Cabulance - "wheelchair transport", often staffed by a EMR (emergency medical responder, a lower level than EMT). Someone who needs assistance and support getting where they're going, but is not in need of or likely to need medical treatment or support during the trip.
And they are reimbursed, or actually generally billed to insurance.
As an ex-paramedic and EMT, both with County Fire and private, there are absolutely those. But many-a-time, some of the blame falls on the physician. Medicare has, for one example, a lovely little form to fill out, just a few fields, mostly checks and multiple choice, to explain why the need for a "fully equipped BLS (or ALS) ambulance" was required, versus POV (private owned vehicle) or cabulance.
The number of times we'd have to hang out at the charge nurse's desk because the physician had scrawled a signature at the bottom of the form and nothing else, etc., was ... staggering.
If that doesn't give that reasoning (unable to stand steady, fall hazard, need for continuous O2, etc., etc., etc.) then no pay. And many insurers would use that same paperwork, not just Medicare. Could we fill it out ourselves? No. I'm not risking my EMS career to be at the center of a "ambulance company employees charged with medicare fraud" news story.
One thing I'd like to point out, many of the Airlift companies, like Airlift Northwest, offer $60/year family insurance for Heli EMS. They'll bill your insurance and accept the insurer's payment as "Paid in full". They also tend to have reciprocal agreements with many other HEMS agencies.
Correct. The only ambulances that typically will stock blood are specialized NICU ambulances and HEMS (helicopter). Although more progressive agencies are looking more and more at part blood products.
> Typically an ems crew will be two paramedics. Average paramedic wage is about $23/hr.
Paramedics and EMTs aren't the same thing. Private ambulance crews running "dual ALS (advanced life support, i.e. paramedics)" are _exceptionally rare_. Normal staffing is Paramedic and EMT, and most often there are crews that are dual EMT.
Average EMT wage is actually about $18/hr (and in much of the south you can be looking at $15-16/hr).
However where wages do go up, but not in a good way, is overtime. The agency I worked would happily schedule you for 36 or 48 hour _shifts_ and had no weekly hour limit beyond "You must take an 8 hour break after 60 hours of shift", I kid you not - and many people will regularly work 72-96 hour weeks.
The big thing is that private EMS writes off a lot of bills and pushes the balance on everyone else. The holy grail for private EMS agencies is "inter facility -out- of a hospital", as oftentimes the hospital pays the ambulance bill and charges the patient.
You also have to be careful looking at FD provided _transport_ as billing for this is often subsidized by property taxes. There are FDs who will charge for treatment and for transport, for transport only (not for treatment), or for neither (my FD did not charge - but there were also differing policies on when we transported, not by default, so you had people literally - and understandably - peeking out their window to see if it was a red FD ambulance/medic unit outside, or a white private ambulance).
Even above and beyond that, there are a LOT of disposable costs you never recoup. Bedding, blankets, gloves, etc.
> This is a short trip in an automobile, essentially a fancy uber ride.
That is a little flippant, as you acknowledge... good way to offend any paramedic or EMT. I've delivered babies en route to a hospital, including breeches. CPR. Emergency airways.
> A new, fully equipped ambulance is about $150k.
Not any more. Thanks, private equity. You can easily be looking at $400K. And they are vehicles that are driven hard, and cold, and maintenance sucks as a result. No warm up times for engines. Private ambulance, it's common to see rigs with 300,000+ miles on them.
> Then you have liability, both for the vehicle and for the medical treatment; that's about $12k per year.
Not for the medical treatment, no. You can get insurance privately as a paramedic but those policies are generally excess/umbrella style or are specifically "occasional only". The last private agency I worked at with a dozen paramedics and 50+ EMTs had at least mid 6 digit insurance bill.
> Throw in money for gas and wear and tear, which should be quite comparable to other automobiles
For a vehicle that can weigh 10,000lb+, that gets started and stopped often 30 times a day, a lot of time driven "foot to the floor" with an attitude of "it's got to get where it needs to go"? No, although one of the first thing any halfway decent sized agency quickly learns to build out is its own full shop and multiple mechanics (my friend is the Head Mechanic at a local county fire agency and oversees 8 FT mechanics and an auto electrician).
This jumped around a lot, I apologize, and I don't mean to shout you down, at all, but, lest you think I'm defending this state of affairs, I am not, in no way, shape or form.
> Safety is extremely important, so you expect some slowness as a result, but it got pretty extreme. I remember one time having to do 6 weeks of testing around a one-line code change because a "helpful" dev fixed a small bug that had no practical impact.
Not to bring Tesla into this, but the contrast here is stunning. From a component manufacturer about the mindset of Tesla:
"Hey, we sent you over the new firmware for the component, check it out." (The test suite for this component takes approximately 36 hours to execute.)
Three hours later:
"This is working so much better, thanks a lot!"
"???"
"Oh, we just flashed a car we have here and took it out for a drive."
Yeah, "almost certainly needs serious work" in that first home was doing some serious heavy lifting - the roof has collapsed and the foundation has sunk.
At least in my state, as a former emergency services worker, our EVIP (emergency vehicle incident prevention) course (which serves as a "substitute" for requiring a CDL to drive an emergency vehicle) absolutely tells you that driver liability can and will flow through to your personally, even when driving a work vehicle for work purposes. (Because that also comes with a presumption of liability for any incident that happens in "emergency mode" departments, agencies will generally also hold insurance specifically for that flow through that says "while the law says you can do anything, with due regard, in emergency mode, as long as you stay in our more restrictive SOPs, our insurer will also cover your personal liability".)
For states where law enforcement cannot do such things directly, they can still contract with a private provider, either as an RFP, or (as in some states) "you can't RFP this butttt if some private provider just so happened to provide it, you can use it".
It's very telling that Flock has only just hired a CISO recently. Garrett doesn't care much for anything that might hint at compliance for data sharing.
Flock knows what inter-agency data sharing is legal and not legal in what states. So you think they'd have the functionality to disable forbidden data sharing when they sign a new agency in that state. They don't do that. "That's not our responsibility." And not only that, but:
Agency: Could we get training on how to do [forbidden data sharing]?
Flock: Absolutely. It's illegal in your state. Now that I've said that, here's how you do it in the app.
Yeah, that was similar to Amiga and the Kickstart concept, initially on floppy, then as a separate ROM module. Going from AmigaOS 1.3 to 2.0 with the applicable Kickstart ROM gave you a whole new UI layer.
> I wanted to sympathize with OP, but I sense that the blog post was written while they were still fuming, and some of their behavior during the process (esp the first job) gave me pause. Maybe its just the timing that makes it feel aggressive.
I do agree. The situation is certainly frustrating. But to me, "by the first evening, I was ready to go postal" is... something of a red flag about their manageability? I'll acknowledge that we have our lanes, and that LI is much more established, but if you were at a startup or smaller org, the whole "not my job" anger after just a few hours would be problematic.
Absolutely. I've had two experiences that stick in my mind - one, where the recruiter told me within the first three minutes that the hiring manager had already seen my resume, they'd both agreed there was amazing alignment, and then proceeded to talk to me for forty five minutes about the company and answer questions to make sure I was interested in the company (I was). Yes, of course, his job, but it wasn't just trite vague and generic "We have excellent benefits", but talked about their path and plans and approach. He was very responsive, and sure enough, excited hiring manager call, and then just one more call, with the VP of Product, who outright said the hiring manager was making the call and decisions, if I was talking to him, I was basically a "finalist", and that he wanted most of the interview to be me asking him questions, not just so I could learn more, but he could see my levels of inquisitiveness, etc. I got that job, the recruiter was very responsive, we even joked that I had a brief moment of doubt when he sent me a message "to connect" after the two interviews: we'd had all our previous conversations via Zoom. I said in my email, "feel free to schedule a Zoom for any time after X or give me a call directly" (admittedly trying to feel things out), and he said "Oh, I can just give you a quick call" (and I assumed it was thanks but no thanks).
The other, they made things work. While normally, we're all accustomed to "Actually X has a conflict, so we need to reschedule" and on and on and you can find yourself a week, two weeks later, waiting still, this company said "X has a conflict, but we're going to put someone else into the interview", and then they had a challenge with someone being sick for a panel interview - "We're going to do the interview without them", i.e. they were committed to "we need to and want to keep moving forward". Every time I've had that rescheduling limbo, as you say, it's a sign (obviously there can be some exceptions), but when a company is working to make things happen, it's generally a good sign about your prospects, the company, or both.