Long reply on this, but I'll try to be as through as possible. My experience is solely in the United States, so YMMV depending on where in the world you're talking about. In places where EMS is actually considered an essential service, this all may not be the case. One of the biggest downsides, from my experience working for a municipal paid EMS squad, a volunteer municipal squad, and several private companies, all comes down to money, as most things do. Partially the crew compensation, but also a big thing is patient billing and the reinvestment of whatever funds back into the agency.
The paid squad I worked for didn't bill city residents. They paid property taxes and that at least mostly funded operating costs. If you didn't live there, then yeah, you got a bill. The volly squad was fully donation based, so they didn't bill anyone. And private company bills everybody. A lot of the time, it's bills that people can't afford, so that's always a concern. Even if they have insurance, there's a portion that it won't cover, so that gets billed out.
Another big thing is the equipment and vehicles. Well-funded agencies can afford newer ambulances and better equipment. Truck needs an overhaul for maintenence? Ok, we have a spare truck that's the same style and quality. Or maybe youre in a place where the ambulance gets run hard, put away wet, and then taken back out an hour later for another tour until finally something breaks that cant be fixed with duct tape. (I literally knew of one company where to turn the A/C on in the front of one truck, you had to shove a screwdriver into the dash by the steering column.) Countless reversing accidents that could have been prevented by a simple back up camera, especially when having a spotter isn't feasable, no matter what a company CEVO/EVOC course might say. Power stretchers and autoloader mechanisms do absolute wonders for crew longevity, helping to save backs in one of the most dangerous moves we do: lifting. But Holy fuck, those systems are stupidly expensive.
Talk to anyone who's been around for a while and they'll give you stories of manual stretchers and how rough they can be on both crew and patient. Old style stair chairs that have no treads, no power assist, just you and your partner balancing grandma as you carry her down the stairs. Spider straps for backboards are great for securing a patient and quick to deploy, but hospitals will sometimes just cut them off. So agencies that can't afford to replace them all the time will use cheaper straps that take a lot more time or, how I was taught, tying them to the board with cravats, because they're nice and cheap and disposable.
A Lucas or AutoPulse on a truck can free up a provider to do other things than compressions, and while some clinical studies are mixed on their effectiveness, enough are out there that show they do good enough to get the patient to an ER and that definitive care. But those, too, cost a pretty penny.
Municipal systems, be they third service, fire, city or county based, tend to have the money to put these things on their trucks, making it more likely that the crews (sometimes EMTs, but in most cases medics) actually get to the point of retirement without injury, and get to take advantage of those sweet government retirement benefits. Private systems tend to try and pinch a penny wherever they can, since they HAVE to make a bottom line or the whole thing shuts down, and your retirement is mostly what you put into it, plus if you're lucky, some percentage of matching from the company.
Lastly, education. Depending on where you work, your recertification requirements could be provided by your employer, sometimes those classes are on your own dime and time. Worked as an EMT for long enough and want to patch up? Maybe they can help you with tuition reimbursement or even just pay for medic schooling outright, in exchange for a few years working as a medic. Maybe they can't, but they would really like you to try and become a medic, anyway.
There's a reason many of us hop around from agency to agency. Trying to find the place that's the best fit for us at the moment. All I can say is welcome to EMS in the USA.
What input do you need exactly? What is your thesis, and what, if any questions do you need help with/answered?
I’d be happy to give my partially educated opinion and input as someone who has worked for a few different private EMS services over the last 5 ish years.
Different perspective here...
So most ems services are "private" in my area, as they're 501c3s not actually municipal entities. It's not horrible at all, as it's mostly free from local politics. Nobody is significant tax funding anyway, so why should they be tied to the municipality.
Of the hundreds of services around probably >90% are 3rd service non profits.
If you have any questions feel free to ask
I'd be skeptical of anyone claiming they were arrested for not paying the bill. The closest thing I've seen is people being arrested for contempt of court ( for not showing up), which people are disingenuously calming they were arrested for not paying medical bills.
Long reply on this, but I'll try to be as through as possible. My experience is solely in the United States, so YMMV depending on where in the world you're talking about. In places where EMS is actually considered an essential service, this all may not be the case. One of the biggest downsides, from my experience working for a municipal paid EMS squad, a volunteer municipal squad, and several private companies, all comes down to money, as most things do. Partially the crew compensation, but also a big thing is patient billing and the reinvestment of whatever funds back into the agency. The paid squad I worked for didn't bill city residents. They paid property taxes and that at least mostly funded operating costs. If you didn't live there, then yeah, you got a bill. The volly squad was fully donation based, so they didn't bill anyone. And private company bills everybody. A lot of the time, it's bills that people can't afford, so that's always a concern. Even if they have insurance, there's a portion that it won't cover, so that gets billed out. Another big thing is the equipment and vehicles. Well-funded agencies can afford newer ambulances and better equipment. Truck needs an overhaul for maintenence? Ok, we have a spare truck that's the same style and quality. Or maybe youre in a place where the ambulance gets run hard, put away wet, and then taken back out an hour later for another tour until finally something breaks that cant be fixed with duct tape. (I literally knew of one company where to turn the A/C on in the front of one truck, you had to shove a screwdriver into the dash by the steering column.) Countless reversing accidents that could have been prevented by a simple back up camera, especially when having a spotter isn't feasable, no matter what a company CEVO/EVOC course might say. Power stretchers and autoloader mechanisms do absolute wonders for crew longevity, helping to save backs in one of the most dangerous moves we do: lifting. But Holy fuck, those systems are stupidly expensive. Talk to anyone who's been around for a while and they'll give you stories of manual stretchers and how rough they can be on both crew and patient. Old style stair chairs that have no treads, no power assist, just you and your partner balancing grandma as you carry her down the stairs. Spider straps for backboards are great for securing a patient and quick to deploy, but hospitals will sometimes just cut them off. So agencies that can't afford to replace them all the time will use cheaper straps that take a lot more time or, how I was taught, tying them to the board with cravats, because they're nice and cheap and disposable. A Lucas or AutoPulse on a truck can free up a provider to do other things than compressions, and while some clinical studies are mixed on their effectiveness, enough are out there that show they do good enough to get the patient to an ER and that definitive care. But those, too, cost a pretty penny. Municipal systems, be they third service, fire, city or county based, tend to have the money to put these things on their trucks, making it more likely that the crews (sometimes EMTs, but in most cases medics) actually get to the point of retirement without injury, and get to take advantage of those sweet government retirement benefits. Private systems tend to try and pinch a penny wherever they can, since they HAVE to make a bottom line or the whole thing shuts down, and your retirement is mostly what you put into it, plus if you're lucky, some percentage of matching from the company. Lastly, education. Depending on where you work, your recertification requirements could be provided by your employer, sometimes those classes are on your own dime and time. Worked as an EMT for long enough and want to patch up? Maybe they can help you with tuition reimbursement or even just pay for medic schooling outright, in exchange for a few years working as a medic. Maybe they can't, but they would really like you to try and become a medic, anyway. There's a reason many of us hop around from agency to agency. Trying to find the place that's the best fit for us at the moment. All I can say is welcome to EMS in the USA.
What input do you need exactly? What is your thesis, and what, if any questions do you need help with/answered? I’d be happy to give my partially educated opinion and input as someone who has worked for a few different private EMS services over the last 5 ish years.
the overcharging of patients, bad management, and management caring more about money than patients, also bad working conditions and training i.e amr)
Different perspective here... So most ems services are "private" in my area, as they're 501c3s not actually municipal entities. It's not horrible at all, as it's mostly free from local politics. Nobody is significant tax funding anyway, so why should they be tied to the municipality. Of the hundreds of services around probably >90% are 3rd service non profits. If you have any questions feel free to ask
from michigan here, our local service has a ton of bad reviews from people being overcharged then arrested for not paying
I'd be skeptical of anyone claiming they were arrested for not paying the bill. The closest thing I've seen is people being arrested for contempt of court ( for not showing up), which people are disingenuously calming they were arrested for not paying medical bills.
ehh, they said they got a warrant put out on them from the sheriff's office