Posted: 12/4/2006 9:27:38 AM EDT
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Reposted from the general forums: Hey folks, Does any EMT here know much about AMR (American Medical Response)? For some reason most of what I've heard so far is fairly negative. Can anyone give me the lowdown? Why does it seem to have such a bad rep? Thanks |
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I began my EMS career with a for-profit service based out of a funeral home (I'm dating myself here). They were ALL about the money. Hell, they had us re-use cravats. Yes, I'm serious. Insert an interlude where I held another job and volunteered with a fire-based volunteer service. If you stayed out of the politics--or intentionally pissed off the chief's daughter  , it was fun but didn't pay anything.Next, I went back to full-time EMS with another private for-profit. It was a great work experience because it was a family-run organization that honestly tried to put the patient first. Great people, great employees. The owner got burned out, though, and sold to AMR. AMR was a corporate behemoth that wanted to change local practices to the corporate method. Of course, those methods didn't work in the local situation, so AMR started losing money in the local population centers we had served. (Ex: you can't charge $5/person to either townships or cities for ambulance service when the company previously charged $1.75/person, and when there are other services willing to do it at $1.75). AMR was a big, faceless corporation. The first thing they did was fire the extremely talented mechanic, because their model called for service by the local Ford dealership. Without going into details, AMR made many similar "corporate" decisions, every one of which cost them profit and employee loyalty. AMR lasted a couple of years before losing so much money they gave up...destroying that family business in the process. AMR had talented people working for them on the ground, but the corporate thing left a very bad taste in many peoples' mouths. Though many people may promote fire-based units, some of those are good and some are not. In my first job, when I worked at the penny-pinching funeral home service, our EMTs averaged much better than the nearest fire-based service. Many of the fire medics worked ambulance only because they had to...but hated the work. They wanted to be on a fire truck (because they didn't have fires and it was a cushy job). The fire service was also based on always having the assistance of an engine company. Their 3-person crews couldn't function with less than 6 people (or at least that's how it seemed). Meanwhile, our 2-person crews saw so much more trauma that we were tuned tight. I'm sure other people can name areas where the fire/private situation is exactly the reverse, though, and the fire guys kick the underpaid EMT-B transfer service's butt. Here's the really short answer--the quality of the EMS service depends entirely on that local service's philosophy, manager, and training. |
| Worked for them in Denver 7 years ago wasn't the worst experience ever but close. As an EMT the one thing that will help you if you work for them is doing some critical care transfers with flight teams. You can learn so much from a flight team and the patient. But you can get that with any private service I guess. Other than that pretty worthless in Denver. El Paso (Co Springs) has a pretty good reputation from what I have heard and seen. In fact I think El Paso AMR just received a national award (saw it in JEMS but cant remember what award). |
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Our little (okay, not so little) private ambulance company in Vegas sold out to Laidlaw/AMR back in '98. I have since watched a company that USED to be top-notch turn into a crap company. Don't get me wrong, we still have some really good PEOPLE working the streets, but the company is so bad to work for that turnover has gotten out of control. Vegas is one of the few "cash cows" in the Pacific Southwest division so we've been used and abused just to keep the money rolling in. My adivce would be to ask the local employees how THEY are being taken care of. Our system may be worse than yours. 
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NOTE:...The following may not be true for ALL divisions of AMR in cities around the country...Im just commenting on the ones around MY neck of the woods: AMR is a shady company, their SOP is to go into a city that already has an EMS provider (such as fire/rescue, or an EMS department) and convince the local government that AMR can provide the EMS for way cheaper than the city's current provider. Then...if the city takes the bait, and gives AMR a contract...they wait till the original EMS provider has sufficiently weakened (I.E. sold off most of their ambulances, laid off personell, etc, etc) and they go back to the local Gov. and say: "Oh man...we are going to have to raise our prices...we cant afford to keep providing quality EMS at these rates". They just got run out of Palm Beach County, and now they are trying to come into OUR territory...They wont be able to though, because we are a fire DISTRICT, and a seperate government/taxing agency...and we have the sole certificate of need locked up. All they are allowed to do around here is interfacility taxi rides (they arent even allowed to turn on their emergency lights.) Im sure they have alot of good people working for them at the rank and file level...BUT, (looking at it from the career fire/rescue point of view)...I have seen many of them that are just unprofessional as all get-up. IMHO, the company is just TOO BIG, and GREEDY to provide quality EMS at the local level. |
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I have never worked for AMR, but worked at a company prior to them being taken over by AMR (the same company Bed_Head is talking about). I still have a lot of friends that work there and I run calls with them on a daily basis. In my experience, working in private EMS is no bowl of cherries to begin with. FWIW I have worked as a paramedic for private companies in Ohio, West Virginia, Nevada, and California, so I have some idea of what I am talking about. The people who work for AMR all think the company took a BIG step down when AMR took over and as I said, it was nothing to write home about to begin with. I am not talking about the equipment or the quality of care. I am just talking about the working environment. The pay/benefit package. The way they are treated, etc. Basically they are typical American company that is ALL about the money who don't give a rat's ass about their employees in any way. Las Vegas for many, many years had one private ambulance company. After AMR took over, a second ambulance company was started in large part by people who gladly quit AMR to go work for the other company. All that being said, working for AMR might be a good stepping stone into the world of EMS. Working in a really busy, progressive EMS system for a couple years looks good on the resume and might be just what you need to land a job you really want. |
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They tried to move in here a few years back too- they ran convalescent/non emergency calls only (they weren’t allowed to run code in the county I worked and only in extreme circumstances in other counties). They tried to sell the local counties on what they could do for them but no one bit fortunately. Their poor service and crappy business model doomed them and they pulled out after a couple short years. They are all about collecting Medicaid/Medicare and insurance and not about the employees or patients. I had a few friends give them a shot (sign on bonuses suckered them in) but they quit after what they described as fraudulent activity, poor management, second rate equipment, etc. They weren’t willing to lie about billing charges so the company could make more. They may be different elsewhere, but I’d take another job before I worked for them. YMMV  |
Lots of good stuff about AMR I see  I work for AMR & while it's not the best paying job I've ever had it's far from the worst job I've ever had. They could pay better, but they pay what we are willing to work for & have a list of EMT's that are willing to work for em if I quit & that speaks volumes. They do have a really good medical/beanies packages & the 401K match is also pretty good. Ya need to look at the entire package & not just what you get in the check. AMR has a really bad rep down in Denver, but from what I understand it's major backstabbing and who has the biggest penis in that AO & nobody gets along with anybody else. Have been told some really wild stories about DG and that's nothing to be proud about when it comes to EMS. We have had several people transfer here from Denver & one lately says he loves it here compared to Denver. On the other hand we have had people transfer to Denver from here for whatever reason. I also knew a guy in Vegas who works part time for AMR and loves it. Regardless if you love AMR or hate AMR working for them does give ya lots of great work experience and ya have to start somewhere & pay your dues before ya can hope to move up the food chain. Shoot me a PM with any questions ya have |
Then why is he still with em instead of looking and getting a better paying job. Sounds like a personal problem to me instead of one ya can lay on AMR's feet 
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AMR is the reason I am not a Medic. I went to Basic school, passed with flying colors, yada, yada, then got to job hunting between graduation and my Registry. I found that AMR is the only game in town here, and got to talking to folks I know. Ruined me on the EMS field here. After I got into Law Enforcement, and dealt witht hese guys on a regular basis, I feel I made the right decision. Our medics here are pretty good guys, but the entire premise of a "for profit" emergency service is the epitome of an oxymoron to me. My city, which is small at ~5000 has one truck on duty. The next city, at ~25000 people, also has one bus on duty. These are the only two trucks in the county, with the exception of a small BLS unit in a small town in the eastern portion of the county. When the Truck from the next town goes on a call, instead of AMR calling the relief crew, they stage our truck. Doesnt matter where the call comes in from,, our truck goes if its next up. Guess what happens if the next call is a 5hr transport from the hospital in the next town to Dallas, TX? We lose our truck, and the truck from the next town is on deck. However, it takes at a minimum, 25 minutes for that truck to get to our town. AMR has decided that since we are only a few miles apart, the relief crew can be done away with. I have waited upwards of an hour for a bus on a serious medical call. When I have dispatch call AMR back, whcih happens to be dipatched out of Wichita Falls, TX, we get the same thing "all the trucks are busy on transports, we will call the relief crew." The relief crew has a 30 minute reponse time to the station. AMR is a fukkin joke, at best. |
Remember that when you or your loved ones need an ambulance. Sure they have problems & ya bet ya they are "for profit" If AMR is so jacked up, why are they not others trying to take over AMR and instead of AMR growing they should be shrinking. But show me a hospital or other ambulance service that's not trying to make a profit & the botton line is something other than cash money. Even fire based medics charge $$$$$ sure ya might not see it up front, but ya will always pay the piper one way or another. |
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I have to agree about this whole "for profit" thing. Public agencies are every bit as money and power hungry as any privately owned business. They are still trying to do as much as they can with as little money as they can. At the same time, all the employees from upper management to the rookies cops and firefighters are trying to make as much money as they can. The big difference is that if a private company isn't making a profit, there is no longer any reason to exist. A public agency on the other hand doesn't have to be run efficently or responsibly to still exist. The problem with health care issues is that there has to be something in between. We need to run health care businesses like a business but at the same time there needs to be some compassion and public responsiblity. I don't know the answer, but it isn't a clear cut answer either way. It is very easy to simply blame AMR for all your local EMS problems but in my opinion, that isn't the answer. One thing that might help is to insist on having a staffed and in-service unit available in your town at all times when you draw up the contract with AMR for service in your local area. For every minute there isn't an ambulance available to respond on a call, they get fined by the county or whatever. This will give them an incentive to provide more than the bare minimum of service to the customer while at the same time possibly allowing them to make more money in spite of themselves. If you look at what it costs to take an ambulance ride, you can see that they could at least break even with one or two transports per shift. So, if they have two units on duty making money and one more breaking even, they are really no worse off than they were before by not having that third unit in-service. |
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Its on the contract, but or city doesnt make them abide by by it. I know, its as much the citys fault as the service. I still blame AMR, and feel that I have good reason. I do not feel that any emergency service should be owned by a private entity. WHen a transport takes priority over an emergency call, its kinda hard to believe they have the interest of the public in mind. You can preach and moan al you want about how a fire service run ambulance is no different. It is different, a lot different, and I see it in action every day in cities around here. The fire service controlled ambulance is a far, far better choice with priorities more in line with serving the public instead of the shareholder. |
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You need to get the word out and get folks to start complaining to their city/county council members. If enough folks complain and document problems then you can get things changed- especially if one of those politicians family members needs an ambulance and it's not available. Nobody thinks about EMS until they need them as we're not as visible as police and fire; EMS is also not reducing your property taxes. If health insurance companies started adjusting your rates according to response times (like property insurers do for fire coverage) then you would hear more public outcry. |
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"The fire service controlled ambulance is a far, far better choice with priorities more in line with serving the public instead of the shareholder." Maybe that is true in your case. I know it wouldn't be true here where I work. But, of course that is just my opinion. FWIW I have worked for five different private ambulance companies in four different states including operations manager of an ambulance company. I have spent the last 15 years working as a firefighter/paramedic. So I have seen three sides to this whole picture: public, private, as well as the management side of private. As I mentioned in another thread, we currently have quite a few units running over 20 calls a day as well as paramedic rescues averaging over 30 calls a day: and we DON'T transport. If we transported, we would be providing wofully inadequate service due to totally inadequate staffing. In addition, the tax payers are already paying for our existance now. If we transported, we would bill the patients for a service they are already paying for, which I personally feel is bullshit. It is all about the money: public or private. You as an individual firefighter may not think that way, but the management does. The paramedics working for a private ambulance service don't give a shit out the business end of things either, but their management does too. |
That pesky little problem hasn't stopped the City of Las Vegas Fire Department. Ooops, I mean the City of Las Vegas Fire and RESCUE, my bad.  And yes, if it happened tomorrow, EVERY fire agency in So. NV would find themselves in a state of chaos- undermanned and ill-equipped. But if it was phased in gradually, it could be a good thing for this area. I can't see the future, and I admit I don't know if it would work out or not, but it has worked in other systems, maybe it could work well here. The key would be to hire all of the good medics here in town already and NOT cross-train them as FF's. There'd no way to get enough good cross-trained people out there anytime soon- if at all. Plus look at all of the great female paramedics out there who are wonderful at patient care, and can lift no problem, but physically can't cut it as firefighters full-time. (do you see me raising my hand?) I can do MY job- but not yours. That being said, I'd love the security and quality control of a FD backed agency instead of being abused "for profit." Ten years ago I would have said that (while all agencies have their good and bad) Mercy/AMR had a higher percentage of REALLY good medics. Now I'd say that both private ambulance companies are sorely lacking and look ridiculous more times than not when compared to the FD's as a whole. Maybe my situation is unique in that I did the fire explorers/cadets and then worked with Mercy- so I've gotten to see alot from both sides (I know you have too, 444....) But being part-time for the last few years and working with sooooo many new EMT's and medics has REALLY given me a different (and NOT good) perspective of what's out there now.  sorry bout the hijack- I know this thread isn't about the southern NV EMS system.... |
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AMR==Another Moron Responding Here in Birmingham 3 Companies compete for ambulance servics. Rural/Metro, The Worst of them all, AMR, and LifeGuard. All are abusing the field level employees so bad that the turnover rate is ove 700% overall! I served 15 years as a Paramedic in one company or the other and am qualified to say this. They are the reason I mailed my license back to the state and told them untill Alabama regulates the employee treatment better, Shove it! It's no wonder there are a shortage of EMTs and Paramedics in Alabama and nation wide. |
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IMO the best part of fire departments billing for their EMS services is the fact that property owners pay taxes. AND ironically they are probably the only ones who can actually pay an ambulance bill or have insurance to pay an ambulance bill. The dead beats (who are the ones calling ambulances in the majority) don't pay taxes or ambulance bills. We pay ours and theirs and pay for the fire department to begin with. But that is definitely a dead horse that is off topic. |
I love when our patients get their undies in a bundle when they find out they are going to be charged for an ambulance ride to the hospital. I usually respond by asking them a few questions. It goes something like this: "Your taxes paid for the infrastructure to deliver electricity to your home, right?" (In Austin they do) "Yes" "But you still get a bill every month for the electricity you use,right?" "Yes" At this point you can see the concept beginning to dawn on them. It's a pay for use service. There aren't many medical profeessions that make house calls, and don't request a fee. |
Bed Head, you are starting to make me glad I didn't go to work for AMR Vegas when they offered me a job. For 6 years I have thought I made a mistake. |
As much as it pains me to say it, you're probably better off.  Although, it wasn't as bad 6 years ago...Thing is, that the whole AREA of Vegas is broken... it's been liberalized and overrun with illegals. The only thing that would fix this area now is welfare and tax reform, and deporting all of the stinking illegals (since we can't rightly deport the trashy "legals" who would still be here). That would take a HUGE burden off of the healthcare system as a whole. Prices of everything would go down- including ambulance bills. ER wait times would decrease dramatically too (duh). Maybe we would actually collect more than 15 cents for every dollar we bill out, crews wouldn't be run so ragged and treated so poorly by management and hospitals alike, and morale all around would improve. As far as the "new breed" of EMT's and Medics who are coming in now... well, there aren't enough old timers to keep them in check. They hit the streets and act like their shit don't stink and think it's cool to act "burnt out" after 3 months. Get a clue. I could go on, but I won't... 
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<<<<In addition, the tax payers are already paying for our existance now. If we transported, we would bill the patients for a service they are already paying for, which I personally feel is bullshit.>>>> This is my first post... ever... so here goes. I feel your "bullshit" comment is bullshit. I work in law enforcement, as well as both public (tax based) and private (for profit) fire/ems. I also know in different parts of the country, things are different so I do not propose my one-size-fits-all comments blanket everything/everywhere but..... at least in Arizona EVERYONE charges for an EMS transport in one way or another as well as fire suppression. The bublic tax-based fire department I work for actually charges MORE per transport than the private-sector one does. Wow, imagine that. Thankfully, there are alot of mutual-aid pacts that keep the most appropriate units responding in cases when numbers are low (units already transporting, etc). I do not profess one is any better than the other, at least in my area.. because you are talking apples and oranges. Rural Metro provides it's subscribers much cheaper fire protection (paid in the form of a yearly subscription) than the other other tax-based fire districts. Rural still provides a quality service at a price the tax-based departments cannot. I know. the numbers are a matter of public information. look at the numbers and the numbers don't lie. I work for them and went through their academy. Rural also paid my costs of going to medic class and paid coverage if my class days fell on shift days. Having said all this.... yes, I also work for a second fire department (also an ems provider, tax based) out in the sticks.. and love it. I have Lifepack 12's (defibrillators) on a Rural Ambulance AND the "public" fire department's ambulance. I've worked code-arrests in both departments, treated gun shot wounds and been in fires with both departments. Did one get a better product from me than another? Not even close. This public department gets money based on area resident's assessed property values... has NICE equipment.. BRAND new engines, tenders and rescues and they STILL get a bill on an transport to the hospital. There are pros and cons everywhere. There is no utopia. Thats the reason they call them "jobs!" I think alot of it is sour grapes. I do know that Rural and Southwest Ambulance have joined and I'm aware that there is alot of politics going on at Southwest, too. Basically, if your job sucks, DO something about it. Go apply somewhere else. If you feel the general public is suffering, then you need to talk to your state's DHS office. How is it they suck? Is it their response times? Could be.. that might be a legitimate reason but if all it ammounts to the fact thay they CHARGE for their services, welcome to the United States. If you have comments, good or bad, feel free to e-mail me and we keep this going and not clutter up the boards. |
Hi Flapsdwn! I sense quite a bit of hostility in your post, and while I'm not going to speak for 444, I do know him personally and he is a really good guy. For a little background in the particular situation he is referring to.... the CLVFR began transporting several years back (to cut through the chase) because a new chief came in from a CA system, saw a "study" that was done, and instead of risking getting ANY kind of FD funding cut, he decided to get into the "game" of EMS transportation. I PERSONALLY don't think that the FD charging for a transport is BS. What I DO feel is BS though, is that in the CLVFR case, their bills are HIGHER than the private ambulance companies here, while still being subsidized by tax money, and also their guys/gals get paid a commission/bonus for every transport they do, every shift. There are many, many gov't agencies that are subsidized by taxes, but we also have to pay for additional services- take going down and getting copies of documents at the recorder's office for example. That's fine. But CLVFR has taken it above and beyond with their billing and "incentives" to their guys. I'm not going to say that it's affected the quality of care that they provide, because I don't know that it has. But it does make one wonder if someone will just treat patients like a cab ride to hurry up and get that next one. Anyway, like I said before, this thread wasn't intended to be about the so. NV EMS system, but it has a bunch of flaws (AMR management being one of them) and it has been pointed out. Take care!
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A couple things to think about: If you never call a private ambulance you never pay a dime for their services, their existance, or for other people to use their services. IF YOU use it, you pay (If you work and have assets, if you an illegal or you are don't have any assets to seize you get it free). If you never call a fire department, you pay for it anyway. Then you advocate paying again if you actually use their services (appearently only for EMS service and not for fire service and all the other stuff). The cost of running the fire department changes VERY little whether everyone is doing the lounge chair louge or running a call. In fire departments, by far the largest expediture is employee salaries. Electricity is just like the private ambulance service. If you don't have electricity, you pay nothing. If you use electricity you pay for what you use. Let me repeat that I am an IAFF member and derive 100% of my income from a county fire department and have for the last 15 years. HOWEVER, I am NOT a tax and spend liberal. Our department is being paid for by the overburdened taxpayer right now. If they get me up off my ass to provide a needed service for them I (as in ME) don't expect them to pay me again just cause I got up and missed my beauty sleep. EMS billing by fire departments is a political tool used in the same was as police department traffic citations. They want to come off with an image that they are self supporting. In reality they spend all the tax money and all the money they get from billing and if they got 20 billion more they would spend that to. And in the end, I would still be running 30 calls a shift because making things better for the guy at the end of the spear is their last priority. |
Extremely well put 
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