BUDGETING THE NECESSITIES
Imagine that you are heading to the store with your grocery list. You have only a small amount of money to buy more items than you know you can afford. What is more important, milk for your children’s breakfast cereal, or that delicious package of brand name cookies you love to eat? Choices… The folks that run the emergency service ambulance corps, the ones that respond to 911 calls and private transport-only units, must make budgetary decisions every day.
There is no one set budget for any agency. Funding varies with each municipality. It does not matter if it is a paid service, raising their own money, paying their healthcare providers, and running a (hopefully profitable) business… or a volunteer service that is dependent on their town’s budget contributions and yearly donation drives. Depending on transport and type of care (BLS or ALS), and if the patient carries insurance, income can include what the agency is paid from each transport from the patient and their insurance.
The managers that run our various EMS agencies throughout New York need to make important choices every day to keep the service running and meet the needs of their community. Choices must be made whether to replace necessary equipment like stretchers or stair chairs, or if there is enough money to replace gloves, nasal cannulas or facemasks, and other necessary items to treat patients. If money is tight, they may have to forget that huge holiday party that their employees, or volunteers, look forward to every year. Often, especially in volunteer agencies, some or all the uniform expenses may fall to the volunteer him/herself.
All Emergency Squads need to cover the cost and maintenance of the vehicles/rigs, purchase of necessary equipment, insurance on the rigs, the building, and the providers in case of injury, and salaries where applicable… and not all paid members are entitled to benefits like 401K and health insurance. While New York State does reimburse initial EMS training costs for both BLS and ALS courses, but there are conditions that must be met such as course sponsors, paperwork filed (by course sponsor), and successfully completing certification.
EMS agencies often receive inconsistent and inadequate funding streams. Ambulance services cannot rely on a patient’s insurance to meet the total expense of their call; if the patient is not transported many insurances may not pay the bill – and the total cost of that run falls on the agency. The 2025 Ambulance Fee Schedule is a national fee schedule for ambulance services; it is a benefit under Medicare Part B, and it is irrelevant as to what state and local costs may differ. Squads with salaried responders pay when there are NO billable calls as well. There are some funding opportunities, but it often takes time and detailed paperwork to apply for grants and such. Managers need to decide on what is truly a necessity on the rig based on available funds.
The past few years have shown a decrease in volunteers and even the lower paid responders. This means that the costs go up to maintain a viable service. Employers must find more incentives, salaries, and benefits, to attract good EMTs and Paramedics. Meanwhile mutual aid numbers and response times due to longer travel keep increasing. It is not a matter of selfishness or lack of concern; both the trained responders and the ambulance squads have bills to pay – and sometimes they must make hard choices.
I'm a former NYS EMT and still part of an EMS & FD family. I like to think I can write ;)
