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DeKalb officials ponder EMS privatization

If DeKalb leaders privatize the county’s emergency medical services, the residents will regret that decision, according to a county paramedic.

“Fire and rescue is a vital part of DeKalb County,” said Denise Porter, who works for the DeKalb County Fire and Rescue Department, during a meeting of the county’s Board of Commissioners on Feb. 22. “It’s like the heart.”

When the Board of Commissioners passed the county’s budget last week, they put into motion the beginnings of a plan to privatize the county’s EMS. The intent of the board’s budget is that the “fire department will privatize most all emergency medical transport effective July 1, 2011,” according to the county budget resolution.

Because privatization was not a part of the proposed budget of DeKalb County Chief Executive Officer Burrell Ellis, county officials are currently studying the feasibility of implementing the idea.

“All departments, including public safety, are still considering all options to comply with the budget as passed by the Board of Commissioners,” said DeKalb’s Chief Communications Officer Burke Brennan. “Nothing will be final until reviewed by the chief operating officer and chief executive officer.”

When you hire a private company, they get paid based on what they do, Porter said.

“When I’m working on a child hit by a car, I’m calculating drug rates, drug doses, IV rates, blood loss–I’m not calculating bills,” Porter said. “Privatizing EMS is not the answer.”

DeKalb County already uses a private ambulance service for some of its EMS calls. The county has a one-year contract with Rural/Metro Corporation, based in Scottsdale, Ariz., which provides emergency and non-emergency ambulance services, and private fire protection services in 20 states throughout the United States.

Rural/Metro has 15 response vehicles in DeKalb County to supplement the ambulance fleet within DeKalb County Fire Rescue, according to Brennan.

Commissioner Kathie Gannon, who voted against the budget, said the county invested “a pretty good fortune” to study combining the fire and rescue departments.

According to the county’s website, the Board of Commissioners appointed an ambulance study committee in 1971 when residents complained about inadequate ambulance service. The committee recommended that EMS be organized within the fire department. In 1973, the fire department formed its EMS division and responded to all rescue calls. In 2002, the department became fully integrated with most stations having an assigned fire apparatus and a rescue transport unit.

Gannon said she is not sure whether privatization is a viable idea for DeKalb County.

“I have seen no financial study at all that says this is a good idea,” Gannon said, adding that she had not seen one that states the opposite, either.

A problem with privatizing is that if there is a problem with a contractor, the county’s procurement process is lengthy, making it difficult to quickly replace the contractor, Gannon said.

Privatization of EMS is an idea worthy of investigation, but there are issues that need to be hashed out, Commissioner Jeff Rader said.

Rader said a major question in the privatization debate is, “What is the role of [the Department of] Public Safety as first responders?”

The county could use contract EMS providers for transporting patients to hospitals, Rader said. Unlike rural areas, metropolitan Atlanta has several ambulance firms to choose from if privatization was deemed viable.

“The success will depend on the details of its implementation,” Rader said.

Commissioner Larry Johnson said he would be willing to support privatization if it is viable and does not compromise the safety of DeKalb residents.

The budget process is an opportunity for DeKalb stakeholders to look at county services and create a better-run government, Johnson said.


Comments (9)

Jonathan Calhoun
Said this on 10/12/11 At 02:32 pm
Ok.... Here is my opinion coming from 14 years in fire and ems with the last 6 as a medic.I have worked both sides, the last 8 years for a county agency. I believe not that county medics are superior but I think that government agencies have an easier time recruiting top notch people, not because of pay, there isn't alot of difference but benefits and working conditions are the key. For the most part with the exception of a select few private agencies the benefits packages are not even close and you can usually be assured that you will have a nicer station to work out of your equipment is usually better and in better shape, and typically you can concentrate on running emergency calls only. All of this makes a difference I have worked for some private companies with 911 responsibilities that would send out their last available units on transports because "that's where the money is at" and it will burn them eventually. I don't think any medic or emt is thinking about the bottom line of the company whole treating a pt. That just absurd thinking but take it for what it's worth privatization was a mistake and you don't cut expenses from public safety this is all bad politics.
Shawn Anon
Said this on 6/7/11 At 12:45 am
From a Paramedics point of view, Whether your local EMS services are provided by a private company or local fire department, your getting the same services. These Paramedics work the same streets and are certified by the same entity. We do not care about billing and it actually is just another part of us doing someone else's job to keep positions down. Reporting and billing has NEVER affected my patient care but I do know of some instances I have seen it lessen patient care. I have seen Paramedics more worried about getting a PCR-Run report completed than "putting their hands on their patients" during a thorough evaluation and treatment. This does happen but it happens on both private ems and local fd ems organizations. Admin places the burden on providers to gather this info and to meet time restraints at the hospital to get back in service because their is a shortage of ambulances on the road because once again administrators are cutting back because your politicians are cutting budgets and the patient suffers. Not saying it should happen, but I have definitely seen it, and continue to see it. It's not rocket science. It;s the trickle down effect from the top of the food chain.
Günther Rückl
Said this on 3/22/11 At 05:27 pm
Dear CFP:
Dear Readers:

It should be irrelevant whether a service is private or public. A nation's people alone can - theoretically - dictate the price AND the quality of a service, or product, any product, indeed, if they just would actively participate in the political process and hold the players accountable. Reality, unfortunately, is that neither private companies nor public institutions routinely deliver high quality at an affordible cost. While private companies often sacrifice access and quality in favor of profit, public institutions may be wasteful and mediocre because of too little pressure to produce superior quality. Neither side routinely demonstrates a sense of high responsibility. There is no natural law that holds that public institution cannot be both, excellent as well as cost-conconscious. As a socialist and physician, I am still waiting to witness the realization of that ideal through a public entity.
Tom
Said this on 3/14/11 At 11:50 am
The ambulance transport service that is provided in DeKalb County is actually not funded by the fire tax. The fire tax each property owner pays as part of their property taxes each year goes to the fire suppression portion of the department for costs associated with that division. This is why you don't get a bill after a house fire, car fire, or another fire department function is performed on your behalf. That said the EMS service in DeKalb as in every other local municipality is paid for by the end user. The money budgeted for EMS comes from the counties general fund which is then paid back through the fee the user pays back either on their own or by an insurance provider. The rates are very high, in fact Gwinnett County just raised their rate to almost $1000 for transport to the hospital in order to eliminate their budget deficit.
Jack Brady
Said this on 3/13/11 At 11:53 am
City private EMS is usually more benefical for the citizens. I agree with another post that private paramedics put billing above patient care. This is and never has been the case. Yet on the other hand I have seen fire based EMS put themselves above there patient. Meaning I have seen then not transport because they are cooking at home or it is 3am and they just want to go back to bed. I have also seen them leave patients on scene and call a private to come reasses and transport. In my 9 years it is rare to see someone who can not only be a firefighter but also be a paramedic. So I will conclude that the citizens will have better and cheaper health care if they bring in a private. Yet they need to release an RFP and bring all the top players in the coutry, Rural Metro and AMR and also look around there state for the top state private EMS companies.
Daniel
Said this on 3/12/11 At 10:25 pm
As a paramedic with 12 years field experience ALL with a private service, how dare you accuse private services of being on scene placing billing above patient care. When I am on scene providing care regardless if it is a medical or trauma call, providing the highest level of ALS care that I can. Granted a for profit service does look at making a profit but not at the expense of patient care. So for you to imply that Paramedics and EMT's who work for private services are lower than county employees is a slap in the face. Maybe you need to come down off your high and mighty "county paramedic" attitude and work for a respectable private EMS agency, instead of spouting off like a know it all.
Wayne
Said this on 3/12/11 At 03:50 pm
De Kalb County needs to do their homework. Rural/Metro is under investigation of fraud in KY. I worked for R/M in Texas. Very Shady. Now
to the Ding Bat Paramedic quoted above, I have been a Paramedic for almost 30 years. Both Public and Private. HOW DARE YOU MAKE A STATEMENT THAT PRIVATE E.M.S. WORRIES MORE ABOUT BILLING. Yes A for profit service is driven to stay alive by profit. But I can state this with out a doubt, I am on scene doing the same thing you are. And so are my partners.So do not ever thing that you being a high and mighty COUNTY PARAMEDIC makes you any better than any one else whom holds a Cert.or License. I am now a County Employee and I have seen both sides. Maybe you need to do some time on a transfer truck and remember its about the people. Let the Management worry about the billing.
Trolly
Said this on 3/12/11 At 11:32 am
I agree with Karen. I don't know why the individual users have to pay for this vital service. The taxpayers support it, yet are billed when they have to use it. When I had two heart attacks I knew I could not afford the service and drove myself the hospital hoping I would not pass out along the way. So, why even have any taxpayer support at all if no one can afford it anyway?
Karen Davenport
Said this on 3/11/11 At 09:36 am
How much will privatization cost individual users? How will it impact our care as citizens? What is the cost difference?

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