No... the point is... stop putting paramedics on fire trucks all together. Stop forcing all the firemen to go to medic school.
Everyone now will be grandfathered in of course, they will never get away with getting rid of folks for being over qualified. No matter how hard they pushed, but implementing new rules. Then you'd save a ton by cutting the salary 5, 10, 20 percent (I dunno, I'm not an economist) on new hires, and in turn reduce the pensions, etc... You'd also save by not having to buy ALL of your apparatus ALS equipment, you could also spend less on purchasing 2-3-4 more ambulances versus a single pumper or ladder truck. All of these things are pretty much mentioned in the article.
Okay, for example: staffing one engine is the equivalent of staffing two ambulances (in terms of personnel). Even if you took away two engines, and added three ambulances, you're still saving hundreds of thousands of dollars just on payroll alone by now having six responders where you used to have eight, AND you can cover more area with the additional unit. It's math... less people = less payroll/bennies/pensions/etc. That's not even counting the money saved on all that other stuff that we've mentioned...
Are you following?
The SoCal model of every EMS response requiring a 5-man crew on a $600,000 ALS engine plus a separate transport ambulance is, on its face, ridiculously wasteful and inefficient. You can probably purchase, maintain, and staff at least two - perhaps three - ALS ambulances for every ALS engine. And you'd need fewer engines, too, if they were only responding to fires and MVC's instead of to every EMS call. It only makes sense when you finally see it for what it really is - a means of maintaining manpower and budgetary allotments, and nothing more. Public safety expenditures well above the national average are a big part of the reason why so many municipalities in CA are in such horrible financial shape. It is unsustainable.
I'm personally a fan of EMS being operated as either a county or city based third service. I think it just makes sense. But I also have to concede that there are lots of examples of FD's doing a really good job of running EMS, and some really good private services, too.
The bottom line is that the vast majority of EMS calls can be safely and effectively run by a single ambulance with a two-person crew, and anything more is simply wasteful.
It is very true that you can get a lot better EMS coverage with a few ambulances than one engine with 4-5 people. However, it is not a matter of meeting EMS demand by adding more engines instead of ambulances. It is instead a mater of using already existing fire apparatus to augment the EMS response, or more typically make up for a lack of deployment on the EMS side. Fire apparatus are staffed and deployed the way they are because there needs to be a timely response to suppression incidents. Regardless of suppression call volume, there still needs to be adequate coverage of a district, especially with type 5 construction, and heavy fire load (synthetics, plastics and such that are found in abundance in modern homes). Along with that, it is not a matter of how many calls are EMS, and how many calls are suppression. Most departments have 70% to 80% calls dispatched as EMS. What most people fail to realize is that a fair number of suppression calls require more than one fire apparatus (box alarms, inside gas leak, pin job, fire alarm, Hazmat, CO alarm, things like that). EMS typically gets an ambulance with two people on it at a minimum. A more fair way to compare suppression vs. EMS call volume would be to count the total number of ambulances that received a call over a year vs. the total number of suppression units that received a call over a year (excluding medical aid of course). That would tell a very different picture than the old "80% of calls are EMS, so take away engines and put more ambulances on the street."
Don't get me wrong, I feel that most places don't put out enough ambulances to handle call surges, much less give the average unit some downtime (#SSM/PUMsucks). The truth is, most employers are going to put out just enough ambulances to handle normal call volume. This goes for fire departments as well as privates, hospitals, and third service municipal alike. They all do it. Given this to be true in many places, it makes sense to have fire do first response to help out, since they are typically more idle than EMS, because they are staffed/deployed to cover an area irrespective of call volume or lack thereof. Look at the NIST studies to see why fire suppression requires a timely response, along with safe staffing levels if you don't believe me.
Having suppression first response may not necessarily affect pt. outcomes, but the manpower does help out the txp crew immensely. How many broken down EMT's and medics do you know that are in pain every day, or had to leave the field? You now have several extra hands to carry equipment and assist in pt. care. I can say from experience that when I was in NYC, 20 min. on-scene for BLS and 30 mins. for ALS was typical for us. In my current system, I can get off scene in 10-15 min. for BLS, and 15-20 for ALS, or 10-15 for ALS if I take the engine medic with me and do most of the stuff in trainsit. There is a time savings to be had with suppression first response. Preferably, it would be BLS suppression with dual medic txp. Otherwise, one txp medic nd one suppression medic, so that you have two medics to care for a critical pt.
As far as revenue, if EMS was not profitable. how would a private company be able to go into contract with the local govt? They would lose money, or the govt would have to pay them enough to make it profitable. Better to leave it to the municipality, rather than have the private operate with managing costs as the highest priority.
