Why private industry has no business in EMS

[thegreypilgrim]

(1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.

(2) Utter lack of any recognizable form of professional management - particularly when it comes to the issue of disciplinary action.

List your reasons

 

[Chimpie]

#1 is an interesting point, but #2 is strictly an opinion most likely based on something you observed.

Can you go into more detail?

Please note that we can already see how this thread can go in the wrong direction. Keep it on topic and post responsibly.

 

[Shishkabob]

Because every street level medic is always in agreement with their COO and don't give a rats butt about any of their patients, right?

 

[thegreypilgrim]

Because every street level medic is always in agreement with their COO and don't give a rats butt about any of their patients, right?

Not at all, my statement was directed at the people who run ambulance companies. Apologies for the vagueness.

 

[Shishkabob]

But you're saying privates have no business in EMS. In my experience, private AND fire are both bad at certain things.


Sure, you have the tops of private agencies who want profit, but that doesn't much effect the street provider. They aren't in it to get the company the most profit they can... they still tend to be in it for the patient.


Flip around to the firebased style, and you have people who have no interest in patient care, being forced to be on an ambulance and to work as a medic that they don't want to do... and complaining about it all the time.




Call me crazy, bit I'd rather have the person who actually cares about their duties and willingly do it working on me.

 

[thegreypilgrim]

But you're saying privates have no business in EMS. In my experience, private AND fire are both bad at certain things.

I didn't say anything about fire-based EMS. For the record, however, I agree and really am just trying to blow off some steam here...

Sure, you have the tops of private agencies who want profit, but that doesn't much effect the street provider. They aren't in it to get the company the most profit they can... they still tend to be in it for the patient.

Of course they are. I'm just saying private EMS management makes it exceedingly difficult for us street level medics to enjoy our jobs and they can affect our patient care capabilities in terms of the equipment they supply us with, policies they enact, trying to squeeze in as many IFT's between 911 calls as possible (thus, ensuring quicker burn-out). The list goes on.

Flip around to the firebased style, and you have people who have no interest in patient care, being forced to be on an ambulance and to work as a medic that they don't want to do... and complaining about it all the time.

Couldn't agree more. I honestly think that neither the private sector, nor FD's have any business "doing" EMS. It should be a public, stand-alone, third service agency. I'm just picking on the private sector at the moment because that's where I work and don't like it.

Call me crazy, bit I'd rather have the person who actually cares about their duties and willingly do it working on me.

What, cowboys with cool patches don't make you feel better?

 

[Seaglass]

If we don't like fire, and we don't like privates, and we don't like volunteers, all we're left with is publicly-funded/non-profit paid third-service. How common or feasible are those, in reality? I only know of one, and it's a combination department that almost certainly couldn't afford a full career staff.

Sure, you have the tops of private agencies who want profit, but that doesn't much effect the street provider. They aren't in it to get the company the most profit they can... they still tend to be in it for the patient.

Agreed. It's not like the street medics tend to see any money they save directly put into their paycheck, anyways. They do directly see patients needing care.

However, the people who run a company do see the bottom line a lot more directly, and they're the ones who make decisions on gear and wages, which really do impact the care that a street medic can provide.

(All opinions here are only for the sake of debate. I think there are good providers and bad in every service, and I haven't decided for myself which models are best as of now.)

 

[Shishkabob]

Ah, well we're in agreement then. I'm sure I could find some bad things about 3rd service... but I'm all tired from another forum debate going on.

 

[thegreypilgrim]

If we don't like fire, and we don't like privates, and we don't like volunteers, all we're left with is publicly-funded/non-profit paid third-service. How common or feasible are those, in reality? I only know of one, and it's a combination department that almost certainly couldn't afford a full career staff.

Hell man, nearly the rest of the developed world has managed to pull this off in creating EMS systems that make those of the US look like baskets attached to bicycles (Australia, Canada, United Kingdom, New Zealand, etc.)

 

[Seaglass]

Hell man, nearly the rest of the developed world has managed to pull this off in creating EMS systems that make those of the US look like baskets attached to bicycles (Australia, Canada, United Kingdom, New Zealand, etc.)

I'm familiar with the ones overseas. American spending and healthcare follow very different models, though, and the fields have evolved differently. So I'm not too interested in it being done elsewhere. I'm much more interested in whether it can be done here, and how.

 

[46Young]

I've never agreed with privates that employ the practice of having their rigs do both 911 and IFT on the same shift. If you want to do both sides, there needs to be a dedicated 911 division and a dedicated IFT division. That way, the 911 service doesn't suffer at the expense of IFT call volume. Staff could do either, depending on the shift. It works well at NY Presbyterian (Cornell) and North Shore LIJ CEMS, although those are hospital based systems. Transcare does the same thing, as does AMR in Brooklyn, and they're both privates.

 

[RyanMidd]

(1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.

I work for private EMS, and I think my arguments to the contrary are pretty strong.

- (Personnel) Every medic that works is working underneath their own accreditation If you screw something up, its YOUR license on the line, not the company's. To me, this dictates that my patient care is gold-standard.

- (Attitude) The EMS communities in Canada are provincial; there is a good chance you work for more than one agency at any given time, and much networking occurs. Your reputation as a medic is at stake if you do not take your work seriously, and it will show when your contracts start to dry up.

- (Management) At a patient-contact level, there IS no management or profit margin. You are working on-car, in uniform, and not thinking about what your employer's revenue for this quarter is.

- (Profitability) Many new EMTs turn to the private industry to earn experience prior to going urban. This means these young medics are out to prove how valuable they are on-car, not how astute they are at billing contruction/oil/sports management companies.

- (Training) I don't know how specific American legislature is, but in Canada, if you are providing healthcare for patients, you are REQUIRED to have up-to-date, valid, and exhaustive certification. There is NO grandfathering, exceptions, etc. If a new drug enters your scope of practice, you cannot be gainfully employed until you have been certified in its use. You cannot simply "work without that drug" until you are trained. Again, its YOUR license, the private company you work for will trade you for somebody with updated skills in a heartbeat. CMA (Canadian Medical Association) accreditation keeps the schools up-to-date, and if the school defaults, CMA pulls their accreditation from that institution. Additionally, provincial legislature holds private care to the same standards as public, including equipment, hours, and even use of lights & sirens.

- (Equipment) The equipment provided by most private EMs providers in this area is comparable to urban/rural services; who wants to be the EMS company that is known for having last decade's models for everything? No, we have Lifepak 12s, spider-straps, auto-injectors, fresh meds, and the works on our rigs, because the clients want the best for THEIR employees.

 

[firecoins]

(1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.

(2) Utter lack of any recognizable form of professional management - particularly when it comes to the issue of disciplinary action.

List your reasons

this complete utter nonsense. Government agencies in EMS are slow, beurocratic organizations that are slow and mismanaged in every manner you say privates are mismanaged. The only difference they don't need to make money. To think of it, I can't find a government agency local state or federal in the US that isn't mismanaged.

Right now there are FDNY EMS ambulances with 2 man stretchers which should be illegal at this point. A private agency providing ALS care in Rockland, NY carries is the first area to carry lifpack 15s and CPAP. Government agencies count on government money which is being cut.

Every paramedic pays for their own schooling. They can't work unless they remain certified. Hence each medic is responsible for his training reguardless of the employer.

 

[firecoins]

I've never agreed with privates that employ the practice of having their rigs do both 911 and IFT on the same shift. If you want to do both sides, there needs to be a dedicated 911 division and a dedicated IFT division. That way, the 911 service doesn't suffer at the expense of IFT call volume. Staff could do either, depending on the shift. It works well at NY Presbyterian (Cornell) and North Shore LIJ CEMS, although those are hospital based systems. Transcare does the same thing, as does AMR in Brooklyn, and they're both privates.

Empress does both as well for Yonkers.

 

[ZVNEMT]

Some private companies do more to provide quality service, equipment, employees, than others. my company in particular is in it all for profit. EVERY employee is part time, yet works 5 days a week on 10 hour shift and some for 32 hour shifts. no benefits. old equipment. company doesn't not provide us with gloves, and when we bring our own and forget to secure them, they end up on the supervisor's(the owner) ambulance. i don't believe the company pays for anyhting other than refilling O2 bottles, fuel, and insurance/licensing expenses.

EMTs are lured in with promises of "call bonuses" and "paid vacation" and "yearly bonuses". all of which only applies to full time employees, which there are none.

when we respond to calls from an ECF we are instructed to take the pt where their private physician wants them to go.... so detroit receiving might be a mile or two away... but we gotta take them to a hospital 10-15 miles out of the way(we refuse to abide by these instructions, but i've worked with the supervisor and he'll do it... claiming "his pulse is 160 because he's septic, its ok" or some bull like that. i think he gets kickbacks from certain doctors for providing them with business, but i can't prove anything.

the eqiupment is out dated. the stretchers are low, and small. not all of our patients fit, we MAKE them fit. not all of our patients want to go, the boss MAKES them go.

its all just a quick buck for the owners, they don't give a rat's *** about the PT, EMTs, or any applicable laws.

 

[thegreypilgrim]

I guess I should have clarified from the start.

I'm NOT trying to argue that the paramedics who currently work for private agencies have no business working in EMS. I'm trying to argue that no paramedic should be subject to the drudgery of having to work for a private ambulance company.

The two worlds of EMS (which is a public service) and private industry simply do not mix. The private ambulance service, when it comes down to it, is simply part of the corporate world where the ultimate end-game is to maintain a profit margin. Everything else is subordinate to this goal. As such, being an employee for such an agency is inherently hazardous and incongruous with one's career motivations.

EMT's and paramedics become medical professionals because they have a desire to do a public good, have an intellectually stimulating career, and other sources of motivation that do not include any features of commercial industry except for the most vague possible connections like "customer service" (although I question this). We are not "business" minded people. It's not any of our concern. We became EMT's and paramedics to be exactly that: EMT's and paramedics.

It is my experience that private industry is more of a hindrance to the deployment of prehospital medical care than anything else. The people who run these operations are in it for the money and nothing more. Most of these ambulance services actually seem more like rackets used for nothing other than latching on to the hemorrhagic cash-machine that is MediCare/Medicaid. All operations are set to maximize this purpose. Hence, the continued use of ambulances so that the engines/transmissions are in excess of 300k miles, corner-cutting on supplies (i.e. not allowing crews to have access to supply cabinets without going through a supervisor), purchasing of lower-quality equipment, saddling field personnel with needless clerical work to expedite billing (i.e. photocopying pt insurance cards), enacting draconian disciplinary action policies (sometimes it seems like infractions are simply manufactured), running crews into the ground by making them run IFT's in addition to 911 calls (this and the previous seem to be designed to maximize burn-out and attrition so as to avoid having to pay wage step increases), and never, ever having an employee's back whenever there is a conflict with a staff member (who was probably quite rude and disrespectful from the start) of a contracted facility or agency. I could go on and on.

The point is, private industry should not be involved with EMS because its business interests are directly counter to the professional goals of the field personnel employed by them. This can indirectly hamper the crew's capabilities to deliver the best care possible. Private EMS also stifles professional development, and would like nothing else but to maintain the status quo of EMS as it currently functions.

 

[JPINFV]

Some private companies do more to provide quality service, equipment, employees, than others. my company in particular is in it all for profit. EVERY employee is part time, yet works 5 days a week on 10 hour shift and some for 32 hour shifts. no benefits. old equipment. company doesn't not provide us with gloves, and when we bring our own and forget to secure them, they end up on the supervisor's(the owner) ambulance. i don't believe the company pays for anyhting other than refilling O2 bottles, fuel, and insurance/licensing expenses.

EMTs are lured in with promises of "call bonuses" and "paid vacation" and "yearly bonuses". all of which only applies to full time employees, which there are none.

when we respond to calls from an ECF we are instructed to take the pt where their private physician wants them to go.... so detroit receiving might be a mile or two away... but we gotta take them to a hospital 10-15 miles out of the way(we refuse to abide by these instructions, but i've worked with the supervisor and he'll do it... claiming "his pulse is 160 because he's septic, its ok" or some bull like that. i think he gets kickbacks from certain doctors for providing them with business, but i can't prove anything.

the eqiupment is out dated. the stretchers are low, and small. not all of our patients fit, we MAKE them fit. not all of our patients want to go, the boss MAKES them go.

its all just a quick buck for the owners, they don't give a rat's *** about the PT, EMTs, or any applicable laws.

If it's so bad, why do people work there? On one hand, yea the companies that are leeches make me sick, but at the same time if everyone who worked there just upped and left one day, then they would have major issues and might have to rethink their ways.

As far as the ECF calls go, I agree with the idea of taking patients to their home hospital in non-emergent cases. Now, yes, the case you cited (septic patient) should go to the closest. However, most patients do not have to go to the closest. The only thing that refusing requests to transport to a home hospital in non-emergent cases does is increase cost to the patient (the closest hospital might not honor the patient's insurance), reduced care (the patient's physician might not have practice rights at that hospital), and produce extra transports to get the patient to their home hospital.

 

[medichopeful]

I only know of one, and it's a combination department that almost certainly couldn't afford a full career staff.

Boston EMS seems to be working out pretty well

 

[firecoins]

The two worlds of EMS (which is a public service) and private industry simply do not mix.

I disagree.

The private ambulance service, when it comes down to it, is simply part of the corporate world where the ultimate end-game is to maintain a profit margin. Everything else is subordinate to this goal. As such, being an employee for such an agency is inherently hazardous and incongruous with one's career motivations.

I do not see how a government agency's goal is your career. No agency public or private is centered around the EMT or medic and their career path. The goal of a private company is to make a profit. Since their is ample supply of the EMT-B, there is no reason to make extra for this. Medics are not in short supply either. This affects the career path.

EMT's and paramedics become medical professionals because they have a desire to do a public good, have an intellectually stimulating career, and other sources of motivation that do not include any features of commercial industry except for the most vague possible connections like "customer service" (although I question this). We are not "business" minded people. It's not any of our concern. We became EMT's and paramedics to be exactly that: EMT's and paramedics.

that can be said about doctors, nurses and a number of other professions. However the jobs are in the private sector. Customer Service might be called a bedside manor in the medical field.

The point is, private industry should not be involved with EMS because its business interests are directly counter to the professional goals of the field personnel employed by them.

Interfacilty transfers are not EMS and public agencies tend not to them.

And private companies/privte hospitals can and do provide quality EMS in 911 systems. Private doctor groups provide Emergency physicians, PAs and NPs.

 

[daedalus]

I disagree.

I do not see how a government agency's goal is your career. No agency public or private is centered around the EMT or medic and their career path. The goal of a private company is to make a profit. Since their is ample supply of the EMT-B, there is no reason to make extra for this. Medics are not in short supply either. This affects the career path.

that can be said about doctors, nurses and a number of other professions. However the jobs are in the private sector. Customer Service might be called a bedside manor in the medical field.

Interfacilty transfers are not EMS and public agencies tend not to them.

And private companies/privte hospitals can and do provide quality EMS in 911 systems. Private doctor groups provide Emergency physicians, PAs and NPs.

All you have done is stated your political opinions against large government and have provided no facts to back up a lot of what you are saying. I can think of a few FDs (government agencies) that do run IFTs around where I live. Most notable is Big Bear City Fire Department. Even this one example disproves what you have said about public agencies not preforming IFTs.