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Journal aukset's Journal: When Competition in EMS Fails the Public

I am a volunteer EMT for the North Area Volunteer Ambulance Corps., Inc., in North Syracuse, New York. It is therefore obvious that I have a bias in the telling of this story. However, regardless of my bias towards my agency, my purpose here is not to put down the neighboring agency nor promote my own. Rather, my intention with this post is to show that competition in Emergency Medical Services can have very deleterious effects for the communities served by the losers.

For background on the story, I will refer readers to NAVAC's Website explaining the situation. A brief summary: NAVAC had since the early 70s been serving a particular area that included the North Medical Urgent Care facility. This facility serves those who need urgent care but do not need a hospital, such as someone with a sprained ankle or a minor respiratory infection. They are not equipped to handle true emergencies such as cardiac events or major trauma events. Thus, many people who self-transport to this facility are in fact in need of much greater care. That is when the ambulance is called. We would provide advanced life support and transport these patients to one of the area emergency rooms. A not-insignificant portion of calls the ambulances were sent on were to this facility and provided a steady stream of income for the agency.

Well, due to a mistake, when NAVAC's certificate was authored back in the 70s when the current EMS system was enacted in the state, the certificate failed to include this area (as well as two other areas that NAVAC had been serving). A few years ago, a neighboring agency that had a different coverage area (NOVA) noticed this mistake and chose to challenge NAVAC. To make a long story short, the challenge has succeeded (so far) and now NOVA, rather than NAVAC, is dispatched to all calls from this facility.

Unfortunately, the level of services NAVAC kept available and were providing to their community was predicated on the income they expected to receive, a good portion of which included the calls from the North Medical Urgent Care facility. Lacking those calls, NAVAC was forced to radically scale back their operational capacity just to continue to break even financially.

So the laws of unintended consequences now strike: those hurt most by this need to scale back operations were not those in the areas that changed providers. Rather, the areas that NAVAC still covers are now at risk. NAVAC has not had to sacrifice quality to stay afloat, but capacity is diminished. Furthermore, with such close neighbors, mutual aid between those two agencies is imperiled as the leadership of the two agencies are not exactly on the best of terms. This latter situation places both areas at risk. NAVAC covers Syracuse's Hancock International Airport, and should a major catastrophe occur where mutual aid is required, NOVA will also likely need to respond. Since the agencies do not have an existing working relationship, a mass casualty incident will have unneeded difficulties within the chain of command.

None of this is catastrophic, of course. NAVAC still operates effectively and will continue to do so whatever the outcome of its Certificate of Need application. It will still offer the same level of quality expected and required by law. It will still play the most critical leadership roles in any mass casualty incidents within its coverage area. It will still ably provide mutual aid to neighboring regions including NOVA's. It is quite certain, however, that due to NOVA's self-serving actions and cross-regional competition, they have substantially reduced the capacity of the ENTIRE Central New York region's EMS system.

Much like Fire and Police, Ambulance services are not something that can be easily privatized and left to competition. The risks of such are real and obvious, and staggering. Ultimately, we are all here to save lives and serve our communities, and putting these services in the position of economic competition with one another is putting human lives at risk. Those economics, the financial capacity of the ambulance service, correlates directly with the operational capacity and quality of care that service can provide to the people it serves.

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When Competition in EMS Fails the Public

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