December 2012

There are a couple of reasons why volunteer fire departments don’t work in many cases. In rural communities, they are an excellent resource, but after a response area reaches a certain size, they generally (with a few exceptions) don’t work.
1. Insurance companies: The real mission of the fire department is not to put out fires. It is to save the members of a community money through reducing insurance costs. Fire departments are rated by the insurance services organization on a scale of 10 (no fire department) to 1 (very few departments achieve this). Rankings range from 1 to 10, with 1 being the best and 10 being the worst. An ISO Class 3 rating is a very good rating especially for a department that has both paid and volunteer staff. Class 1 is very difficult to achieve as it means total fire protection. Departments that are outside city limits tend to receive Class 8 or 9 because of extended response times and lack of water supply, and this is true whether or not the department is paid or volunteer.

This is where volunteers shine. In rural areas, the cost/benefit of maintaining a paid department is out shone by volunteers.

2 Liability: In general, it is difficult to discipline volunteers. After all, it isn’t as if you can suspend them without pay or terminate them. In addition, many younger volunteers tend to drive way, way too fast when responding to calls, and they tend to freelance more. This causes liability issues, especially in urban areas where there are more chances of hitting someone.

3 Activity levels: The training and response levels demanded of firefighters increases every year. In urban and busy suburban departments, a fire station may easily run 3,000 or more calls per year. It is difficult to find volunteers who will dedicate themselves like this. I know there are departments who have volunteers at this level, but they are the exception, and not the rule.

There are other reasons, but these are the big ones. I say this after spending 8 years as a volunteer and having to face all of the above issues. Volunteerism used to be fairly strong in central Florida, but it has all but disappeared within the last 5 years. That is also the case in many other areas of the country.

There are many paramedics out there who work for private ambulance companies and claim that paramedics in the public sector (like firemedics) are incompetent and lazy. While I admit that this is true in many cases, I also have to say that the state of the for profit medical world today is committing fraud for profit.

When I worked for the fire department, there were many paramedics that did everything that they could to get out of doing work: this often meant that patients were shortchanged and care suffered in the name of laziness. I fought the battle against lazy medics for years.

The flip side of that is what happens in for profit systems: systematic Medicare and insurance fraud.You see, insurance and Medicare will not pay for a patient to travel anywhere by ambulance, unless there is no cheaper way for the patient to safely get to his destination. Here is how and why it becomes a systematic fraud on the taxpayer:

When a person is in a nursing home, the nursing home gets paid a fee for the housing and basic care of the person. This includes food, medicine, and transportation to medical appointments. For a patient who is on dialysis, this means three trips a week to and from the dialysis center. The only way that a nursing home can get out of paying for the transportation is if an ambulance is required because of the person’s inability to take another means of transportation. This creates a situation where the ambulance company lies to get the business, and the nursing home lies to get out of paying for the person’s transportation.

It is so bad, that some nursing homes tell the physical therapists that they should stop rehabilitating a person’s ability to walk once they can walk 30 feet. Anything more than that, and the person is considered no longer eligible to ride in an ambulance. The ambulance company then instructs the transport crews to avoid using the word “ambulatory” in reports, and even threatens termination for any crew that allows a patient to walk to the truck and/or stretcher.

I have been on calls before where we are supposed to take a person from home to dialysis, and the person pulls up next to us in traffic while driving their own car, and told us she will be home in 5 minutes so we can take her to her appointment. Does that sound like an ambulance is the only way for her to go?

Private ambulances doing transfers, 911 calls, nursing homes, hospitals. The health system of this nation is broken, and riddled with fraud. Making everyone have insurance is not going to make it any better.