The cost of doing business in EMS

Like it or not, the reality of doing what we do is that EMS is a business, and like any business, income must at least meet or exceed expenditures to remain solvent and afloat


It may be EMS math 101, but the cost of a fully (paid) crewed, operational, fueled and supported ambulance running 24/7/365 runs into hundreds of thousands of dollars (8,760 unit hours per truck, per year, for full-time members of staff, plus all the supporting works, is in the ball park of $350,000). Depending on the peak of day requirements, which multiplies the baseline, as well as other standby and community support activities, the pure cost of doing business spirals up very quickly. Chiefs know their own numbers and understand that the cost of readiness is not cheap, even in the volunteer and not-for-profit sectors. Understanding the bottom line, P&L, EBITDA and the general fact that everything costs something is a story we must all be prepared to accurately tell in order to survive. 

In the news this week, we saw more stories of the daily struggle that organizations are facing to remain both staffed and funded. The Minnesota Department of Health revealed 80% of the state's rural ambulance services rely on volunteers, and 60% of volunteer services are short-staffed. The solution inevitably will require the installation of paid staff, which presents the twin issue of funding and sourcing the appropriately certified clinicians – who live there or are prepared to move.  

Meanwhile, in Ohio, the debate in a local council chamber centers on whether they want to pay to keep EMS squads operating in their locality. The underlying issue with this story is one of affordability, and is a scenario that is being played out across the country. Not far up the Turnpike in the metro Flint, Michigan, area, medical calls for service have exceeded the budget for two straight years in a row. The resultant action may well be a raise in levies, charges and taxes, which is always a politically sensitive issue, or even to put the service out to competitive bid, itself a political hot potato.

The reality of doing what we do is that EMS is a business, like it or not, and like any business, income must at least equal or exceed expenditures to remain solvent and afloat. Even not-for-profit does not mean all for free! Sitting at the heart of the matter is one of my many elephants in the room – that of reimbursement and appropriate funding. We have recently arrived at the point where we have a federal opportunity to demonstrate the true costs of doing business, which, in turn, may lead to fair and appropriate reimbursement, which may assist with the news issues of the week.  

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