This paper examines the extent to which ambulance, emergency and firefighting services in Europe are threatened by the processes of commercialisation and privatisation. There are different traditions of provision of ambulance, emergency and firefighting services in European countries. They can be analysed in terms of providers of services but also the extent to which services are publicly funded and free at the point of delivery. In some countries, fire-fighting is traditionally done by volunteers. In others, the for-profit sector has been a provider for many years. Ambulance services are sometimes run by not-for-profit providers, such as the Red Cross. However, in the majority of countries ambulance, emergency and fire-fighting services are publicly funded and delivered by the public sector.
With new developments in medical treatments and surgical techniques, pre-hospital emergency care has become recognised as playing an important role in healthcare.[i] This has led to international debates about the role of ambulances in emergency medicine, which focus on whether trauma patients should be taken to hospital as quickly as possible or whether they should be treated at the scene of the accident or incident.[ii] Countries differ in their approach to the use of ambulances but countries which focus on treating patients at the scene of accident/incident have introduced multi-disciplinary ambulance teams which often include doctors, nurses, paramedics and drivers. Training for emergency medicine has become more focused and increasingly professionalised.
National arrangements for ambulance and emergency medical services are influenced by the historical background to the provision of emergency services. Some countries still use large numbers of volunteers. Other countries are increasing the professionalization of emergency medical services, which is creating highly trained ambulance teams.
Recent changes in healthcare systems, including contracting out of services, is beginning to impact on the ambulance and emergency medical services. The United Kingdom has contracted out patient transport over the last ten years but there are indications that a for-profit ambulance sector is developing. Falck, the Danish provider, has expanded into several European countries since 2000 and in the last three years the company has expanded into North and South America.
Fire brigades also provide some ambulance services in Denmark, Norway, Portugal and Sweden. Fire services are increasingly being merged with emergency, civil defence or disaster management services and are taking on a wider range of tasks and responsibilities.
Ambulance and firefighting services are still predominantly provided by the public sector in Europe. There are developments that show that processes of commercialisation are beginning to impact on these services. The expansion of Falck as the largest European provider of ambulance and firefighting services into several European countries shows that contracting out to the private sector is expanding. The example of G4S shows that a company that provides outsourced services to the public sector can expand into non-emergency ambulance service provision as part of its work in the healthcare sector. The development of emergency medical services as a specialist service provides an opportunity to outsource these services to for-profit providers alongside other clinical outsourcing. The expansion of Falck is most specifically focused on ambulance and fire-fighting services but the company is also making small investments in medical centres, which suggests that it is testing the market for wider healthcare service provision.
[i] Waks C. (2008) The persistence of the audit culture: supervision within Swedish Ambulance services International Journal of Public Sector Management 22(1)36-45
[ii] Waks C. (2008) The persistence of the audit culture: supervision within Swedish Ambulance services International Journal of Public Sector Management 22(1)36-45