There are multiple service-delivery models employed all across the United States. Depending on the area or territory served, government structure, political climate and available funding, each model alternative has its place.
Some areas have contracted services, others have county EMS-only agencies and still others have a fire-based EMS system. There are pros and cons for each system; lengthy, valid arguments and discussions can be had for each side. The result is that leaders and managers need to adopt systems that are the best fit for the communities they serve.
A fire-based EMS system can significantly benefit a community and reduce expenses if properly implemented. Contracted EMS services can provide superior levels of service and care; however, a frequent review/rebid process may result in a provider change every couple of years.
A hospital-based system can provide exceptional care, but may be limited in available resources, response areas, transport destinations, etc.
When deciding on which system to employ for your area, performance metrics are arguably the best tool.
The data and the response information to determine your agency’s performance metrics are typically available from your jurisdiction’s dispatch center, along with a GIS coordinator or a knowledgeable record-keeper within your organization. Standards such as those outlined by the NFPA should be looked into and appropriately applied.
Many agencies use metrics that consider turn-out times, response or travel times, unit-hour utilization, return of spontaneous circulation, transport times and various others. These performance metrics eliminate the bias that can exist when evaluating which system works best for you. The numbers will speak for themselves.
Regardless of which system model you use, it’s important to compare apples to apples, ensuring your community is getting the best bang for its buck.
Safer building materials and practices, sprinkler initiatives and fire-prevention measures have significantly reduced the number of structure fires, and fire calls in general. This has resulted in significant fire-department budget cuts, layoffs and even closures.
Meanwhile, population is increasing, people are living longer lives and affordable healthcare is more difficult to access. As a result, EMS calls have increased tremendously and will continue to do so, necessitating the provision of prehospital care and transport. One way we can protect the jobs of firefighters, both career and volunteer, is by expanding the role of the fire department in providing EMS services.
Fire-based EMS systems afford for employees to be cross-trained (working in both fire and EMS positions), operate out of existing fire stations and provide a revenue stream for their governing body/agency.
Rotating employees between fire and EMS units allows for reduced stress load and a chance to diversify skills and abilities. Employees are no longer stuck in one position for years on end, but can rotate between job types and riding positions. This tends to improve morale, improve job performance and reduce protocol errors.
Using a fire-based EMS system and running ambulances out of fire stations can help reduce costly start-up expenses, using facilities that are already strategically placed throughout a community. This allows a governing body to eliminate construction costs of new stand-alone facilities, furnishing and outfit costs, and multiple utility bills.
Another advantage is that the governing body or agency can bill for services rendered. Many government agencies will use their finance department to handle billing and collections while others find it beneficial to outsource this service. Regardless of your choice, EMS billing is another revenue stream to help offset the costs of providing an EMS service.
It doesn’t matter which system, governing body or agency you work or volunteer for. Using performance metrics, coupled with funding alternatives, will yield the best result.
The majority of agencies across the United States are fire-based EMS systems, though this doesn’t mean this is necessarily the best system for your community. As leaders in the world of emergency services, we must take the time to use our data, along with available funds, area served and expected performance levels, to ensure we’re providing the best level of care possible to our communities.