By Richard Marinucci
In my last Web feature, I discussed my opinions regarding an article published by the New York Times regarding some of the issues related to the privatization of fire services in some limited communities. The article expressed many of the disadvantages and appeared supportive of a more traditional fire department. I offered my views with mostly a perspective on the firefighting aspect. This time I wish to focus on other aspects, especially emergency medical services (EMS).
First and foremost, remember that EMS is much different historically than the traditional fire service. Fire departments are relatively recent delivery systems for EMS in many, if not most, communities. Others did much of the work. It may have been privates, hospital systems, or third services provided by the municipality. Fire departments have increased their involvement for various reasons, mostly because of their organizational structures that lend themselves to a proper response, both in time and with adequate personnel. Some have implied that fire departments have ventured into EMS because of the decline of fire calls so they could “justify” their existence. While this may be debatable, there is no doubt that the added value to the community should be the main focus of the discussion.
There is a direct relationship between response times and successful outcomes. There should be no debate that if the proper treatment is not received within a specific time, the results of the call will not be good. This varies by the type of call. If it is a cardiac arrest, then the time is more critical than a broken bone. Still, there is a direct correlation to response times. As such, many privates require the response of fire departments because they need the service to arrive and begin sooner than their typical model allows. They usually cannot afford to deploy units to meet response time criteria. As such, fire departments allow privates and third services the ability to cover more territory and increase utilization of units so that a profit can be generated (or at least break even). It is doubtful that EMS alone can generate a profit without governmental health.
Another consideration is staffing. While not every call requires more than a couple of medics, those that are more serious require more hands to help in order to affect the outcome. Again, privates and third services are challenged to adequately staff units and still generate the income necessary to cover the costs. What this means is that response time issues along with staffing needs have necessitated that fire departments respond to EMS calls. This essentially is a subsidy to another service. Often fire departments function as first responders, and the private or third service arrives to assume additional care and transport. They then invoice the patient, and the fire departments don’t receive any of the funds generated. Simplified, the community is using tax dollars to help privates generate income for their bottom line. Without the additional staffing and shorter response times, the privates probably could not cover their bills.
This is but one aspect. There is a quality issue involved. I don’t want to imply that licensed medics vary in skill level based upon who their employer is. The difference could be familiarity with response districts and continuity of care. Fire station locations and personnel assignments should translate into better understanding of first-alarm districts, even without CAD. Firefighters should know more about their districts because they are smaller and they are general