As grant funding becomes more and more scarce throughout all disciplines, many organizations are moving toward regional approaches to emergency services. Emergency Management is becoming regionalized, Public Health is regionalizing their efforts, and even communications centers are regionalizing across counties. All this is supposedly being done in an effort to increase access to grant funds by providing more "bang for the buck" through the development of regional efforts rather than jurisdiction/agency specific capabilities. While regionalization sounds good in theory there are certainly issues that arise alongside it. These issues can include allocation of tax dollars for instance. Another large issue seems to be that all the regionalization by various entities is taking place independently, thus developing differing regions that overlap and possibly creating more confusion. However, there have been instances where regionalization has helped rural communities to pool their resources and provide a much more comprehensive approach to emergency services to their citizens. What do you think? Is regionalization making its way into the EMS world? If so, is it a good thing? What are some stories of how regionalization has or hasn't worked in some areas?
In the UK, we went from something like 40 EMS agencies to 11, whilst it could be argued that costs are reduced from removing back office systems. It ended up with agencies spanning 200 - 300 miles and therefore having to create a uniformed service model and not best serving the needs of individual communities.
Another downside is integrating all the different areas into one, and still 6 years on issues are still being identified. Staff being trained for example and agencies selling of local assets and having staff needing to travel to the new regional offices.
Saves costs but causes a lot of headaches
In the USA, the average ambulance service operates 5 units and exists at the edge of survival. There are many "general managers" who have to be (and cannot possibly be) experts at all aspects of the business. There are few specialists, because the organizations are too small to support them. If those agencies pooled their resources, they could have a single GM, and some specialists in operations, finance, fleet, logistics, etc.
This would also solve part of our biggest dilemma - the revolving door of human resources, which exists in part because we have no opportunity for good people to advance their careers. Bigger organizations need supervisors, specialists, teachers, etc. - all of which provide opportunities for people to strive for and achieve.
A great example of regionalization happened in Oregon in the 1990s. Five fire districts combined over a period of years to create Tualatin Valley Fire and Rescue, which is now a 7-city, 3-county fire district, CFAI accredited and a "destination employer" for firefighters and paramedics from throughout the northwest.
Mom and pop operations have no bargaining power, no political power, and nothing to offer their personnel. Ergo, I hope their days are numbered.
It's pretty much a matter of time in many places, though everyone trying to protect a fiefdom can slow it down some (or a lot, depending on local politics, which is why my county has 1 PSAP, while Cuyahoga Co OH has 47).
It doesn't have to be rural per se for regionalization to work. One suburban ambulance service I worked for for several years was formed when the 3 VFDs then providing ambulance service had problems crewing for calls, and now runs full-time personnel at all hours of the day (2 crews 8a-midnight, 1 crew overnight). Granted, it only covers 1 township--but it's basically the same theory on a smaller scale.
That's right. And it surely doesn't have to be rural. In fact, the economics are probably better in a suburban area, where there were (historically) more local, independent agencies. Better fodder for merger. The example I gave, from Oregon, involved suburban Portland - what was rural 40 years ago but which is now solid first-ring suburbs.
It's all about doing without the fiefdoms....