From: Tom.Batchelor@f222.n137.z1.fidonet.org (Tom Batchelor)
Newsgroups: misc.emerg-services
Subject: Volunteer vs. Paid.
Date: Sat, 07 Nov 1992 12:29:00 -0800

Good question, regarding paid vs. volunteer ambulance services. It's 
one that many have debated over the years. I have run, worked for 
and generally operated volunteer and paid agencies and they both 
have their place.
For example, some communities have "outgrown" volunteer services. If 
the volunteer service cannot get out and run calls (especially 
during the daytime - more on that later) then some sort of paid 
agency takes over.
There are basically three kinds of services that provide EMS care... 
First, there are Fire Departments, then, Municipal Third-Services 
(non-fire, non-police) and of course, commercial (private). There 
are also hospital based services, but unless they are funded by a 
public hospital, they are usually considered privates.
Each provider is unique and can provide a host of services to the 
community that they serve. For example, Pinellas county Florida, has 
a "Public Utility Model" private system. That means, that they run a 
two-tiered system (Fire Department in non-transport ALS units) and a 
private service providing the transport. They are also at the ALS 
level. These kinds of systems are usually run on a performance-based 
contract and because the municipality (or County) actually ownes all 
the equipment and facilities, the only thing the privates provide is 
the manpower, training and other things as specified in the 
respective contract.
Incidentally, this kind of two-tiered system has been touted as one 
of the largest... And, most expensive EMS system in the country (by 
JEMS magazine, a few summers ago).
In the municipal area, the Fire Department is pretty much 
self-explanitory. Municipal third-services on the other hand, are a 
relatively new breed of providers when compared to the Fire Service. 
They operate off tax base (usually about 80-90% of their budget) and 
most bill for service.
The real conflict occurs when you look at the motivation of each 
provider. Fire Department and Municipal Third's pretty much want to 
simply provide the most "cost-effective" service without 
compromising patient care. Privates, on the other hand, must provide 
emergency care under a hefty subsidy or contract, in order to turn a 
profit and when they don't, they risk going out of buisiness. For 
some municipalities, they feel that this kind of arrangement with a 
private contractor (providing a subsidy) is the best way to go. 
However, in most cases, the patients also get billed a HEFTY charge 
as well.
So, in a nutshell, it would all depend on a few things, as to 
whether or not a municipality chooses a private, public or volunteer 
service... Political climate, needs of the community, money, all 
play a part. The fact of the matter is this: many volunteer services 
are simply being phased out because there are just not enough people 
to staff them. And, for those municipalities that are "mandated" in 
its charter to provide the service, that can mean a devastating law 
suit if the volunteer service failed to respond (or respond timely) 
especially, if known problems existed before.
Again, real good question. And, yes. The issue has been explored 
several times in JEMS magazine, for one. Contact them and find out 
which issues contain the data you wish.
Good luck.
 * Origin: Who needs smoke detectors... Sleep with a Firefighter!
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