Private Companies Getting "Real" Calls?

[MMiz]

Where I'm located, private companies run the show. AMR used to dominate the county, but their slow response times started to anger cities. Now there are several private companies.

About 1/2 the cities in the county operate FF/Medical of some sort, with about 1/4 being ALS. The other half half the private company as the primary responder for all medical and trauma calls.

For most private companies, the majority of the money is made on interfacility transfers.

Working private BLS, 50% of my calls were interfacility transfers. 45% of my calls were as a 911 additional response unit, and 5% were to low priority BLS emergencies, without RLS.

Ask any private EMS company, and they'll tell you their bread and butter calls are the interfacility transfers. That's where the money is to be made in EMS. Many EMT-Basics hate working BLS non-emergencies, but I feel its a part of the job.

Now getting to the main point, in my area, private companies see just as much trauma as the FF/EMT crews. In other areas, private companies are just used for transports.

I know this is discussed in another thread, and I know many of you FFs place little value in private EMS, but I'm wondering everyone's opinion on this one.

 

[Luno]

Okay, I'm a little opinionated , but here's my take on things.

For most private companies, the majority of the money is made on interfacility transfers.

The majority of our calls are 911, with few (maybe 10%) being interfacility, incl. SNF emergency calls that FDs don't respond to. While it's taken as gospel that Private AMBs make their living off of interfacility runs, I've looked at the billing statements, and I don't understand how they can when the majority are Medicaid/Medicare which pay $80 flat for a BLS transport. And insurance companies are billed $450 - $600 for emergent transport.

Ask any private EMS company, and they'll tell you their bread and butter calls are the interfacility transfers. That's where the money is to be made in EMS. Many EMT-Basics hate working BLS non-emergencies, but I feel its a part of the job.

While BLS non-emergencies, i.e. facility tranports, are "less than glamorous," some can be real emergencies. I have one incident in mind I'll share, I was working with an EMT that had apx. 6 mo in service, (which in our high burn rate position is considered senior) who was upset about being called to do a SNF to ER transport. He walked in with a "load and go" mentality, and I as the sr. EMT on the rig tried to "liven up" the call for him, making him hump the jumpkit in with us. The pt was decreased LOC (original complaint for transport), however I instructed him to do a full "head to toe" workup on the PT. The results were interesting to say the least, pt was tachycardic, diaphoretic, and had a BP 70/30. We did not have a SpO2 monitoring device, but since pt appeared A&O he readied him for txpt. While he still maintained the "facility, load and go" opinion, the pt continued his downward spiral. It took a little "emphatic communication" to break this EMT's attitude difficulty, when he finally realized what was going on, the pt was moved to Trendelenburg, and O2 was applied. Post Tburg/O2, the pt stabilized and was transported. Emergencies are out there to be worked, just remember to keep your eyes open to see them.

I know many of you FFs place little value in private EMS

I find this attitude (though very prevalent) to be abjectly deplorable, and illustrates the FF/MFR/EMT (paramedics are excepted, as a higher level of medical care) who exhibits it, their total lack of concern for the well-being of the patient. We are all on the same team, and "trained" to the same standard. However, in my experience we, EMS only workers in my area, see between 5-6 years worth of FF/Aid patients in one year, by simple repetition have further refined skill. The opinions of FFs that EMS has very little value, underscores their lack of desire to perform a medical function, and illustrates their desire to simply fight fires. I also feel that FFs are blind to the fact that were it not for us, they would be taking in every drunk and mild fever patient, they've recommended to transport, instead of returning to their station to go back to sleep. Needless to say, private EMS is the municipal/gov whipping child.

YMMV
Luke

 

[SafetyPro2]

As a FF, I personally have no problems with the private companies around here and the EMTs and Paramedics who work for them. That's not to say I haven't had problems with a few individuals from time to time, but that just comes with the territory. Two of our FFs, in fact, work for a private ambulance company as their paying job.

Around here, other than AMR, most private companies do mostly interfacility transports. AMR handles the 911 contract for LACoFD and a few other non-transport fire departments, but I'd say the majority of FDs provide their own EMS and transport.

AMR also provides back-up support for other departments, such as mine. For example, if we have a major TC with 3 or 4 patients, we'll generally call for an AMR ambulance rather than requesting mutual aid from another department.

In all those cases, however, the FD generally provides the primary patient care. LACoFD, for example, will have one of their Paramedics ride in the ambulance while the other follows in the squad. AMR will have one of their EMTs in the back as well with the other driving, but the FD Paramedic (as the higher medical authority and as the jurisdictional representative) will handle the patient care. Same goes when AMR transports for us. Even though the AMR EMT and our EMT are the same level, we handle patient care because of jurisdictional authority.

A few of the other private companies have 911 contracts here and there, but AMR's definitely got the lion's share in Southern California. Down in San Diego, it's Rural/Metro, and they've actually formed a joint venture with the San Diego FD.

In some of the more rural parts of the state, private companies provide most of the EMS with the FD handling just first response.

The only real issue with private companies around here is that they have a high turnover rate. Because most all FDs in the area require EMT-1 as an entry requirement and prefer Paramedic, most private company EMTs are just in it to get some experience before either going onto a fire academy or medic school. As a result, an EMT with 6 months on the job for a private company is generally considered "senior".

 

[rescuecpt]

As a FF, I object to Luno's generalization about firefighters. We're not all like that. Granted, I'm a critical care EMT as well, but most of the guys in my department are more supportive and necessary to EMS than you can imagine. With a small squad with limited resources, I need firefighters to fetch equipment, perform extrications, carry patients, and drive the ambulance. Through a training program I put together with one of the medics my firefighters know where the equipment is on the ambulance, how to turn on the oxygen and other important on-board equipment, and other invaluable information, such as how to make a hospital notification when I'm alone in the back and knee-deep in patient care.

Granted, some of my guys can't deal with blood, guts, etc... I respect that- to each their own. They made me aware of their feelings and they help out in other ways.

Anyway... go easy on the FFs, they're not all like the few that don't value EMS.

 

[PArescueEMT]

I can say that I am one of the lucky one's in my city. I have been working in private EMS for 5 years as an EMT-B. Out of most of my co-workers, I think that I have among the best working relations with PFD. (Philadelphia Frie Department) I have worked side by side some of the best medics the city has tho generally the city frowns on Private EMS handling 9-1-1 emergent calls, i agree that the training is standard.

In my area, Private EMS get's their "Bread and Butter" from dialysis transports. They are my least favorite type of call but are a fact of EMS life here. In the city, PFD handles most of the interfacility trasnports. The only time they don't is if one of the hospitals has a "Retreval Team" that is willing to transport the patient. I was a driver for Temple University Hospital Transport Team's Specialty Care Unit. They are one of 4 hospitals that have transport teams. Private EMS is around to basically handle SNFs, ALFs, Hospital discharges, and dialysis transports. Having served in a 9-1-1 system i can understand the generalized outlooks here. But they are not fair in all cases that are used. So I'll hand this soap box off to whosoever wants it next and gracefully bow out.

 

[Jon]

Originally posted by PArescueEMT@Sep 10 2004, 12:14 AM

I can say that I am one of the lucky one's in my city. I have been working in private EMS for 5 years as an EMT-B. Out of most of my co-workers, I think that I have among the best working relations with PFD. (Philadelphia Frie Department) I have worked side by side some of the best medics the city has tho generally the city frowns on Private EMS handling 9-1-1 emergent calls, i agree that the training is standard.

In my area, Private EMS get's their "Bread and Butter" from dialysis transports. They are my least favorite type of call but are a fact of EMS life here. In the city, PFD handles most of the interfacility trasnports. The only time they don't is if one of the hospitals has a "Retreval Team" that is willing to transport the patient. I was a driver for Temple University Hospital Transport Team's Specialty Care Unit. They are one of 4 hospitals that have transport teams. Private EMS is around to basically handle SNFs, ALFs, Hospital discharges, and dialysis transports. Having served in a 9-1-1 system i can understand the generalized outlooks here. But they are not fair in all cases that are used. So I'll hand this soap box off to whosoever wants it next and gracefully bow out.

I disagree slightly - PFD don't do hospital to hospital unless they are IN the ED when the patient needs to be transferred out, yesterday. pretty much every hospital has a contract with 1 or more BLS/ALS services.

Other than that, PFD is ok, not great, not bad.

but at least half of the private EMS employees in the city couldn't find their postierior with both hands and a map.


Jon

 

[MassMedic1052]

Hi all! I'm new to the boards. I would just like to say that I am both a Transfer Medic and 9-1-1 medic and truthfully the transfer side of it can be alot more difficult than the 9-1-1. I work for a private here in Massachusetts (No,Not AMR)and on my transfer shifts we go do coverage for towns that their 9-1-1 truck is out on other calls but we also do the hospital to hospital transfers. Alot of these patients are B.S but you do occasionally get those that have like 5 pumps running intubated and all that and it can get nerve racking in doing those calls. Anyways........I have a question Have any of you heard that AMR was recently sold to a Canadian company? I received an e-mail with a newspaper article attached saying that as of 12/28/04 it had been sold

Be safe
MassMedic1052

 

[Margaritaville]

Okay, I just can't let this one go.

Not all of the country works the same way. I am a career Firefighter/Paramedic. I have been career for nearly 10 years and was a volunteer since 1984, so I really am SENIOR.

Not all places have AMR or private companies that contract. We have 2 small private companies that do not do emergent transports. If it goes through 911 it is dispatched as such(just as if the patient needs to go to the ED the crew will call for a 911 unit). The response is by fire department personnel be it BLS or ALS.

In the next county over there are chase units, but the FD must still bring ambulances.

In my department we are Fire/EMS. If there is an ambulance call, my partner and I take the medic unit. If there is a fire call we take the Engine/Tower/Rescue or what ever is needed. We are one entity. Even on the volunteer side, if our guys are out on the road, dispatch will page for volunteers to staff our units. I can't count how many times I have pulled off my fire gear, to do patient care, or put my gear on because we needed someone to go interior/or run the pump panel.

One cannot work without another! Rescue capt, I am glad that you saw a need for cross training. It is not an option, its the way things are today.

I don't care if your the best damn paramedic god in the world - If I need to get a subject out of a burning building - you better daggone well know why I am doing the things that I am, and what to look out for for me and the patient. Just as a FF who thinks of the ambulance as a gut bucket with a bunch of know it alls. Nothing burns me up more than a firefighter that treats EMS like a necessary evil or a an EMS provider that thinks firemen are just there to watch and be treated like pack mules.

In some parts of this country this is all we have, and we are managing with less and less all the time. Thats why most of us are cross/cross trained. No more specializing, at least not in our neck of the woods! That luxury we just don't have.

 

[Jon]

Originally posted by MassMedic1052@Dec 28 2004, 09:47 AM
Hi all! I'm new to the boards. I would just like to say that I am both a Transfer Medic and 9-1-1 medic and truthfully the transfer side of it can be alot more difficult than the 9-1-1. I work for a private here in Massachusetts (No,Not AMR)and on my transfer shifts we go do coverage for towns that their 9-1-1 truck is out on other calls but we also do the hospital to hospital transfers. Alot of these patients are B.S but you do occasionally get those that have like 5 pumps running intubated and all that and it can get nerve racking in doing those calls. Anyways........I have a question Have any of you heard that AMR was recently sold to a Canadian company? I received an e-mail with a newspaper article attached saying that as of 12/28/04 it had been sold

Be safe
MassMedic1052

Amen on Transport ALS being difficult. been there, driven them medics. If the medic is competant, it can be stressful for them. if the medic isn't competant, I end up having to talk them through setting up a pump.

Margaritaville Wrote:
Okay, I just can't let this one go.

Not all of the country works the same way. I am a career Firefighter/Paramedic. I have been career for nearly 10 years and was a volunteer since 1984, so I really am SENIOR.

Not all places have AMR or private companies that contract. We have 2 small private companies that do not do emergent transports. If it goes through 911 it is dispatched as such(just as if the patient needs to go to the ED the crew will call for a 911 unit). The response is by fire department personnel be it BLS or ALS.

In the next county over there are chase units, but the FD must still bring ambulances.

In my department we are Fire/EMS. If there is an ambulance call, my partner and I take the medic unit. If there is a fire call we take the Engine/Tower/Rescue or what ever is needed. We are one entity. Even on the volunteer side, if our guys are out on the road, dispatch will page for volunteers to staff our units. I can't count how many times I have pulled off my fire gear, to do patient care, or put my gear on because we needed someone to go interior/or run the pump panel.

One cannot work without another! Rescue capt, I am glad that you saw a need for cross training. It is not an option, its the way things are today.

I don't care if your the best damn paramedic god in the world - If I need to get a subject out of a burning building - you better daggone well know why I am doing the things that I am, and what to look out for for me and the patient. Just as a FF who thinks of the ambulance as a gut bucket with a bunch of know it alls. Nothing burns me up more than a firefighter that treats EMS like a necessary evil or a an EMS provider that thinks firemen are just there to watch and be treated like pack mules.

In some parts of this country this is all we have, and we are managing with less and less all the time. Thats why most of us are cross/cross trained. No more specializing, at least not in our neck of the woods! That luxury we just don't have.

Crosstraining is important, as is being cross-equipped. If FF's are riding da' Bus, they should have their gear (for MVC's and Fires) and airpaks (for rescue / assistance at fire/hazmat or just a REALLY bad DOA) Also, there should be a GOOD set of BLS gear and an AED on the rescue and at least the first out engine - thats' firefighter safety - if one of your brothers goes down, ANY EMT on the engine should have access to gear that can SAVE them.

My county in PA is all at least part vollie, both fire and EMS, except for a few industrial brigades. some co's have full paid crews on during the day to roll an engine/rescue/tower and an Ambulance, and others only have enough to roll the bus and leave someone for the fire stuff.

some squads are still all vollie, but they are mostly fire side only.

As for for profit transport squads, most places don't play well with others, and if the ALS intercept is transport-capable, they take the patient, if they aren't, then they ride in the transport truck, sometimes.

Jon

 

[MassMedic1052]

Whoaaa....Apparently I missed something. I have no issues with the local Fire Departments for the most part we work side by side with them and they have always been helpful......As for me being a ff'er or a volunteer FF'er I'm all set I have a hard enough time dealing with heat and humidity in the summer let alone going into buildings that are on fire or etc....

Be safe
MassMedic1052

 

[rescuecpt]

Can't we all just get along??? :lol:

 

[MassMedic1052]

AMEN!!!! Like I said I think I missed something ......I was going back and reading some of the posts and I had a little accident..WHOOPS Coffee all over the Dell Laptop now that's a crime.....I think I saved it I am typing on it as we speak so hopefully I did it.........Anways off to the next topic

MassMedic1052

 

[Margaritaville]

Sorry Massmedic,

It was not aimed at you. Careful with that coffee. I just get hot under the collar, when this subject is broached. I hate to see our goals get clouded. We are all in this to help people and let us never forget that.

It certainly isn't for thepaycheck!!

Be safe everyone and Happy New Year

 

[MMiz]

Many great points have been expressed in this post!

One person remarked about private BLS not having great map skills, and that's one thing that I've found to be completely untrue. While I have no sense of direction, every single one of my partners pretty much has our area down and can locate an address within 15-20 seconds.

Personally I'm not sure I believe that FF/EMS should be a single entity. I just read an article showing that FF and EMS have two separate goals with two separate management systems.

EMS is a relatively new and evolving field, we'll see if there are any new trends.

 

[Margaritaville]

Matt,

I agree this is an evolving field, but not new. My service started in 1963. That is over 40 years ago. Some of the 8 gentleman who originally started it are still around and are delighted at the level in which EMS has developed.

Now, I agree it is farm from perfect, but in the last 20 years that I have seen - the growth has been tremendous.

I pray that we will continue to grow as fast in the next 40 years as the last 40. How amazing will that be!! I just hope I am here to see it.

 

[PArescueEMT]

EMS is relativly new when compares to the other emergency services. I understand that 40 years doesn't seem new, but when you look at my old fire Co. (founded in 1896) EMS is new. We do have separate management needs, but I don't think separation is necessary. Understanding of eachothers job, and not having sepatation of the services is needed moreso than adding further separation.

9-11 showed that we in the emergency services can get along, WITHOUT separating. Now, things around my way have almost returned to buisness as usual.

 

[vamedic]

OK, here goes something from a newbie to the forum. I will not take exception at anything that has been said, but I will start wit the fact that I work for AMR. The city I work in relies on us to handle ALL 911 calls for the city, in addition to interfacility transports.
I came to this from the Baltimore city Fire Department, so I have had the pleasure of working in a close knit fire/ems system. I will say this: If private ambulance work is about the money, please believe that it is only so for the administration side of things. When I get a call, whether emergent 911, or non-emergent transport, I treat it the same way. For the person needing us, their situation is the most important thing in the world to them at that moment. We are expected to show that patient that it is the most important thing to US also. The city fire department works with the same values, and are an invaluable "brother service" to us. The bottom line is that it's all about the patient.

 

[PArescueEMT]

Originally posted by vamedic@Jan 6 2005, 04:39 PM
OK, here goes something from a newbie to the forum. I will not take exception at anything that has been said, but I will start wit the fact that I work for AMR. The city I work in relies on us to handle ALL 911 calls for the city, in addition to interfacility transports.
I came to this from the Baltimore city Fire Department, so I have had the pleasure of working in a close knit fire/ems system. I will say this: If private ambulance work is about the money, please believe that it is only so for the administration side of things. When I get a call, whether emergent 911, or non-emergent transport, I treat it the same way. For the person needing us, their situation is the most important thing in the world to them at that moment. We are expected to show that patient that it is the most important thing to US also. The city fire department works with the same values, and are an invaluable "brother service" to us. The bottom line is that it's all about the patient.

I'm sure that nobody here will deny that. I have the same outlook as you do. When I say "private ambulance" we are talking about companies that were started, or kept going by the ability to make a "quick buck." I work for one myself. The owner has stated that it is a great way to make good money.

One company I worked for was really disorganized and the owner sold in a year and a half after making all of his money back, PLUS $500,000 after taxes.

Where I am at, "private ambulances" are not dispatched by a local 9-1-1 center, and are ofter frowned upon for rendering assistance at 9-1-1 calls (i.e. MVC, wittnessed syncopal episode in a public place) unless the 9-1-1 crew knows and trusts the private staff.

I understand where you are coming from, but I can see both sides of the coin.

 

[Jon]

In fact the owner of one local company recived some VERY admiring glances when he pulled up to the ED I was doing -P school clinicals at in his nice corvette convertable to hand out the free pens, lanyards, etc. that the companies give away for advertising. general agreement of ED staff was the we need to start an ambulance company.

Then again, if you underbudget and don't have enough liquid capital, you could easily go under in the first year while waiting for insurance payments.


Jon

 

[DFDEMS]

My biggest problem with "privates" and 911 calls is when the "privates" stretcher fetch for the local FD. Its usually total crap for all involved..

The Fire side usually looks down on "privates" and seems to think they only show up as labor from my past experiences (not from where I currently work for the record). You get a medic on a private rig, he is still a medic, let him work as one. What crap.....

The private medic? He usually gets treated like sh*t, like he's 3 days new so all of the "important" decisions are left to the fire medic.

The patient.. The patient in most cases pays taxes to have a medic on the engine. The engine shows up, the private ambulance shows up end everyone gets a $400.00 ride to the hospital at the patients expense with the fire medic in charge...

I think its a lose/lose for all involved.

the citizen gets jacked twice, the FD always seem to dislike the private unit that shows up. The private unit that shows is usually relegated to labor. Great system....

For some reason I think it should either be the FD transporting or the FD responding with a private as assistance, not head MF in charge. It never seems to work well any other way...

For the record one more time.......This wasnt based on where I work (we dont get an engine or a private). More on where I have worked and done clinicals over the years..

Stay safe