EMS is in Trouble

If you’ve worked in or with Emergency Medical Services (EMS) over the past couple of decades, you probably know it’s in trouble in many areas around the nation.  As with many organizations, finances are the culprit.  Many EMS organizations simply can’t make ends meet.  Costs for equipment, insurance, fuel, training, and facilities often can’t be balanced in the black against recovered income.  It’s not to say it can’t be done – some are doing it, and successfully.  But many are having a difficult time.  Staffing is another problem.  Volunteer services must constantly recruit and work to retain staff.  Volunteer fire services are experiencing similar recruitment and retention problems.  Even with diligent efforts, day time coverage in some areas is a challenge while many of these volunteers are working at their primary jobs.  Paid services struggle with staffing as well.  It’s no mystery that EMTs and Paramedics don’t get into this business to make good money.  According to a study posted by Monster, the highest paid states provide pay in the $20-$35/hour range, but it slides quickly, with not only the lowest paying states paying in the teens, but the average also sitting in the teens.  Yep, you could be out saving lives and someone working at McDonald’s makes more money than you do.  It’s a rather depressing valuation.

When you couple these two big factors – volunteer staffing and finances – it gets even more difficult.  Paid and volunteer services alike are kicking calls over to mutual aid providers because of being short staffed, which means they miss revenue, which continues to make matters worse.  Many volunteer EMS services, as well as volunteer fire services, are hiring day-shift staff so they can continue to meet needs in their communities during these more difficult timeframes.  For those of you keeping score at home, that’s more cash out.  It might pay off for a busier provider, but certainly not for a provider whose call volume doesn’t balance the checkbook.  Yes, it continues to provide a service to the community, but it’s not sustainable in the long run.

How are the private paid services doing?  Many aren’t doing so well, either.  We see service areas shrinking all around the nation, with paid services seeing diminishing revenues from less dense population areas.  Quite a few paid services make ends meet from interfacility transfers, which are low cost but require volume to make reasonable revenue.

Municipal services are another category which generally have a poor income statement.  I think it’s great that some municipalities provide EMS transport services.  Financially, these services are underwritten by tax payers, with some cost recovery possible through billing insurance companies.  The costs of most municipal services, however, are generally higher, as EMTs and paramedics are government employees, often unionized, and with benefits.  It’s great for them, but not good for the municipal comptroller.  That said, it’s one of the most sustainable models since the underlying financing is spread across all the jurisdiction’s tax payers.  Still a challenge, though, when you consider the tough financial constraints many jurisdictions are facing.

So what’s to be done?  We will eventually need to see a shift in how EMS is provided across the nation.  It is an absolutely necessary service, just as important as roads, fire protection, or law enforcement.  While we won’t see a sudden change, I believe the way forward will be municipal services, or municipally-funded services (those being private or volunteer, but under contract with one or more municipalities).  EMS, similar to other disciplines in public safety, is a public service, and foundationally will need to be publicly funded in order to sustain.  This is nothing new, as there are a number of EMS providers already following this model – that being the maintenance of a contract with one or more municipalities to provide EMS services, for a fee, while also gaining revenue from third party billing, as well as fees for stand-by services for sporting events and other mass gatherings.

What trends do you see in EMS organizational models where you are?  Are the current models sustainable?  Do you view EMS as a public safety endeavor similar to law enforcement and the fire service?

© 2016 – Timothy M. Riecker, CEDP

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2 thoughts on “EMS is in Trouble

  1. Nice job in giving a general overview of a critical service with a complex set of operational challenges. After over 30 years in public safety communications, much of it directly involved in EMS communications, I have arrived at the following to describe my opinion about quality EMS service provision:

    1. The best EMS systems draw their operating paradigm from both public safety and health care systems.
    2. A profit motive is incompatible with the essential mission of public safety.
    3. Therefore, the best EMS systems are those with a high degree of emphasis on quality of care, administered by public safety providers.

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