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Worth What You Pay For It


Back way before my EMS career I did a short stint selling retail electronics. For the most part I sold stereo gear, with some CB and scanner sales on the side, plus various other items. I worked for a now defunct chain that was in competition with Radio Shack. This was back before Radio Shack became mostly a cell phone retailer and one could buy real electronic items. Anyway, one of the promos our competition ran was for “free batteries” with the purchase of certain items. When customers would come in and want to know why we didn’t offer free batteries, our stock answer was, “Free batteries are worth what you pay for them.” Sometimes it even worked and when it didn’t the customers usually found out that we were speaking the truth and came to us for their replacement batteries.

In later years I learned that in general free advice was like free batteries, generally worth what you pay for it.

I have no reason to think that free ambulance service will be much better.

Council debates free ambulance service

Councilmen Tim Shuffett, Ryan Brand, Aaron Hankins and Jim Lienhoop said during a City Council meeting Tuesday that they see no reason to select any of the applicants that would require a subsidy when others have proposed to offer the service with no subsidy.

Unlike them, I can think of several reasons not to take the “free” service. Of course unlike them, I actually know something about the delivery of EMS and understand that it’s about more than response times and giving people rides to the hospital.

It’s free, but is it any good? The Board should look at the details of the RM and Trans-Care offers and see how many units will be assigned, if they will be dedicated to 9-1-1 or shared with the far more lucrative transfer and return service. What will the crew configuration be like? All ALS, all BLS, a mix? What type of vehicles will be used? Will they be new units or ones that have been used for a while or maybe even purchased used once the contract is awarded? Speaking of which, what is the term of the contract and is there an “opt out” if it becomes too expensive for the “free” service to keep providing “free” service?

Speaking of response times, will the “free” services guarantee that they will have an ambulance on scene in a specific time or are they going to respond on fire or other first responders to stop the clock? That’s a frequent technique used to meet response times and shift costs of maintaining equipment back onto the community without appearing to do so?

Sadly, the article addresses none of that and there is no way for me to tell if any of those questions have been asked. Surely a reporter would ask those questions IF he or she knew what to ask or at least who to ask.

Even more sadly I suspect that the contract will be awarded to one of the “free” services and by the time anyone realizes the service isn’t as good (if they do), it will be too late.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.


  1. It may have been you that said it a couple weeks ago, but I think this sums it up pretty well.

    Cheap, fast, or good, pick two.

      • I thought those great words came from you. I still believe truer words were never typed.

        • I must confess that they were not originally mine. I believe I took them from a sign in an auto parts store back before there were chain stores. Still, it’s generally true, no matter where it came from.

  2. Wise words TOTWTYTR. That said, without actually looking at the proposals and asking the questions you ask, I wouldn’t be quick to simply dump the “free” services. I happen to work for an agency that receives no direct taxpayer subsidy…and haven’t in decades (or longer perhaps). And we do with with ALS personnel and our response times are set by the county (and met by us)…where the clock is stopped by statute on the arrival of the first ALS ambulance (there are provisions for BLS…but there’s little tiered response here…most of the BLS cars primarily do transfers and returns).

    So, excellent words of warning…but “free” services aren’t free anyway. In our case, the volume is sufficient for user fees and reimbursement to pay for it. Other places…that wouldn’t work.

  3. I’m guessing that if you came to the UK and had a problem you wouldnt want rescuing by the RNLI, coastguard, fire & rescue or myriad of autonomous paramedic services? Free at the point of service, foreign thanks gratefully received!



    • It’s free, is it? Everyone who works there volunteers, all of the equipment is donated by the manufacturers, fuel is given by the refiners? No, it’s not free, you pay high taxes for those services. RM and Trans Care are for profit services, they don’t provide anything for “free”. They are angling to make a profit, whether by billing the patients or picking up transfer and return runs.

      • Given the size of the service area (on a brief search, I couldn’t find much on call volume), I would bet that they’re angling to do the transfers/returns. The city population is around 40k…which means not a lot of volume. For our roughly 700k population base, we have about 41k transports (or about 1 transport for every 17 people).

        If we use that highly unscientific number, we’ll see that the annual 911 transport volume is about 2350 (if all else is equal). Now, depending on pay and overhead, that may be the bare minimum transport volume for 1 (one, uno, un, ein) full-time ALS ambulance…maybe. Obviously 1 truck cannot do all of those calls, because it doesn’t take into account the possibility that more than one call is happening at once and geographic coverage. So…all of a sudden, either a subsidy is needed, or a different revenue stream (like interfacility transfers) has to be developed.

        Now, the tricky part will be whether they can monopolize the transfer business. Otherwise, if one of the for-profits comes in, they’ll dump the place in a hurry if they can’t get a decent ROI within 2-3 years. Then, they’ll have to start this all over again with someone else, or pay a subsidy to a for-profit company.

        • Nice analysis, Bob. I’d also guess that their coverage will include transfer trucks pressed in to service as 9-1-1 trucks if it gets busy. Which likely means newer and less experienced providers. When AMR serviced a number of communities south of where I work, they would put one truck at a location where three communities met and designate it to cover all three communities. So each community thought that the truck was “theirs” when in fact it was no one’s because it was also available for transfers. If that truck became busy, the next one was at their main base 15-20 minutes away. Of course the also used the FD first responders to stop the response time clock. All part of minimizing costs and making the “free” ambulance service possible.

          Interestingly, AMR eventually lost all of those contracts to a competitor that put in an honest bid and explained why it wasn’t more expensive, just more honest. For once, the politicians bought that story and didn’t just look at the dollars and cents.

          • Yep…we had the bigguns (AMR & RM) browsing around here about 15 years ago now. Problem is that in Minnesota, 911 primary service areas are awarded by the state EMS board. There are no “contracts” per se. A PSA holder keeps their PSA until such time as a) they don’t want it or b) it’s proven that they can’t serve it adequately (a hard thing to prove in most cases). Only then is an opportunity for a change in license holder allowed.

            Oh, and transfers? Nah…non-emergency transfer licenses are pretty much open. There are no exclusive contracts for non-emergency work. If someone wants to do non-emergency work and can provide some sort of service, they can apply for (and usually get) a license. Within the metro area, we have 1 service that only does transfers and 3 others who have EMS service areas as well, but also hold transfer licenses. During off hours, they do adjust their staffing to cover both (recognizing that they do have a response time requirement for their 911 service area…at least in our county, where the clock stops when the ambulance arrives (first responders are just that…they don’t impact the EMS clock at all). Add the really countless chair services now and it’s not a friendly place for the big for-profit agencies.

          • I spent some time watching the big companies back in the mid 1990s when “consolidater mania” was all the rage. I noted that AMR in particular did really well when they bought existing companies and had exclusive franchises for a county or region. They didn’t do so well when there was open competition, especially for the non emergency work. They came in to my area, bought a lot of small companies and for a while it looked like they might be the only private in the area. Then, their lousy service and corporate disdain for their customers caught up with them. Amazingly the competition that was left grew and some new companies popped up. Now, they are just another private ambulance provider in the area.

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