1. America’s Fire Service At a Crossroad You Must Know Which Way to Turn!

2. United Airlines Flight 401 and a 75 cent lightbulb
Understanding what was really important is not better characterized than the story of Eastern Airlines Flight On approach from New York to Miami, a light that indicates proper deployment of the landing gear failed to light. They plane flew in large circles over the Florida Everglades with a full load of passengers. The crew was trying to determine if the bulb was bad or if the gear was not locked.
When the flight engineer tried to remove the bulb, it would not budge and so the other members of the crew tried to help him, As they struggled with the bulb, the plane simply flew into the swamp. Dozens of people were killed. With a high priced professional crew, they fiddled with a 75 cent light bulb while the plane with its passengers flew into the ground.

3. What’s Wrong with This Picture?
Fire chiefs with a tenure of 2 to 3 years
Overloaded with just the oh my god, just get me past 5 o clock

4. Incorrect Decisions or Lack of Decisions in Public Safety are expensive and may cost the Chief his or her Job.
Solid decisions about the future direction of your department requires:
A knowledge of what are the external threats to the future of my department.
What are the external opportunities available to my department.
Where is the industry heading?
Is my service on a competitive footing?
Do we offer an excellent product at a competitive price with excellent service (the three pillars of retail success)
What pressures will be impacting my budget in the next few years.
How does my department measure up with my competitors?

5. Is your Department on a Competitive Footing?
Are there competitors that want to take away our service?
It’s usually too late once a competitor shows up at your door step and offers a better, cheaper and more innovative service to your city.
Competitors often come out of no where!

6. Do You Know Where the Future of EMS is Heading?
If you don’t know what dangers are ahead, then it
may well be too late once you figure it out.

7. You Can’t See the Future if you are Buried in the Maze

8. If your EMS Call Load goes up 10% per year and your Medicare Population goes up 5% per year and your costs go up 4% per year…..

9. Castle Rock CO Total Ambulance Transport Revenue Fire Chief is Sleeping Well at Night!

10. Castle Rock Co Transports Compared to Revenue per Transports

11. Castle Rock Colorado Per Transport Cost vs Per Transport Revenue

13. This Will Happen to Your Transport Partner as well.

14. AMR Entity 1 Combined Impact of Medicare and Medicaid impacts

15. Someone Dialed 911 and Wall Street Answered!
New York Times Article
June 26, 2016

16. When You Dial 911 and Wall Street Answers
Since the 2008 financial crisis, private equity firms have increasingly taken over public services like emergency care and firefighting, often with dire effects

17. Private Equity Firms Own 25% of all Ambulance Providers (As per NASEMSO)
Of the 12 ambulance companies recently purchased by private equity firms, three filed for bankruptcy in three years.
Trans Care
As a result of Trans Care’s sudden exit from the 911 market, the City of Mount Vernon N.Y, is developing its own ambulance service within the fire department. A private ambulance company is providing service in the interim.

18. If your EMS Call Load goes up 10% per year and your Medicare Population goes up 5% per year and your costs go up 4% per year…..

20. New Revenue Streams for EMS
New Revenue Streams for EMS! -GEMT -ALS Pass Through -First Responder Fees

21. Mobile Integrated Health Care or Community Paramedicine
Mobile Integrated Health Care or Community Paramedicine. Is it right for your department? 8 Questions that will help you figure that out

22. EMS Situations that Shout Watch Out
Continuing to pursue an eight minute response time
Continuing to support a 24 hour work schedule for all EMS deployments
Continuing to support low Unit Hour Utilization rates
Baby boomer retiring at 10,000 per day
Increasing Medicare payer mixes
Increasing Medicaid payer mixes
Throwing ALS recourses at a BLS problem

24. Questions?