Ambulance Chasteners

Imagine it, the worst possible scenario: You're having a heart attack, your breath stopping, the life trying to escape from your body. Or you're a broken mess on the highway, wreckage jammed around you, blood choking you.

It can't get worse. And then it does.
The ambulance takes a long time to arrive, much longer than it ought to. And if you're not dead by the time it gets to you, the people responsible for keeping you alive until you reach the hospital--the people who insert a tube in your throat, give you an IV or try to start your heart beating again--may not have slept for 24 hours, and are being paid $5 an hour.

The history of ambulance services in Maricopa County is sordid. Private companies, competing for business, have acted like organized criminals. Ambulance drivers have lied about their locations, pretending to be closer to the scene of an emergency than they were. Dispatchers have alerted their own ambulances to an emergency before making an official dispatch over the open frequency. Money, not life, has been the bottom line.

And it still is.
Joe works for Southwest Ambulance. He started as an emergency medical technician, at $5 an hour. Now he's a paramedic. He gets $7.50 an hour. "On average, in order to make my bills, I work between 80 and 100 hours a week."

He works 24-hour shifts, so he at least manages to get a couple of days off to recuperate. "I do this because I like the work. I'm not in it for the money. Unfortunately, I have to work those hours to make ends meet. It's a very rewarding job, but, when you consider the training we go through and the educational qualifications that we have, we're underpaid."

As understatements go, that one is astounding. Paramedics undergo a year of training. Before that, they must be emergency medical technicians, which involves a semester at college and at least 1,000 hours' work in the field. EMTs get the same starting salary as a worker at McDonald's.

But wages are not the only problem, according to Joe. "We don't have enough ambulances, especially in the east parts of the Valley--Tempe, Chandler and Gilbert. The EMT who's driving the ambulance might have been driving for 36 hours straight, which is dangerous."

If you're not obviously wealthy, you may not get an ambulance in time to save you. "We have several units at any time of the day which Bob Ramsay, our CEO, keeps out of the system exclusively for what we call interfacility transports--taking people from nursing homes to hospitals and back. Even though an accident may happen across the street from those ambulances, and they could be on scene and rendering treatment immediately, he will not dispatch that ambulance. He will have an ambulance come from as far as five, six, seven miles away. No matter how serious the accident is--somebody could be dying--the ambulance right there can't treat the patient, because they need to stay available. It's a money issue--a guaranteed payment for interfacility transport, which is preauthorized by the insurance company, while in an emergency situation there's no guarantee of payment--we just have to hope they have insurance." Proving again his mastery of understatement, Joe adds, "It's immoral."

Other workers are less laconic. Martin and Chris, both EMTs, joined Southwest less than a year ago, and they're already at the end of their ropes. "Bob Ramsay only cares about what makes money," says Martin.

"They tell us this is a right-to-work state," adds Chris. "So if we don't like it, we don't have to work there. But they don't have the right to exploit. . . . We don't have good equipment, we don't have good ambulances, but you can bet he's [Ramsay] getting his money."

When they're on duty, Southwest staff members are required to be in their ambulances at all times. You take it in turns to leave the vehicle long enough to do what you have to do. If you need to eat, drink or relieve yourself at any time in a 24-hour period, you run out, do it and get back as fast as possible. For $5 an hour, the company owns your time.

So why do they do it? Both give the same answer, and it's the answer Joe gave, too--they love the work, which is just as well because they have little time for any life outside of it.

But their compassion is finite--it stops at their boss. Both Martin and Chris have the same dream: that Bob Ramsay has an emergency, and no ambulance shows up to save him. They laugh with relish as they talk about it.

When you consider the chilling pep talk that Martin claims Ramsay gave at orientation, it's hard not to feel that the hatred is justified. "He came in and he said, 'I understand that you guys are here to save lives and everything, but I want you to know that the most important thing you do on a scene is get the insurance information. I don't care what else happens--you've got to make sure the insurance papers are correct so we can bill them.'"

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Barry Graham