Our client was a new owner of a private ambulance agency. During my consultant orientation, one of the ambulances was dispatched to an activated fire alarm in an occupied hotel. The ambulance arrived within three minutes and was staging outside, as required by their town contract. I showed up at the 11-minute mark and saw no fire apparatus, the alarm still sounding, and contractors continuing to work and generate dust in the lobby. The volunteer fire station where this ambulance is posted remained unstaffed. No rigs responded. The fire chief was coming from his day job, with a response time over 35 minutes. When the chief arrived, the fire alarm was silenced, and the ambulance was released from the scene.
Consultants are used to provide experienced analysis using specialized skills. We are also hired to do the unpleasant and difficult tasks when implementing change. The ambulance agency covered a portion of a county and had 9-1-1 ambulance contracts with seven towns. Another private ambulance service covered the rest of the county. Our client’s ambulance agency was in a financial crisis.
Unsustainable Town “Exclusive Ambulance” Contracts
In this state, the towns function as EMS gatekeepers. They can designate the town’s permitted EMT-level ambulance provider. The previous owner signed “exclusive ambulance” contracts with seven towns in the county that were covered by the other ambulance service. These contracts were restrictive. The exclusive ambulance could respond only to emergencies within town borders. The exclusive ambulance had to respond to every fire department call within the town.
The process to pull town ambulances for a mass casualty incident, or to help with the Friday afternoon surge of interfacility transports from the hospital, was difficult – we would not get a timely response from the town. The rent we paid to house the town’s exclusive ambulance in some volunteer fire department buildings was above the fair market rate I could get for space in an industrial park.
About half of the exclusive-town ambulances had a transport Unit Hour Utilization of 0.08, responding to 1 or 2 calls a day.1 The combined UHU for the town ambulances was 0.125. The only revenue was from billing for transports. Servicing the seven exclusive town 9-1-1 contracts was creating a multi-million-dollar loss for the ambulance agency. Towns refused to amend the contracts, so the client authorized us to give notice that the contracts would be terminated in 120 days.
Working The Change Process
The first step was to meet with leadership in each town, explain the situation, and propose a solution. For the town described in the opening paragraph, we offered to continue using the town fire station as a post for the rudimentary system status management we were implementing for ambulance deployment.
For all seven towns, there would be no exclusive town ambulance contract. If they stayed with us, they could not select which crew would respond to their town. The towns have three choices: they could continue to allow our ambulance agency to respond to 9-1-1 calls; they could select the ambulance service covering their side of the county; or they could do something else.
Ambulances would no longer respond to every fire company dispatch, including activated fire alarms with no report of smoke or fire. An ambulance would respond to:
- Possible working fires with trapped occupants
- Confirmed working structure fires
- Transportation accidents with injuries
- Greater alarm events
- Any situation where the on-scene fire or police incident commander requested an ambulance.
The ambulance agency will track all EMS calls into the town and provide town leadership with a monthly report on ambulance response times. The ambulance agency will identify responses that exceeded the agreed-upon response time requirement and notify town leadership the next business day. We offered to provide town hall meetings to explain the changes.
A Very Angry Fire Chief
The chief who responded to that activated fire alarm at the start of this article was the angriest. He used reverse 9-1-1 to gather a town hall meeting in the high school basketball court. That town has a few assisted living and over-55 facilities. Those residents were in the front row. Behind them were the volunteer firefighters. John Smith and Mary Doe, senior ambulance agency employees who worked the day shift on the town’s dedicated ambulance, sat behind the firefighters.
I could not understand why the fire chief was so angry. The fire department is not the town’s EMS first responder. The fire company does not have an AED. The town police respond with lights and siren to every EMS 9-1-1 call. Patrol vehicles have an AED. They arrive within two to three minutes. In the past five years, all but one of the cardiac arrest resuscitations in the seven towns included a police-operated AED.
Diving Deeper
I later learned that the angry volunteer fire chief documented fire company/fire chief response to fire incidents using the town ambulance response time. The two- to 10-minute fire company/fire chief response times reported to the mayor and town council were based on ambulance response times; the actual fire company/fire chief response time was much longer. This had been going on for a while.
The most senior ambulance agency employee, Joe Smith, retired when the exclusive ambulance contract ended. Smith started a dozen years ago with the ambulance agency assigned to this town. He did not work at any other ambulance assignment. Smith became a town volunteer firefighter. The fire chief justified using the ambulance response time to the mayor because Smith was a VFD member.
Mary Doe, his partner, started on the town ambulance seven years ago. She moved to a weekday surge unit but left the agency within three months. The surge ambulance did 4 to 8 transports in 12 hours, while the town ambulance averaged 0.7 transports in 24 hours.
Six towns stayed with our ambulance agency. Moving from many slow, exclusive town ambulances to regional coverage for the towns with a basic system status management deployment raised Unit Hour Utilization from 0.125 to 0.30. The ambulance response times to the towns increased by an average of 1.2 minutes. The previous owner was “planting his flag” with these ambulance contracts in towns on the other side of the county, hoping to push out the other ambulance service. The town contract with the angry fire chief was losing almost half a million dollars a year.
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1 Unit Hour Utilization is a High-Performance EMS metric calculating the time-on-task workload of a staffed ambulance per hour.
Elements, identifiers, and sequence of events may be altered in “war stories” to protect the innocent or work better as an example.
Featured picture: Action Ambulance. (2026, February 10). Our Ossipee Valley crew has been busy at work. Thank you to everyone who has helped out! [Instagram] https://www.instagram.com/p/DUmw9cFjqUt/
P.S.: Here is a different view on the issue of EMS-only staff doing firefighting tasks
Davis, J. (2026, August 21). Somerset EMS, fire chiefs revive plan to cooperate on fire calls: ‘We don’t want to start nothing else,’ commission president says. The Baltimore Sun. https://www.baltimoresun.com/2026/08/21/somerset-county-ems-volunteer-fire-calls-policy/
Fire officials say the county’s volunteer firefighters are aging, and new members have been harder to find. County EMS crews are often first to fire scenes, yet current policy can leave them standing by while shorthanded fire companies get to work.
Somerset took over county EMS late last year, while volunteer fire companies remained independent. Some fear the county eventually wants to absorb them, despite repeated denials by commissioners.
County officials said no one is asking an ambulance crew to put on a mask and charge into a burning building. The request is simpler: If a hose needs pulling, a hydrant needs connecting or tools need carrying, don’t make trained hands stand by and watch.
With that, Somerset County officials and volunteer fire chiefs are developing a policy allowing county EMS crews to provide that kind of assistance, reviving a plan that collapsed amid fears of a county-run fire department.