Sounding the Alarm: How Private Interests Are Encroaching on Emergency Services.

• Author: Potter, Steven

A few years ago, the emergency medical services system serving the 8,000 residents of four small communities in south central Wisconsin faced a dilemma.

Due to the retirement of one superstar emergency medical technician, the Marshall Area EMS system--which serves the village of Marshall and the towns of Medina, Sun Prairie, and York, comprising a seventy-two-square-mile area about thirty minutes northeast of the state capital, Madison--needed to be revamped.

The municipal commission charged with deciding the area's EMS future saw a large expenditure coming. Initial estimates for hiring new EMS staff had an annual price tag of about $140,000. "Most governing bodies, when they're not used to that large expense of paying salaries and benefits, they kind of get sticker shock," says Scott Allain, the Marshall Area EMS director.

As time stretched on, no feasible plan presented itself. "Two years into this, we weren't really coming to any resolution," Allain says. "The morale among our on-call staff wasn't the best because I don't think people had a clear vision as to what we're doing [or] if we were dissolving."

Allain approached neighboring communities to see what they could offer.

Ideas for consolidating or contracting out to other communities were floated. Ultimately, the commission in charge didn't like those options because, Allain explains, "if you contract or if you consolidate, you have to give up a bit of control."

The commission also explored going with a for-profit EMS provider, at an estimated cost of about $230,000 a year. But in the end, this option was rejected. Explains Allain, "They felt they would have no control over any increases, no control over any purchasing. And once you go that route, it's hard to go back, because you sell off all your assets. What if ten years from now, [the for-profit EMS company] goes away?"

After negotiations that included teaming up with the local volunteer fire department, who would chip in for the salaries of emergency medical technicians, or EMTs, in exchange for their administrative support and help around the firehouse, Allain was able to strike a deal to hire two day-shift EMTs and retain his on-call, night-shift EMTs for a total of only $20,000 a year more than the commission was previously paying.

"That was a palatable cost and we get to maintain our local control," he says.

It was a near-miss of a fate that more and more communities are facing: turning control of their most critical, life-and-death services, their EMS systems, over to profit-seeking providers.

For communities that choose to privatize their EMS system, there's no shortage of options. While industry experts say the number of private EMS providers in America is unknown, for-profit companies range from single-ambulance operations in rural locations to huge multistate conglomerates.

The biggest player in the for-profit EMS market is Colorado-based American Medical Response, Inc., which operates in more than 2,000 communities across forty-six states and Washington, D.C., and is estimated to transport some five million patients each year through their EMS, nonemergency, and medical transport fleet of ground and air ambulances. The company, which is also the primary emergency response contractor for the Federal Emergency Management Agency, was sold by Envision Healthcare to the private equity firm KKR for $2.4 billion in 2017. American Medical Response did not respond to interview requests for this article.

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