Labor & Politics

Fire-Based vs. Private EMS

NEP Nation Staff

April 10, 2023

When people dial 911 to report a medical emergency, they expect an immediate response from local emergency medical providers tasked with providing critical life-saving care in their area. But far too often and in far too many places, the private ambulance companies contracted to respond to them put their bottom line above service. As a result, emergency units are often unexpectedly "browned out" or closed due to staffing or budget issues.

In Northern California's Sonoma County, elected officials are now facing such a situation. These officials are hearing bid proposals for the county's advanced life support ambulance service. The Sonoma County Fire District is vying to bring fire department-based EMS to the county.

"Fire-based EMS is the wave of the future," said Mike Stornetta, president of Professional Fire Fighters of Sonoma County IAFF Local 1401. "Fire department-based EMS gives our 911 and emergency medical response systems back to the public where it belongs. The residents we serve deserve to have public oversight over their EMS response system."

Sonoma County's firefighters already respond to EMS calls. Still, too often, the first-on-scene emergency responders wait an unacceptable amount of time for an ambulance to arrive and transport the patient to an emergency room, jeopardizing the lives of the residents and visitors they serve. Moreover, when their current for-profit ambulance company, American Medical Response (AMR), is stretched thin, it's not above reducing the number of ambulances available, putting even more stress on the fire department, which is expecting the ambulance company to hold up its end of the bargain.

"Sonoma County is living in a broken system right now," Stornetta said. "The private provider is worried about their bottom line and not what's valuable to the public. If they feel they need to brown out ambulances to meet their bottom line, that's what they're going to do. We should not let a private business dictate the EMS needs of our residents."

Officials in southern California's Riverside County just rejected a contract extension with AMR, citing the company's failure to meet response time standards and other expectations. AMR reportedly missed response time benchmarks in five of 12 months between July 1, 2021, and June 30 of last year. And that allegedly sent basic life support ambulances to emergencies requiring advanced life support ambulances hundreds of times.

"We have two hospitals in our city and one right outside of our city," Murrieta Fire Chief Bernard Molloy told the Press Enterprise. "So ambulances are never very far from us. It's not like these are long response times."

Even so, in Murrieta, response-time benchmarks are only being met 54% of the time. This benchmark is an improvement from 2022's measure of 42%. Still, officials worry that these delays not only put patients at risk, but also tie up firefighting resources.

"First responders sit on scene and aren't able to transport that patient to the hospital in a timely fashion," explained Molloy. "When we're waiting for these ambulances to come, we no longer have a fire engine that can do fire engine work because we're stuck with the patient."

In more extreme cases, but also far too familiar ones, private ambulance services decide a market is not profitable enough and threaten to leave altogether at the end of their contracts. With local public emergency response agencies often no longer having the vehicles, equipment, or staffing to immediately resume such a service, these private contractors come back with significantly higher cost proposals to maintain service. When local governments can't absorb these exorbitant costs, the private contractors cease providing service. As a result, the existing publicly funded emergency service systems usually have to find a way in a hurry to fill the massive void left behind.

Akron, Ohio, will soon be facing such an extreme situation. Paramedics from the Akron Fire Department currently transport patients who need priority and advanced life-saving care. AMR transports patients with less critical needs. In August, AMR will stop providing service to the city, citing financial reasons. As of now, the fire department will take on this additional level of service.

"Being a paramedic for the city of Akron has never been easy. Long days, missing meals, sleep, and being the difference between life and death are a daily occurrence," stated Akron IAFF Local 330 President Kevin Gostkowski. "With the departure of AMR services, Local 330 paramedics will be forced to pick up the slack. Over the next few months, a lot will be asked of these extraordinary people. They are doing their absolute best, with a situation not of their doing."

Local officials in these affected places are quick to point out that the hardworking emergency medical professionals employed by these for-profit ambulance services aren't to blame for their company's actions in putting profits over service.

"While the men and women of the current ambulance provider are working extremely hard, they are unfairly doing so under a broken system," Stornetta said. "The workforce that's already here will be hired under a fire-based EMS system – no one will be losing their jobs."

AMR Regional director of operations, Jeremy Schumaker, told the Press Enterprise that the company continues to struggle with staffing shortages impacted by the COVID-19 pandemic.

"We continue to compete for the same diminished pool of paramedics with every other EMS agency across the country (and) with all of the fire departments represented (in the board chambers)," said Schumaker. "I think we're going to see some significant improvements in the coming months," he said. "But there's still a long way to go."

Photo by Robert Linder on Unsplash