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EMS needs to self-rescue our agencies

They are certainly worth saving, but EMS needs to stop sounding the alarm and look for internal solutions


“EMS must evolve our business models, care-delivery paradigms and employee retention strategies if we are to remain an effective force for good in our communities,” writes Farnsworth.

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All around the country, EMS is sounding the alarm, metaphorically calling 911 for someone to save us – Congress, the state, taxpayers, anyone. I see the comments time and time again; online, in podcasts and in conversation. Who is going to fund us? We need money. Someone has to fund us. The reality is abundantly clear, no one is coming.

Our industry cannot even agree on what to call ourselves, much less to take the steps essential to become an essential service with government funding. Perhaps instead of throwing our arms in the air and waiting for rescue, we should start swimming. We as an industry need to quit waiting for someone to pay us large sums of money to provide a service.

The altruistic nature of many first responders has left us in a position where we feel obligated to help. Carpenters don’t build houses for free, dealerships do not give away vehicles, and hotels do not provide free room and board. The time has come to recognize that EMS is a business, and must be operated as such. I am not saying that management or anyone else needs to get rich, but we must balance operating costs, employee pay and revenue streams. If revenue streams are not adequate to employ and adequately compensate personnel, we need to improve revenue streams.

Stop saying we have a shortage of EMTs and paramedics

Do we really have a shortage of workers? I would argue that we have a shortage of people willing to continue working for peanuts or volunteering to work as EMS providers. There are many agencies that are still flourishing.

What are these agencies doing differently?

They are paying people a living wage, allowing their personnel to work one job instead of four.

They are focused on their people and on the long game.

They are upping the ante on retirement, vacation time and pay, ensuring that their personnel has time for family and legitimate work-life balance.

Providers are being asked to do more and more, with increasing calls for service everywhere. We wouldn’t dream of asking the town dentist or the veterinarian to volunteer to provide those services. Why do we feel that asking people to volunteer for EMS is appropriate? How many CNAs are volunteering to assist people with activities of daily living? I don’t know any. We have to stop asking people to volunteer for the provision of professional medical services.

Increasing revenue streams

The burning question is, how do we increase revenue streams when insurance companies control what we are paid? It’s quite simple really. We stop relying solely on funding streams tied to insurance companies. As an industry, we start thinking like business leaders.

For far too long, we have promoted great providers to leadership and management roles. We need business leaders in the front office: an understanding of EMS is necessary, but an understanding of business is essential. Securing revenue streams is the way forward.

Start asking questions about unit hour utilization of your resources. Start asking how often your teams are idle.

Can we generate additional revenue by offering CPR classes in the community for a fee?

Can we contract to provide non-emergent transport?

Can we start a wheelchair van service, staffed with an EMT?

Is your agency engaged in disaster or wildland fire deployments?

Are you providing event coverage for free, or are you charging a fee that actually provides a revenue return to the agency?

Sit down and start to have real discussions about alternative revenue streams that can be captured with existing resources. Start to look at the ways in which improved revenue streams can improve your ability to fund and retain high-quality employees.

We cannot continue to do business the way we have always done it

The time for rescue has passed. EMS must work as an industry and as individual agencies to save ourselves. We must self-rescue. Stop waiting for someone to find a solution and innovate your own.

We all know that we are essential, and we know that communities would be in dire straights without our service. Do our communities realize how much we are needed?

Every system is different – the conditions, the call volumes, the availability of providers, the tax base, the available revenue streams – however, solutions exist, we just have to find them and develop them.

EMS must evolve our business models, care-delivery paradigms and employee retention strategies if we are to remain an effective force for good in our communities. In the words of Mahatma Ghandi, “Be the change you wish to see in the world.”

Just because no one else has done it, does not mean it can’t be done. Go out and find your solutions and rescue your agencies. They are certainly worth saving, but we can no longer wait for rescue.

Reuben Farnsworth has spent the last 20 years in EMS, holding positions from EMT-basic on a rig, to executive project manager for an international expeditionary medicine company. Reuben is currently the clinical/operational coordinator for Delta County Ambulance District, where he leads the community paramedicine team and ET3 implementation. Reuben is a frequent speaker at conferences all over the country. Reuben can be reached at You can also follow him on Facebook for updates from the RockStar Medic.