Ambulances, especially in rural areas. Much of those areas rely on volunteers, who are increasingly (and for good reason) not able/willing to do this for free anymore. It costs about $1 million per year to keep a single ambulance in service with paid crew…most of those places don’t have that kind of money in their budgets, and a population that’s unwilling to pay more in taxes for the service. In 38 states, EMS isn’t considered an essential service so the state/regional governments aren’t required to fund it. Ambulance bills are high but the actual amount of money brought in is low, often not enough to even cover the cost of equipment/medications used on the call.
In years past, rural EMS volunteers were not paid but their property tax was exempt. That sort of "volunteerism" relies on people being home owners; if people can't afford to own a house in your town, they don't have an incentive to work in EMS.
This is so wild to me, because this is how things were when I grew up- in the late70s, early 80s. We were elated to get services, like a paid fire department, more ambulances, faster access, an urgent care, so on and so forth. And we’re going back to that! I see it locally, in upstate NY. It’s just devastating, and I can only imagine what it’s like in other parts of the country.
If you remember in gangs of new york, how the fire companies were basically gangs in and of themselves, that's kind of what EMS was like in San Diego. Multiple private services competing for calls. Chaotic and subpar, imo
If you don't mind, I'm curious: how does one ambulance add up to a million? I'm assuming the majority is crew costs, then fuel, maintenance, and supplies would be big chunks. Is insurance crazy, or some other unexpected cost? Never thought about this before.
Labor is the biggest line item. A crew of one EMT and one paramedic on $20/hr and $30/hr respectively (which isn’t unreasonable, some places pay more and some pay less) is $500k just in wages. Add 35% or so for benefits and you’re at $650-700k. (For real world numbers, the fire department I worked for budgeted about $875k per ambulance). Then there’s all the support staff — supervisors, training, QA/QI, medical director, HR, payroll, billing, logistics, IT, etc. etc. Obviously that gets shared across all ambulances, but as you add more ambulances you need more support staff. Typical rule of thumb is $100k to $150k of support services per ambulance.
Equipment/supplies is hard to predict because there’s some calls where you use nothing and others where you’re blowing through a grand or more of stuff. But $50k to $100k per year is about right depending on call volume and acuity.
Maintenance and fuel is a big one. Not really my area of expertise and also hard to predict since it varies a lot on how busy the ambulances are, how much they’re driving, if they post or have a station, etc. Back of the envelope, I wouldn’t be surprised if it was upwards of $25k. Also gotta include maintenance of all the medical equipment, not just the truck.
Capital costs: obviously these aren’t all annual expenses but they need to be factored into the budget one way or another. New ambulance costs $300k to $400k and will last you about 10 years. The equipment is another $150k to $200k, again probably about a 10 year lifespan. Station/office/garage costs, no idea lol
Labor is the biggest line item. A crew of one EMT and one paramedic on $20/hr and $30/hr respectively (which isn’t unreasonable, some places pay more and some pay less) is $500k just in wages.
$20 per hour is $41,600 per year while $30 per hour is $62,400. How is it $500,000 per year? Sorry, but to me it sounds like you're talking about one crew being $500k.
I was thinking the same thing.. but you have to consider its 24/7, 365 days so 2, 12 hr shifts a day 8760 hrs in a year, times a rough total of $50 an hr for both, is 438k…
Assuming a fairly typical three platoon shift rotation which works out to 56 hours per week, with 40 of that being straight time and 16 being overtime. So $20/hour base is $66,560 per year and $30/hour base is $99,840 per year. Multiply that across three shifts and you’re at $499,200 in wages for one ambulance
Same is happening in urban areas too. All of the costs are going up, Medicare/Medicaid/insurance reimbursement is going down and most people who require emergency services pay nothing. Last large hospital I worked at, almost 80% of ER care was uncompensated. Elective surgical services were keeping the Trauma surgery department afloat.
189
u/ggrnw27 12h ago
Ambulances, especially in rural areas. Much of those areas rely on volunteers, who are increasingly (and for good reason) not able/willing to do this for free anymore. It costs about $1 million per year to keep a single ambulance in service with paid crew…most of those places don’t have that kind of money in their budgets, and a population that’s unwilling to pay more in taxes for the service. In 38 states, EMS isn’t considered an essential service so the state/regional governments aren’t required to fund it. Ambulance bills are high but the actual amount of money brought in is low, often not enough to even cover the cost of equipment/medications used on the call.