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EMS economics: How we'll evolve financially

Editor's note: The mayor of Tampa, Florida, recently announced the city would start using debt collectors to recoup millions of dollars in unpaid EMS bills.

Well yes, the economy still stinks.

If anyone thought that this country was heading out of the woods financially, the downgrading of America’s credit rating, the ongoing idiocy in Washington, and the fall of the stock market over the past few days has pretty much imploded that thought. For local governments, this really will set them back significantly in their recovery.

This article really brings home the fact that, at the core of our industry, there's really not that much of a fundamental difference between public and private agencies. In order to stay in business, you have to generate revenue. Maybe it's from a bill, or from a tax, or an assessment; regardless of the source, the almighty dollar drives the ability to provide the service.

Even volunteer organizations have to pay the rent, pay for maintenance, and pay for equipment. In the past, public agencies could pass along the rising costs to its "consumers," (taxpayers), or find money through the general fund. That simply isn't an option anymore.

Here is another potential outcome. If you can't raise revenue, you have to cut costs. Considering that we are still trying to understand the value of providing care in the field to overall health care, I foresee rough waters ahead for how we provide frontline response.

I don't think anyone will argue with the need to provide emergency transport. I do think there will be broad re-examination of heavily staffed ALS systems, either with paramedics on first response, non-transport units, or two paramedics on a transport unit.

To a certain extent, I am okay with that — we should always be looking for optimal response patterns. But when an agency is facing financial failure, the cuts often go deep and produce potentially bad outcomes. Let's hope that we'll find a happy medium to get past this crisis.


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