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Michael Bay’s latest action-packed big-budget affair tells the story of a military veteran who steals millions of dollars from a bank in order to pay for medical bills. As part of their getaway, he and his partner-in-crime steal an ambulance, leading to a spectacular car chase through the streets of Los Angeles. The movie, released April 8th, is straightforwardly titled Ambulance , and has so far proved to be a box office flop . But as researchers studying the ambulance industry, we’re less concerned with the artistic or monetary merits of the film, and more interested in the particular vehicle that it spotlights.
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The ambulance used as the movie’s centerpiece bears a name familiar to many: Falck. Indeed, the movie feels like one long commercial for Falck Ambulance. A Falck-branded ambulance even made an appearance on the red carpet at the film’s premiere. They are a privately-held company , with more than 3,000 patient transportation vehicles in 15 countries, owned by a number of different entities, including an investment company with ties to toy manufacturer LEGO. One key component of Falck’s business model involves cities and towns contracting 911 ambulance coverage to them. As part of these contracts, Falck provides a certain number of ambulances to respond to medical emergencies. It’s a vitally important job—and Falck doesn’t always meet expectations.
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Alameda County, California is very familiar with Falck’s business model. In 2019, Falck won the contract to provide ambulance service to Alameda County after promising ample staffing and response times of under ten minutes for serious emergencies. However, the company’s performance has left both officials and residents unsatisfied. An investigation by a local news station found there were nearly 1,000 calls where Falck failed to meet the standard response time in December 2021 alone. Currently, Falck is under scrutiny in San Diego for not deploying enough ambulances to meet the needs of the city.
The private ambulance industry is big business, and Falck is not alone. A recent report projects the global ambulance industry will exceed 50 billion dollars by the year 2026. Private ambulance services have proliferated, replacing city-owned or local-hospital-based ambulance agencies with multi-state conglomerates operating hundreds of trucks throughout a region. The largest of these conglomerates is Global Medical Response (GMR). According to their website , GMR is responsible for 7,000 vehicles and nearly 500 aircraft that provide EMS services on 6 continents and respond to more than ten million patients per year. Despite its size, GMR is a relatively-young company – a company formed through a series of successive mergers between smaller medical transportation companies, culminating in a single privately-held mega-corporation. One of their owners is Kohlberg Kravis Roberts & Co (KKR) , one of the largest private equity firms in the world and the one-time owners of R.J. Reynolds Tobacco .
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There has been almost no quantitative research examining private ambulances. However, we can look to the experiences of communities that have been served by for-profit ambulance companies—many do not have positive things to say about their experiences. Pflugerville, Texas recently terminated their contract with Acadian Ambulance after just a few months, citing slow response times and complaints by residents. Colorado Springs, Colorado has been in a multi-year battle with American Medical Response, a subsidiary of GMR, in pursuit of the response times that were originally promised.
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We have some ideas about why these relationships have gone poorly. City-owned ambulances need to break even at best, and hospital-based ambulances are used as rolling advertisements, meaning bad publicity is like kryptonite. But for-profit ambulance companies have an incentive to maximize profit by limiting overhead as much as possible. This may involve staffing as few trucks as possible, leading to prolonged response times because there are not enough ambulances available to respond to calls. Minimizing overhead may also involve paying personnel as little as possible and minimizing benefits, despite working them as hard as possible and providing them with bare minimum levels of equipment . And, it’s not just patients who suffer because ambulance companies have prioritized profit over performance. EMS providers themselves have exceedingly high rates of burnout and psychological illness . This may be one explanation why there is a nationwide shortage of EMS providers .
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