Depending on what type of fiscal year your agency works with, you might be “up to your eyeballs” in budget work. Even if you are not based on the calendar year, it’s something you should already be thinking about.
A lot of considerations are in the mix depending on the type of EMS service you run (commercial, not-for-profit, volunteer, hospital-based, or local government), or if you are a combination agency such as fire and ambulance. Where does your funding come from – insurance billing, local municipality, donations and/or subscriptions, or maybe grants? Finally, whose responsibility is it to do the paperwork on your budget, is it your own directors, your local government’s accounting department, the hospital that oversees you, or do you hire an outside agency?
Let’s assume that it is all on you. The first thing you should do is familiarize yourself with at least the last three years of your agency budget. What are your annual expenses? If you are fire/ambulance service, try to assign how much of each expense belongs to EMS alone. Include salaries (if any); fuel to keep your rigs running, vehicle expenses like maintenance and insurance; equipment; uniforms; and house expenses like rent or mortgage, utilities, repairs, etc. Don’t forget to look at your income as well and the changes over the past few years. If the income versus expenses has changed radically, does it correspond to changes in your town (population, income, infrastructure)? And if so, what trends will be affecting your profit and loss columns in the coming year?
Whether your staff is salaried, volunteer, or a combination of both, you do need to allow a budget that will aid in both retention and recruitment. Many managers make the mistake of putting all the money into recruitment and nothing into retention and this philosophy, at best, provides a very high turnover. Maybe you can keep your rigs and office staffed adequately, but you lose a lot of experience, and you will have to keep training newcomers (which will actually cost you more if they need to ride with a full crew in order to get used to the way your company does things), and the solidarity of your existing crews can go downhill rapidly and they will often look for a better position elsewhere. Salaried employees need a realistic living wage, volunteers should be recognized as well for the time they put in. Even throwing a yearly picnic or an in-house holiday party will help to keep morale up without going broke in the process.
Remember that the budget that may look so good on paper may not be realistic for your individual agency or the community it serves. Assume that no matter how healthy your budget looks, there will always be some surprise – an expense you weren’t expecting, less reimbursement from insurance companies, or even an accident, injury, or worse affecting your headquarters, rigs, staff, or patient. Look for available grants, it wouldn’t hurt to have someone versed in grant writing to help you out. When you can cut corners safely, such as if you can remount an ambulance instead of replacing it, definitely look into it.