Private EMS second class?

[Veneficus]

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?

 

[shfd739]

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.

 

[mycrofft]

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

 

[46Young]

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.

 

[Veneficus]

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.

 

[46Young]

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.

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.

 

[mycrofft]

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.

 

[DrParasite]

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.

 

[mycrofft]

"...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.

 

[RocketMedic]

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?

 

[shfd739]

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.

 

[RocketMedic]

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

 

[ZootownMedic]

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.

 

[Tigger]

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...

 

[ZootownMedic]

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......

 

[Hunter]

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.

 

[CrackerBDingus]

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.

 

[ZootownMedic]

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.

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........

 

[Tigger]

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.

 

[46Young]

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.