The nationwide trend toward privatizing ambulance services has not reached Howard County, but fire officials here say they want to be ready if the challenge comes.
An evaluation report by a seven-member advisory panel organized last fall recommends that the county Department of Fire and Rescue stave off such an option by improving its services and its communication with citizens.
Scheduled for release later this week, the report suggests giving community classes on cardiopulmonary resuscitation, outfitting fire engines with more life-saving equipment and hiring a medical director to oversee the department's emergency medical services (EMS) division.
Such improvements -- along with the department's request for money for 25 additional employees in next fiscal year's budget -- will make privatization an unwelcome alternative, Chief James Heller hopes.
"We have to be competitive," Chief Heller said. "Whatever we do, we have to make sure we do it better than anybody else would do. So if a private service came here and looked at our services, they'll say, 'We can't touch it.' "
Private ambulance services survive on user fees. With its many wealthy, insured residents, Howard County would be a highly attractive market for those businesses.
That concern prompted Chief Heller and several other county representatives in November and January to visit fire departments in Richmond, Va., and Seattle, where private ambulance companies have contracts.
"I don't fear it, I respect it," Chief Heller said. "These are no fly-by-night outfits with no talent. I'm concerned about the long term."
Privatization of local ambulance services is spreading across the nation, prompting concern in fire departments.
Nearly half of all emergency ambulance services in the United States already are run by private companies, said Brenda Staffan, administrative director of the American Ambulance Association of Sacramento, Calif., an organization of private ambulance businesses.
Public-private partnerships between government agencies and these companies are intended to provide quality health services at the lowest cost, saving taxpayers money, Ms. Staffan said. By charging users of ambulance services or their insurance companies, these arrangements free public funds for hiring more firefighters or police officers, she said.
Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems, said private ambulance companies have challenged the efficiency of fire departments nationwide, especially where there are problems with funding and performance.
"As a general rule you tend to see public-private partnerships evolve where you have troubled systems," said Dr. Bass, who coordinates statewide emergency medical services. "You don't see any in Maryland because by and large it's a pretty healthy system."
County Executive Charles I. Ecker says Howard County officials have not been contacted by private companies and would not consider such a proposal right now.
"I think we do an excellent job here," Mr. Ecker said. "But we can improve."
Mr. Ecker is reviewing the advisory panel's critique of Howard's fire department.
Part of that report focuses on ways the fire department could become more community-oriented.
Too often, Chief Heller said, residents meet fire personnel only at the scene of a serious incident when they are being provided medical treatment.
This is one of the ways in which fire departments must change their traditional approach in order to improve their work, said Bruce Walz, an associate professor at the emergency medical health services department at the University of Maryland Baltimore County and a member of the advisory panel.
Mingling more with citizens might pay off if a private ambulance company makes a pitch for the county's business, Chief Heller said.
Fire officials said they also want more support from the county to build on their programs. Chief Heller said that for the fiscal year that begins July 1, he is requesting a budget of more than $17 million -- $1 million more than this year.
The money would be well-used, fire officials said, because Howard County firefighters are cross-trained to deliver emergency medical services as well as battle fires.
Last year firefighters responded to about 39,000 calls, of which 14,000 were for medical emergencies.
Private ambulance crews deal with medical aspects of emergencies, so they would only duplicate what county firefighters already do, the advisory panel concluded. And if a private company contract were to expire, the county might have to start all over with a new company unfamiliar with the county, the panel warned.
Sgt. Kevin J. Henry, president of the Howard County Professional Firefighters Local 2000, says he and his co-workers can do the job.
"But we just want to make sure we're providing the highest grade of service to the citizens," he said.
The union represents the county's career firefighters. The department has 211 employees, 186 of them at fire stations. Another 180 to 200 active volunteer firefighters also work in the county.