Considerations in Privately Operated Emergency Ambulance Services

What is going on? I do not understand why people think it is difficult to run a positive cash-flow private ambulance service. Indeed, over the years I have heard that running a “for profit” service is close to impossible, with barriers every-way you turn. Certainly, it can seem like obstacle after obstacle stops the progression from “Ambulance Service Start-up” to an effective and cost-effective emergency/ non-emergency ambulance service.

And, yes, services are falling-over. There’s the relatively small, 75 staff “Universal Ambulance Service, Inc”  that collapsed in 2013 (checkout the providence journal)  to the large “TransCare” (New York, Pennsylvania Delaware, Maryland  and Washington, USA). This is not just about the USA in the UK there are similar stories, such as Sussex Patient Transport.

In most countries I have worked, there are no significant legislative barriers to establishing an ambulance service. Whether it can undertake emergency responses is another story, but even then, many countries have greater flexibility than Australia in allowing private emergency medical responses. Regardless of the location, there will be laws that need to be followed, of course, but there is certainly scope to establish such a service. Indeed, in most of these countries, it is often the case that the only ambulance service in existence is privately operated. However, many lack the “best practice” pre-hospital standards. And I still do not understand why.

There are many factors that go to establishing such an organisation but I would argue there are some things that are vital. The overwhelming factor, the supreme objective for any health service, is about people and the quality of care they provide. First- an ambulance service needs to have good people with fantastic training.

Not just a person with a glorified first aid certificate. Oh, this will allow you to provide a cheap service but not necessarily an effective service. Even with the evidence that reinforces the appropriateness of BLS in the prehospital field (as opposed to ALS), a first aid certificate and a vehicle does not make a Paramedic, nor an ambulance service. Well trained people who understand what they are doing and can have a conversation about treatment with peers. That is the type of person you want.

The Ambulance service needs to be responsive, both operationally as well as to your community and stakeholders needs. This feeds into your overarching governance arrangements; supportive medical structures, reliable vehicles, excellent communication and partnerships with medical (hospital) services and operational/ clinical “best practice”.

And costs. It does all boil down to costs. Do you really know your operating costs? Do you have a business model that ensures more income than expenditure? Are charging appropriately? And I certainly understand that running any organisation- public or private, for profit or not for profit- is more involved than these few questions, these are simple governance questions that can be asked to ensure you are on the right track.

The longer it takes to answer the funding question, and the more complex the response, the easier it is to decrease the transparency of operational budgetary concerns.

Once you have established the organisational and governance pillars, operational arrangements, staff management and resource plan in place, you have answered many parts of the success equation. The rest -customer service- should be relatively easy.… You did enter the business with a thoroughly researched marketing plan or, alternatively, an establish client base …. didn’t you?

…. Craig Hooper

Craig Hooper  

Craig is a health and emergency service management consultant specialising in pre-hospital and emergency operations. He has more than 25 years experience in operational management, emergency planning and service implementation in more than 10 countries.

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