Are Private ambulance really EMS?

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AfxEMT

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I work for an ambulance service that primarily does transport. from dialysis to discharge to city to city, State to state transport & some "911" from nursing home, special hospitals, people having emergencies wanting to go to their preferred hospital,

Whenever we take somebody to the ER we get bumped up in favor of the fd/rescue.

Are private ambulances really part of ems?
 
Depends, in that case you can make the argument that your company isn't really "emergency" medical services, though I assume you're still EMTs and/or Paramedics staffing an ambulance fully equipped with medical supplies and other emergency gear that can respond to cases where the primary 911 jurisdiction is overwhelmed (either by an MCI or just a surge of calls greater than their capacity) so even if your a backup, rarely called provider, you still would count as an EMS assest.

On the other hand, lots of private companies are the primary 911 provider for their areas. Even locally where fire has jurisdictional authority and provides the paramedics, they don't operate any ambulances so my private company is dispatched on all EMS calls in our area, and provides all transport BLS or ALS (fire medics hop in the back of out ambulance for ALS) so it would be hard to argue my company is not an EMS provider simply because we are privately owned and operated.
 
When i worked for amr and a smaller private company we were the sole 911 providers for a rural county in NM. There's a lot of private ems divisions that are the contractsd 911 either as part of a tiered system or as the sole responder
 
AfxEMT said:
Whenever we take somebody to the ER we get bumped up in favor of the fd/rescue.

Are private ambulances really part of ems?
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What does "bumped up" mean?


I dont personally view those agencies that only do IFT as EMS, and we would only call them if there was an MCI at a facility in which they have a contract for transportation services. We dont usually call them for mutual aid due to volume or just a big car collision. Some places further south actually do 911 for towns and in those places, yeah they are EMS.

Its two totally different kinds of medicine that have been lumped under one banner.
 
I work for a private service, and we provide all 911 medical services for the area (a decently large city with a lot of rural surroundings we also cover) as the fire department is solely BLS and doesn't even possess any ambulances.


I would like to think of myself as EMS here, but maybe I am just an a-hole with a stethoscope. *shrugs*.
 
As other people have said, there's private services that are the sole provider of 911 services. Some that work right along side or in support of government agencies. And yes some that shuttle people back and forth from different facilities. Working in inter-facility you can see some incredibly sick patients and learn things that 911 Medics/EMTs might not know. However you miss out on the trauma side of the job (which is not to say 911 is all trauma every call). If you want to define the 'real' EMS as the people who mostly deal with serious threats to life, limb, or eyesight, I don't think most 911 agencies would make that cut. From my experience, and anecdotally from reading this and other forums, a lot of calls are not emergencies.

I will say I think straight IFT services are a step below groups that do 911 or do both, but I wouldn't count them out of EMS.
 
I think if your primary role is to respond to emergencies, that is, a call initiated as a request for FIRST RESPONSE medical attention, treatment and transport... Then yes, it's an EMS agency.

If you do primarily IFT and residence/Dr office/dialysis, and may occasionally get a call to take an acutely ill or injured person to the first point of medical care, you're a MTS (medical transport service) and you're no different than a taxi driver who occasionally had a sick person request a ride a to the hospital.
 
DEmedic said:
I think if your primary role is to respond to emergencies, that is, a call initiated as a request for FIRST RESPONSE medical attention, treatment and transport... Then yes, it's an EMS agency.

If you do primarily IFT and residence/Dr office/dialysis, and may occasionally get a call to take an acutely ill or injured person to the first point of medical care, you're a MTS (medical transport service) and you're no different than a taxi driver who occasionally had a sick person request a ride a to the hospital.
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This. I've worked both sides. I currently work at a 911 private ambulance company whose sole purpose in this county is to run 911 calls. If this is what you do, then yes you're EMS.

Now if you work for a private ambulance company that primarily does what DEmedic has already pointed out then you're a medical transport service. You may have ambulances, AED's, and all the other "fun" BLS stuff but at the end of the day you're not running calls in the emergent setting. 95% of my calls when I worked at a MTS were pre scheduled dialysis, the other 5% were SNF to the ER or ER to SNF. We never responded in a emergent way so I never considered it as EMS.
 
^This.

IFT is still EMS, in some contexts. There's nothing non-emergent about taking an AMI from an urgent care or doctor's office or nursing home or private caller to a PCI lab, responding to a fall at a contracted facility or the like.

There's nothing emergent about toting a stable patient to and from their appointments because they "need an ambulance."
 
I've worked both sides, strictly 911 service and a transport service that only ran 911 when the county got hammered. On the private side we covered 2 small hospitals and did all the STEMI, trauma, stroke, and really bad off patients between those hospitals and the major trauma, cardiac, stroke, peds centers. Our usual transport was 82 miles, most of that rural highway. When we had someone bad off we ran L&S per protocol and were "allowed" to run 15mph over limit. On an 80 mile trip open highway, very few lights, it did shave several minutes off our transport time. Everyone will say that 911 is "cooler", " more exciting", etc, but the sickest and most critical patients I had, most of the real emergencies, were usually on the transport side.
I mainly worjk the ER nowadays, we don't bump people up or down based on them being a 911 ambulance or a private. We bump them based on patient acuity. In our area the transport guys will usually get priority on a room, while a large percentage of the 911 patients will go out to triage,
 
Not much to add to what's already been said, but many transfers are certainly part of EMS. Most every transfer I take these days needs to be taken out of the local hospital, just like the patient at home has some vaguely time sensitive complaints.
 
I used to take people to the dentist, I wanted to rip off my
Emt patch. It's a starting point, you learn basic skills, and most systems will pull them into the 911 system during MCI. But no, it's more "MS" than EMS
 
Yes, part of the problem is when people start thinking that "transports" are not part of EMS. Transport services still provide essential services for some, in both non-emergent and emergent situations. You are practicing an EMS skillset, and are an EMS professional. When you start thinking they aren't one, or believe that you are not an EMS professional, then it's time for you to leave the field or at the very least reevaluate where you are in your life and the career you have chosen.
 
What do you mean by "EMS skillset" or "EMS professional"? If you mean driving an ambulance and moving a stretcher around, those are skills that have nothing to do with providing any kind of medical service. Transportation is transportation. No need to try to dress it up like more than it is.

Essential or not, scheduled interfacility transports do not fit my definition of "Emergency Medical Services." No need to get offended. I'm not saying one is better than the other, but responding as the first medical contact for a patient in the field is the crux of EMS. This doesn't imply one doesn't see more sick, intellectually challenging, or complicated patients in CCT settings, because you certainly do.

I absolutely agree that most of 911 based service is hardly emergent, and much is barely even medical. In any case, 911 providers are still providing initial triage and care of some type, along with transport to a medical facility for further treatment. A huge part of that is being the entry into the medical system. Taking responsibility for continuing care of a critically ill patient with multiple drips, devices, and vent settings is arguably more interesting, but seems to have completely different goals than that of the 911 based classic EMS model.

I'm completely with previous posters that distinguish private services that primarily respond to 911 calls for service from those that exclusively perform dialysis and physician's office transfers. In that comparison, the former certainly qualifies as EMS and the latter just happen to use a similar vehicle and horizontal bed. CCT is an incredibly interesting field, but I'm not sure they necessarily fit the definition of EMS, nor do I think they would want to be included.
 
What do you think of when you hear EMS? Do you think of running 911 calls? Or do you think of running dialysis and discharges?

Both are under EMS, although the medical transports are more like the red headed stepchild. But still both have the same goal: treatment and transport of the sick and injured. One is doing it via the 911 system (true EMS) and the other is doing it through prescheduled dialysis, hospital discharges and SNF transports (red headed stepchild EMS).
 
chaz90 said:
Essential or not, scheduled interfacility transports do not fit my definition of "Emergency Medical Services." No need to get offended. I'm not saying one is better than the other, but responding as the first medical contact for a patient in the field is the crux of EMS. This doesn't imply one doesn't see more sick, intellectually challenging, or complicated patients in CCT settings, because you certainly do.
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Sometimes I feel like I am my patient's first medical contact when I show up at our local critical access ED...
 
chaz90 said:
What do you mean by "EMS skillset" or "EMS professional"? If you mean driving an ambulance and moving a stretcher around, those are skills that have nothing to do with providing any kind of medical service. Transportation is transportation. No need to try to dress it up like more than it is.
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If that's what you choose to make of it, then that's on you. But, patient contact is more than just starting IVs, etc. An EMS skillset involves taking vitals, visual/verbal/physical assessment, and simple patient interaction. These patients go in the back of an ambulance because that is the help they need. If you choose to not see that and to not treat that as EMS then that is you imposing too narrow and simple of an EMS worldview on what private ambulances do.

chaz90 said:
Essential or not, scheduled interfacility transports do not fit my definition of "Emergency Medical Services." No need to get offended. I'm not saying one is better than the other, but responding as the first medical contact for a patient in the field is the crux of EMS. This doesn't imply one doesn't see more sick, intellectually challenging, or complicated patients in CCT settings, because you certainly do.
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Like I said above, your definition is far too limited. And sure, I will get offended. You're basically slapping every person who works IFT in the face and telling them they are not EMS because they don't run 911. Never mind the fact that most probably do anyways, and that the majority of 911 calls are no different than IFT calls. And no, responding as the first medical contact for a patient in the field is not the crux of EMS. Providing care is the crux of EMS, whether you are first on scene, last on scene, or a link in the chain.

chaz90 said:
I absolutely agree that most of 911 based service is hardly emergent, and much is barely even medical. In any case, 911 providers are still providing initial triage and care of some type, along with transport to a medical facility for further treatment. A huge part of that is being the entry into the medical system. Taking responsibility for continuing care of a critically ill patient with multiple drips, devices, and vent settings is arguably more interesting, but seems to have completely different goals than that of the 911 based classic EMS model.
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Again, IFT does the same thing. They are providing care of some type, along with a transport to either a medical facility for further treatment or to a home so they can continue with their life. Being the entry into the medical system is no different than being the middle, or the exit, you're just a part of the chain, same as everyone else.

chaz90 said:
I'm completely with previous posters that distinguish private services that primarily respond to 911 calls for service from those that exclusively perform dialysis and physician's office transfers. In that comparison, the former certainly qualifies as EMS and the latter just happen to use a similar vehicle and horizontal bed. CCT is an incredibly interesting field, but I'm not sure they necessarily fit the definition of EMS, nor do I think they would want to be included.
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They also use EMS skills, make patient contact, and provide care of some type, but you do seem to be selective in your application of EMS so none of that probably matters to you.
 
BillThompson said:
If that's what you choose to make of it, then that's on you. But, patient contact is more than just starting IVs, etc. An EMS skillset involves taking vitals, visual/verbal/physical assessment, and simple patient interaction. These patients go in the back of an ambulance because that is the help they need. If you choose to not see that and to not treat that as EMS then that is you imposing too narrow and simple of an EMS worldview on what private ambulances do.



Like I said above, your definition is far too limited. And sure, I will get offended. You're basically slapping every person who works IFT in the face and telling them they are not EMS because they don't run 911. Never mind the fact that most probably do anyways, and that the majority of 911 calls are no different than IFT calls. And no, responding as the first medical contact for a patient in the field is not the crux of EMS. Providing care is the crux of EMS, whether you are first on scene, last on scene, or a link in the chain.



Again, IFT does the same thing. They are providing care of some type, along with a transport to either a medical facility for further treatment or to a home so they can continue with their life. Being the entry into the medical system is no different than being the middle, or the exit, you're just a part of the chain, same as everyone else.



They also use EMS skills, make patient contact, and provide care of some type, but you do seem to be selective in your application of EMS so none of that probably matters to you.
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They all play a role, yes. But to say basic IFT services are EMERGENCY medical services is untrue. There is nothing emergent about bringing someone home from a doctors appointment. It's a medical service yes.

Same goes for 911 only trucks. I have no problem not calling myself EMS 95% of the time. Because those calls are non-emergent and do not need an ambulance. So maybe your view on EMS is too wide and can't understand the difference between a service to a person and emergency service to a person.
 
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