To the extent that we are provided with first aid kits to use when patrons injure themselves here in the library to prevent them from bleeding all over each other, us, or the books, yes.
Except for the certified part. The training consisted of “here’s the first aid kit.” 
Did you charge him $990 for it? If no, then no. If yes, then yes, and you’re cheaper than most!
Where can I sign up?
Regardless, its better than when the ambulances were run by the local undertaker (Usually a different van) and the crew had Boy Scout first aid.
The OP specifically mentioned AMR (American Medical Response). Per their website, they do provide emergency care in some communities and the parent company’s website says that “AMR is the leading provider of ambulance services in the United States.”
Ambulances aren’t even free up here in Canada (unless you have optional supplementary insurance).
And we are only 35 years beyond that kind of service in this area. The only way to know if the body was dead or alive is the speed the undertaker was driving.
And in those days the undertaker would stop at a local pub and enlist a helping hand.
As to the OP’s question,
Ambulance service operation can be self supporting in community’s with large call volume. We do not have the call volume to support our service so there is a tax levied against the taxpayer to subsidize us. This is much less tax $ than it would take to run the service with public workers.
There are 2 large municipality’s close by that are looking very closely at privatizing the ambulance service.
Fire departments are not all run by the government, however the government pay’s a private contractor for fire protection and the fire contractor also bills insurance company’s.
Site
Answer is simple. AMR can pay its BLS and EMTs about $3 over minimum wage and get away with it. ALS certs will pull in more but still, probably nowhere near as much as the government employees. And AMR doesn’t have to provide its employees with a defined benefit pension. And may not be unionized.
Simply put, AMR can offer the labor cheaper than a government agency can.
Ignoring the cost discussion, the practical (and IMO historical) reason that ambulance service is intrinsically different from police & fire service is the idea of spreadability.
In other words, it is not only possibly but quite likely that in a metropolitan landscape of even modest size a bar room fistfight could spread into a citywide riot without a police force of some kind. Fires are even more obviously likely to do this (i.e. spread uncontrollably) without a fire brigade.
But without an ambulance service, all that can happen is someone might not get timely medical treatment and die. Don’t judge that statement on individual moral grounds, but on what the immediate consequences for the rest of the city’s population would be. Namely almost nothing. Eventually a population realizes the “that could have been me” aspect and something is done. But it’s always a secondary, developed issue. Police & Fire control are primary and immediate ones.
And this is just as true now as it was say at the end of the 19th century when modern police & fire departments first started forming.
…but also a fact of life. Response time depends on the distance from your house to the nearest fire station. Should a remotely located farmer subsidise a service that will never benefit him?
What if I’m a professional criminal? Should my tax money be spent on institutions that hurt my business?
I could hire private security, but why can’t I hire police protection (given that I am not a professional criminal)?
But they are, for starters they are limited by budget.
Well, I rarely ask for anything. Never the less, the US army is heavily privatized (Blackwater, Halliburton, etc).
But looking at that site, AMR operates ambulances in Brooklyn – where they are side by side with FDNY ambulances and volunteer ambulances.
So, while apparently a few particular hospitals use the service, it is not accurate to say that ambulance services in Brooklyn are largely private. The AMR service appears to be associated with a few particular hospitals. I wonder why.
Yes, in some communities, AMR operates along side fire department ambulances. In others, they are the only ambulance, with the fire department sending first responders in an engine or something along those lines.
Waitaminnit…you can tell the future and know when you’ll face emergencies? Cool! I wish I had that superpower 
The conditions by which ambulance services are free in Canada are rather odd, but seem to be based on things being a true emergency, like getting you off the highway after a car accident. When I had an injury that we opted to take an ambulance for out of my home, I ended up having to pay for it. I think we thought they’d bring us to one of the bigger hospitals in the city, but instead they brought us to the one 700m from home (we didn’t know they took emergency/ambulance calls!). In hindsight, I probably could have walked there, though it would have been excruciating to do so.
Insurance covered the bill, but it was $125 for the ambulance. And $1.25 for mileage :smack:
Sooooo not free. Ambulances: expensive. Childbirth: super expensive.
A large chunk of AMR’s, and other companies like them, business is contracted ambulance service with the municipality. Meaning that the local government found out that they could pay AMR to provide ambulance services cheaper and with better response times than they could provide the service themselves.
Also a large part of ambulance services is getting the billing done properly. The service is not free, even if provided by a municipality. There are lots of regulations that are required for proper billing, especially if medicare or medicaid is going to be paying. AMR and other companies have developed comparative advantages in doing this, since they do it across the country at hundreds if not thousands of locations. Much better than a local city or county government that only does it for themselves.
They also leverage their best practices from other locations to run an effecient emergency service. AMR’s sister company, also is the largest emergency room provider in the country. They contract with various hospitals to oversee and run their emergency rooms. For many of the same reasons I mentioned above.
There are an extremely wide variety of ambulance service delivery models in the US. Modern Emergency Medical Services, with trained providers and specialized vehicles dates back no later than the 1960s (although there were certainly ambulances before this). As EMT and paramedic training came about, communities were left to their own devices to decide how to provide ambulance service, this resulted in a wide variety of providers. The most common types are, in no particular order,
Hospital-based services, both public and private. For example, Denver, CO and Hennepin County, MN have public, hospital based ambulance services. A large number of public and private hospitals in New York City provide ambulances to the New York 911 system, as well.
Fire-based Transport- This model has grown by large amounts recently, with many fire departments taking over service from other agencies, including the FDNY takeover of NYC*EMS, the Kansas City Fire takeover of MAST, and the San Francisco Fire takeover from the Department of Public Health. There’a a big push by the IAFF to have more fire departments take over ambulance transport.
Fire-based treatment with private transport- in LA County, the LA County Fire Department responds with paramedics on fire apparatus and a private ambulance (AMR) responds with basic EMTs. If the patient only needs basic life support, the ambulance will transport and the fire crew goes back in service. If the patient needs advanced life support, the fire paramedic will ride in the AMR ambulance.
Public, “3rd Service”- A public service not under the aegis of another public agency. Police and Fire would be the first 2 services. Austin/Travis County EMS is a good example.
Private- This covers everything from tiny Mom-and-Pop services with 1 or 2 ambulances all the way up to the big national companies like AMR and Rural/Metro.
Police-based- Very rare, the only examples I can think of are Woodbury, MN and Nassau County, NY.
Public Utility Model- this style was run as a tax-supported public utility, overseen by a board of directors. MAST- Metropolitan Ambulance Services Trust in Kansas City was the only one I knew of, 'm not sure if this model is used anywhere following their demise.
St. Urho
Paramedic
Thank you, St. Urho. This is very helpful and interesting.
What is preventing AMR from hiring paramedics (and/or having their EMTs upgrade), and doing ALS transports on their own? It seems inefficient to send a fire department paramedic on an AMR ambulance, since his unit is then presumably out of service until he gets back.
Also, I suppose the lines between the scenarios you describe can be blurry, and maybe it’s a hybrid, but it seems like this kind of thing might be yet another category:
http://www.remsa-cf.com/about-html/history.html
They say they’re a “non-profit community service using no tax dollars.” Kind of interesting.
As is the coastguard.
There’s always someone that decides who’s going to respond to 911 calls. Typically it’s the city or county. In this case, AMR has a contract with either LA County or the LA County Fire Department that spells out their role. If they were to upgrade their service, they’d piss off the fire department and put their contract in jeopardy, spend more money, and get no extra reimbursement.
It’s a terribly inefficient system, and the fire apparatus is out of services until they get their medic(s) back.
You’re right. We (around here) tend to lump the non-profits with the privates, even though that’s not really the case.
Or a very efficient system, in which on advanced life support calls, one paramedic knows exactly what has been done to the patient from first response until reaching the hospital, and on basic life support calls the paramedic is released ASAP to put the first responders back in service.
Or an inefficient system in which you send an expensive fire apparatus on calls where it’s not necessary and send paramedics who aren’t capable of transporting a patient.