Need info on AMR

[Beagle189]

Fellow EMS workers, I need info if you work or have worked for AMR. Need the good and the bad on all aspects. The county I work in is considering a Public Utility Model for EMS. My service - a nonprofit agency -has ran it for 25 years. Now the county Gov't is thinking PUM and may put the entire county service area to a bid. AMR has just opened an office in my area- in the last week and doesn't have any ambulances here yet. Anyway the rumor mill is working overtime. I need info just in case a contract is bid out. Any info other than what is on the AMR website is appreciated.

[MedicRN]

I've worked for the outfit in Mississippi (8 years ago). I thought they were a good company to work for.... progressive protocols amongst other stuff (been too long to remember much else).

[AnthonyM83]

I've sent several emails to both their N. Calif and S. Calif. recruiting email addresses (listed on main website) with no replies, as well as to their general email with no replies. I prefer email over calling for basic info so that I can keep track of what each office tells me (as I'm considering a few different locations). I take the attention they give their possible recruits as an indication of how they might treat actual employees. So, not looking good on that front.

I did have a really positive experience with a paramedic supervisor who helped out during one of our trainings in EMT school (moving CPR, loading and going, etc). Also overheard some really horrible stories at the firehouse from the recruiters that they heard from various recruits. Example: One employee decided to apply to a firestation, so they fired him, then rehired him the next day, so that he now has a termination to explain in each future job application. Or if you leave to work for fire, you're told they'll never be re-hired. But I'm sure management varies some with location.

[Dustdevil]

Working for a PUM managed by AMR is a lot different from working for AMR, actually. Medically and operationally, everything will be controlled by the "ambulance authority" board, not AMR. They only thing the contractor does is manage personnel and day to day operations, basically. In that respect, they do about as well as anybody else. Big organization behind them that has a lot of resources for taking care of their people. Good benefits and educational programs. They'll get by with paying as little as they can, but no worse than what is being paid there now. When they took over the PUM around here, they sent in out of towners as management, but supervision was all local people, so it won't be run by people without a clue. Although, they bring in a lot of strange, out of town ideas that will feel weird until you get used to them, but change is good.

The whole PUM concept is a joke. It has not worked out anywhere it has been implemented. The dickwads that sell it (Fitch and Associates and some other idiot) make all sorts of promises about how it will save the area huge money and will pay for itself within so many years. It never has. It never will. They always end up spending more money than they ever have had to before. Subsidies go up, not down. Response times go up, not down. None of the promises are ever fulfilled. But in many cases, it does at least create a much better working atmosphere and level of professionalism than what previously existed. Lord knows it did here.

The biggest downside of the PUM is its reliance on SSM, which has also been pretty well disproven everywhere it has been implemented. Not only does it not positively effect overall response times or mortality rates, it shortens the life of the ambos (creating more expense), and burns out paramedics at a much greater rate than before, creating a perpetual turnover that AMR loves since if nobody stays but a few years, they never have to pay to retire anybody. Nobody retires from AMR. They will make sure to burn you out before that ever happens.

[noahmedic]

I could write a thesis on the downfall of the PUM for EMS, but it does have one upside, it separates EMS from Fire. I agree with Dust, I feel it creates a more professional organization, but the 12 hours stuck in a unit are hard, and sometimes very, VERY boring. I know that EMSA (well actually Paramedic Plus ) has a very high turnover rate, but it seems like every EMT and Paramedic in Tulsa has worked @ EMSA sometime. Sorry I can't tell you much about AMR, but I do know a lot about the pros and cons of the PUM.

[Ridryder 911]

I agree, there is a lot of turnover Noahmedic, but I see that in a any EMS. I am not totally against PUM. Actually, it leads to some creditability. Since it is not fire, or county-3'rd party, there is not the sense of being declared public servants attitude. I am not sure how Tulsa area feels but that's was were EMSA was originated and combined the 2 agencies (OKC & Tulsa) together. Which was really a pretty impressive endeavor for 2 large cities to do approximately >100 miles apart.

Yes, it has its problems, but which EMS does not. The main thing I have seen, is there is no continuous whining or fighting in competition in EMS ... there is only one, no turf wars, one consistent medical control and administration. The local medial authority receives input every quarter from the medical society chapters, and ACEP, etc. for protocol review etc. labor they have a union (although not powerful) there are several medics that have been with the company since incorporation or greater than 10 yrs.

So Dust, I have to disagree OKC & Tulsa appears to be pretty successful... yes, it has had problems like every EMS & although I am NOT a big EMSA fan, it has been running for over 15 years. Which in EMS years is a long time

.

Every so often there always the old rumor the "Fire Department take-over"... but, most of us in EMS knows that F.D. does not want to get up at night for granny calls, nursing home & B.S. calls. Even Tulsa has cut back the number required Paramedics on the F.D., and is perofoming a pilot study testing a new EMT /I level developed for them to allow Intermediates to give limited med.'s in lieu of Paramedics. From what I have heard, they have NO desire of having Paramedics, just the ability to state that they are "ALS" as described in their union contract.

I have never worked for AMR, and everything I have heard has been opposite from each other. Either you love it or you hate it. I guess it like any other service all dependent on location, local management on implementing and adapting and maybe what the prior EMS was in comparison. From what I have seen although, is the downsize of services they have proposed at one time. The great and mighty conquer appears to be more puffing and coughing than steaming through.. this is like any health care agency.. (anyone remember Columbia HHC?) . Time has a way of taking care of things...

Be safe,

R/R 911

[Dustdevil]

So Dust, I have to disagree OKC & Tulsa appears to be pretty successful... yes, it has had problems like every EMS & although I am NOT a big EMSA fan, it has been running for over 15 years.

I'm not saying it is not successful at providing quality care. What I was specifically referring to were all the promises that made the PUM so attractive in the first place which have never panned out. Remember when they first came out and it was promised that the great thing about the PUM was that it would greatly reduce and eliminate subsidies for ambo service because the exclusivity ordinance would allow the contractor to make such a huge profit on transfers that they could afford to give EMS away for free within 5 years? LMAO!! Bledsoe and I both wrote editorials on that, appeared at council meetings and everything. What did we know? We were just a couple of idiot paramedics. Well, obviously we were right when we pointed out that the math simply did not, and never will add up. The cities now pay many, many times the subsidy they paid when the PUM started exactly 20 years ago, and it keeps going up. And the response times keep going up too. Another promise never realised.

Practically none of the positive things you seen in any PUM are actually the result of the PUM concept itself. The only things that are positive are the things that could have been implemented by any organization, even if they weren't PUM's. Clinical sophistication, high educational standards, good benefits and positive working conditions are found in many agencies. And, in fact, they were not as good in the PUM I worked for as they were in other services I worked for.

So yeah, in that respect, the PUM is a total failure and does not achieve anything that could not have been achieved otherwise.

[noahmedic]

Nothing personal against EMSA, in fact I still work there on occasion. In fact, I think EMSA does a great job providing high quality care to the citizens of Tulsa and OKC and they sure are not recognized in the local area for it enough. As far as turnover goes, you are correct, it is bad in any part of EMS, even where I work now we a turnover problem with nurses. Regarding the "public servant" attitude, I for one do not view myself to be a "public servant", I am a medical professional. My issue is not with EMSA it's with the concept of the PUM, and the fact that several aspects of it do not work as advertised.

As far as Fire taking over EMS, at least in Tulsa I can tell you that will never happen. Tulsa fire is not planning to hire and pay any more people for their paramedic level skills. The small amount of time between when fire arrives and when EMSA arrives does not warrant having a medic on every fire engine. As a side note to this EMSA has allowed MedSupport (wheelchair/stretcher van service) to do some of the more routine transports that do not require ALS care, I'm sure this has eased the burden of some of the nursing home and hospice transports.

I agree with Rid on AMR, you hear good and you hear bad, but ultimately you will probably have to go to work there and decide for yourself.

[Ridryder 911]

Noahmedic have you heard any rumors on the trial study of the "Advanced EMT/I" as of yet ?.. I agree, there is a lot of problems with PUM. Then I have seen very few services without any "major" problems, and when you finally do .. they go and screw things up later on ...

You know EMS is not really that complicated of a profession, usually people make it more that it really should be. I did work at an EMS once that was total medic units, and we finally developed into a great EMS. We did not have any turnover rate for 10 years... oh, an occasional squabble but it was very minor and resolved itself in a day or so. Unfortunately, most of crews either got tired or older or both... probably the best times in EMS & we knew it ...

If most medics did their full job and people left most their attitudes at home, then management treated employees as adults & expected them to behave and perform as such, things would be better. Finding all those combinations is the hard part.

Be safe,

R/R 911

[Dustdevil]

I worked at one of those, Rid. Funded by the county. Run by the hospital. All paramedics. Great pay (hundreds more per month than deputies). Great benefits. MD who was formerly with Seattle and gave us Carte Blanche to do whatever we found appropriate, no orders needed. Ten employees who stayed for years and years and years without turnover. Couldn't have asked for a better service.

Then one day the county commissioners decided they wanted direct control over their money and that they could do it better than the hospital. It's sucked ever since. Constant turnover. Lower pay (hundreds less than deputies). EMT's on the trucks. Wearing the same uniforms as the cops. But hey, those giant Freightliner ambulances the volunteer fireman director suckered them into buying (instead of raises) sure are pretty! :roll: