Recognizing our emergency medical technicians during this National EMS Week gives the Rio Grande Valley an opportunity to review delivery options for this piece of critical emergency services to our residents.
Nationally, not all programs are housed in public fire departments. There are more than two dozen EMS delivery options from purely public or private operations; regional or local service areas; volunteer or professional EMTs; or combinations thereof. Which one, or ones, are best for Valley cities?
Like any rational consumers, we want the best service at the lowest cost. So is this best done by the public or private sector? Both are capable.
In Texas, most metro areas have public-based EMS, but the Valley tends to rely on private providers. It really is a local decision based on a city’s immediate needs and priorities, rather than relative philosophical merits of capitalism or socialism. So what factors drive the public-versus-private decision matrix?
Costs can be a major barrier to entry for any city. Purchasing the best ambulance, a mobile intensive care unit, costs approximately $170,000. Then there are supplies, salaries, insurance and other operational expenses.
A private company provides a turn-key option, often at no cost to a city. However, a city’s startup and operational costs can be offset by several revenue streams such as Medicare, Medicaid, insurance and private pay. These revenues tend to yield a net surplus for fire departments.
The bottom line is that if there were no profit in the EMS business (aka surplus in the public sector), the private sector would not be in this business.
The complexity of fire department-based EMS also is daunting. Financing vehicles, equipment and supplies; hiring EMTs, contracting with supervising physicians, billing companies, collection services, obtaining federal and state certification and coordinating these will send any fire chief running for a handful of non-steroidal anti-inflammatory drugs — stat. Private companies take this headache away from fire departments and elected and appointed officials. Yet, like anything worthwhile, vale la pena.
What about community size and sustainability? Fire-based EMS are now operating in smaller communities such as Alton, Mercedes and Palmview. In fact, no community should be too small to have a public EMS program since market failures are the raison d’être for government involvement. Hidalgo County has an emergency service district for this very reason, and Starr County Memorial Hospital operates its own fleet of rural ambulances.
What of control and accountability? Fire-based EMS programs are under the direct control of your fire chief, city manager and city council. There is no middleman between the patient and the EMS provider. Information is shared, problems are resolved directly.
Finally, there is service. Fire-based EMS programs in the Valley tend to use the highest trained professionals (paramedics) and operate the best equipment (MICUs). That matters when people need life-saving services.
Yet, we also need to become better-informed consumers of health care. Before we dial 911 we should know if our ambulance is public or private. Is it staffed with the highest-trained professionals (paramedics), with the best equipment (MICU)? What are average response times? How are issues resolved, with the city or the ambulance company?
The first link in the emergency response process begins with the consumer. Let’s learn and take charge.