Ambulance question

[joen7xxx]

I have noticed in my travels around CA from Sacramento to San Diego that there are numerous smaller ambulance companies around the state. They never seem to be responding code 3, so I assume their bread and butter is in code 2 transports. Are these usually basic EMT units? Can someone still make a "private call" for an emerency ambulance directly to these companies instead of using the 911 dispatcher? Just curious. As you can see from my avatar, I used to do this many years ago.

Thanks

Joe

 

[clanusb]

In most of the larger incorporated areas of the state such as Sacramento, the fire departments have taken over 911 ambulance services. Primarily (and sadly) because of the amount of revenue the departments can pull in from a single transport. However, in Sacramento there are some AMR units still providing 911 ALS ambulance service to the county because of prior contracts with the county of Sacramento. These ambulances (AMR 23 and 54 to name two) post within the area of those fire stations, and the crew of these ambulances live out of that ambulance for the duration of their shift. Other areas such as in Stockton have contracted with private ambulance companies to provide 911 ambulance services.

The private ambulance companies provide inter-facility transports, to and from transports, and most of the time even wheelchair vans and other non-emergency services. These ambulances are all code 3 equipped in case their patient happens to go down hill in the middle of a transport. There are BLS, ALS, and CCT ambulances. BLS would consist of a crew of only EMT's. ALS would be atleast one paramedic, and CCT (critical care transport) would have atleast a paramedic and a nurse or doctor).
These companies also provide "medical stand-by's" at high school football games and other sporting events, however in Sacramento County, they could only provide care until the first in FD operated ambulance showed up on scene to transport.

Anyone can call a private ambulance company to give them a ride to the hospital, or for an inter-facility transport, however it has to be non-emergency. If it is an emergency the person would be instructed to call 911

 

[GrumpyGuard]

Some counties such as Santa Clara have a contract with a privet ambulance company for all 911 emergency calls, but also have non-contracted companies that will provide non-emergency transports as well as back up the contract agency. They have county installed radios that allow direct dispatch as well as the ability to ring down the hospital to give patient information to the emergency department. I am not up on Santa Clara as I have not worked EMS there in nearly 30 years. In Fresno County where I currently reside all emergency and non-emergency traffic is handle by American Ambulance. To the best of my knowledge Fresno County does not have any other ambulance companies. We do have several handicap and medical (bus) transportation companies, but none of these run any ambulances.

 

[Kingscup]

Anyone can call a private ambulance company to give them a ride to the hospital, or for an inter-facility transport, however it has to be non-emergency. If it is an emergency the person would be instructed to call 911

Just to clarify, you can call a private ambulance company to transport you to the hospital if the patient's physician has setup a room and will be admitting you to the hospital. If you are going to be seen in the emergency department for an acute illness or injury then the local 9-1-1 provider has to be called.

Counties and regional EMS systems have to put out bids for 9-1-1 contracts (usually every 4-5 years) where both public and private entities can bid on these contracts. Some places, due to state law, are not required to do this if the they have been providing the service since prior to 1980. I am not sure how fire depts (i.e. Sacramento) were able to take over service from a private company while in San Bernadino, they were not able to do that. These contracts only apply to 9-1-1 service. Any private ambulance company can provide non-emergency transfers (i.e. hospital to hospital, hospital to home, home to doctor's office etc.).

 

[Kingscup]

In Fresno County where I currently reside all emergency and non-emergency traffic is handle by American Ambulance. To the best of my knowledge Fresno County does not have any other ambulance companies. We do have several handicap and medical (bus) transportation companies, but none of these run any ambulances.

Within Fresno county, The fire departments of Sanger, Selma, Kingsburg and Coalinga handle their cities and the surrounding areas. Sequoia Safety Council handles Reedley/Orange Cove and the surrounding areas. I am not sure if the are a private company or a third service since I think they are apart of the community services district. Fresno used to have 1or 2 non-emergency ambulance companies but I don't think that is the case anymore.

 

[clanusb]

Just to clarify, you can call a private ambulance company to transport you to the hospital if the patient's physician has setup a room and will be admitting you to the hospital. If you are going to be seen in the emergency department for an acute illness or injury then the local 9-1-1 provider has to be called.

Counties and regional EMS systems have to put out bids for 9-1-1 contracts (usually every 4-5 years) where both public and private entities can bid on these contracts. Some places, due to state law, are not required to do this if the they have been providing the service since prior to 1980. I am not sure how fire depts (i.e. Sacramento) were able to take over service from a private company while in San Bernadino, they were not able to do that. These contracts only apply to 9-1-1 service. Any private ambulance company can provide non-emergency transfers (i.e. hospital to hospital, hospital to home, home to doctor's office etc.).

In Sacramento, theres a loophole....AMR couldnt be kicked completely out. Which is why there are about 3-6 AMR ambulances running around Sacramento as 911 ambulances. Since all the ambulances just got shuffled around, Im not sure where they all ended up at. I know for certain there is an AMR 23 (station 23's area) and AMR 54 (54's area). There used to be AMR 109 which has been bumped out by Sac Metro Medic 109. I want to say the others are AMR 101, and 62

 

[joen7xxx]

I wasn't concerned with AMR vs the city and county units. I was specifically asking about the smaller companies and their place in today's EMS world. Sounds like primarily transports or as we used to call them "grunts". I bet they pay better than 911 with less liability. Collection rates on emergency calls has always been lousy.

 

[clanusb]

I wasn't concerned with AMR vs the city and county units. I was specifically asking about the smaller companies and their place in today's EMS world. Sounds like primarily transports or as we used to call them "grunts". I bet they pay better than 911 with less liability. Collection rates on emergency calls has always been lousy.

as we've all been saying..its different everywhere you go. Some companies grow to be like AMR and become a machine that infests everything. Some such as TLC Ambulance here in sacramento are very tiny, and have remained local. Others such as First Responder or Protransport1 are growing. They play a large part, while usually not noticed, they are needed.

on a side note..if there is not a company that is able or willing to transfer a patient here in sacramento, a FD medic will be dispatched (if it is an urgent case) and that FD gets reimburse for fuel and time on top of the regular payment.

 

[karldotcom]

I saw a Hatzolah EMS Supervisor vehicle a couple weeks ago in North Hollywood.... I remember the discussion of "the Jewish ambulance" seen in L.A. a couple years ago....guess it has been successful.

The Yeshiva World - Frum Jewish News

I also recently saw a private ambulance rolling code in the middle of City of LA about a week ago...I think the patient must have been having problems during a transport.

 

[hose-reel]

It depends in the Central Valley there are still a lot of smaller ambulance companies that have 'their ground' that is their response area, and their's only unless they are overwhelmed by too many calls. Your right collection rates aren't always that great.
The reason you probably didn't see that many code 3 ambulances is because a majority of agencies turn off the lights and sirens when they are the freeway, unless it is really moving slow. The thought being that they shouldn't be doing more than 70 or so anyways, so why have the lights on and scare everyone behind them, or have the lights on and being passed by other cars. Also a majority of the 911 calls do not result in code 3 hospital runs.

 

[akulahawk]

In most of the larger incorporated areas of the state such as Sacramento, the fire departments have taken over 911 ambulance services. Primarily (and sadly) because of the amount of revenue the departments can pull in from a single transport. However, in Sacramento there are some AMR units still providing 911 ALS ambulance service to the county because of prior contracts with the county of Sacramento. These ambulances (AMR 23 and 54 to name two) post within the area of those fire stations, and the crew of these ambulances live out of that ambulance for the duration of their shift. Other areas such as in Stockton have contracted with private ambulance companies to provide 911 ambulance services.

The private ambulance companies provide inter-facility transports, to and from transports, and most of the time even wheelchair vans and other non-emergency services. These ambulances are all code 3 equipped in case their patient happens to go down hill in the middle of a transport. There are BLS, ALS, and CCT ambulances. BLS would consist of a crew of only EMT's. ALS would be atleast one paramedic, and CCT (critical care transport) would have atleast a paramedic and a nurse or doctor).
These companies also provide "medical stand-by's" at high school football games and other sporting events, however in Sacramento County, they could only provide care until the first in FD operated ambulance showed up on scene to transport.

Anyone can call a private ambulance company to give them a ride to the hospital, or for an inter-facility transport, however it has to be non-emergency. If it is an emergency the person would be instructed to call 911

CCT must be staffed with (at the minimum) two EMTs and an advanced provider that is authorized to provide CCT services. Most of the time, it's two EMTs and an RN. If the RN is also EMT certified, then only two people must be on board. Certain Paramedics can be authorized to have an expanded scope to provide some CCT services. It's rare, but a Physician could be on a CCT truck. Most of the time that would be transplant-related.

Also, anyone can call a private ambulance company to transport them to the hospital. It does not have to be non-emergency... a person can legally refuse to call 911, even though they'll be instructed to do so. I used to work as a Paramedic for a private ambulance service. I've transported many patients directly to the ER... sometimes Code 3. No, I didn't work for AMR.

In the Sacramento region, Fire has largely taken over 911 EMS. Other places have a muni Third Service. Many counties also contract with private companies for 911 service.

And no... Private ambulance services that are non-emergency do not pay better than 911. While collection rates are low with 911, the volume of calls can make up for that. Small non-911 providers pay low because they don't normally make a large volume of runs so they also operate on a very thin margin. CCT can be profitable and BLS companies may also get into the CCT business because a few runs can cover daily operating costs for a small fleet.