IS it True About Private Companies?

Cory

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I recently had a conversation with my cousin who is an EMT-I for a local FD. I happened to tell him that I still had an interest in EMS, but I wasn't really interested in fire fighting. He told me that (of course) there are private EMS companies. But he also told me that in this part of the country (Ohio) they mostly just do transports from nursing homes to doctor's appointments.

Now I know there is a long history og FD's and private EMS having tensions between them. But is it true that private companies don't have a lot of emergencies?

To be honest, I hardly ever see any private ambulances around here. I think I have only seen one even run L&S before. But I have always noticed that the local FD's EMS are very active (maybe that is from growing up next to a fire station all my life, i don't know)

He also mentioned that if I get my EMT-P certification, at most FD's I will work oretty much nothing but EMS. And if I get EMT-B with the pure intention of working EMS, I will get about 80% of calls as medical.

Anyway, its late, so sorry if this makes no sense. Hopefully I didn't answer all of my own questions. I am really more interested in what private companies are like in other places.


-Cory-
 

8jimi8

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It depends on how the private company is contracted. Private companies have 911 contracts in the hill country area of Texas, but not in most major metropolitan areas. Privates ambulances are sometimes diverted to emergencies as first responders if they are in the area, even they are not contracted for 911. So, you have to do your research when you are looking for a job. That is a great question to ask before your apply.

For instance in San Antonio city proper, Fire first responds to all calls and AMR (a private company) has the contract to transport. Now then in the unincorporated areas around San Antonio, Fire still first responds, but Acadian AS has beaten AMR out for the contract and now does all of the transporting; however they also do interfacility transports, (like the nursing home, doctor appointments you mentioned).

Make sense?
 

usafmedic45

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He told me that (of course) there are private EMS companies. But he also told me that in this part of the country (Ohio) they mostly just do transports from nursing homes to doctor's appointments.
It depends on the service and the community. I can't speak for Ohio specifically though.

Now I know there is a long history og FD's and private EMS having tensions between them.
That's something you hear played up a lot on forums like this one, but I've worked in several states and I've yet to encounter a situation where there was a "turf war" and the only time I've ever seen issues come up was when one service or the other was delivering substandard care.

But is it true that private companies don't have a lot of emergencies?
Like I said, depends on who you are working for. Some private companies I ran almost nothing but emergencies, others I did nothing but transfers. I've also seen rural FDs where they will do non-emergent transfers....so there are no hard and fast rules.

He also mentioned that if I get my EMT-P certification, at most FD's I will work oretty much nothing but EMS.
Not always true....a lot of FDs have plenty of medics and I know of one where you have to bid to get on the ambulances. However, most places they are more than willing to put those who want to focus on EMS on the medic trucks rather than trying to shoehorn less eager FFs into those slots. It just depends on how your department is staffed and how well managed it is.

To be honest, I hardly ever see any private ambulances around here. I think I have only seen one even run L&S before. But I have always noticed that the local FD's EMS are very active
It could just be a selection bias. I know the private services that run "transfers" out of the ECFS here run lights and sirens all the time when they have emergencies at those facilities. Of course, they are usually also the ones that catch critical care transfers when the weather keeps the flying billboards on the ground.

And if I get EMT-B with the pure intention of working EMS, I will get about 80% of calls as medical.
Not sure what exactly you mean, but that's about a normal breakdown between fire/EMS calls in a combination department (~80% EMS/~20% fire) and pretty close to medical/trauma split in EMS (~80% medical/~20% trauma).
 

Cory

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Yes, thank you.

So in other words, in SAn Antonio, FD doesn't do any transports? OR is that only when a private company is already on scene?

So in other words, if there is an MVC, the FD responds, they have the patient, they are treating them, but the private company isn't there, then is the FD allowed to trasport? Or do they have to wait?
 

8jimi8

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I think it goes both ways. I've seen the FD do transports, but i've also seen the private companies bring them in and the FD return to service.
 

Fir Na Au Saol

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I guess it depends on where you are...

The private ambulance service I was working for had the primary 911 transport ticket for Valencia County NM. We did some IFTs but mostly 911. The local FDs were primarily volunteer with the exception of the Cities of Los Lunas and Belen and few were more than BLS capable. They only transported if we had no trucks in county and they would attempt to rendezvous with one of our units whenever possible. It was often the case that there was no FD rescue available outside of of LL and Belen, particularly at night.

In Albuquerque and Bernalillo County the FDs respond along with Albuquerque Ambulance Service to all EMS calls. AAS is the primary transporting service, but FD will transport when an AAS unit in unavailable.

The City of Rio Rancho used their FD as their primary transport service and does not use AAS.

Superior Ambulance Service in Albuquerque is primarily a transfer service, but their operations outside Albuquerque are 911.
 

Mountain Res-Q

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Several examples of different ways things are done in my neck of the woods:

My county uses BLS Fire First Response (no transport) and private (non-profit) ambulance service that does all 911 calls and IFTs. Fire is first on scene, starts evaluation and treatment, hands it over to the ambo medic, and assists as needed.

Next county over uses the same setup, except one Fire District has it's own transporting ALS ambos and medics on the engines and so the private company hardly even enters the district.

Another Fire District in that county has a different setup. They have medics and ambos, but do not have the contract to transport except in an emergency when the private boys are out of position. So the evaluate and treat on scene until the private boys show up.

Where I worked in another county, Ambo was all private. ALS rigs for 911 and some ALS IFT, and BLS rigs for most IFTs. Fire had no ambos, but was experimenting with medics on the rigs.

A little farther north, the main city uses strickly Fire Medic ambos and private companies do stricktly IFT (where the money is).

So it all depends on where you go. I can't speak for Ohio, however, but never use your local areas system for a reference on how EMS is run in general. Some places have a better setup, some worse. Also, on a side note... don't knock IFT type stuff. 911 may seem more glamerous and fun, but there is something to be said for the solid foundation on pt. care that IFT can provide.
 
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Linuss

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It all depends on which city/area you're speaking of.


Fort Worth fire is a non-transporting service that responds to all priority 1 and 2 calls. MedStar, a private company, does 911 in Fort Worth.

Whereas in Dallas, Dallas FD does 911 EMS.

In Arlington, AMR runs the 911 ambulances, but works out of the fire station, and drives Arlington FD ambulances with teeny tiny "AMR" stickers on the door.

Go up to Wise County, and they have a 3rd service, completely separate from Police and Fire.
 
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fast65

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I have no idea how private ambulance companies work in the larger cities, but around here we only have one private company and they do non-emergency transports only. Basically they took the load off the FD so that they didn't have to do interfacility transports. From what I've heard the FD and private company here work pretty well together, I've been told that a couple of the paramedics from the FD work for the private company as well. I wish I could be of more help.
 

AZFF/EMT

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In the metro phoenix area it varies. Some departments have Rescues and others use either Southwest ambo or PMT ambo. In cities like glendale, FF/PM's ride in on every ALS call even though the ambo is ALS. Some cities like Sun city and peoria the SW ambo's are BLS and FF/PM's ride in on every call as well. It all depends on the individual city. You can work in county areas of AZ for southwest or River medical and you will be the only medic on scene and you are in charge. Lifeline Ambulance in area like wickenburg and circle city this is the case as well. Fire is BLS.

At my department we have rescue's staffed by 1 fire medic and 1 fire emt, we serve our own district, our neighboring city and two other fire districts near by. We are also the secondary provider to gila bend.
 

WuLabsWuTecH

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I'm in Franklin County (Columbus) and NO Privates do 911 service here except for contract 911 with nursing homes and hospitals without EDs (surgical hospitals). I'm not sure about where you are in Ohio, but at least in the Franklin County area, it is not cost effective for privates to do 911. In order to be allowed in the Automatic Response Dispatch Pool, you have to be staffed with at least 2 medics. To the privates, as long as they can get patients and run ALS with 1 medic and a basic, they'll continue to do that. Also, we have something like 85 medic companies in the county so even under most MCIs, there is no reason to recruit the privates. (And most engines have 2-4 paramedics on them too!)

I believe in the more rural parts of the state some privates do 3rd service 911. Life, and Rural Metro come to mind as doing a little bit of 911. Pickaway Plains also does 911 and they do a lot more than the other privates is my understanding.

Like I said, when you has as much funding as we do (fortunately or unfortunately, take your pick) and some medic companis running only 2-3 calls a day, there is no need for contract service. Also, in the rural areas, the volunteer presence is still quite large. Heck, we'd still have volunteer departments in the cities if the automatic dispatch guys didn't refuse to dispatch volunteers!
 

firecoins

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- The private company I work for does nursing home emergencies. Instead of calling 911, they call us.

- Certain towns with volunteer corps have contracts with our company or other companies where we do "mutual aid" for them if they can't get a crew out.

- More urban towns in the area have FD or PD based ambulance so cops or paid firefighters do 911 EMS. Paterson, NJ uses firefighters. Greenburg, NY uses cops.

- In NYC, hospitals based units and private companies respond to 911 calls under the command of the EMS division of FDNY. The private companies are usually contracted by the hospitals meaning theyt respond as a hospital based unit despite the ambulance and personell are connected to the company only. The FDNY has an EMS only division. FIrefighters do not work in this division.

Yonkers, NY pays a private company to do 911. The company also does transports.

Newark, NJ and Jersey City, NJ have hospital based units.
 

Sasha

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It's a growing trend for areas to go instead of private and third service EMS to go to fire based EMS. I think this is great.

But also keep in mind interfacility is not simply nursing home to doctors appointments. To me it is better than 911 (and yes, we go lights and sirens when the call actually warrants it, but most times it does not just like more 911 calls don't warrant lights and sirens.) and it is more of a brain challenge. You are actually dealing with sick people. I've only ever gotten one stubbed toe x1 week ago complaint, and the only reason we were called is because the toe was getting necrotic and needed to be removed. However today alone I've seen more people in actual need of medical care than 911 EMTs/Medics would see in a week. And if you're attracted to pretty lights and sirens, we went code 3 three times. ( 1 stroke alert, to amd from code 3, and 1 person who deteriorated en route and had to be intubated by my medic.)

So just becuase it's IFT don't completely count it out. ;) Many educational opprotunities.
 
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WuLabsWuTecH

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It's a growing trend for areas to go instead of private and third service EMS to go to fire based EMS. I think this is great.

But also keep in mind interfacility is not simply nursing home to doctors appointments. To me it is better than 911 (and yes, we go lights and sirens when the call actually warrants it, but most times it does not just like more 911 calls don't warrant lights and sirens.) and it is more of a brain challenge. You are actually dealing with sick people. I've only ever gotten one stubbed toe x1 week ago complaint, and the only reason we were called is because the toe was getting necrotic and needed to be removed. However today alone I've seen more people in actual need of medical care than 911 EMTs/Medics would see in a week. And if you're attracted to pretty lights and sirens, we went code 3 three times. ( 1 stroke alert, to amd from code 3, and 1 person who deteriorated en route and had to be intubated by my medic.)

So just becuase it's IFT don't completely count it out. ;) Many educational opprotunities.
I'm gonna agree with sasha that there is a lot to be learned in IFT. A lot of it is a lot of "Real" medicine and I learned about a lot of different conditions, medications, treatments, etc. when i worked IFT. I'm working 911 now and I think I actually enjoy it more than IFT, but the variation in patient conditions I feel is a lot less. When doing IFTs, EVERYONE is sick. 911 is hit/miss.
 

Mountain Res-Q

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It's a growing trend for areas to go instead of private and third service EMS to go to fire based EMS. I think this is great.
What Sasha means, Cory, is that she has seen the positives of a Fire Based EMS system in her area and likes it. that doesn't mean that it works well in every area or is the best way. I have the exact opposite opinion based on what I have seen in my area... the key thing is always going to be whether or not any service can provide GREAT medical care. If fire can do that... GREAT!!! In my area... that isn't the way it works best... a non-profit third party is the best for my county.

However, take what she says about IFT: Take it as gold. Newbie EMTs see IFT as some sort of punishment they ahve to endure before they graduate to 911... PURE BS!!! The best EMTs I know are the ones who work 911 and when they pick up extra shifts they aim for IFT. The realize the benifit of the educational opurtunities that IFT provides and the real patient care opurtunites that we should be looking for... not just the l/s...
 

Sasha

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I'm gonna agree with sasha that there is a lot to be learned in IFT. A lot of it is a lot of "Real" medicine and I learned about a lot of different conditions, medications, treatments, etc. when i worked IFT. I'm working 911 now and I think I actually enjoy it more than IFT, but the variation in patient conditions I feel is a lot less. When doing IFTs, EVERYONE is sick. 911 is hit/miss.
I loved seeing how all the diseases and disorders come together and paint a bigger picture, and seeing a patient's care BEYOND that 20 minutes you have them.
 

Mountain Res-Q

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I loved seeing how all the diseases and disorders come together and paint a bigger picture, and seeing a patient's care BEYOND that 20 minutes you have them.
I liked having access to a hundred page chart and beiong able to review parts of it so that I understood more about the patient and how I could best interact with them as people. The medicine is always cool to, but I liked conversation with the ones who were older and had so much to offer in the way of experience and insight... and of course the psych "the ants are all over me" are fun to. :p
 

Meursault

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story, questions, a signature within the post?
Yes. Unequivocally. The nation is so similar that we, like your source, can make sweeping generalizations about call volume and type, attitudes, relationships between services, and all the other things you asked about.

I could mention my experiences, but what I hope you wanted to ask is "What's working for a Cincinnati-area private service like?". Telling you about Boston won't help.

If you are legitimately curious about what EMS is like in other cities, states, and countries, I'd suggest looking back through old threads. The OP struck me as a bit... biased?

Now I know there is a long history og FD's and private EMS having tensions between them. But is it true that private companies don't have a lot of emergencies?
In short, lurk more.
 

Sasha

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I liked having access to a hundred page chart and beiong able to review parts of it so that I understood more about the patient and how I could best interact with them as people. The medicine is always cool to, but I liked conversation with the ones who were older and had so much to offer in the way of experience and insight... and of course the psych "the ants are all over me" are fun to. :p
Also gotta love the old ladies and their babydolls. Even worse when the baby was invisible. Can never keep track of those things! ;)
 

Mountain Res-Q

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Also gotta love the old ladies and their babydolls. Even worse when the baby was invisible. Can never keep track of those things! ;)
My fav to this day remains the 85 y/o psych that was pregnant. Interacting with her was great (honestly - and not in a cruel way). The way I handled just the simple act of (crazy) human to (crazy) human commuication convinced my FTO I was ready to be on my own and convinced me that I wasn't half bad at this. I wasn't about the L/S. It wasn't about the patches and "prestige". It was about the people and doing what you can for them, which can be mostly being an approachable human being and not some "holier than thou" paragod or an adrenaline junkie. Of course, the L/S are fun too... ^_^
 
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