One-third of emergency medical services (EMS) and fire department managers surveyed in December by Best Practices in Emergency Services and the National EMS Management Association (NEMSMA) report that budget cuts will put lives at greater risk by forcing emergency response agencies to operate with fewer and lesser trained personnel on older ambulances and fire engines. Sixteen percent say that budget cuts increase the risk to property, and nearly half say the public should be concerned about emergency services in the near future.
More than 450 managers took the voluntary online survey in December, representing all types and sizes of emergency response agencies in the United States and Canada.
When asked how budget cuts will impact EMS and fire response in their community, 66 percent said that the public will notice a decrease in non-essential emergency response services. Thirty percent said that their departments would have fewer resources on the road during peak demand hours, and 23 percent said that 911 callers should anticipate longer response times. Twelve percent said to expect lower levels of patient care as budget cuts are forcing them to send EMTs instead of highertrained paramedics on some calls and reducing their budgets for continuing education and training.
Fifty-two percent of respondents reported that they have already cut their budgets, although it appears that most cuts in 2008 were relatively small (five percent or less). Only 10 percent of EMS and fire managers reported that they are trimming their budgets by10 percent or more.
When asked how budget cuts were affecting them, 64 percent of managers said they had eliminated all capital and equipment expenditures other than those that were required by law. Half said they were not replacing vehicles that they might have taken off the streets during better times.
According to one respondent, “With the reduced budgets, we cannot replace equipment, so it gets older and less reliable and may not always get us to the scene. We are already facing that right now. We will not be able to purchase newer, nicer equipment that saves time in patient care.”
Forty-seven percent are looking to their personnel – the largest cost for most EMS and fire agencies – to trim costs by reducing overtime hours. Thirty percent are hoping that their customers will make up some of the shortfall by increasing their response and transport fees, although it remains to be seen whether they can collect on those charges.
Most managers seem to be focusing their efforts on programs that will have the least impact on customer service, such as curtailing travel to conferences, eliminating some types of training, decreasing on-hand inventory, doing more comparative shopping when buying supplies, and reducing non-essential services to the public – all in an attempt to minimize the impact of the recession on their core service – saving lives and property.
A smaller percentage, however, operate so close to the margin that budget reductions of even a few percent have caused them to eliminate jobs (13 percent), use lesser trained or fewer responders on their trucks (7 percent), cut salaries (7 percent) and close stations (0.6 percent).
Next year will really tell the tale, managers say. Most managers anticipate their budgets shrinking again next year by as much as 10 percent. Twenty-four percent of managers anticipate budget cuts of greater than 10 percent next year.
Eighty-six percent reported that budget cuts of 10 percent or less would make a critical impact on their ability to serve the public. Only 7 percent of those surveyed indicated that they did not anticipate budget cuts in 2009, and only 14 percent said that they could withstand budget cuts of more than 10 percent.
The recession could not have come at a worse time for EMS and fire departments, many of which are seeing an increase in call volume because of aging Baby Boomers and un- or under-insured Americans who are calling 911 because they do not have adequate primary healthcare.
“While the EMS departments are going through all of the budgetary cuts, the number of responses is projected to go up,” said one respondent. “We are expecting increases in responses from more frequent use of the emergency departments as primary care for an increasing out-of-work population.”
Four hundred and fifty-three people responded to the survey. Thirty-eight percent hailed from small services (under 500 calls annually), 24 percent from mid-sized services (3,000 calls per year or fewer), and 38 percent from large services (more than 3,000 calls per year). Most respondents represented publicly run EMS services in either fire departments, publicly-held hospitals or another type of government agency, such as a health department. Fifteen percent reported that their EMS service was privately owned and operated.
About Best Practices in Emergency Services
Best Practices in Emergency Services is the leading publication for EMS and fire managers, and publishes industry information, articles tips on operating efficient and effective emergency services operations. Learn more at www.emergencybestpractices.com.
About the National EMS Management Association
NEMSMA is a membership organization of more than 1,500 EMS professionals with an interest in leadership, management and quality. Learn more at www.NEMSMA.org.