Editorial: Fire vs. Private EMS

As the title implies, we have come to accept that there is competition between Fire Based EMS and the private sector providers of EMS. The implication here is that we will have a winner and a loser in this competition. While in many cases competition can be beneficial, we all must be concerned that the patient is not one of the losers in this race to see who "owns" EMS.

Now that I have your attention, allow me to bring focus to one troubling aspect of this competition, and it is, who "owns" patient care? I have heard both sides of this issue for some time, and much of the rhetoric has been unprofessional and disrespectful. I have been in the business for more than 4 decades and feel more than qualified to offer an opinion. But before I do offer my opinion let's review some facts.

The majority of calls for emergency service, excluding law enforcement received at our nation's 911 call centers are for medical emergencies. In many cases these calls will represent 70 to 80% of all calls for service. It is also a fact that the number of calls for EMS services are rising while calls for fire related services are in decline. One last factoid to frame our discussion, because of deployment and coverage by our nation's fire service, fire departments have demonstrated that they are in the best position to rapidly respond to a citizen in need of EMS services. In fact, EMS 1st response in 99% of the nation's communities is provided by the fire service.*

It is also a fact that hospital systems across the country rely on the private sector to transfer patients within their system for diagnoses, treatment and care. Those same private sector firms provide both BLS and ALS transport in many communities. The private sector relies on existing non emergent contracts to provide the necessary transports so that emergent services can be provided in many communities, simple economies of scale.

Without question there is the common practice of fire and private medics both attending to the care, treatment and transport of patients. Fact is, fire and private medics working together is going to occur, the question is, how well are we managing this care and does this "competition" in the street add to or detract from quality patient care?

We can also all agree that providing EMS services from time of call until that person in need is provided definitive treatment and care is a complex set of necessary tasks with the requisite funding that must be provided to operate the system. Once the call is initiated the chain of care from the call taker, through dispatch of the appropriate apparatus, equipment and trained personnel, scene stabilization, patient triage, treatment and care, and of course transport to the appropriate emergency department must be managed and paid for.

Add to this complex set of requirements the number of individuals and agencies with the requisite authorities and responsibilities to manage these local EMS systems; it is easy to see that EMS in the United States is a marvelous and complex network. What makes this entire system work or not work as well as it might are you and I, the selected individuals who are all the caregivers in this system.

So let me ask the provocative question: why then is there a continuing argument between individuals in the system and between the leadership within the EMS systems regarding who should be providing this service? And perhaps more troubling question embedded within this argument is the question of who is better.

The answer is quite simple actually. The best service is provided by the medic, either fire or private with the attitude, training and skills to provide the best patient care. It does not matter what uniform that medic wears, which is the silliest of arguments. Over the years I have seen the best of individuals in both systems and would vigorously defend both.