Providing EMS: Everyone Wants A Piece Of The Action

Tension between the fire-rescue service and the private ambulance industry has escalated to a new level of anger and mistrust. It's part of a long-running, bitter battle over who is going to be the major provider of emergency medical care - municipal fire departments or private ambulance companies? The stakes are enormous, involving the future of this country's fire-rescue service and the pre-hospital emergency care field, which is a business worth an estimated $10 billion per year.

In this latest skirmish, fire leaders accuse the private ambulance operators of planning a smear campaign to discredit the fire service and the performance of firefighters on EMS calls. Their goal is to achieve the privatization of emergency medical services and the huge profits it would bring to the ambulance companies. According to an industry spokesman, this plan was the brainstorm of a few individuals and rejected by a majority of private ambulance operators.

The plot was reported by Gary Ludwig, chief paramedic for the St. Louis Fire Department and an executive board member of the EMS section of the International Association of Fire Chiefs (IAFC). In last month's issue of the IAFC's On Scene newsletter, Ludwig revealed that he had received a confidential document prepared by a group of private ambulance operators, in which they proposed a nationwide attack on the fire service for failing to provide adequate emergency medical care. It called for spending $250,000 on a public relations campaign aimed at convincing the news media, elected officials and taxpayers that their communities would be better served if private ambulance companies took over emergency medical services.

This would produce lucrative EMS contracts and fees for the ambulance operators. Specifically, their strategy was to highlight case histories in cities where fire department ambulances had failed to respond or had unacceptable response times and a generally low standard of service. They also intended to undermine the favorable public perception of firefighters and blame the International Association of Fire Fighters (IAFF) for being the major obstacle to more efficient and less costly emergency medical services. The union was to be branded as a selfish organization whose only interest is preserving jobs and creating new positions for paid firefighters.

Ludwig shared his information with the union and it brought a strong response from IAFF President Alfred K. Whitehead. "The for-profit ambulance operators want to break down the image of firefighters as America's heroes," Whitehead wrote in the IAFF's monthly newspaper. He warned his members to be alert for any mistake that might be exploited by the private ambulance industry to "weaken our position as the largest providers of pre-hospital EMS."

There are many EMS configurations across the country, ranging from cities where the fire department does all of the pre-hospital emergency care - including ambulance transport - to those where the public and private sectors share responsibility, and some where EMS is mainly in the hands of private ambulances. According to Ludwig, 45% of the nation's pre-hospital EMS care is provided by career fire departments, another 17% by volunteer fire departments and rescue squads, and 9% by a "third service," in which ambulances are operated by hospitals or municipal health departments. That leaves about 30% for the private ambulance companies. "The fire service dominates a $10 billion a year industry," Ludwig points out, "...we are the safety net for our communities and that's what the private ambulance operators are going after."

Trace Skeen, president of the American Ambulance Association and chief executive officer of a private ambulance company in Portland, OR, insists that the controversial document was a "preliminary memo" drawn up by a small group of operators and never seriously considered by the ambulance industry. "It was rejected; it is not the direction we want to go," Skeen told Firehouse. In his view, the fire service is giving the document "a lot more credibility than it ever deserved."

While denying that there is an organized effort to discredit firefighters, Skeen concedes that it's "no love fest" between the ambulance industry and the fire service. "Some fire departments and some ambulance operators have gone to extremes to emphasize the weakness of the other," Skeen says. He cites jurisdictions where they cooperate, with fire departments providing first-responder coverage and private ambulances transporting patients to hospitals. "It's a public policy decision as to who does what," Skeen explains. "...the private ambulance industry would like to see some type of competitive process to look at all the issues...More progressive leaders are trying to find solutions. We're not enemies."

The working relationship between fire departments and private ambulance operators varies greatly across the country. But this latest flap is another round in an on-going battle that will continue to heat up as more fire departments expand their emergency medical operations beyond the first-responder system. The private ambulance industry is determined to gain a bigger share of a growing market and, even if the anti-firefighter campaign doesn't materialize, there is an obvious warning to the fire-rescue service: if you're going to run ambulances, make sure you have the resources, training and staffing to do it right.

Hal Bruno, a Firehouse® contributing editor, is a political analyst with ABC News in Washington and served many years as a volunteer firefighter.