Op-ed column: Privatization of ambulances not the answer to EMT shortage

Rotterdam Volunteer Ambulance is suffering financial problems and may have trouble meeting its oblig

Rotterdam Volunteer Ambulance is suffering financial problems and may have trouble meeting its obligations. Recently, following internal political squabbling, the Duanesburg Volunteer Ambulance suffered severe volunteer shortages and could not meet its obligations. In both cases, one proposal was to use Mohawk Ambulance, a commercial for-profit service, instead.

Although this is a convenient solution, it should be considered carefully.

Although Mohawk Ambulance has many fine employees, it is a private company, run for profit. One advantage to capitalism is that competition brings efficiency and quality. However, since the 1980s, when its parent company absorbed Schenectady Ambulance Service, Mohawk has had a competition-free monopoly to provide ambulance service in the city of Schenectady and most of Glenville.

Furthermore, many of Mohawk’s best quality recruits come from area volunteer services. Often young, enthusiastic volunteer EMTs accept low wages and long hours to enter commercial ambulance work and gain experience, access to paramedic training and do what they love to do full time. Often, after a year or two, they move on to higher paying municipal or commercial EMS work. Mohawk is in many ways an entry-level agency that recruits from area volunteer services.

Question of quality

It is my suspicion that if local area volunteer ambulances begin to disappear, the quality of the typical Mohawk ambulance recruit will go down and the quality of care provided by this company may suffer.

For the record, I’m an EMT who worked for Mohawk both in the 1980s and briefly last year. (After six weeks, the manager decided to can his two oldest, most educated recruits, I suspect because we asked questions during orientation he couldn’t answer. The other dismissed employee, a retired RPI professor bitten by the ambulance bug, still serves in good standing in Albany County volunteer EMS.)

I’ve also worked for Schenectady Ambulance Service in the ‘80s, Empire Ambulance in Troy and various volunteer fire and emergency medical agencies. So I know something about what ambulance work and ambulance workers are like.

There’s a lot of stress, a lot of independence, a lot of power over other people (in fact, some of the worst, scariest EMTs I’ve seen over the years are attracted to the field by the chance to have power over others). There’s a lot of exposure to ugliness. You see people die, you see people who’ve hurt each other, you see people who’ve hurt themselves, you see people who’ve entered a downward slide and just don’t care anymore. Teenage mothers with three kids and little children living in rat holes where nobody should have to live. Drunks and the emotionally disturbed or agitated threaten you.

Problem of burnout

When I left ambulance work, human resource people used to look at me funny when I answered the question, “What was your least favorite thing about your last job?” with “When drunks throw up on my shoes and then threaten to kick my teeth in.”

After a while, burnout sets in and you sometimes find yourself not caring about what happens to people who just don’t seem to show any interest in caring for themselves.

You go out at all hours in all weather and sometimes it’s just not safe. During my time in ambulance work, I was a passenger in four ambulances that crashed, fortunately three at low speed. You eat too much fast food on the run and don’t sleep enough.

We often worked more than 60 hours a week, week after week, sleeping in the garage when we could, tolerating low pay because the hours were so long it added up to a (barely) living wage. Besides, there’s an addictive appeal to ambulance work after a while.

As crazy as it sounds, I often miss ambulance work and wish I was doing it again, although I know it’s for the best that I left.

Still, normal people avoid death, disease, human malaise and violence, especially when they really understand them.

The egos of the people involved are often large.

Every ambulance organization I’ve been involved in considered itself above average, if not the absolute best agency, but only at the skills that its core members considered important.

Often these were the more “masculine” or technical skills, while the more “feminine” aspects of emergency health care get neglected. I’ve met more than one EMT or paramedic who considered themselves highly skilled and knowledgeable in how to treat the badly injured, but who would occasionally just skip changing sheets and blankets on a stretcher, a highly unsanitary practice, because they just did not feel like doing it that day. Besides, they figure, who will ever really know?

This is what happens when burnout combines with long hours and low pay.

Competition needed

One way to increase quality of care provided, get the worst excesses reported more quickly, and increase attention to detail among EMTs is through competition and inter-agency rivalries.

Based on my experiences, wide-ranging monopolies by commercial services should be avoided in emergency medical pre-hospital care. Not only do these hinder recruitment of new workers, monopolies encourage situations where people are so eager to work in EMS that they settle for long hours and low pay. Such conditions increase burnout among workers, which leads to low quality patient care.

Turning over large stretches of Schenectady County to Mohawk Ambulance is not a simple, problem-free solution to the shortage of EMTs in many towns.

Peter Huston lives in Scotia. The Gazette encourages readers to submit material on local issues for the Sunday Opinion section.

Categories: Opinion

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