We Need to Keep EMS as a Public Service
By Albert B. Kelly
Over the last several decades, it is not uncommon to hear someone share their thought that government should be run like a private sector business. For a long time, I never really questioned the idea and to be truthful, in some instances it sounded about right. After all, a well-run business could lay claim to efficiency, good stewardship of money and resources, and if all goes well, perhaps a little surplus to show for it all.
But when that idea is applied to all the things that government does, I’m not so sure that the idea always stands up to scrutiny. For one thing, government takes on those things that the private sector doesn’t deem profitable enough to invest in, whether vaccines, disaster relief, basic infrastructure, and other areas where the need is great but the ability to profit is not. In many ways, government is the place of last resort for projects and services where the service aspect must necessarily take priority over the profit aspect.
This private versus public debate demanded that we give it due attention over the last several weeks as residents expressed their concerns and suspicions over the possibility that private sector money might take future control, whether directly or indirectly, of the Cumberland County Utilities Authority in the name of upfront cash against future revenues from ratepayers. When you get down to it, the suspicion is that service to the public would take a back seat to private sector profits no matter what promises get made.
Another area where serving the public versus serving a private sector balance sheet is in the area of EMS ambulance services. It is not a simple discussion because the cost of equipping and staffing an ambulance squad is not insignificant and many communities are looking at their bottom lines and trying to decide if a private framework is the way to go. But the question can’t be viewed strictly through the lens of a dollars and cents. I say that because there are simply some areas serving the public must always come ahead of profits and this is one of those areas.
I am proud to be able to say that Bridgeton’s EMS Division has a first rate operation that places service to the public ahead of other considerations. That’s not to dismiss EMTs working for private and semi-private entities, but simply an acknowledgment that on the private side of the ledger, the corporate mindset governs decisions and this often plays out in subtle ways, whether in staffing that gets spread a little too thin or lengthening response times due to co-mingling nonemergency transports with the life and death variety.
In other instances the private versus public thing plays out in how calls get prioritized meaning that a private entity might prioritize taking a call in a neighborhood perceived to have a higher caliber of resident with good insurance that pays more than a call in a neighborhood that is perceived to have residents that are insurance-poor and the private entity passes that call off to the public provider under the framework of “mutual aid”.
The public service mindset is oriented differently. It’s not that the economics of the thing don’t matter at all; it’s just that the economics don’t come ahead of serving the public and the metric by which success is measured is different and this matters when you’re talking about a division, such as Bridgeton’s, that covers some 76 square miles, serves five communities, and averages slightly less than 5,300 calls a year.
Bridgeton’s EMS Division works hard at doing what they do well and they punch above their weight. This is true whether service is rendered on seemingly routine transports, multi-victim accidents or providing mutual aid to other squads whether public or private.
When all is said and done, I have no idea if emergency ambulance services can ever become one of those arenas that the private sector can both do well at while still making a decent profit. Providers should never be a respecter of persons and I hope this particular service, and by extension patient care, doesn’t get watered down in the interests of an entity’s bottom line. Emergency Medical Services is one of those basic constituent services that is challenging, especially in a place such as Cumberland County, but I’m not at all sure the answer is to privatize.