating at a national level of standard care but at a bare state minimum.  We don't have capnography.  Half the time our monitors don't work and when they do the a third of the leads don't print correctly or aren't even recognized.  We recently got a 911 contract and we're funneling a lot of money into that with new units, new monitors, training for old medics who aren't up to speed, refurbishing IV pumps, etc. I think this is great stuff but we only run 2 units in that area. We run 10 trucks for our main area and we have critical care paramedics running in units without IV pumps or functioning monitors transporting critical patients without air condition in south-east heat and humidity! 

We respond emergent to 911 roll-overs, nursing homes, LTACs, and private residences with substandard gear that has affected patient care.  We work long hours, for less pay, some of the worst benefits I've ever seen, with medics who are not trained up to even 75% of what would be considered safe.  It's not because they are bad people but we don't run the volume that 911 does in terms of medical and trauma patients.  At my private service I see maybe 6 patients a week that will be transported to the ER and of those 6 patients I might have to ALS one of them.  Some weeks I'll run many many more ER calls than IFT but that happens so rarely it averages out to where 10-20% of my patient contacts are actually complaining of something.  You do your assessments on your transfers, try to stay sharp, but it's hard.

Where I live we have a private service covering our area. Acadian. We have 500sqmi of land with 34,000 residents covered by two medic units with the nearest hospitals 20 minutes away from the closest points.  We don't have any hospitals in our parish at the moment.  If they get two calls they rotate IFT dedicated trucks into the area or pull from their other 911 contracts.  Two trucks for 500 square miles.  Now they are great trucks that are well maintained with good equipment but that's part of the problem with private services.  The people cutting the checks care about the bottom line and not about what's right.  Working in 911 dispatch I saw first hand how they operated.  We have guys flipped over in a ditch unresponsive waiting 45 minutes for an ambulance, 30 minutes, response times are horrible.

I'm very pro-third service EMS.


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## Anjel (May 12, 2012)

Amen. 

However I have been hearing lately that there are talks that we are doing a better job than PFD. 

Especially with the hospitals. I think private EMS doing 911 is new to some people. We just have to work harder and prove ourselves, which sucks, but the reality is that cities are seeing how much the FD is costing them. And it is cheaper for us to come in and do the dirty work. 

I dropped a pt offf at the ER the other day and a FD was there dropping someome off too. The parents of our pt went to the FD and thanked them for their hard work and ignored us. Stupid. But oh well.


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## jgw1981 (May 12, 2012)

I completely understand the QA/QI thing for sure!  I don't get it so much from my company, it actually get it from my med control authority.  I was questioned by letter 3 weeks after a call why I didn't provide the 2nd and 3rd dose of 12mg of Adenosine for SVT per protocol, and my answer was simple....it converted to NSR with the 6mg dose and there was no need for follow on doses.  Make me wonder who is reviewing these.


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## jgw1981 (May 12, 2012)

Public third service is a great idea, however all too often doesn't work so well.  Calling it a 3rd service in and of itself implies that it gets treated less than its police and fire counterparts.  Systems like Boston, Sussex County, and to an extent New Orleans (to name a few) work reasonbly well because they are ran on their own merits, not as a "toy" of the suppression division.  While New York runs ok, there have been numerous articles about how the FDNY treats EMS as the red-headed step child.  And ask the EMT's and Paramedics of Detroit Fire Department EMS how being a "3rd Service" is working out for them.  Even before the big budget crisis, DEMS got the short end of the stick from DFD.  A system that did work very well was MAST Ambulance in Kansas City.  Well equipped, great service marks, good response times across the board.  KCFD decided they wanted to take it over and while still well equipped, and the firefighters still provided good service, the response times took a big time hit.  When politics and red-tape get in the way of doing things the right way nothing works well.


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## Frozennoodle (May 12, 2012)

jgw1981 said:


> Public third service is a great idea, however all too often doesn't work so well.  Calling it a 3rd service in and of itself implies that it gets treated less than its police and fire counterparts.  Systems like Boston, Sussex County, and to an extent New Orleans (to name a few) work reasonbly well because they are ran on their own merits, not as a "toy" of the suppression division.  While New York runs ok, there have been numerous articles about how the FDNY treats EMS as the red-headed step child.  And ask the EMT's and Paramedics of Detroit Fire Department EMS how being a "3rd Service" is working out for them.  Even before the big budget crisis, DEMS got the short end of the stick from DFD.  A system that did work very well was MAST Ambulance in Kansas City.  Well equipped, great service marks, good response times across the board.  KCFD decided they wanted to take it over and while still well equipped, and the firefighters still provided good service, the response times took a big time hit.  When politics and red-tape get in the way of doing things the right way nothing works well.



New Orleans EMS is probably the one thing the city does well. I'm curious: what is your opinion of King County?


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## Anjel (May 12, 2012)

Is Lapeer county EMS a third? I think so. Theh do ok. But totally not staffed enough to handle their volume.

All of the cities they cover each have their own vollie. That seems to workwell. Just their response times suck.


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## jgw1981 (May 12, 2012)

I honestly do not know enough about King County (I am assuming in WA.) to have an opinion.


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## jgw1981 (May 12, 2012)

Their Cardiac Arrest survival rate is apparently out of this world!


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## NYMedic828 (May 12, 2012)

jgw1981 said:


> Public third service is a great idea, however all too often doesn't work so well.  Calling it a 3rd service in and of itself implies that it gets treated less than its police and fire counterparts.  Systems like Boston, Sussex County, and to an extent New Orleans (to name a few) work reasonbly well because they are ran on their own merits, not as a "toy" of the suppression division.  While New York runs ok, there have been numerous articles about how the *FDNY treats EMS as the red-headed step child.*  And ask the EMT's and Paramedics of Detroit Fire Department EMS how being a "3rd Service" is working out for them.  Even before the big budget crisis, DEMS got the short end of the stick from DFD.  A system that did work very well was MAST Ambulance in Kansas City.  Well equipped, great service marks, good response times across the board.  KCFD decided they wanted to take it over and while still well equipped, and the firefighters still provided good service, the response times took a big time hit.  When politics and red-tape get in the way of doing things the right way nothing works well.



Word. -_-


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## Veneficus (May 12, 2012)

I know it is a rant but...

I think you are reading too much into the rhetoric. 

Of course this is what the FD will say, they are trying to use fear to protect thier budget and their job.

It is not personal, they would say children are demonspawn parasites who bleed society to death if they thought it would help.

They are just desperate and not smart enough to make a reasonable argument.


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## abckidsmom (May 12, 2012)

Veneficus said:


> I know it is a rant but...
> 
> I think you are reading too much into the rhetoric.
> 
> ...



And they get their talking points from the AFL CIO. It's not like union propaganda has ever made sense, even when the position they hold is completely correct.


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## Veneficus (May 12, 2012)

abckidsmom said:


> And they get their talking points from the AFL CIO. It's not like union propaganda has ever made sense, even when the position they hold is completely correct.



Yea, I like the statement about when you have a medical emergency you will not get a professional firefighter.

Could you imagine using a different profession?

When your toilet is leaking, you will not get a professional mason to come and fix it.

or 

When you go to the emergency room, a professional carpenter will not be there.


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## jgw1981 (May 13, 2012)

When I have a FIRE I expect a professional Fire Fighter to show up, when I have a medical emergency, I expect a professional EMT / Paramedic to show up.  Since when does union membership indicate a professional?


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## Veneficus (May 13, 2012)

jgw1981 said:


> When I have a FIRE I expect a professional Fire Fighter to show up, when I have a medical emergency, I expect a professional EMT / Paramedic to show up.  Since when does union membership indicate a professional?



I don't think you understand how propaganda works...

The claim doesn't have to be true. You just say it enough until everyone thinks it is.


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## Hunter (May 13, 2012)

Veneficus said:


> I don't think you understand how propaganda works...
> 
> The claim doesn't have to be true. You just say it enough until everyone thinks it is.



This unfortunately
 Beats this
Vvvvvv






jgw1981 said:


> When I have a FIRE I expect a professional Fire Fighter to show up, when I have a medical emergency, I expect a professional EMT / Paramedic to show up.  Since when does union membership indicate a professional?


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## johnrsemt (May 14, 2012)

To the OP;  find some of the towns that are losing fire based EMS coverage and send letters to the editor of the local papers; stating what you said.  That they are not better EMS providers just because they are FF.  People don't know that and need to know that.   
   Probably won't help with 90% of the people but some will read it,  and politicians do actually read some stuff (or their staff does).


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## 46Young (May 14, 2012)

Veneficus said:


> Yea, I like the statement about when you have a medical emergency you will not get a professional firefighter.
> 
> Could you imagine using a different profession?
> 
> ...



The IAFF considers volunteers the enemy, since they "steal jobs" and other nonsense. They pissed off a lot of members when they tried to prohibit career firefighters from volunteering in other departments that have Union jobs. There are a lot of career FF's that volunteer as fire and EMS. Their propaganda is cheesy and embarrasing.


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## 46Young (May 14, 2012)

IMO, the privates don't belong in 911 EMS; pt care and being wholly dependent on income to sustain the operation do not mix.

I'd like Third Service EMS if they paid much better and had more career development in place. It's too much of a dead end job as it stands. Fire is really the only EMS delivery system that allows you to make a comfortable living and have a good retirement, for the most part. I could count the well paying Third Service EMS departments on one hand. Hint, $50k/yr is not that generous if you have to work 56 hours a week to claim that as a base. Even at 48 hrs it's lousy.

I used to think differently, but when evaluating an employer I first look to how the department benefits the worker, and consider everything else secondary. The EMS system could be the most progressive in the world, with top of the line equipment and liberal medical guidelines, with an 85% cardiac arrest save rate, but I'll still hold a disdain for that system if their employees are being paid peanuts, working long hours, no career advancement to speak of, and having a crappy retirement to look forward to.


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## abckidsmom (May 14, 2012)

46Young said:


> The IAFF considers volunteers the enemy, since they "steal jobs" and other nonsense. They pissed off a lot of members when they tried to prohibit career firefighters from volunteering in other departments that have Union jobs. There are a lot of career FF's that volunteer as fire and EMS. Their propaganda is cheesy and embarrasing.



It actually makes me sick that we use our money to support this stupid machine in the name of "brotherhood."  I resent the heck out of the stupid union dues and I am NOT looking forward to this election year with those stupid firefighters in stupid union tshirts used as a political backdrop supporting whichever guy is giving the most promises to the AFL-CIO.  

It doesn't even have to have anything to do with the union.

They consider part-time medics the enemy too, since they take a 'real' position away.  And yet the full-time medics love when I work and give them a break off the stupid medic unit.  As if I ever wanted a break from the medic unit too.  

/rant.


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## Veneficus (May 14, 2012)

46Young said:


> IMO, the privates don't belong in 911 EMS; pt care and being wholly dependent on income to sustain the operation do not mix..



The same could be said for private hospitals, where do you draw the line?


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## shfd739 (May 14, 2012)

46Young said:


> IMO, the privates don't belong in 911 EMS; pt care and being wholly dependent on income to sustain the operation do not mix.



Do what? So if the privates dont do it where are these communities supposed to come up with money to start and support a third service? And there is still the possibility of the service being under fire and not living up to its potential or being a crappy third service. 

I think its up to whoever is administering a 911 contract to a private to have a tight list of requirements and then enforce it.

Yes I work for a private and we have a large 911 contract. Our areas are recieving great to excellent response times and care. The county couldnt duplicate what we are doing for anywhere close to what our yearly stipend is.

To add to the topic- I do feel privates are treated as second class. Some local agencies can do whatever they want as far as patient care and transport decisions and nothing comes of it. We do it and are strung up for it. 

Heck one of the other agencies around here can do something in error and we get blamed for it. Point out the error and who really screwed up and then there is no apology to us.


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## mycrofft (May 14, 2012)

The mayor, city manager, County Board or Grand High Poobah needs to take everyone by the scruff and settle them down. Trouble is politics and money, as always.

Without a public option, private will start short-sheeting the taxpayers (someone has to pay for the high cost of EMS and it often can't be the patient, and it costs good money, which they would prefer to pocket, to staff and run enough positions for geographic coverage). Without pressure from privates or a third service option, FD gets fat, smug and happy.

Firefighters in an environment with good fire prevention have a lot of "downtime". (Airports sometimers use firefighters as refuelers too, for one example). Yet, you need a critical mass of firefighters to meet peak demands, cover outages due to illness or disaster, and attend funerals and parades. That "downtime" is to civic managers like a line of coke on the bathroom counter to a Narcotics Anonymous member. EMS fills that gap. It also means firefighters, not ethically and legally bound medical professionals, run the show and control care.

Yes, you need a union. If it gets too political, vote the ratbahstids out, but politics is the recourse to strikes. And especially for private EMS workers.

Prehospital EMS in my opinion needs to be a civil independent service, and medically controlled, not run by a former firefighter administrator any higher than third rung below the Boss. Every five or eight years there should be a competitive bid for private service to cover the transports not requiring ACLS. Private should be allowed to provide IFT and standbys without ruinous license and permits, just stiff and strict monitoring. Volunteers should be welcomed and empowered in rural and frontier settings around a paid core.

And ice cream for all.
h


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## 46Young (May 14, 2012)

Veneficus said:


> The same could be said for private hospitals, where do you draw the line?



Private and not for profit hospitals provide a more useful service, and are more indispensable than private EMS. They're the ones that are developing specialty services to remain viable. Private hospitals are falling like dominoes due to uncompensated cases and other forms of poor reimbursement, so if a private hosp can stay in business, it takes the burden off of other healthcare institutions in the region. Look at the St. Vincent's CVC chain in NYC. They went down, and the remaining hospitals now have to absorb the same liabilites that took down CVC, and also deal with the increased volume.


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## Veneficus (May 14, 2012)

46Young said:


> Private and not for profit hospitals provide a more useful service, and are more indispensable than private EMS. They're the ones that are developing specialty services to remain viable. Private hospitals are falling like dominoes due to uncompensated cases and other forms of poor reimbursement, so if a private hosp can stay in business, it takes the burden off of other healthcare institutions in the region. Look at the St. Vincent's CVC chain in NYC. They went down, and the remaining hospitals now have to absorb the same liabilites that took down CVC, and also deal with the increased volume.



But a private hospital can provide far worse care than any poorly run EMS service and cost everyone from patients to taxpayers considerably more.

I don't understand how you can be anti-private EMS for economic and quality care reasons and not also be anti to institutions that are far larger and do the same thing.

Case and point, crappy EMS service skimps on patient care to maximize profit, how much do they get? A few hundered, maybe a few thousand bucks?

Ultimately that patient is dropped off at a hospital that can pick up the slack in poor care in just a few minutes.

A hospital is looking at hundreds of thousands and millions to billions of dollars of maximizing profit.

THe medicare/medicade rules specify if you sign out AMA, for any reason and go to another facility for that same reason, they do not cover the cost.

That means the crappy private hospital economically forces patients to undergo their poor care to maximize profit, for the duration of the stay.

That also means the patient will not recieve the benefit of somebody who picks up the slack for the deficit in a few minutes. In fact, they might not even survive the experience or the long term deficit could be much worse than death. 

But no agency holds these hospitals to task for it and the community can't cancel their contract with said facility.

Moving healthcare (which EMS is part of) to government control is generally frowned upon by US society. I respect your opinion, but I am just pointing out that nationalizing a specific private healthcare function is a slippery slope.

There are many poorly run privates who provide poor care, but I would argue there are just as many if not more poorly run FDs providing poor EMS care.  (probably less third services than all of them combined, simply because there are fewer.) But I would offer you caution in those generalizations.

The absolute worst EMS service I ever worked for, saw, or even heard of was a municiple 3rd service. A private or FD taking over could only be an improvement.


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## 46Young (May 14, 2012)

shfd739 said:


> Do what? So if the privates dont do it where are these communities supposed to come up with money to start and support a third service? And there is still the possibility of the service being under fire and not living up to its potential or being a crappy third service.
> 
> I think its up to whoever is administering a 911 contract to a private to have a tight list of requirements and then enforce it.
> 
> ...



If a private ambulance service can profit from providing 911 EMS to a region, then the local municipality can financially support it's own service. In Virginia, the poorer counties are subsidized in part by the state, and also run by volunteer departments in many cases. If a county needs this aid, a private will certainly not be able to be cash flow positive when operating in the same location.

If you claim that a private can provide EMS for cheaper than the local government, then you're saying that you're okay with replacing employees that earn a liveable wage and a good retirement with largely transient stepping stone employees that work for welfare wages and crappy benefits. Keep in mind that payroll is by and far the largest expense and employer will have, so to provide a cheaper service, the employees will be compensated at a much lower rate. Low pay and subpar benefits are two of the main reasons single role EMS has mostly transient employees rather than "lifers."

I do agree that there is a double standard with operational standards from muni to private. I suppose that the municipality can impose more strict standards when they're outsourcing for a service rather than when their own people are doing the work. You can't exactly penalize yourself, but you can certainly penalize a contracted service.


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## mycrofft (May 14, 2012)

*Not for profit....*

The most profitable hospitals with the largest recompense for their administrators around here as all not for profit. This includes a state university affiliated teaching hospital and the Mercy (Sisters of Mercy) network. We don't even have a true private hospital, closest are some freestanding surgical centers and SNF's, the last private one closed in 1990. We gave away the County hospital decades ago. 

"Not for profit" means the corporation doesn't keep the money unless it is for future development , amortizing future expenses, etc. Two of ours have bought up most of the surrounding (and very expensive) properties, and one has had plans to develop them ostensibly as an adjunct to their facility and to raise funds. None of their administrators are living lives of poverty.


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## DrParasite (May 14, 2012)

with all due respect to the OP, Private EMS providers ARE often treated as second class citizens.  More often they are treated this way by their employers, moreso than their fellow responders (hence less money, poorer benefits, worse working conditions).

Not only that, but as the old joke goes, as long as someone is willing to do the job for less, there is no incentive to pay better wages.  yes, it's a joke, and a sad one, but if you are willing to work for 25k, why should I pay someone else 35k to do the same job?

I don't like private EMS.  you might be the exception, but I know too many providers who are in it for the paycheck, and once they leave, they want nothing to do with the career.  no outside training, no extra effort, no pride in the job, they are just doing it until something better comes around.  in fact, many/most are doing the private thing until a FF or PD job comes along, so they don't care, since once they get the better job, they will not care about their EMS career (or what they did before they got hired).

Private EMS only makes money when they are on calls and transporting patients, which is once of the reasons why it is run so cheaply and staffed so poorly.  FD typically have other responsibilities when not on jobs, and if not, well, it's tax payer funded, so it isn't that big of an issue since there is no real loss since the FD is a known and accepted black hole for money.

And lastly, if I am making $50,000 doing my job, and you come in saying you are willing to do my job for $35,000, resulting in me getting laid off and losing my source of income, than I won't be happy with you, and I hope my fellow brothers wouldn't be happy with you either.  and if the roles were reversed, you would feel the exact same way.


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## mycrofft (May 14, 2012)

"...but if you are willing to work for 25k, why should I pay someone else 35k to do the same job?"

Uh...Nepotism?

I once worked at a medium-sized (60 employees) factory where the owner had two sons and his dad on the payroll. The youngest son was hired on as head of the two man shipping and receiving dept (the other guy taught him how to do it and did most of the work) and was paid more than the shift supervisor (he bragged about it). His elder son was paid more than the other salesmen. Guess which company had trouble keeping the most qualified sales and shipping people?
But do not think nepotism is only in private sector.


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## RocketMedic (May 14, 2012)

My fear is that government or civic medicine would follow in the footsteps of Kansas City at the best, or Washington DC / Detroit / US Army at the worst.

After all, if an AED and a King LT becomes all that's really needed, why shouldn't a 68W be able to handle the world?


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## shfd739 (May 14, 2012)

46Young said:


> If a private ambulance service can profit from providing 911 EMS to a region, then the local municipality can financially support it's own service. In Virginia, the poorer counties are subsidized in part by the state, and also run by volunteer departments in many cases. If a county needs this aid, a private will certainly not be able to be cash flow positive when operating in the same location.
> 
> If you claim that a private can provide EMS for cheaper than the local government, then you're saying that you're okay with replacing employees that earn a liveable wage and a good retirement with largely transient stepping stone employees that work for welfare wages and crappy benefits. Keep in mind that payroll is by and far the largest expense and employer will have, so to provide a cheaper service, the employees will be compensated at a much lower rate. Low pay and subpar benefits are two of the main reasons single role EMS has mostly transient employees rather than "lifers."
> 
> I do agree that there is a double standard with operational standards from muni to private. I suppose that the municipality can impose more strict standards when they're outsourcing for a service rather than when their own people are doing the work. You can't exactly penalize yourself, but you can certainly penalize a contracted service.



I'm not neccesarrily saying the private can do it cheaper. There are a lot of fixed expenses no matter who is running it. I also think when start factoring the normal local level government beauracracy is when things get overly complicated an exspensive. From that standpoint it's easier and cheaper for a government to use a private provider and pay a stipend to help offset the expenses. Write up a set of requirements and be done with it. 

My folks are also getting a very livable wage that is on par with the local 3rd services and FDs that people seem to favor so much. Same goes for our retirement program for the ones that participate. 

Don't paint all privates with the same broad brush as being evil.


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## RocketMedic (May 14, 2012)

Not to mention that most private services won't do something like invest the entire surplus into new tankers or SCBAs or something.


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## ZootownMedic (May 15, 2012)

Hmm...interesting topic. Here in my city the FD has medical control over all medical calls per the city charter however the private ambulance company which responds to all 911 calls in the city is the sole transporting agency. Everyone gets ALONG just fine let me tell you....:rofl:

Actually its chaos. There is always enough Paramedics on scene to kill someone. The FD engine usually has a medic, then the private ambulance company shows up with their medic, and sometimes the LT on the engine used to be a medic and now is a LT but still has their input on patient care. Then you have the FD medic that technically has scene control but they aren't going with the patient....the private ambulance medic is. It only gets worse from there. As a whole the FD here has a pretty poor reputation when practicing medicine. Their Medical director doesn't allow RSI while the private ambulance companies MD does. I think they are even about to start pulling the medics off the engines as well as the trucks to save costs. FD protocols are changing too and I don't think they are even supposed to be intubating anymore and are moving to King airways and combitubes(because their intubation success rate was so poor). The sad fact is, most of the private ambulance company paramedics are GREAT medics who are career medics. Most of the FD medics are career FIREFIGHTERS who did the medic thing to get promoted or because they had to. This shows in the standard of care as well as the quality of Paramedicine. The private company practices emergency medicine ALL THE TIME. The FD medic is gonna do fire training almost all the time. FD's consider EMS inferior and they train like it. Personally, I like the idea of a private ambulance company...in fact I just got hired by it and it is likely if it wasn't for them I wouldn't be graduating from Paramedic school with a job. That said....many private ambulance companies have high turnover rates, reputations for hanging medics out to dry, crappy pay and benefits and so on and so forth. In the end I think it is just the way it currently is....and its up to all of us to try and fix it the best we can.


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## Tigger (May 15, 2012)

I'm told the AMR/Fire relationship has been much worse in the Springs in the past, but I agree that it could be better. There's also the whole thing about AMR medics having a larger scope than Fire's medics yet still not being in charge. An AMR medic could be told not to RSI by the fire medic despite the fire medic not being authorized to perform RSI...


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## ZootownMedic (May 15, 2012)

Tigger said:


> I'm told the AMR/Fire relationship has been much worse in the Springs in the past, but I agree that it could be better. There's also the whole thing about AMR medics having a larger scope than Fire's medics yet still not being in charge. An AMR medic could be told not to RSI by the fire medic despite the fire medic not being authorized to perform RSI...



I know right!? I have heard that the relationship has improved over the years. My first ride as a Paramedic student back in October was a ped arrest where the fire medic came running out of the house with a 'intubated' kid and a uncuffed, unsecured tube flopping around in his mouth. When my preceptor checked tube placement via capnography and auscultation and found the tube dislodged and pulled it the fire medic flipped. Later he blamed my preceptor for the child's death. Its just constant fighting between the two agencies it seems and I have only seen bits and pieces since I am still relatively new to the system. Probably not isolated to Colorado Springs or even Colorado if I had to guess......


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## Hunter (May 15, 2012)

Imho I don't think fire and ems should be combined, bottom line different jobs and different interest, the only reason fire departments combined with ems is to help pay some of their expenses. In other words just like private EMS companies they're in it for the money. But that's a whole other topic. 

As far as private ems being second class it's the same with public sector, it's suppl about the culture in areas/management/street staff, if it's accepted as the norm to do things the wrong way you'll drag down even the new people who come in trying to do a good job but get picked on for being different by the people who are comfortable with slacking and not doing their jobs.


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## CrackerBDingus (May 15, 2012)

SmokeMedic said:


> The sad fact is, most of the private ambulance company paramedics are GREAT medics who are career medics. Most of the FD medics are career FIREFIGHTERS who did the medic thing to get promoted or because they had to. This shows in the standard of care as well as the quality of Paramedicine. The private company practices emergency medicine ALL THE TIME. The FD medic is gonna do fire training almost all the time. FD's consider EMS inferior and they train like it.



My personal opinion, even if not viable is that FD hires medics to act as medics, not FF. In Newport everything is public, which isn't a bad thing. There are 3 dual medic rigs for transport and almost every engine here has a medic on board as well. I was in the fire explorer program for a little while and most medics were indeed career FF first, but when put into the medic program fell in love. Even on of the captains here started as a medic and went fire to get better pay but viewed himself as medic first fire second. 

While you can integrate the two roles there is an obvious disconnect in the method most areas are using currently. As backwards as OC is in methods and scope the idea of showing up with an engine and a private ambulance has worked quite well. Doctor's and CARE specifically are huge and well liked for the quality of EMT they usually have on scene. Gurney pushers or not they jump in readily. Even at Shoreline the ET shifts are competent, they just don't have basic supplies (I have worked on many rigs from there that didn't have lancets for glucose levels). OCFA really just wants better equipment when a company responds. 

The issue of transience isn't really a huge deal. Most companies don't want nor expect lifers when private. I didn't go into EMS to go into EMS, I went into EMS to gain experience for my eventual goals. Does that affect my pt care? No. I don't want to work here and learn nothing then kill hundreds of patients as an MD. I expected low pay, I :censored::censored::censored::censored::censored: about it, I deal with it and will move on. Someone else will then take my place who will be better or worse than I am, but if you're in EMS for the wrong reasons then you're never going to provide adequate care.

The main problem with the issue of FD vs. EMS is the stereotypes about both camps coming from both camps. When there is a clean slate that both agencies share and cooperate in ET calls, most often the care is astonishingly high. When fire or EMS waltz in with the "man-in-charge" complex going on things go downhill fast.


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## ZootownMedic (May 15, 2012)

CrackerBDingus said:


> My personal opinion, even if not viable is that FD hires medics to act as medics, not FF. In Newport everything is public, which isn't a bad thing. There are 3 dual medic rigs for transport and almost every engine here has a medic on board as well. I was in the fire explorer program for a little while and most medics were indeed career FF first, but when put into the medic program fell in love. Even on of the captains here started as a medic and went fire to get better pay but viewed himself as medic first fire second.
> 
> While you can integrate the two roles there is an obvious disconnect in the method most areas are using currently. As backwards as OC is in methods and scope the idea of showing up with an engine and a private ambulance has worked quite well. Doctor's and CARE specifically are huge and well liked for the quality of EMT they usually have on scene. Gurney pushers or not they jump in readily. Even at Shoreline the ET shifts are competent, they just don't have basic supplies (I have worked on many rigs from there that didn't have lancets for glucose levels). OCFA really just wants better equipment when a company responds.
> 
> ...



I agree with you to a point but I think you are missing MY point. Firefighting is not EASY and is a profession, just as paramedicine is. The problem exists when a fire medic has to do BOTH. Most Fire Medics do not work at a fire department and sit on a ALS rig and run ems calls. They are called FIRE Medics for a reason, they run fire calls too. That means they have to train for fire emergencies with their fire crew as well as keep up on their Paramedic training. EMS crews that work for private ambulance companies are not tasked with the 'dual' training. Being an expert and staying on top of new technolgies, techniques, and skills for both firefighting and paramedicine is a incredible challenge. Some do it(and do it well) but that is the exception not the rule. The bottom line is the person that practices and devotes themself to one discipline is almost always going to be better at it than someone that has to split their time between two equally challenging professions. Your fire medic's heart my be in the right place but that doesn't mean their skill level or clinical judgement is gonna be. Just the way it is........


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## Tigger (May 15, 2012)

Clinical capacity and judgement is entirely person dependent. There is no reason why someone cannot be an excellent paramedic and firefighter, they just have to work harder. There are far too many examples (especially in the emergency services) where professionals fill more than one role, yet this is the only one that brings up any argument. If firefighters can't make clinically sound medics because the fire training gets in the way, what say you to third service EMS medics running rescue trucks, HAZMAT units, and the like?

If a person has a desire to be good at all they do, they will be. Too many institutions allow their providers to be less than good at what they do, and that's where there are problems.


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## 46Young (May 15, 2012)

shfd739 said:


> I'm not neccesarrily saying the private can do it cheaper. There are a lot of fixed expenses no matter who is running it. I also think when start factoring the normal local level government beauracracy is when things get overly complicated an exspensive. From that standpoint it's easier and cheaper for a government to use a private provider and pay a stipend to help offset the expenses. Write up a set of requirements and be done with it.
> 
> My folks are also getting a very livable wage that is on par with the local 3rd services and FDs that people seem to favor so much. Same goes for our retirement program for the ones that participate.
> 
> Don't paint all privates with the same broad brush as being evil.



On several occasions, I've said that I don't agree with a fire department taking over EMS services, unless the existing system truly needs to be replaced. I disagree with forcing EMT's and medics to do fire suppression in order to do EMS. I also don't agree with privates trying to take over EMS from a muni service, be it fire based or single role, unles the existing service is a train wreck.The private is surely going to offer less pay, less benefits, and a comparitively undesireable retirement plan (if any). Really, the only private I know of that offers pay, benefits, and working conditions equal to or superior to the local muni services would be Acadian, from what I've heard. I have a friend that works at Suburban EMS in PA who speaks highly of them as well. No one else comes to mind.

My background: Private EMS for six months, and then five years with a hospital based 911/IFT provider in the NYC 911 system. Now 4 years at my FD. In NYC, you work for FDNY EMS for the benefits, job security, and pension, or you work for the hospitals for better money, schedules, and working conditions. There are two privates, but they are less desireable than the hospitals. The NY scene is different than many other areas. They are in direct competition with FDNY EMS for employees. Their pay, schedule, and working conditions are more desireable than FDNY in most cases because they have to offer something to lure quality employees away from them. Mostly anywhere else you go in the country, the hospital or private provider is virtually guaranteed to offer less than the municipal provider they seek to replace. I don't know of any privates that offer a pension anymore, either.


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## 46Young (May 15, 2012)

SmokeMedic said:


> I agree with you to a point but I think you are missing MY point. Firefighting is not EASY and is a profession, just as paramedicine is. The problem exists when a fire medic has to do BOTH. Most Fire Medics do not work at a fire department and sit on a ALS rig and run ems calls. They are called FIRE Medics for a reason, they run fire calls too. That means they have to train for fire emergencies with their fire crew as well as keep up on their Paramedic training. EMS crews that work for private ambulance companies are not tasked with the 'dual' training. Being an expert and staying on top of new technolgies, techniques, and skills for both firefighting and paramedicine is a incredible challenge. Some do it(and do it well) but that is the exception not the rule. The bottom line is the person that practices and devotes themself to one discipline is almost always going to be better at it than someone that has to split their time between two equally challenging professions. Your fire medic's heart my be in the right place but that doesn't mean their skill level or clinical judgement is gonna be. Just the way it is........



A paramedic curriculum is two years at best if done through a university, or around a year or so if you cut out the gen-eds. My fire academy was 23 forty hour weeks. That's 1 1/2 to 2 1/2 years of education and training. The didactic material in the fire academy wasn't that challenging. Important and relevant, but not challenging. The same goes for the psychomotor skills. So, the education and training that is needed to be released as a FF/medic falls well short of the education and training necessary for a Bachelor's degree. A good FD will have in-station EMS and suppression drills, as well as out of service multi unit drills/CEU's. That still leaves all of your time off duty to take additional fire or EMS training opportunities.


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## RocketMedic (May 16, 2012)

46, many private companies are better than the county services out this way, or on-par with them. Then again, many are not.


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## 46Young (May 16, 2012)

Rocketmedic40 said:


> 46, many private companies are better than the county services out this way, or on-par with them. Then again, many are not.



What does the typical enmployee salary/benefits/retirement package look like out your way?

For example, in Charleston SC back in 2008 when I worked for them, medics worked either 48 hr or 56 hr schedules. Starting pay was around $38k/yr, up to 68k max in 11 years. 28 and out pension @ 1.8% (just under 50% of salary) and a three year TERI (known as DROP elsewhere). Typical 12 days leave, six days of sick leave, etc.

Fairfax VA has a 56 hour workweek. Medics start out at 54k/yr after the academy and ALS internship, plus cert pay of 5k/yr, riding pay of $2/hr on the engine as a medic, and $3/hr on a txp unit (average 7k/yr give or take $1k). FLSA and night diff count for another $4k/yr. It's about $70k/yr. 25 and out pension @ 2.8%, and a three year DROP. Medical insurance is portable, but the county does not pay 75% of the premium after retirement - you pay 100%. Right now I accrue approx. 6 hours/PP for sick, and 10.5 hrs/PP for annual leave.

In NYC, my hospital had a 40 hr workweek, which they paid 37.5, and OT if no meal breaks. Around $30/hr for medics, 403b, vested in 5 years. FDNY's info is on their site.

Edit: Seriously, if you could give me an approximation, I could pass that on to all the EMT's and medics in my area that don't want to do fire. They've asked me on numerous occasions where to go to do EMS with good pay and bebefits.


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## jgw1981 (May 18, 2012)

In the Detroit area, for the private companies, a Paramedic will start $11 - $13 an hour most medics averaging around $35k with overtime.  Lots make less, some make more, but they work crazy hours.  Full time will get you benifits, typically with high co-pays and doesn't cover much (just ask anyone who has the insurance, and it doesn't matter the company).  Most privates do a fair amount of IFT in addition to rescue contracts and municipal back up calls.  More and more municipalities are losing ALS transport due to FD funds being cut back, and staffing being below what could support that duty.  Those fire departments that are hiring start someone at about $38k base with benifits that are superior in most cases to the private ambulance companies.  Most of those fire departments that are hiring are in wealthier areas like Oakland county (although the city of Hamtramck appears to be hiring, but I believe they are a BLS department).  Those areas have reasonably low call volumes compared to the more urban areas.  Also to speak of money, in the urban areas, there are more patients that are on medicare / medicaid, which pays but not neccesarily the amount billed.  Wheras in suburban areas, there are more people with insurance through employers which does pay better.  That being said.....rescue isn't where ambulance companies make their money, at least not here.  Transporting ALS costs more than it makes in far too many cases.  The money is made by taking those people out and doing the IFT runs.  Its said at many companies that the BLS makes the money, ALS just gets the glory.


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## RocketMedic (May 18, 2012)

46Young said:


> What does the typical enmployee salary/benefits/retirement package look like out your way?
> 
> For example, in Charleston SC back in 2008 when I worked for them, medics worked either 48 hr or 56 hr schedules. Starting pay was around $38k/yr, up to 68k max in 11 years. 28 and out pension @ 1.8% (just under 50% of salary) and a three year TERI (known as DROP elsewhere). Typical 12 days leave, six days of sick leave, etc.
> 
> ...



Out here, EPFD starts paramedics in the low $40k range, with a 56-hour workweek and cert pay. The privates generally pay in the mid-20s to the mid-40s depending on schedule and experience. That's for paramedics.

The lowest one is $10/hour for paramedics at Life Ambulance El Paso. The average is around $12/hour. OT is plentiful, benefits aren't fantastic unless you're on the fire department. Retirement is meh at best.

East Texas has some better opportunities.


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## DPM (May 18, 2012)

How many other developed countries have combined Fire / EMS systems? I can't think of any from Europe, NZ Australia are 3rd service.... 

I think in many instances the budget required for a 3rd service agency is available... The fire department gets it. If  the FD ran only Fire / Rescue calls, what would their call volume be? And with those numbers, could they justify their current staffing levels? 

I know it's a huge can of worms, but if FD didn't have EMS as well, would they be able to justify their staffing? Removing paramedics from engines, in some cases I'm sure, would remove the need to have as many fire houses. 

The payroll savings, as well as maintenance etc etc, would they leave enough in the budget from a properly run Ambulance Service?


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## CrackerBDingus (May 18, 2012)

In Socal I asked my emt instructor what fire salaries start as. For his deparment Anaheim, a FF starts at 60k no OT. He claims many get up to 100k with OT. I don't even know what a fire medic makes, but I'm willing to bet they start around 70-75k and OT gets huge. Who says EMS doesn't make money?


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## FourLoko (May 18, 2012)

Tigger said:


> Clinical capacity and judgement is entirely person dependent. There is no reason why someone cannot be an excellent paramedic and firefighter, they just have to work harder. There are far too many examples (especially in the emergency services) where professionals fill more than one role, yet this is the only one that brings up any argument. If firefighters can't make clinically sound medics because the fire training gets in the way, what say you to third service EMS medics running rescue trucks, HAZMAT units, and the like?
> 
> If a person has a desire to be good at all they do, they will be. Too many institutions allow their providers to be less than good at what they do, and that's where there are problems.



Werd. Nothing catches on fire around here except the hills and that's Wildland FF.

City fire medics have plenty of time to practice, study, etc. Easy.


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## terrible one (May 18, 2012)

CrackerBDingus said:


> In Socal I asked my emt instructor what fire salaries start as. For his deparment Anaheim, a FF starts at 60k no OT. He claims many get up to 100k with OT. I don't even know what a fire medic makes, but I'm willing to bet they start around 70-75k and OT gets huge. Who says EMS doesn't make money?



Private EMS doesn't make money. And outside CA and vegas/Clark county. The majority of FDs don't start anywhere near that much.


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