Introduction
The Emergency medical services (EMS) is defined as a network of people, procedures, and equipment which respond to medical emergencies that occur in the community with transportation (if necessary) to a medical facility or pre-hospital services. The Emergency Medical Services once comprised of first-aid provided by fire departments, hospital-based ambulances, and local funeral homes. The benefits associated with higher levels of on-scene emergency treatment at the level of paramedics was demonstrated during the Vietnam War. A study conducted by the National Research Council reinforced these conclusions resulting in the 1996 National Highway Safety Act, through which funds were provided for communication, training, and ambulances. There were many private ambulance firms formed as a way of appropriately addressing the proliferating emergency transport market.
Poor system design by the 1970s resulted in private companies having a reputation for inconsistent quality. The Municipalities were aided in becoming the dominant Emergency Medical service providers by the 1973 and 1976 Federal Emergency Medical Services Acts. However, the federal funds soon dried up, and fiscal stress was experienced by many cities; consequently, a significant Emergency Medical Services was played by the Private Sector. With the emergence of many national firms having high levels of technical sophistication, the private ambulance industry experienced significant consolidation. Basically, there are two types of emergency ambulance capabilities. This includes Basic Life Support (BLS) which refers to the provision of first aid (including cardiopulmonary resuscitation), defibrillation, oxygen, and transportation. There is also Advanced Life Support (ALS) that involves the provision of fully-fledged paramedical care such as advanced airway technique, intravenous technique and administering drugs. This assignment examines the differences between the Public and Private Emergency Services and how they can influence decisions pertaining their services.
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Public Emergency Medical Services
According to Elite Ambulance, public ambulances services, receive support through both the tax revenue and user fees. The Public Ambulance Services are funded by the taxpayers, for instance, those that are provided by fire departments, regardless of whether the services are used or not(Kim & Lee, 2012). The paramedics working in the public ambulance services according to the Bureau of Labor Statistics are paid 17.36 U.S dollars as the mean hourly wage and 36,110 dollars as the mean annual wage. The transport mileage, type of care that is given to a patient and the agency determine the cost of the public ambulance services.
The Fire and Emergency Medical Services in D.C for example, charges, 428 dollars for Basic Life Support (BLS), that includes vital signs monitoring and basic or minimal treatment, 508 dollars for Advanced Life Support (ALS) for patients. The D.C Emergency Medical Service also charges 735 dollars ALS-2 transport that includes Cardio-pulmonary Resuscitation, Breathing Tube, multiple medications and other advanced life support (Suter, 2012). A common publicly operated model is the Emergency Medical Service system that is directly managed by the municipality that it services. The local government, regional or state government may also provide these services.
Services operated by the municipality may be funded through service fees and supplemented by the use of property taxes. The Emergency Medical Service system in such cases is regarded as too small to be independently operated. Therefore it is organized as another municipal department branch, including the Public Health Department. Such service may not operate in small communities with small population and tax-base unless it has community volunteers (Kim & Lee, 2012). In such instances, the municipal funds may serve as a source of funding for the volunteer squad. However, it relies on volunteer donations to the expenses associated with the operations. The equipment, vehicle, as well as standards of training, must be adhered to hence providing a significant challenge for the volunteer groups since it carries out most of its own fundraising(Suter, 2012). In case the volunteers are not available, America's small communities may not have access to the Emergency Medical Services and may seek services from distance communities. The ‘third service’ option is the other operating model for the Emergency Medical Services that are publicly operated.
The Public Emergency medical Service agencies can also receive considerable funding from Federal and State programs. The Federal grant usually flows through the state to the local level. The funding for emergency medical services by being directly provided by the state. Most state EMS bureaus and Fire Marshal’s offices provide subsidized training programs to the first responders in addition to offering technical assistance to the local agencies (Wang et al., 2013). Volunteer emergency medical services can raise funds to improve service delivery and capital purchases through the funds donated annually by corporate-giving programs and private foundations.
Some fire departments and emergency medical services create separate non-profit organizations that accept donations for the local causes connected to their mission. Examples of such private sector sources of giving include corporate giving whereby the public safety agencies solicit services and grants from the national corporations (Kim & Lee, 2012). Corporate donations come in the form of in-kind contributions, donations, and executive loan programs. Also useful are the program-related investments that may be a source of zero-interest or low-interest loans especially for projects aimed at capital improvement. Lastly, there are foundations that provide a source of revenue through management assistance grants, equipment grants, seed money, planning grants and support grants.
This service is organized into free-standing, separate municipal department, consisting of organization which may have similar characteristics with police or fire departments, however, it is operated independently. The Emergency Medical Service system in a variant of this model may be considered a legitimate third emergency service, but governed by a contractual agreement with a private hospital, company or another organization (Wang et al., 2013). This model at times is called the ‘public utility' model. It is a measure aimed at saving the cost, or it may be due to the community feeling that they do not have the resident expertise required in dealing with issues involving medical oversight and control, and also the legal requirements associated with Emergency Medical Service.
The Medical Emergency Service system may be integrated into another municipal emergency operations in yet another model. Such operations include the police department and the fire department. The integration can be partial, where administrative services, control and command, and even quarters may be shared by the Emergency Medical Service staff (Wang et al., 2013). In instances where there is full integration, the Emergency Medical Service Staff may undergo full cross-training to carry out the entry-level function of a different emergency service, whether policing or firefighting. Since the municipal workers perform many functions and are not idle, a majority of the communities view this as adding value to the community.
Private Emergency Medical Service
Some cities are involved in contracting all the functions that require the provision of emergency medical services to the private companies. This is considered by many as the second most popular choice. The ambulance services to communities are provided by a number of large nationwide companies. The state of Louisiana, for instance, came up with great statewide service that serves communities and rural areas (Suter, 2012). Hundreds or even thousands of people are employed by this company. Some fire departments may respond to medical on medical calls by using their fire apparatus.
Emergency Medical Services that respond that respond to the emergency calls to 911 are the most popular United States ambulances. Hundreds of Emergency Medical Services that answer the many emergency calls are available (Wang et al., 2013). Private companies also operate other ambulances that provide services that the one offered by the 911 Emergency Medical Services. Patients are taken to any hospital that they choose by the private ambulances, as opposed to the city ambulance where they are brought to the nearest hospital that is within a radius of ten minutes from their pick-up location. All hospitals should accept walk-in patients from both private and public ambulances.
It is a requirement that private ambulances have appropriately trained personnel to provide emergency medical services. Besides, medical equipment, as well as at least one emergency medical technician, must be on board the vehicle (Suter, 2012). The Health Department regulates the private services in contrast to the volunteer ambulances serving both urban and rural areas that are not controlled by the government agency.
The private ambulances, as mentioned above, take the place of Emergency Medical Services in instances where a specific hospital is required by the patient or when the case is not really considered an emergency (Kim & Lee, 2012). There are many other ways in which the private ambulances are useful. For instance, the patient may request the private ambulance to take him or her to a distant hospital where the doctor of the patient is situated. Patients in need of comfort while traveling to a treatment center, clinics or doctor's office can also contact the private ambulance. This is because they have the necessary convenience, space, and medical assistants ready to offer the attention and care in accordance with the needs of the patient.
The patients are picked up by the private ambulances from the health centers where they are discharged to bring them home. They are also involved in the transport of patients to and from the nursing homes. Private ambulances are able to provide services outside of the city. Some companies may require on-call ambulances for the employees particularly in instances where events are held outside the offices (Suter, 2012). Celebrations and significant events having many guests can also hire private ambulances just in case of emergencies since they can function well for this purpose. Private services comprise of basic equipment essential for basic life support. It also has paramedics, emergency medical technicians, and a driver who is specially trained to offer transport to patients that require urgent attention. Besides, they have wheelchairs, ambulates and other equipment used in supporting patients who cannot walk.
The Cost of Private Ambulance Services
There is no regulation with regards to ambulances from a private company. The fee structure of the private services typically consists of charges for mileage, weekend and night charges, the base rate and others. The bill may also be dependent on the category. For instance, the rate can be 400 dollars plus 6.50 dollars per additional mile rate for Basic Life Support (nonemergency or emergency). Advance Life Support Level 1 at 450 dollars plus 6.50 dollars per mile rate may also be included in other categories. Under the same category, an Advanced Life Support Level 2 rate may be 875 dollars plus 6.50 dollars per mile rate. A rate of 450 dollars plus 6.50 per mile rate may be charged for Specialty Care Transport. A person can reach the private ambulance services through their specific phone and office numbers (Kim & Lee, 2012). The private services are not reached through a single number, a particular private service may, however, be recommended by some physicians. In short, the private ambulance services are only involved in the provision of non-emergency services.
Differences Between Private and Public Emergency Services
The Public operated Emergency medical services are known to respond to all calls made to 911. Each year, around one million emergency calls are made. On the contrary, the Private ambulance companies provide services that go beyond the ones offered by the Emergency Medical Services. Reaching the Private services does not involve dialing 911, as is the case with ordinary public ambulance services (Wang et al., 2013). Instead, the primary purpose of the Private ambulance services is transferring and transporting patients to special health care facilities, nursing home, hospitals, or to and from their homes. Also, they are only useful as back-up to the public ambulance services in responding to the emergency calls.
Of importance to note is that private ambulance services are owned and operated by a handful of hospitals. Another big difference observed is that local city ambulance takes their patients to a hospital that are near and within the range of 10 minutes. Private ambulance services, on the other hand, take place to any hospital of their choice. It is a requirement that all hospitals take all the emergency patients from both private and public ambulance services, whether the admissions are prearranged or not. In contrast to the public ambulance services, the private ambulance services require that their personnel undergo an emergency medical training (Suter, 2012). The private services also have certain types of medical equipment and a minimum of one emergency medical technician. This difference is noted in New York for instance, when a person who needs to report a medical emergency dials 911. The call is transferred by the police operators to the Emergency Medical Services headquarters, where the call is assessed by a medically trained operator, who then brings it to the dispatcher that makes contact with the nearest ambulance. Either an ambulance having advanced life support with paramedics or that comprising of basic life support will be sent to the scene, depending on the situation.
Public services in contrast to the private ambulance services are free to deal with only emergencies where time is the essence. The private services respond to non-urgent situations including a call that request a person to be transferred to a nursing home or a different hospital. Whenever a person dials 911, he or she is brought to the nearest hospital (Suter, 2012). However, the city will not be responsible for transferring the patient in case the doctor is affiliated with a different hospital. The patient has to work with the doctor for the private ambulance to him or her up. The private ambulances are also involved in transporting discharged outpatients to their homes or nursing homes.
The patient can also be transported by the private services to the outside of the city, and this is not allowed for private ambulance services. The other services offered by the private ambulance services and not offered by the public services include hiring by large corporations for events to have emergency medical services on site for the employees. In contrast to the public emergency medical services, only a few private ambulance services have the paramedics on board. The majority have technicians trained in splinting, first aid, child delivery, cardiopulmonary resuscitation and extricating victims from accidents (Suter, 2012). The private ambulance services, in comparison with public emergency medical services, have lower rates of pay. The cost of the private services depends on the Basic Life Support (BLS). Advanced Life Support care provided, the type of transport whether emergency or non-emergency and the total distance traveled. Regarding funding, the public emergency medical services have been receiving part of the municipal budget, while the private companies usually bill for their services.
The difference in the private and public emergency services is associated with controversies. Private ambulance firms are alarmed at what is regarded as a nationwide movement by public departments to take over some or all paramedic services. The public operated services appear to eat into their hard-won businesses (Wang et al., 2013). The public operated Emergency Medical services often view the paramedic services as a logical extension of their mission for public safety. This is mainly observed because there is a downward trend in fire incidents and therefore less traditional activity is left to justify the investment of the community in equipment, stations, and firefighters. Only 13 % of about 15.3 million calls in 1993 was accounted for by fires while 57% was about a request for assistance in medical services.
Private ambulance companies, on the other hand, view emergency medical services as changing into an extension of the of the medical care, particularly the trend today towards managed care(Bigham et al., 2012). These companies cite the growth of programs involving ‘treat and release’ in many states. Also noted by the services is the desire for managed –care systems such as HMOs to have the patient delivered by the ambulance directly to his or her own hospital, which cannot generally be done by the fire departments (Suter, 2012). Money is involved on both sides of the argument. Third-party insurers such as Medicare, Medicaid, and private insurance companies all will reimburse patients for bills for the paramedic calls requiring transport.
The fire departments which treat but do not engage in transporting objects to the private ambulance firm alone receiving reimbursement, while their own costs must be obtained from taxpayers. Thus, there is an argument for fire departments to start carrying out the whole job to receive reimbursement payments (Wang et al., 2013). The same set of facts are used by the used by ambulance companies that treatment and transport should both be performed by the private sector, for the taxpayers to be saved the costs that should be borne by the third party players. Charges and counter-charges are made with regards to quality of service, cost and response time.
Also, there is often the addition of ideological arguments, with some people of the opinion that the paramedic service like police and fire, is inherently a public service function, and is therefore not right for private firms to be making money while saving lives. Some express opposing views that fire departments funded by the tax have no business engaging in private sector business which the ambulance companies can perform very well, at little or no cost to the taxpayer (Doyle, Graves & Gruber, 2017). Given the complexity of Emergency Medical Services and the conflicting arguments, boards of supervisors and city councils are usually confused and may not know how to provide the emergency medical services best.
In my opinion, the private emergency medical services are better prepared in offering the emergency medical services because they have the well-trained personnel and the necessary equipment. They are also well organized and can provide a wide range of services that cannot be offered by the public emergency medical area. The government should consider investing more in the private companies and offer the necessary support to improve the services.
Conclusion
In the healthcare sector, the provision of cost-effective and high-quality services is no longer considered mutually exclusive. United States Emergency Medical Services are at a crucial juncture as prompt, effective response are continued to be demanded by the public hence leading to the straining of the municipal budgets and decrease in ambulance reimbursement. The Emergency Medical Services systems should come up with innovative ways that adopt the patient-centered and evidence-based approach. The government should consider investing in the private ambulance services to improve the response and quality of services of both emergency and non-emergency medical services.
References
Bigham, B. L., Buick, J. E., Brooks, S. C., Morrison, M., Shojania, K. G., & Morrison, L. J. (2012). Patient safety in emergency medical services: a systematic review of the literature. Prehospital Emergency Care , 16 (1), 20-35.
Doyle Jr, J. J., Graves, J. A., & Gruber, J. (2017). Uncovering waste in US healthcare: Evidence from ambulance referral patterns. Journal of health economics , 54 , 25-39.
Kim, M. S., & Lee, K. Y. (2012). The job satisfaction and turnover intention of emergency medical technician in the private ambulance service. The Korean Journal of Emergency Medical Services , 16 (1), 65-80.
Suter, R. E. (2012). Emergency medicine in the United States: a systemic review. World journal of emergency medicine , 3 (1), 5.
Wang, H. E., Mann, N. C., Jacobson, K. E., Mears, G., Smyrski, K., & Yealy, D. M. (2013). National characteristics of emergency medical services responses in the United States. Prehospital emergency care , 17 (1), 8-14.
