The Emergency Medical Services industry is a plucky, hard-driven lot these days. We’re the healthcare safety net for every socioeconomic class. When the normal points of entry into the healthcare system fail to catch a disease process or when the unthinkable happens, calling 911 for an ambulance is the best option for most people. In fact, those that truly need us and can’t access us mostly die. Those that do access us enter into the most immediate and highly skilled acute care setting currently available. We catch the uninsured who can’t manage their chronic conditions through primary care. We catch the immediately injured trauma patients from falls and car accidents. We catch the tired, the poor, and the huddled masses with no one else to turn to. We catch the rich who think that 911 is the most direct route to care in the hospital. We treat the homeless in their boxes on the curbside. We treat the athletes who injure themselves on the field. We treat the uninsured small business owners who were so scared to go to a doctor for fear of the bill that they waited too long and their lives are in danger. We treat the naked drunks swigging tequila straight from the bottle while peeing into their shoe. We treat the scared elderly lady who may have taken too much of her medication regimen. We treat everyone, regardless of their ability to pay, in their time of perceived need.

And we’re stretched to our limit and something may have to give.

“Emergency Medical Services” or “EMS” systems are complex organizations made up of multiple players from different disciplines. Everyone knows the title “Paramedic”, some know the term “Emergency Medical Technician” or “EMT”, and some still occasionally utter the detestable term “Ambulance Driver” relegating today’s highly trained and equipped Paramedics to the level of yesterday’s pioneers who simply drove really fast in hearses borrowed from the local funeral home. In just about every community in the United States ambulances are just a phone call away. Almost everyone has access to the 911 system and almost everyone knows just who the first people they want to see at their side when the unthinkable happens. No one gives us a moment’s thought until that time though, and that may prove deadly as our country’s economic woes drag on. Ambulances, with their “duty to act” and care for anyone who calls for them anytime they call for whatever reason, rely on the Fee-for-Service model to pay their bills. Communities are generally mandated by law to provide for ambulance service within their jurisdiction and this creates a problem. The fee-for-service model relies only on income from billing those whom can pay only when the ambulance transports them to a destination. This leaves a large amount of time when the ambulance is in service but not occupied with a call, with at least two crew members on duty, when the ambulance service cannot recoup any fees for its time. Some communities supplement their services with tax dollars; however this model places a disproportionate burden on property-tax payers who demographically are not the ones who most call for ambulance services. The homeless, the transient, and the person just-driving-through-town don’t pay those property taxes but are entitled to the same level of service as the tax payers, whether they can pay the fee for service or not. Ambulance services have come to survive on these property tax revenues and insurance payments from those with insurance. While governmental organizations like Medicare and Medicaid do pay a highly discounted rate, usually paying several hundred dollars less than what is billed by the service and usually paying months after the transport occurred, they are not covering the true costs of treating their patients.

Industry experts are forecasting that the current US economy will hit the EMS industry very hard in the coming months. As factories and commercial entities close their doors, the people losing their jobs lose their employer-provided health insurance. This is a double-edged sword, because in addition to the former employees becoming newly uninsured, the shuttered facilities populating the tax plots are not pumping the industrial and commercial tax rates into the coffers that are the trickle of life into the ambulance services. That dwindling tax revenue is the small lifeline that keeps them in-service during the times when they are sitting idle, ready for the next call, or are transporting those who just cannot pay. Combine these facts with the fact that the now-uninsured people will begin to defer primary and preventative medical care until their chronic or non-diagnosed conditions become so severe that they must call an ambulance, placing yet another patient on the stretcher with no possible way to pay the bill.

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