# Starting an on-site standby EMS company



## mmoradia1 (Jun 18, 2014)

Hi everyone, I was thinking about starting an on-site event EMS company. I have a name registered and everything, but I'm honestly not sure where to go from there. I was wondering if any of you have experience in this area or advice to offer. Again, I'm not looking to start an ambulance company, but an on-site standby one (football games, etc). Thanks!


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## teedubbyaw (Jun 18, 2014)

Good luck with that. You'll need very deep pockets. Medical director won't be cheap.


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## mmoradia1 (Jun 18, 2014)

When you're registered and licensed for a county, there's already a medical director that's set. Why would you need a separate one if you want to start a company?


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## akflightmedic (Jun 18, 2014)

I have posted this before for others with similar questions. Having a name and registering an entity does not prepare you for a business.

Where is your business plan? From your questions you have zero concept and my impression is you think you can just grab a basic trauma bag and sell yourself for a standby event.

I am a business owner. I speak facts.

You are going to have lots of overhead. In order to provide medical care, you will need a Medical Director. This is a private business and therefore you cannot use the county or regional medical director. This ignorance alone makes me strongly suggest you go do lots more homework and come back when better prepared.

After the Medical Director who will need a salary which also will reflect his own insurance costs (medical mal and such) your new entity is going to need Medical Malpractice insurance and Worker's Comp insurance. To sell yourself to standbys, you have to prove you have this coverage in effect and typically you need a 1M/3M aggregate minimum.

No public event is going to touch you without these things because it then makes them liable for your action or inaction.

You need a lawyer. As a small business, find a friendly one who will be available but affordable on per diem basis. The lawyer should review any contracts you entertain. Should also help you write/develop internal policies and procedures which are all part of a normal business and required contractually. If the lawyer is unable to assist then you are going to need a consultant to assist you with these things.

Medical suppliers...who do you have relationships with? They can make you or break you in terms of cost. With low quantity purchases do not expect many price breaks.

What are your protocols? Carrying any medications? Do you know the legal ramifications/risks of carrying OTC meds and dispensing them? Should you dispense those meds or just make them available? Do you know the liability of speaking too freely when on event and giving advice to a patient? Everyone has a smart phone these days, you will be recorded or filmed...dont think you are not worried about this because you do right all the time...that is irrelevant. They are called frivolous suits/claims for a reason. Do it long enough and you will get your fair share.

Then you have your advertising costs. Your website. Your phones, your fuel your vehicle. All tax deductible for the entity but who is gonna track these and help you? Thats right...you need a CPA at the minimum.

I have so much more to share but this is more than enough to get you started. Take the free advice. Your idea is sound, many people do it, there is plenty of work out there...but at this point you are set up for failure before you even get started. Do more research and press on...


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## mmoradia1 (Jun 18, 2014)

I appreciate your detailed advice. As stated though, I'm simply looking to start a stand-by company. No ambulances. No vehicles. Simply contracting with events and placing EMTs as needed. Rather than "hiring employees", I'm simply acting as an agency, placing them wherever EMTs are needed.


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## mmoradia1 (Jun 18, 2014)

I'm simply trying to understand what it would take to act like an agency... placing EMTs wherever one is needed, whether it be a wedding, party, game, whatever. I'm not going to employ anybody or have my own protocols to follow. As an EMT for the county and being licensed and registered, I don't see why going beyond the scope of how we were trained is necessary.


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## DesertMedic66 (Jun 18, 2014)

So you don't want to hire employees but you want to be an agency that places EMTs in different areas? That's really sketchy.


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## mmoradia1 (Jun 18, 2014)

How the hell is that sketchy? Are you serious? It's exactly the same as me being hired to work at a wedding. I'm hired, just one person. Instead, I want a company that'll take care of all of that. It's like an agency.


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## DesertMedic66 (Jun 18, 2014)

Easiest way to get this solved is contact the county medical director and see what he says about it. I'm betting his answer is no.

If you are working at events as an EMT but are not affiliated with a company there is major issues there.


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## UnkiEMT (Jun 18, 2014)

It depends to a huge degree on where you are, laws vary WILDLY by state, and even county.

I'm not going to talk about the business end of things, because I'm really not qualified to.

On the medical legal requirements:

As someone earlier said, you're going to need both medical malpractice insurance and workman's comp insurance (Yes, even if it's just you, you still need to be covered when you're working.)

You will need a medical director, the odds are good that you can't glom onto the county's/state's director, but that's gonna be region specific. You'll have to pay to develop your protocols, then to administer them. If you have access to a reasonable set of protocols that you can copy (or if your state publishes protocols), that might cut down the expenses significantly, but you'll still have to go over them carefully and modify them. Ranges for medical director salaries I've seen have been from 500USD/month to 2,500USD/month...that being said, those were all for ambulance services, not standby services, I don't know how that might affect things.

You'll need a business license, which depending on area might be a huge pain in the *** or might be quite easy.

You'll probably need a clinic license to dispense drugs, and a pharmacy license to buy them (Obviously you won't need the pharmacy license to buy OTCs, but even oxygen may require one.), you may also have to get a consulting pharmacist, they tend to go for 50-100USD an hour.

If you're able to work at the ALS level, you might be required to carry all the drugs in scope, in which case you'll need a mid level provider DEA license.

and, of course, as someone else mentioned, a supplier. Good news here is that boundtree will give pretty decent price breaks to even miniscule services, so once you're all registered, that part should be easy.

That's what I can think of off the top of my head, and as noted, doesn't touch on the business side of things. Ultimately though, you should go talk to your state EMS office, they can tell you exactly what you need to do in order to be able to operate.

All told, your better bet may be to associate with a current service, and negotiate with them to let you work under their umbrella in exchange for a cut of the profits (possibly still needing to carry your own insurances.)


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## Jim37F (Jun 18, 2014)

Look at it from my point of view. I'm a relatively brand new EMT, only a year and a half since I got my card, and I have precisely zero business experience, BUT I'm also pretty much the kind of guy your looking to hire, and to me, if I was looking for a gig like you want to offer, and one of my buddies described your company using your exact words here, to me screams "SHADY!! STAY AWAY!"

Why? Well the big obvious one is that you want to be a medical provider without a medical director? Really? Even the 100 or so dialysis shuttles here all have a medical director. I guarantee you all your competing standby companies will have one and all have already done all those things akflightmedic mentioned. 

What about medical supplies? I assume your intending to get at least some sort of BLS jump bag. How are you going to get that? Every. Single. Piece. Of medical equipment we have, even the single use disposable stuff, ALL say on the package that it requires a medical prescription in order to be used.

No insurance? So what happens when someone drops from a heart attack and is simply gone despite my (and hopefully my partner's) best efforts at CPR? When the grieving family sues, what are you going to do? Pass it on to me? 

I just get the impression that I'd be better off finding out what you want to charge, then charging 10% less and just doing it myself and take home more than your willing to pay me.


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## akflightmedic (Jun 18, 2014)

Even as a staffing agency as you described, you still need insurance coverage. Why would I hire one of your people to be at my event without any kind of legal protection or authority to operate? 

I would not want independent operators, I would instead hire from a company who has all their ducks in a row, even if the cost is slightly higher. 

Even Nurse Staffing Agencies have insurance on all their people. You have to. 

Like I said, your ideal is not unique however it is doable. You just need to get a lot more behind the scenes work done and lay a solid foundation upon which to build. You will fail otherwise.


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