Garland, TX – The City of Garland has created the Fire & EMS Stakeholder Committee to find ways to reduce costs within the Fire Department. During these discussions, the committee will consider privatizing its Emergency Medical Services (EMS), raising metaphorical alarms regarding potential impacts on community health and safety. The committee convened for the first time to discuss the implications of such a significant move; the public can listen to the full meeting online here. For some background, the City of Garland, like many cities across Texas, is facing budget constraints and looking for ways to reduce costs in the operating budget.
“Take care of our people, and be good at our jobs” – Chief Lee
State of Garland EMS
Currently, Garland’s EMS operates on a 24-hour on, 48-hour off schedule, but the proposal from the department is to shift to a 24-hour on, 72-hour off model, which would reduce the number of consecutive days on for staff and ease mental health burden on emergency responders. Recent studies have determined that more time is needed between shifts for emergency responders to recover. This change is partly driven by an annual overtime cost of over $1 million within the Fire Department. While city officials assert that the department is fully staffed, the reality may suggest otherwise, as could be inferred by the overtime costs. One suggestion to ease the burden on the Garland Fire Department is to privatize EMS, but this comes with an increased risk to the community.
Financial Cost of Private Ambulatory Service to the Community
The city has established transport fees for EMS, charging residents and non-residents differently based on the level of care provided. For instance, Basic Life Support (BLS) transport costs residents $450 and non-residents $550, while Advanced Life Support (ALS) transports range from $500 to $725. Such fees are manageable under the current public service model, which provides relatively affordable care. However, concerns arise that privatization could eliminate these cost advantages, especially for uninsured patients who currently do not face charges for ambulance services. The state average cost of an ambulance ride varies by type of service, with private services driving costs up: $1,345 for basic life support (BLS) and $1,498 for advanced life support (ALS) ambulance rides. The financial cost of an emergency to the community would likely triple.
The Fire & EMS Stakeholder Committee’s discussions are particularly timely, as national studies indicate that privatized EMS can lead to higher out-of-pocket expenses for patients and more complex billing processes. A significant portion of privately serviced patients may experience surprise billing, with studies showing that 28% of commercially insured emergency transports resulted in unexpected costs.
The Quality of Life Cost of Private Ambulatory Service
Moreover, recent studies have shown that communities with privatized EMS often face longer wait times and higher associated costs, which can lead to increased mortality rates, particularly in low-income areas like Garland. A lagging response time on arrival would mean that arrival at a hospital, which is already farther away since we do not have a hospital in Garland, would be further delayed. In trauma care, the “golden hour” refers to the critical first 60 minutes after an injury during which prompt, life-saving medical treatment is administered to maximize the chance of survival and minimize long-term complications. In patients with life-threatening injuries, receiving definitive surgical care within that window offers the highest chance of survival. Each additional 10-minute delay can increase the odds of death.
History of Private Ambulatory Service
Emergency medical services, in modern standards, are typically viewed as a public responsibility; however, the growing trend of re-privatization has raised concerns about the quality and accessibility of care. Ambulatory services in the United States began as a private venture with the first ambulance service recorded in 1865, and for many years, ambulance service was an unstandardized mix of fire departments, hospitals, volunteer groups, and funeral homes. A pivotal 1966 report, “Accidental Death and Disability: The Neglected Disease of Modern Society,” exposed the failures of the unstandardized system. This led to federal legislation that pushed states to develop organized, regulated Emergency Medical Service (EMS) systems, which included training standards, enhanced equipment, and coordinated dispatch. Then in the 1970s, federal authority and funding, along with the development of paramedic training, helped create the organized, professional EMS system that exists today.
Considerations for the Future
As Garland continues to develop multifamily housing and densify its population, the need for reliable and accessible EMS grows ever more critical. The city has also been in the process of relocating fire stations to improve emergency response times, a strategy that may be jeopardized by a shift toward private ambulance services, which may not be positioned in the same manner as public fire stations.
With the potential for privatization looming, community members and stakeholders are urged to closely monitor developments and engage in dialogue regarding the future of EMS in Garland. As the city weighs the financial implications of privatization against the critical need for quality emergency medical care, the stakes are high for residents who rely on these vital services in their most vulnerable moments.
Councilmembers on the Fire & EMS Committee
Margaret Lucht, District 5
Carissa Dutton, District 6
Chris Ott, District 8
