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With the state jumping in to fix the problem, city officials now have some serious changes to make. Privatizing the EMS system is now on the table as a big possibility. Personally, I think it should have been on the table a long time ago, but that’s neither here nor there at this point. The talking heads at City Hall say it will save money while the union heads say it will cost the city money. So which is it?

There are a lot of details I don’t know about Detroit’s EMS system so I can only speculate based on some assumptions, so if I’m wrong about something, please feel free to correct me.

It’s pretty obvious at this point that Detroit EMS operates at a loss. This isn’t much of a surprise to me given the unemployment rate in Detroit and the fact that 911 simply isn’t a money-making enterprise. It’s very rare to find an EMS system that actually makes money on 911 calls alone. Where the money is usually made is event standbys and inter-facility transfers. Most private ambulance services use both to offset their losses from the 911 calls.

I’m not sure if Detroit EMS runs inter-facility or just 911, but I’m going to assume they only run 911. If I’m correct, then it is going to be virtually impossible for any service – whether it be public or private – to operate without a subsidy. So what can they do? Well 2 viable options exist. They can either pay a private service a fixed subsidy to run the 911 calls, or they can pay them no subsidy and give them exclusive rights to the inter-facility transfers and 911 calls. Personally, I think the second option is better at this point.

They can set performance requirements as a condition of the contract. These might include response times, minimum staffing, complaint resolution, etc. The service that wins the bid is required to operate within their budget and meet the requirements of the contract. I have seen this type of exclusive operating contract work very well in several areas, including a few that I have personally worked in. Where things usually go wrong, is when the city decides to start over-regulating the ambulance service to the point that they can’t afford to operate without a subsidy. At that point your right back to square one.

If the City of Detroit goes through with this decision, then my advice to the city is this:

Pick a good company with a good reputation. There are plenty of them out there. Give that company exclusive rights to all emergency and non-emergency responses within the city limits. Set reasonable requirements and hold them to it. After you do all that, stay the hell out of their way. Don’t start trying to fix something that isn’t broke.

I’m sure plenty people will disagree with me on privatization, but we do know that the public system isn’t working for them. The city has proven itself incapable of keeping a balanced budget, so why not wash their hands of it and allow someone else to manage the EMS operations? I really hope the best for the EMT’s and Paramedics working in Detroit. We’ll see what happens in the next couple months.

In a very large portion of the country, private business is already providing these life saving services at no cost to the tax payers. With so many cities and counties operating in the red, I’m left to wonder why more areas aren’t being serviced by private companies. By switching to a private or pay-per-service system, municipal governments can save a truck load of money. That is money that can be used to fund or improve critical services like law enforcement, roads or fire suppression.

There are certainly valid arguments, none of which are financial, that oppose such systems. Many people feel that emergency medical services is a responsibility of the government, and therefore should be operated by the government. Some more arguments against private EMS include:

• Stability

• Oversight

• Accountability

• Quality of care

I can certainly understand a fear that a private ambulance can “go under”, leaving an area with no coverage. However, during these tough times, there is hardly any stability with any branch of the government. Layoffs and budget cuts are forcing public agencies to decrease personnel and number of units available. The risk is equal on both sides of the fence. For every ambulance service that goes out of business or loses a contract, there are several financially sound companies waiting for opportunities to expand. If we trust privately run hospitals to service communities, then why can’t we trust private ambulance service?

The argument about oversight, accountability and quality of care with private ambulance services is weak. In reality, there is more government oversight when it comes to contracted services then there is when the city or county runs their own service. Private ambulance services have to follow strict guidelines in order to maintain a contract. With no contract, the company can’t operate, which translates to no business. Contracts call for response time compliance, number of units available, quality assurance programs and complaint resolution. When fire or third-service based systems are in place, all the governing boards typically care about is amount of money they spend. Which, by the way is usually over the top.

Private business has to earn their money and manage it. If they don’t generate enough revenue, then they can’t operate. Sound familiar? If you are a working person supporting a family then it probably does. Government agencies don’t have to worry about generating income. They just spend the money and ask for more when they run out. It sounds harsh but it’s true. Next time you get behind on your car payment or mortgage, try asking your boss for more money and tell me how it goes.

In conclusion, I feel that private business is just as capable if not more capable of providing efficient and quality emergency medical care. As always, I welcome all questions and comments. You can e-mail me at sean@medicmadness.com or simply comment below.

Have a great week.

Obviously public recognition of EMS professionals working in the private sector is nowhere near the calliber of public entities. No one wants to make movies, tv shows and half-naked calendars about “those ambulance guys”. But why is that? Why cant everyone share the spotlight?

You can blame the fire departments, you can blame the police, or you can blame the public, but the real answer lies within the EMS system.

Ambulance services do not operate like fire departments. For example; an ambulance shows up to the scene of an accident, loads the patient and leaves. All of the real work is done en route to hospital in the privacy of the patient care compartment. No cameras and no reporters. Fire departments on the other hand, have more work to do once the ambulance leaves. Their job does not stop with patient care. This leaves time for the news to show up and interview captains and battalion chiefs. If private ambulance providers were sitting on scene talking to the media, they would never get their jobs done.

As an EMT or a Paramedic, what would you do if a reporter showed up at the hospital and asked you what treatment you performed and how the patient turned out? Well if you enjoy having a job you tell them that you can’t answer those questions due to privacy laws. The media knows this, so they don’t bother.

I have worked in private ambulance for quite some time now. I have felt the frustration. I know what it feels like to think that nobody cares. Although something happened to change that. I got recognized for a call I responded to in 2007. I was interviewed several times on TV and in the news papers. They sent me to our state’s capitol to meet legislators and receive the “Star of Life” award. It was a great experience, but at the same time it seemed like a bit much. Here I was getting all the credit, when the only thing I really did was be in the right place at the right time. Any reasonable paramedic would have run that call just like I did had they been there instead of me.

It was at this point that I realized that I don’t do the job for the recognition. I know the value of my work and I know the impact I can have on peoples lives. All of us our here to do the same job. We help people in their time of need and get them to definitive care.

So in conclusion I say this. When you see other people taking credit for the work that you are doing, don’t worry about it. The people you helped know exactly what you did and you know exactly what you did. That is all that truly matters.

Thank you for your time, and please e-mail me with any questions, comments or stories. Thank you!