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Editorial: Money's the motivator for EMS oversight, and lack thereof

For many years, the officers of the various private volunteer fire and ambulance companies that provide a valuable public service to Harford County have strenuously resisted any financial or strategic oversight by the Harford County government.

This is not to say that the volunteer companies are somehow rogue with regard to the very high level of services they provide. The ambulance service is under the strict supervision of the Maryland Institute for Emergency Medical Services Systems, and the fire side of the volunteer companies is under similar strict training regimens for the people who respond to calls. In short, Harford County is blessed with dedicated, well-trained volunteers who donate a professional skills set for the public good.

While the volunteers historically have donated their time, in recent years the demand for ambulance service has been such that some volunteer companies have paid ambulance members to respond to emergency medical calls. Furthermore, even the volunteer time of the firefighters and medics has a high cost associated with it. Fire equipment is expensive to purchase and every bit as expensive to maintain.

The county allocates more than $11 million a year to the private volunteer fire and ambulance service companies to help cover the costs these organizations bear.

Furthermore, such are the demands for fire and ambulance responders to spend a lot of time training, that old-fashioned fundraising efforts like firehouse carnivals have really become obsolete.

That doesn't mean, however, that the fire companies are without sources of income beyond what the county provides, which brings us to the main reason why the fire and ambulance companies were for so long resistant to county oversight: Money.

Meanwhile, the reason the fire and ambulance companies appear to be warming to the idea of county government oversight also can be stated in a single word: Money.

A key source of fire and ambulance service money for many years, in addition to the county's substantial allocation, has been a state law regarding donations requested from people who are transported by volunteer company ambulances. The requests for donations have the appearance of a bill, but individuals who receive them are not obliged to pay if they don't have insurance. Under the state law, however, an insurance company that receives the same bill/donation request for someone who is covered by that insurance company is obliged to pay the bill in full.

These bills/requests for donations are substantial: several hundred dollars each, multiplied by a substantial percentage of the thousands of ambulance trips made each year in Harford County.

Exactly how much? Well, that's part of the money reason why fire and ambulance companies have resisted financial oversight. As a result, the numbers are, to some extent, a matter of conjecture. The only company whose income from the insurance payment requirement is known for certain is Havre de Grace's Susquehanna Hose Company, which does not have an ambulance component and receives no such funding.

By contrast, the Bel Air Volunteer Fire Company, one of the two or three busiest ambulance services in the county, does collect through the insurance payment requirement and has managed to amass a multi-million dollar reserve fund over the years. Is it a coincidence? There's no way for the general public to find out.

There's another sticky issue regarding the management of the ambulance trip insurance money, namely that the fire and ambulance companies aren't under any particular obligation to spend the money on ambulance-related expenses. How much of the ambulance insurance money ends up being spent on fire equipment? There's no way for the general public to find out.

All of which neatly circles back to the reason why the fire and ambulance companies have lately warmed to the idea of submitting to public oversight of their finances, and, to some degree their service strategies. The volunteer service has found that managing a paid, or partially paid, ambulance service is an expensive proposition, and it has sought, and received, county money to help cover those costs. But the county allocation hasn't been enough, or at least so say the fire and ambulance companies. Is there enough money coming in through the ambulance insurance bills to cover the cost of running an efficient, paid ambulance service? There's no way for the county government or general public to know, so long as there's no public oversight.

As it stands, the fire companies are in the unenviable position of having a substantial private income source, coupled with a long-standing county government income source but yet still having to ask for more from the county. The county has found a way to say "no more money" until the financial picture is made clearer.

The fire and ambulance companies, realizing they're in need of a substantial amount of county funding, appear willing to do what they should have been doing all along: Be financially up front with the county government, not to mention with the people they've been serving all these years.

Copyright © 2014, The Baltimore Sun
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