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There are two components to this question. First, should the fire department be providing first-responder medical services? Second, should the fire department be providing transport medical services?
The heart of the policy issue for fire-based EMS is threefold and based on desire: What level of pre-hospital medical care does the community desire? Does the community desire to have the fire department provide some component of its pre-hospital medical care? And, does the community desire to pay for some form of government-provided pre-hospital medical care?
The issue is best addressed by assessing the current system. What is working? What is broken? Across the country, the pre-hospital delivery of health care is shifting toward cost efficiency in today’s economic climate; cities may be unwilling to pay more for services that are currently provided by a private entity. Financial investment comparisons, conducted through efficiency studies, reveal economies of scale associated with employee cost and utilization, vehicle purchasing, medical equipment, supplies and communications.
If we look at how private-sector businesses operate – i.e., remain competitive in the market – we find that reductions in goods and services often result in the private side examining its business model and finding more efficient ways to compete for customers. This may be by reducing payrolls, eliminating staff, changing product lines and collaborating with fellow businesses.
Difficult economic times are driving local governments to re-examine services offered and to what degree those services are provided. As stated previously in this series, our customers are very conscious of government spending and often critical of new endeavors. This is not to say that progressive organizations should not examine their business to reveal efficiencies and perhaps take on new programs. That progressiveness, however, must be balanced with the reality of the “new normal.” Is the timing right for new initiatives when the taxpayer is looking for less government?
Are there opportunities for improvement? The evaluation of an EMS system’s efficiency and effectiveness may best be conducted by an independent third-party. (Note: The authors are not seeking business opportunities with this recommendation, as they do not conduct such EMS system evaluations). City leaders should carefully assess the data collected in any study of efficiency and effectiveness. Most cities are interested in curbing future expenditures. The bottom line may be based on cost and not who is best to treat the patient; it is about conserving money and capitalizing on efficiencies of service.
An independent evaluation by a reputable firm ensures that no special interest influences the findings. Before embarking on an endeavor that can result in the creation of an EMS system that is worse than the one currently in place, it makes sense to determine whether anything is wrong with the current system. No system is perfect; there are always opportunities for improvement. Even if the evaluation determines the current system is functional, it is likely to also reveal opportunities to make changes.
There are distinct advantages and disadvantages for fire-based EMS systems, whether at the first-responder or transport level of service. Arguments can be made for and against the fire department providing medical services. Here are some items for consideration, with full acknowledgment that determining whether some of them can be viewed as assets or liabilities will depend on local circumstances and which side of the fire-based EMS issue a person lines up on:
• Management. A true business model and plan are required to successfully manage an EMS-delivery system. Most fire departments lack this business model background and experience. It is essential that senior leadership acknowledge the need for a “business mind” and select a leader to manage that aspect of the department.