There is a serious long-standing crisis in the Chicago Fire Department’s Emergency Medical Services, and it has a simple solution. The city needs to make EMS a priority once and for all, and that not only means increasing ambulances, but also creating a Bureau of EMS within CFD under its own command.
Chicago’s long-neglected investment in EMS has cost the city lives and income.
CFD handles thousands of calls a day. Yet the city currently has just 80 ambulances. By contrast, New York City has 450 ambulances. This limits Chicago’s EMS response times, forcing the city to engage in the very expensive practice of using fire trucks on EMS calls and paying exorbitant amounts of overtime to exhausted EMS personnel. Furthermore, it has lost the city opportunities for income generation.
We don’t need a study to justify bringing the active fleet to a minimum of 125 ambulances or creating a bureau of EMS under a separate command to ensure that EMS needs are prioritized and managed effectively. The expansion of EMS assets would save lives and help generate income.
Even under the current system, which collects only a small portion of what is billed, EMS is a revenue producer, with every ambulance generating enough revenue to pay the salaries of the crew. The issue of more ambulances is not a revenue issue. The overtime savings alone would go far to cover much of the cost. A new ambulance would pay for itself in one to two years. Every day the shortage of ambulances manifests in longer response times, the city is vulnerable to lawsuits.
That said, the city has also failed to take full advantage of the revenue-generating potential of a fully supported EMS program. EMS is potentially a big revenue producer. A well-equipped and effectively managed and supported EMS can be significantly monetized, generating far more than enough resources to cover the costs of expanded and needed services. This can be accomplished by taking full advantage of available Medicaid and Medicare reimbursements and more effective billing of private insurers and expanding the city’s capacity to compete with private EMS providers by giving services to private events.
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CFD has failed to recover the billable revenue it’s entitled to. CBS affiliate WBBM-Ch. 2 reported that in 2018, only 22% of total billings were collected and, in 2019, only 17%.
CFD could generate revenue by establishing a community health center program on the scale of Los Angeles to provide federally reimbursable health services to those living in poverty. Such a service would more than pay for itself and help generate additional income to support further expansion of EMS ambulances and crews. This program would significantly increase the quality of life for the patients while also reducing use of the 911 system.
The department could also find additional revenue by starting biohazard cleanup after a car accident. This has been a significant source of revenue for years for many fire departments nationwide. CFD has failed to adapt.
Ultimately, like New York City, a Bureau of Emergency Medical Services would ensure emergency services and personnel receive the attention they and the city it serves deserve. The bureau would set priorities, develop EMS budget recommendations and manage services.
To quickly secure additional personnel, CFD could lift the age limit of 38, expand cross training and target firefighter candidate recruits who are already EMS-qualified. They could also give firefighters opportunities to provide emergency services on their days off. It could also create a special recruitment and training program with Chicago high schools and city colleges to provide a pipeline of potential EMS candidates from the communities they would serve.
Emergency medical personnel are among our most important front-line responders, and providing them with the necessary tools and leadership to do their jobs most effectively is not only critical to EMS personnel, but also the public they serve. EMS is a resource that needs to be fully exploited; its potential has long been ignored by the mayor’s office and CFD leadership.
Paul Vallas is an adviser for the Illinois Policy Institute. He has run for Chicago mayor twice and was previously budget director for the city and CEO of Chicago Public Schools.
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