20 Tough Questions For the Fire Chief: Are You Prepared To Answer Them? Question 15

This question is a continuation of last month’s discussion about fire-based EMS. While it is widely considered a best practice by efficiency consultants to benchmark and compare your organization to others, this question implies, ironically, that such a...


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A vital (and sometimes overlooked) factor in determining whether a fire department should enter the EMS transportation business, or be providing EMS of any form for that matter, is whether the existing fire department personnel are capable of providing EMS. While it may be a logical extension of the mission, it should not be assumed that individuals who signed-on to be firefighters will be quality medical providers.

A top-notch firefighter who faints at the sight of blood or who suffers from trypanophobia (a fear of medical procedures and/or hypodermic needles) may not be suited to serve as an EMT or paramedic. Involving the membership in the EMS transportation decision process is vital and you need to determine, in advance, how to get members on board and, equally important, how you will resolve the issue of those who cannot or who do not want to support EMS transportation. As the employer, you may have the legal and contractual right to determine the scope of services, but involving the members in the process of changing the scope is critical to the success of implementing EMS transportation services.

Financial factors

As communities experience the financial strains of a changed economy, the natural course of action is to look for ways to reduce costs or to enhance revenues. One way revenue can be enhanced is through EMS transportation. However, according to the White House website (http://www.whitehouse.gov/our-government/state-and-local-government), revenue generation should never be the primary function of a government-provided service (excluding the Internal Revenue Service).

The website also says the function of a municipality is to “…generally take responsibility for parks and recreation services, police and fire departments, housing services, emergency medical services, municipal courts, transportation services (including public transportation) and public works (streets, sewers, snow removal, signage, and so forth).”

Local governments can charge fees for services so long as state law does not prohibit them from doing so. While taxation has long been the primary source of revenue for most municipalities, many charge fees for services ranging from building permits and inspections to CPR classes and recreational programs and more.

“A fee charged by government is just another form of taxation,” a resident once exclaimed during a public meeting I was attending where the elected officials were debating whether to start billing for what had previously been free EMS services (that included transportation). The lure to start EMS transportation for the benefit of revenue generation can be strong. However, healthcare reform, including changes in Medicare and Medicaid laws, has reportedly made reimbursement more challenging than ever.

The problem with predicting future revenue from EMS transportation in the future of healthcare remains very unpredictable. This means the solid financial projections generated today could quickly change and EMS transportation could become a financial burden on the community in the future. It would be unfair for elected officials to hold fire department administrators accountable when changes in healthcare impact EMS transportation revenues. But we all know that is a real threat. One way to reduce the possibility of being caught off-guard is to create three sets of financial projections based on best-case, most likely and worst-case scenarios.

Cost of entry

There is a cost for entering the EMS transportation business. The first, and perhaps most obvious, cost is the need to have vehicles to transport patients. Those vehicles must also be provisioned with medical equipment and supplies. Add the cost of maintenance, fuel and insurance.

EMS transportation will also require trained personnel to staff the ambulances. This will most certainly require the addition of personnel to avoid the creation of a dangerous depletion of firefighting resources to staff ambulances. EMS transport personnel also require training and ongoing continuing education to ensure skills remain sharp. Some of the training and continuing education may be done on shift, but some classes are so extensive that attendance may have to be done off shift and require paying overtime. This is a financial consideration that should not be taken lightly as labor costs are the single largest expense in an EMS transportation system.

System demand & system abuse