When dialing 911, would you rather be a patient, or a customer?

Dear Editor:
At the scariest time in your life – when you are worried about your safety, your health, your ability to live – when the paramedics arrive, would you rather be a patient or a customer?
Privatization of government services is done for one reason only: cost savings. There are some areas of government where privatization can help make certain tasks typically held by the public sector more efficient, more streamlined, and thus, ultimately, less expensive.
Emergency Medical Services in the public sector are driven by one reason only: life safety.
Yes, paramedics operate within protocols defined by their scope of practice, but these protocols and standards are written based on what is most successful and will save lives based on empirical research and evidence.
There is a reason why privatization of 911 services is not the standard across the country. If it were anything other than cost-savings, every single city, county, and municipal service across the nation would utilize this model, rather than hovering around 30%. Why don’t most cities do it? First, privatized EMS workers eventually reach the point where they are paid lower wages, affecting turnover and experience levels. Second, the decision is difficult to reverse once made, as start-up costs become a political liability that many decision- makers try to avoid. Ultimately, the safety of the public is held hostage by a model that is profit-driven. The patients become customers, and profit becomes the priority.
Obviously, no company is willing to look at what a human life is worth (at least publicly), nor would it be ethical to do so. However, in a for-profit EMS model, every decision ultimately impacts this ethical consideration:
• Staffing is profit-driven, meaning the fewest people possible are stated in an attempt to increase profitability.
• Wages are profit-driven, meaning the lowest wages possible are paid to increase profitability. This results in lack of the typical competition that governs wages, leaving only the newest EMS workers taking these jobs simply to gain experience before moving on.
• Protocols are profit-driven, meaning the threshold for when to administer potentially life-saving drugs is driven not by the clinical necessity determined by an experienced paramedic, but by strict protocols designed to provide guardrails for less-experienced personnel.
Like many for-profit businesses, the opportunity to enter a new market is taken into consideration when bidding. Higher wages and more personnel may be promised initially to ensure shorter response times. These promises soon become stagnant, however, as profit remains the primary motive and everything else is viewed as an expense.
So, knowing that a decision made today can impact the community for decades, and imagining a day when your life may require intervention from a paramedic, ask yourself: do you want your responding paramedic to be viewed as a resource or an expense? Do you want your 911 call to take secondary priority to a private transport that can be billed at a higher rate? Do you want the response time of the paramedics who come to your aid to be a mere line item impacting a private company’s profitability?
Ultimately, with your life on the line, do you want to be a patient or a customer?
Gary Bruns, 
President of the Nebraska Professional Firefighters 
Association