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Make no mistake about it – the decision to privatize all or part of any public safety emergency response system is a political decision driven by several factors, the least of which sometimes is the safety of the public.
That seems like a brash statement, but it really isn’t. For elected officials, making decisions about the safety and well-being of constituents should be first and foremost on their list of priorities, but that is not always the case.
How many times, and for how many years, have fire chiefs and union leaders nationwide warned about the downside of profit-based (private) public safety emergency response services? Their concerns are often met with reactions like “The fire chief is just resistant to change, is not innovative and is trying to protect his/her turf” or “The union is just trying to protect jobs and the security of their union.”
Neither statement is based on fact, and actually they amount to political excuses for trying to blow off the opinions and concerns of the professionals they hire to respond to and manage public safety emergencies. A perfect (and current) case-in-point is the emergency transportation component of the EMS system.
It is widely recognized that an EMS call for service requires notification, dispatch, response, extrication (where necessary), triage, treatment and transportation. This is a continuum of steps that must be taken to successfully provide critical emergency services to people who call 9-1-1.
Have you ever wondered why that last step (the ambulance ride) is the step in the continuum that is most frequently singled out for privatization? It’s not complicated – there’s money in it, and the people who own private ambulance companies tend to financially support local elected officials, which can affect their votes. If there wasn’t money in it, private companies would not be vying for ambulance contracts within government jurisdictions.
Fire chiefs and union officials have often cautioned government officials that the privatization of emergency services can result in diminished service quality and prolonged response times. They have also made clear their concern that if, for any reason, the private ambulance company suddenly decides to close, the safety of the public would be jeopardized.
In some locations, policy-makers listened and kept the entire EMS response system fire service-based. Elsewhere, the concerns fell on deaf ears and fire chiefs and union officials were accused of exaggerating potential negative effects. However, something has happened yet again that should get the attention of elected and appointed officials – but will it?
In December 2013, First Med EMS, which operated under the names of TransMed, Life Ambulance and MedCorp, ceased operations. This company serviced more than 70 municipalities in Kentucky, North Carolina, South Carolina, Virginia, West Virginia and Ohio. The shutdown occurred without notice, leaving public officials – with the exception of the fire chief – shocked that this could happen.
Even though the officials acted surprised, they must have known that this was not the first time such an event has happened. Private companies providing fire suppression and EMS have gone under in many places, each time without warning. Of course, there is no warning, because the company does not want its creditors or contractors to know of the plans to fold for fear they might intervene.
“How could this happen?”
Fire chiefs and union officials have had to react immediately to this loss of service, while the policymakers act stunned and appalled at these “totally unforeseen circumstances” that have put their constituents at risk. “How could the fire chief have let this happen?” they ask.
This is an opportunity for fire service leaders to re-inform and re-educate their policymakers about the perils of private-sector public safety emergency response services. In doing so, the advantages of fire service-based EMS systems can be put on full display as well.
It’s not about turf or jobs; it’s about the safety of the public. To some extent, the issue boils down to a simple matter of corporate mentality and the impact it has on employees and the services they provide. In a fire chief’s world, when crews return from EMS calls, the chief wants to know (first and foremost) if the patient lived, while in the profit-based world the executives tend to be focused on whether the patient paid. Did he live or did he pay?
It’s such a mentality that is prevalent at the very top of the system that creates big differences in organizational culture and the quality of service. The fire department clearly comes out on top every time in that comparison.
Risk of failure
In this new year of 2014, fire service leaders should make an enhanced effort to bring the situation involving First Med EMS to light in their local political arena. Elected officials deserve to be well informed of these types of system failures and the real potential of their decisions concerning whether to privatize emergency response services.
For those who have built fully fire service-based EMS systems, be sure the policymakers know the wisdom of their decisions. And for them, as well as those who chose instead to enter into private-sector contracts for service, remind them of the many times when private-sector fire and EMS response systems have closed shop, leaving communities to scramble to protect the public.
As I said previously, this could be a real opportunity for those in the fire service directly impacted by this issue – if they choose to take advantage of it. n
Dennis Compton presents “If You’re an Officer, Be a Leader” and “Critical Fire Department Challenges Can Have Political Solutions: What Are They?” and moderates the “Chiefs Panel” at Firehouse World 2014.