PUMs and ALS at Risk

EMS isn't immune to tough times

 

 
 
 

Bryan Bledsoe, DO, FACEP, FAAEM, EMT-P | | Monday, April 6, 2009


As the economy falls, EMS is one of the first public entities to get the shaft. A simple review of recent news articles illustrates this. For example, a few weeks ago the city council of Kansas City, Mo., voted to move the city s ambulance service from the public utility model (PUM) MAST to the city government, making all MAST employees city employees. This move will effectively kill another PUM -- the management scheme developed in the 1980s and touted as the great savior of EMS.

Numerous issues and politics are involved in the disintegration of MAST, but one thing became very clear -- many in Kansas City don't appreciate the tireless efforts of the MAST employees.

Some oppose the plan because the city would have to place the new EMS employees into the city s pension plan. They say the cost savings from the merger would be offset by city contributions to the government pension plan for the new EMS employees. Stated another way, the opponents are saying that EMS employees shouldn't be afforded the same governmental benefits and retirement that police officers and firefighters receive and that the government should continue to oppress the men and women in EMS in order to save a buck.

Just to be up front, I've always opposed the PUM as a concept. I think it's a scheme to hire EMTs and paramedics without providing them with civil service protection and benefits enjoyed by all other public safety and public health workers. Jim Page was onto this PUM boondoggle many years ago when he called the PUM plan a "labor management scheme."

Many PUMs depend on a young and somewhat itinerant workforce. The new EMT or paramedic often cares little about their retirement. Thus, the lack of a good retirement plan may not be seen as a problem for the young employee -- but it becomes a significant issue if one wants to make EMS their life s work.

Now, 600 miles to the northeast, some city leaders in Columbus, Ohio, want to change the Columbus EMS system from an ALS system to a BLS system. Although there may be some scientific merit behind it, I don t think their motives are scientific. They are political -- after all they are politicians. It seems more like a scare tactic to make the public more readily accept other budget cuts. "OK, you can postpone fixing the potholes on my street as long as you don t mess with the ambulance service."

The same thing happened several years ago in my county in Texas. The citizens of Ellis County voted for a tax rollback and it passed. Property taxes were cut back almost 30%. How did the county respond? Well, the first thing they did was to lay off sheriff s deputies, jailers and county constables. The local paper was filled with stories of delayed police response times and such. Thus, the taxpaying public was punished for their decision. But, as time went on, county services slowly returned to pre-rollback performance and all was well. Such is the standard operating procedure for any governmental entity.

As the economy remains in the septic tank, governmental entities look at EMS as an expendable service. And guess what, most EMTs and paramedics will simply say, "Thank you, sir. May I have another?"

In a perfect world, EMS would be the last thing cut when times are tough. How about firing some of those pointy-headed analysts and managers that sit around city hall waiting for the 5 o'clock bell so they can leave? Instead, they pick on the good men and women in EMS and the fire service. That seems to be the American way. A shame it is a shame.




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Related Topics: Administration and Leadership, Leadership and Professionalism, Operations and Protcols, MAST, PUM, Bryan Bledsoe

 
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Bryan Bledsoe, DO, FACEP, FAAEM, EMT-PDr. Bledsoe is an emergency physician and Professor of Emergency Medicine and Director of the EMS fellowship at the University of Nevada School of Medicine in Las Vegas. He is the author of numerous EMS textbooks and articles.

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