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 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
The previous owner signed “exclusive ambulance” contracts with towns that would normally have been covered by the other ambulance service. These contracts were restrictive. The exclusive ambulance could only respond to emergencies within the town borders. 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.
Most exclusive-town ambulances had a transport Unit Hour Utilization of 0.08, responding to 1 or 2 calls a day.1 The only revenue was from billing for transports. Servicing the 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. We offered to continue using the town fire station as a post for the rudimentary system status management we were implementing for ambulance deployment. There would be no exclusive town ambulance contract; the town could not dictate which ambulance crews could post in the town.
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 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 were renegotiating the rent if we continued to use the volunteer fire station. 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. Two senior ambulance agency employees who worked the day shift on the dedicated town 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. In most of this county, the town police respond with lights and siren to every EMS 9-1-1 call. The patrol force is credentialed as Emergency First Responders. Patrol vehicles have an AED and first aid supplies. They arrive within two to three minutes. In the past five years, all but one of the cardiac arrest resuscitations in the towns included a police-operated AED.
Diving Deeper
I later learned that the 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 the ambulance; 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 assigned to that town’s ambulance retired when the exclusive ambulance contract ended. He started a dozen years ago with the ambulance agency assigned to the town ambulance. He did not work at any other ambulance assignment. 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.
Moving from many slow, exclusive town ambulances to regional coverage for the towns with a basic system status management deployment raised Unit Hour Utilization 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. This town’s dedicated ambulance contract 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/
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