Why private industry has no business in EMS

[firecoins]

In an industry where EMTs work for free, how long can we blame private companies for low wages?

 

[rescue99]

In an industry where EMTs work for free, how long can we blame private companies for low wages?

Three things are needed to be where FD/PD are today. Education, organization .......not necessarily in that order. The third thing? Takes solidarity.....something EMS sorely lacks.

 

[MagicTyler]

I see no reason why this is any different than a private hospital. An agency sending one of their ambulances on a non-emergent transport when the agency also does 911 is no different than a hospital using an OR for an elective surgery when a trauma may come in.

 

[redcrossemt]

(1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.

Disagreed! Government-funded services have the same issues. I've worked for private services who have been all about the profit, and I've worked for private services who provide quality equipment, training, and management because they know the bottom line (i.e. profit) depends on quality patient care, satisfied/happy employees, and good customer service. I think you'll find "conflicts of interest" in all services - no matter how they are funded, or whether overseen by a CEO, governing board, or mayor.

(2) Utter lack of any recognizable form of professional management - particularly when it comes to the issue of disciplinary action.

Again, disagreed! Who's to say that giving someone the title of "Chief", "Lieutenant", or anything else makes them an effective leader, or that it creates professional management? I've seen lots of poor excuses called "management" at government-funded agencies, both fire and third-service. I've also seen poor management at private agencies. But, as an argument to your point, I currently work for an excellent private agency that has excellent, experienced EMS management staff in an effective, organized structure. We have a reasonable disciplinary action policy that is enforced. And medical errors and protocol problems are brought to an outside regional medical control authority for review.

This is a weak analogy. It is much harder for abuse or corner-cutting to take place while running a hospital than it is with ambulance companies. Operating something like a hospital is so heavily regulated that they almost are public facilities. And despite this, nurses, doctors, & other healthcare professionals who work for private hospitals likely do experience similar nonsensical affronts to their professional & ethical concerns brought up by the corporate aspects of their institution which they did not sign up for.

I think your analogy is actually the weak one. Look at public county hospitals in poor cities! They are the best examples of lacking equipment, poor facilities, etc. And all of this despite the heavy regulation you talk about. Corner-cutting does occur in these facilities, and typically much more than in the private facilities that can choose which patients and insurances to accept.

I'm not sure what you're getting at here. Private ambulances often do both 911 and IFT's, and in working for these services you get caught up in both. Public agencies sometimes do them as well if an urgent transfer out of an ED from a "doc-in-the-box" hospital is needed.

Public agencies in many areas do non-emergency basic inter-facility transports. It just depends on the region, the system, and the needs and capabilities of available agencies.

I work for a private ambulance service. Our 24-hour cars are station-based and expected to do almost solely 911. We do occasionally do emergency inter-facility or critical care transfers when needed; and we occasionally do basic inter-facility runs during high call volumes. Our 12-hour ALS cars are expected to do a mix of all sorts of calls, and they do. I don't see how doing inter-facility transport calls causes burn-out any faster than doing 911 calls...

 

[downunderwunda]

At the end of the day, the question that really needs to be answered is what should be the primary role for EMS.

Should it be to provide initial & primary care, developing over time to extended careto all people, regardless of socio-economic status, or should the concern be for billing & profit.

There is no reason why government departments cannot be run as a business enterprise, with the focus being on service delivery, rather than profit.

This does not mean the EMS should have an open cheque book, but would make the accountable for the funds they do spend.

The other side to this is that if people are provided with a free or subsidised service, not just EMS service, but full medical service, they will acheive better outcomes from things like myocardial ischaemia, not having to decide if they scould afford to have surgery etc will aloow them to again be a contributing member of society & the taxes they pay help the next person who is need.

This is social medicine. It is provided in the third world & most first world countries, with the exception of the US. It is far from perfect, but then again, so is choosing to suffer with an AMI because you cant afford the treatment, from ambulance to hospital.

 

[ExpatMedic0]

I would think the number of Paramedics who prefer to work for a private EMS company over some kind of municipal department such as FIRE, PD, or 3rd party EMS would be an extremely low percentage.

IMO, a municipal EMS 3rd party system by far makes the most since, such as Boston EMS, Or Honolulu EMS.

Lets face it, most of the time in most areas of the U.S. your going to get paid WAY less working for say AMR for example vs the fire department medics in your town, your not going to get a pension of any kind, maybe some crappy 401k you could never even consider to retire on alone, If you get an affordable health care plan your lucky, burn out, moral, and turn over is always going to be a huge problem in private vs municipal for all those reasons and many more.

But above all else, like the guy who stated the thread said on the first post, conflict of interest for a private company with profit and business needs.


Would you like your Police Department or Fire Department to be contracted private company's?

 

[PotatoMedic]

Would you like your... Fire Department to be contracted private company's?

Some are and from what I have heard. The workers hate it! The only reason they are there is because it is a job. Pay is nothing, training is nothing, equipment may be good but that means nothing if you cant use it.

 

[redcrossemt]

But above all else, like the guy who stated the thread said on the first post, conflict of interest for a private company with profit and business needs.

But the point has been made that fire department and other governmental EMS agencies have the same problems... Municipal funding is being cut in all areas, it's hitting EMS providers hard, and many of these departments no longer have all the great equipment and training they once did. Chiefs are forced to balance their lines in the city budgets. There's lots of good examples in the news right now of municipal EMS staffing/deployment shortages with increased run volumes for those still working.

 

[rescue99]

But the point has been made that fire department and other governmental EMS agencies have the same problems... Municipal funding is being cut in all areas, it's hitting EMS providers hard, and many of these departments no longer have all the great equipment and training they once did. Chiefs are forced to balance their lines in the city budgets. There's lots of good examples in the news right now of municipal EMS staffing/deployment shortages with increased run volumes for those still working.

Seems so many FD's went ALS without realizing the need for funding to support long term cost increases. I know our FD doubled in size nearly. Which means so did the cost. The biggest question that had to be answered 15 years before they went ALS was; how are we going to ensure funding 10, 15, 20 years from now and beyond? City planners were smart enough to realize ALS isn't self supporting in itself.

Future planning realistically takes into consideration ebbs and flows of the local, not necessarily, national economy. Plans must take into consideration that insurance pays FD's exactly the same as it will an EMS service. Payment for services is also dependent on a patients ability to pay thus, how are negative revenue calls going to be absorbed?? Unfortunately, many FD's are discovering the high price of doubling man power with promises they cannot financially keep. Cut backs and lay offs are hitting some areas pretty hard because of poor planning.

EMS services make money in call volume. Municipalities are only as profitable as the call volume within it's own area. EMS adds an deletes workers as their business flows. The IAFF wasn't thinking about that when it lobbied for ALS. There's alot more to being ALS than securing FD jobs and providing care.

Just my random thoughts on the subject....

 

[downunderwunda]

But the point has been made that fire department and other governmental EMS agencies have the same problems... Municipal funding is being cut in all areas, it's hitting EMS providers hard, and many of these departments no longer have all the great equipment and training they once did. Chiefs are forced to balance their lines in the city budgets. There's lots of good examples in the news right now of municipal EMS staffing/deployment shortages with increased run volumes for those still working.

If funding is hitting the government sector, wont it also be hitting the private sector??????

A government run organisation should have a charter for minimum standards of care. This is passed on to the patients, funding becomes secondary.

Private companies it is the primary concern. This is a problem.

 

[rescue99]

If funding is hitting the government sector, wont it also be hitting the private sector??????

A government run organisation should have a charter for minimum standards of care. This is passed on to the patients, funding becomes secondary.

Private companies it is the primary concern. This is a problem.

LOL..we must come from different worlds! I see minimalization in standard of care being provided by way, way too many FD's...which are municipalities!
A few are decent but, few are keeping up on low volume skills and practice.

Ever see a 15 year fire/medic stick a 20g angio into a pacemaker, give it fluids and drugs while 3 co-workers looked on and atta-boy'd him? Bent it into a huber first of course! If it wasn't so pathetic it could have been funny. There were 4 dummies, not just a single fool on duty in one station! Stunned and amazed! All I could think was; God help us all!

While I know bad service and skill can be seen everywhere, by shear volume of calls, the better skills and knowledge favors privates. I'm fairly certain most can at least tell the difference between a pacer and a med port anyway. ^_^

 

[redcrossemt]

If funding is hitting the government sector, wont it also be hitting the private sector??????

A government run organisation should have a charter for minimum standards of care. This is passed on to the patients, funding becomes secondary.

Private companies it is the primary concern. This is a problem.

My point is exactly that -- funding issues effect BOTH governmental and private EMS agencies, and the problems faced are similar.

Minimum standards of care... Hmmm... Not sure exactly what you mean. Around here, EMS agencies are regulated by the state and, in my state, local medical control agencies. Both governmental and private agencies are required to provide the same level of care, meet the same staffing and training requirements, etc. As said previously, I've seen lots of great municipal agencies that put patients first, but I've also seen the opposite. Same holds true for private agencies -- there are good and bad.

 

[redcrossemt]

Ever see a 15 year fire/medic stick a 20g angio into a pacemaker, give it fluids and drugs while 3 co-workers looked on and atta-boy'd him? Bent it into a huber first of course! If it wasn't so pathetic it could have been funny. There were 4 dummies, not just a single fool on duty in one station! Stunned and amazed! All I could think was; God help us all!

I haven't laughed this hard in a while!

I'm glad he bent the needle first, at least...

 

[downunderwunda]

Minimum standards of care set a benchmark. Government organisations, free of the profitability shackels tend to be more progressive with implementation of new treatments & options.

Private industry waits til they have no choice to increase profitability.

Profitability should not be a part of anyones healthcare journey, rather the focus should be on wellness & reducing the stress on the patient to ensure full healing.

 

[vquintessence]

WARNING: OPINIONS in my post.

Minimum standards of care set a benchmark. Government organisations, free of the profitability shackels tend to be more progressive with implementation of new treatments & options.

This is where our worlds completely differ my friend! The feds & state gov't serving under my Old Glory have two primary concerns/attitudes: Status Quo & maintaining it's own Beurocracy. Those minimum standards that are set, are more often than not, what is implemented and followed. Over time, those minimum standards become a lost objective when it comes to forward progress because change (at gov't level) is an expensive political risk and has the potential to create power shifts from within.

To quote Oscar Wilde "Bureaucracy expands to meet the needs of the expanding bureaucracy." It's so easy to get lost behind red tape. Now Private Industry on the other hand... change, can mean more money.. which is the reason private industry exists. New treatment paths, potentially create new billing.

Example: Private service I work at has obtained project waivers from the state for BLS to administer Narcan as standing order for very specific situations. So BLS unit administers naloxene, calls for ALS intercept. ALS arrives and provides appropriate care. In the end of the call: the company bills for BLS level 2 and ALS level 1.

A cyncial perspective would assert that's an extra wad of cash for the company. A humane perspective is that the pt got their respiratory drive and GCS back that much sooner due to BLS interventions; perhaps reduced risk of aspiration? Perhaps reduced risk of barotrauma from BVM? In the end, my service has done a justice to the pt as well as themselves.

Government waits til they have no choice to adapt.

IMHO, I fixed the above quote for ya.

 

[reaper]

LOL..we must come from different worlds! I see minimalization in standard of care being provided by way, way too many FD's...which are municipalities!
A few are decent but, few are keeping up on low volume skills and practice.

Ever see a 15 year fire/medic stick a 20g angio into a pacemaker, give it fluids and drugs while 3 co-workers looked on and atta-boy'd him? Bent it into a huber first of course! If it wasn't so pathetic it could have been funny. There were 4 dummies, not just a single fool on duty in one station! Stunned and amazed! All I could think was; God help us all!

While I know bad service and skill can be seen everywhere, by shear volume of calls, the better skills and knowledge favors privates. I'm fairly certain most can at least tell the difference between a pacer and a med port anyway. ^_^

Once they told him it was a pacer. Did they also tell him there is more to a Huber then just a bend!

 

[downunderwunda]

WARNING: OPINIONS in my post.



This is where our worlds completely differ my friend! The feds & state gov't serving under my Old Glory have two primary concerns/attitudes: Status Quo & maintaining it's own Beurocracy. Those minimum standards that are set, are more often than not, what is implemented and followed. Over time, those minimum standards become a lost objective when it comes to forward progress because change (at gov't level) is an expensive political risk and has the potential to create power shifts from within.

To quote Oscar Wilde "Bureaucracy expands to meet the needs of the expanding bureaucracy." It's so easy to get lost behind red tape. Now Private Industry on the other hand... change, can mean more money.. which is the reason private industry exists. New treatment paths, potentially create new billing.

Example: Private service I work at has obtained project waivers from the state for BLS to administer Narcan as standing order for very specific situations. So BLS unit administers naloxene, calls for ALS intercept. ALS arrives and provides appropriate care. In the end of the call: the company bills for BLS level 2 and ALS level 1.

A cyncial perspective would assert that's an extra wad of cash for the company. A humane perspective is that the pt got their respiratory drive and GCS back that much sooner due to BLS interventions; perhaps reduced risk of aspiration? Perhaps reduced risk of barotrauma from BVM? In the end, my service has done a justice to the pt as well as themselves.




IMHO, I fixed the above quote for ya.

The quote didnt need fixing.

The health system needs fixing, begining with the notion that everyone must pay & get billed for every pimple on their ***.

when it comes to forward progress because change (at gov't level) is an expensive political risk and has the potential to create power shifts from within.

Change, at any level of government is there as a whim of the people. The people who vote them in.

If (&this is a generalised comment to everyone worldwide) people were not so apathetic, then the status quo would not remain. People can force change. People will not get off their fat asses to effect change because they have been told, wrongly, that the US has the best system in the world. Until the masses believe otherwise, & it has to start from inside the health system, you will NEVE effect any change & your system will get worse.

 

[rescue99]

The quote didnt need fixing.

The health system needs fixing, begining with the notion that everyone must pay & get billed for every pimple on their ***.



Change, at any level of government is there as a whim of the people. The people who vote them in.

If (&this is a generalised comment to everyone worldwide) people were not so apathetic, then the status quo would not remain. People can force change. People will not get off their fat asses to effect change because they have been told, wrongly, that the US has the best system in the world. Until the masses believe otherwise, & it has to start from inside the health system, you will NEVE effect any change & your system will get worse.

Gosh, I was hoping we'd get a little thanks for all of the free healthcare support we spread around the world. I tend to minimize comments made by people who have to vote or face being fined!

 

[redcrossemt]

The quote didnt need fixing.

The health system needs fixing, begining with the notion that everyone must pay & get billed for every pimple on their ***.

Change, at any level of government is there as a whim of the people. The people who vote them in.

So the problem is that fire departments, third services, and private providers ALL bill the individuals. That's how the system is in America. I'm not sure it's the best system out there, but it's what we have. And, with what we have, I can't say that the government-run agencies do any better than the private agencies. The status quo is that all of the agencies, no matter if they are government or not, depend on revenue, and have to balance their budgets.

 

[rescue99]

Once they told him it was a pacer. Did they also tell him there is more to a Huber then just a bend!

Kept suggesting that fading spike was not artifact but in fact, was a pacemaker. Poor old soul was so thin I could almost read the serial number! The huber bend was a classic!