Problem Identification:
The cost of operating Baltimore’s EMS system will always far exceed the levels of revenue the Department can collect.

Recommended Action:
Consider the creation of a public utility to manage the City’s EMS functions.

Cost Savings, Organizational, Revenue Enhancement, and Service Improvement

Functional/Operational Area:

Estimated Annual Impact:
While the immediate financial impact cannot be estimated, a task force should be assembled to study the benefits of implementing an EMS public utility for Baltimore City.

Estimated Implementation Cost:
Not Determined

Barriers to Implementation:
Opposition from the Department’s union and local commercial ambulance service vendors to a new service delivery model for EMS.

Projected Implementation:
180 – 270 days

Next Step:
Create a task force to study the creation of an EMS public utility in Baltimore. Additionally, senior-level City officials should visit select cities with EMS public utilities to ascertain the merits of further investigation.

Through an EMS public utility, a municipality awards the right to provide emergency and non-emergency services to a single vendor. All ambulance traffic originating within the jurisdiction is channeled to the single provider. In general, only large ambulance service providers or hospitals have the depth and expertise to provide the required services on this scale.

Municipal franchises of this type have many precedents, the most prominent of which is cable television service. Instead of having many companies and the local government meeting local medical transportation needs, one provider can standardize service quality and respond efficiently with peak staffing models. This may also be termed as a competitive wholesale service model.

If an EMS utility model is designed appropriately, a municipality retains control and cannot be held hostage by the service vendor due to the presence of three devices:

– A performance based contract;
– Retaining ownership of the ambulances and medical equipment; and
– Requiring a performance bond.

The EMS public utility is a service delivery model that might yield a far more efficient and responsive system for Baltimore’s citizens. EMS public utilities are characterized by high levels of customer service and efficiency. Major cost savings are realized when non-emergency ambulance traffic cross-subsidizes emergency traffic. Fourteen North American jurisdictions have EMS public utilities. In many areas, this model has either eliminated, or greatly reduced the need for local subsidies for emergency ambulance services.

The City of Richmond is the jurisdiction closest in proximity to Baltimore that employs the EMS utility model. With approximately 55,000 transports per year, the Richmond Ambulance Authority has a 70/30 emergency to non-emergency ambulance call ratio and is considered to be one of the leading urban EMS systems in the nation.

Jurisdictions with EMS Public Utilities

Richmond, VA
Kansas, MO
Charlotte/Mecklenburg County, NC
Lincoln, NE
Pinellas County, FL
Reno, NV
Davenport, IA
Fort Worth, TX
Fort Wayne, IN
Monterey County, CA
Little Rock, AR
Solano County, CA
Tulsa, OK