In the fire service, the career versus volunteer battle is a never-ending debate.
And, in a similar vein, the discussion of private versus public ambulance services is often met with animosity.
In Costa Mesa, Calif., city officials voted against a public-private model, stating that they wanted to maintain the city’s current ambulance transportation service. The plan would have assigned ambulance transport to the fire department for patients with serious injuries, and to a private company for non-life threatening cases.
D.C. Fire and EMS introduced a similar plan, which passed unanimously among city council members. The plan allows private companies to handle low-level transports, while D.C. Fire and EMS ambulances handle more emergent cases.
Putting aside any pro-public or pro-private arguments, here’s a breakdown of the differences between private and public ambulance services.
Ambulance service systems in the U.S.
According to the National Association of Emergency Medical Technicians, the breakdown of ambulance service systems in the U.S. includes:
- Fire department with cross-trained EMS personnel: 40%
- Fire department with separate EMS personnel: 9%
- Government or third service: 14.5%
- Private company: 18%
- Hospital-based service: 7%
- Other: 8%
- Public utility model: 2%
- Police department with cross-trained EMS personnel: 0.5%
- Police department with separate EMS personnel: 1%
Public ambulance services
Public ambulance services, according to Elite Ambulance, are supported through both user fees and tax revenue. Taxpayers fund public ambulance services, like those provided by fire departments, regardless of whether or not they actually use the service.
Public ambulance service paramedics, according to the Bureau of Labor Statistics, get paid:
- Mean hourly wage: $17.02
- Mean annual wage: $36,110
The cost of public ambulance services is dependent on the agency, type of care given to a patient and transport mileage. For example, D.C. Fire and EMS charges:
- $428 for BLS transport, which includes minimal or basic treatment and vital signs monitoring
- $508 for ALS transport, which includes advanced life support care for patients
- $735 for ALS-2 transport, which includes extended advanced life support, such as breathing tube insertion, CPR, multiple medications and other extended care
- $6.55 per loaded mile
Private ambulance services
On the opposite spectrum, user fees solely fund private ambulance services; taxpayers do not fund these agencies. Therefore, patients are only billed when they use the services.
Generally, public ambulance services typically respond to 911 calls and private providers perform interfacility, discharge and other scheduled, non-emergency transports. However, there are private services that contract with municipalities to provide 911 response and there are public services that perform interfacility, discharge and other scheduled, non-emergency transports.
The services performed are dependent on the particular agency and not whether they are public or private.
Private ambulance services tend to have the lowest rates of pay. However, they are also more willing to hire newer, less experienced employees if you want to get your feet wet in EMS.
The cost of private ambulance services is dependent on the type of transport, such as emergency vs. non-emergency, ALS or BLS care administered and total distance traveled, Elite Ambulance noted.
Difference in care?
Across the pond, the National Health Service (NHS) is spending more than $100,000,000 a year hiring private ambulances to supplement their services.
As a result, The Guardian reported that many patients feared that private ambulance services may result in a lower standard of care compared to publicly-run ambulance services. The U.K.-run website started a survey, asking to hear from those who work for private ambulance services as well as patients who have been treated by them. They want to know if:
- The standard of care is different
- The qualifications, equipment and training differs for private EMS employees
- The patient had any concerns
- Differences exist for employees
In the United States, equipment and qualifications are set at the state and local level. While it’s possible that some states have different requirements based on whether the service is public or private, that would only apply in that particular state.
As a patient, have you noticed a difference in cost and service between public and private ambulance services? Furthermore, as a private EMS provider, does your equipment and qualifications differ from public EMS providers? Let us know in the comment section below.
This article, originally published on Oct. 23, 2017, has been updated.
