TLDR warning: Novel ahead.
A couple years ago my buddy and I worked on starting our own company. It's crazy money to be playing with if you don't have any idea what you're doing. I busted out the old notebook with all our notes and this is what I can tell you. This is what a naive 23 year old me thought was golden.
The plan was to buy two rigs for $20k each. We decided to staff one rig a day on a 24hr shift. Crew 1 would work M/W/F. Crew 2 would work T/Th/Sat. My buddy and I would staff the back up rig incase another call came in while the 24 car was out. The Sunday 24 would be covered by one of us and the ops manager. Dispatch would be covered by 3/4 12 split for both day and night dispatch.
So, with that very basic idea, we spent a couple months and ran all the numbers we could think of. From ambulances to staples, We went through everything you may need and factored it in. Or so we thought. We both had worked in the field for a while by the time we started working on this and thought, "How hard could it be?" We had grandiose plans of paying everyone good money and having the best stuff, but soon we were cutting corners left and right trying to get cost down.
We went and talked to company owners. From guys who were running real profitable companies to guys who just bought a rig and, "I worked at my current company until I stole enough supplies to stock our rig. Then we were in business." Every one we talked to said don't do it.
What we came up with was as follows.
Startup: $120,000. This number would always fluctuate.
Operating cost for 1 month: $33,488.
Operating cost for 6 months: $200,928.
Employee payroll without benifits (4 EMTs, 4 Dispatchers, 1 Ops Manager, and 1 biller.) for 1 month was $20,760.
By the end of all our tweaking, Everyone, but the Ops manager, was payed $10hr and we never factored in paying ourselves.
There is still a myriad of things we never figured out. Which would really increase our start up costs. I have lists of things with question marks by them.
A. Licensing costs
1. State/CHP requirements?
2. DMV Fees?
3. County business license?
4. City business license's?
5. Other?
B. Insurance requirements
1. Vehicles?
2. Workers comp?
3. Health benifits?
4. Other?
C. Miscellaneous
1. CAD System?
2. Radio Frequencies/FCC licensing?
3. Tracking employee hours?
4. Where does the O2 come from?
5. EPCR?
6. Marketing Supplies?
7. Medical Director?
8. Other?
Much to my buddy's protest, you can't just buy a rig off craigslist in the morning and be running calls that night. Starting your own company is doable. LA is a testament that anyone can buy rig, and maybe a fire truck, and declare themselves an ambulance company, but if you haven't thought of everything, and I mean everything, it'll swamp you eventually.
I have no idea what our supervisors do. I see them every so often when I go to main. They're sitting at their desk drinking Pepto Bismol from the bottle and staring at a piece of paper like an alien who has never seen such technogy before. They're just two steps up the ladder and look like they're about to break. My buddy and I had a combined 3 years of EMS experience when we thought this out. Now with 6 years in the field, I still wouldn't be comfortable taking this on. If I don't know what my Supervisor does every day. How could I be his boss? I'd still like to try it, but I'd need at least a handful of years as an Ops manager or a ton of money to just throw at it.
You may have all the passion in the world for helping other people, but if the calls aren't coming in, or medicare again kicked back that transport, or your plan isn't completly squared away, you're not going to be providing for your family. You'll soon be astronomically in debt and living in your ambulance van down by the river.
TLDR: Didn't buy the rig off Craigslist. Decided it was a bad idea.