This will be the first in a multi-part series about private EMS.  Those of you who follow my Twitter feed will know that I have finally gotten a new job that will allow me to leave my horrid private ambulance job.  (Because I have found a new job, I have unprotected my Twitter account.  I am no longer on my best behavior.)  With only a few shifts left, I have found myself reflecting back on a long career in EMS.  I have worked for private, non-profit, fire-based, and government-based services in different areas of the country.  I have opinions about all sorts of _______-based EMS, but private EMS is the one that needs an exposé.  Over the next few posts I am going to detail just what can go horribly wrong with such a misguided model.

But before I get down to the axe-grinding that will be the meat of this series, I would like to describe to you what can happen when private EMS does work.  Believe it or not, it is possible.  The very first service I worked for was Central Ambulance in Dallas, TX back in 1995.  I had completed my EMT training earlier that year, and went straight into paramedic school without ever having worked a day in the field.  After a few months, it became painfully clear that I would need to work as an EMT if I was going to ever hope to graduate and become a paramedic.  The material was just too foreign to proceed without any experience.  Someone in my class told me that Central Ambulance was hiring and that they had flexible schedules.  By December I had been hired and began my training. 

Those of you have worked in the private sector may be shocked to learn how organized and structured my orientation and training were.  The hiring process itself took two days.  There were several tests, skills exams, and scenarios.  Not everyone was hired.  Many were culled from the list of possible candidates until the final job offers were made.  After I was hired I was given a full two-week classroom orientation.  This included protocol review, drivers training, map drills, safety classes, mass casualty scenarios, and facility orientation.  After that I rode as a third person on a non-emergency transport truck for two weeks to get my feet wet.  The medic who worked on that truck had been in the field for 20 years and I received a well rounded education.  Then I was placed as a third person on one of our 911 trucks for another two weeks to become acclimated to the emergency side of our operation.  During this entire process, I was taken through a very detailed orientation packet and the director of training was in constant contact with me and my preceptors.  At the end of my six weeks I was released to work on a truck, but was placed with an experienced paramedic since I was fresh out of school. 

Now doesn’t that process sound well organized and sane?  It was, but I can tell you that was the last time I saw anything like that.  It has been down hill ever since.  That original company was a mom-and-pop organization that had been recently purchased by Med-Trans.  They followed OSHA safety regulations to the letter.  They had quality training done by competent professionals who were closely monitored by management.  The process was well documented and patient care was excellent.  I remember while going through that process I was thinking to myself, “Yep, this is about how I thought EMS would be.”

Larry Johnson and Bryan Bledsoe soon afterwards started our critical care program and our company began flight and ground operations serving the critically ill in the region.  Again, that was a very well-planned and well executed process with excellent results and fantastic care. 

The reader should also note that I am in no way saying that this company was perfect.  Far from it.  Working there had its frustrations just like any other place I have ever worked.  There were quite a few unpleasant characters, and not everything went perfectly.  But on the whole, I always felt as if my superiors were very cognizant of my skills and abilities and worked hard to provide the proper resources so that I could do my job.  This place was very fragile though and it did not take much to topple it.  As a matter of fact, all it took was for AMR to merge with Med-Trans for the nightmare to begin.  The sweeping misguided changes that ensued left the place a twisted wreckage of its former self.  The management one by one found other jobs, leaving in disgust.  And eventually so did I.  In a way, most of my career has been spent trying to chase or recapture that first experience.  For a very brief period, I saw what EMS could be.  If I hadn’t had that initial first impression, I am certain that I would have never stayed in the business.  I, like so many others, would have tolerated it for a couple of years and moved on in disgust.  But I have a keen memory, and I am tenacious to a fault. 

But that first experience is not what this series is about.  I just wanted to describe that in order to lay a foundation.  I don’t want the reader to think that I have some sort of biased view against private EMS.  Nothing could be further from the truth since I have seen it work.  However, I will make the argument that trying to create such an effective environment from the confines of the private model is practically impossible.  And if a service is successfully born from this model, it is fragile and anemic, teetering on the brink of collapse any moment because the motivation for service is flawed.  I have seen lesser people create similar results more easily with different models and different motivations.  I have also seen what happens when greedy and inept people are given the reins in a private model.  But that will have to be the subject of a post tomorrow. 

Stay tuned.

Bookmark It

Hide Sites