Leadership Perspectives: Navigating the Complex Landscape of Private and Public Ambulance Services

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Dereck W Rickman, Tracy Rickman, Don Mason & Ygnacio Flores
July 28, 2025

In the critical realm of emergency medical services (EMS), effective leadership is pivotal to navigating the intricate balance between private and public ambulance services. While appearing the same to the person on the street, these services are unique in their organization and management. Leaders must strategically evaluate and integrate the strengths of both sectors to enhance patient care and operational efficiency, ensuring that the needs of diverse communities are met. Balancing regulatory oversight with accountability and leadership fosters a culture of accountability and leadership while also increasing capacity. By prioritizing transparency and ethical standards, leaders can enhance trust within the community they serve and strive to reduce costs while improving effectiveness. The question posed, however, is whether it directly refers to privatizing ambulance services or is only about advocating for improvements that benefit patient care. Conversely, leaders in public ambulance services must navigate complex political landscapes, including dealing with local government regulations and securing public funding to maintain accountability to the public. Transparency is a key element in achieving this. The crux of the dilemma is if outsourcing services equates to efficient services to the public.

At the time of this research, many fire departments have assumed control of ambulance operations managed by private organizations. This shift, such as the one approved in Fort Worth to move EMS services from MedStar to the Fort Worth Fire Department (FWFD), underscores the need for strategic resource allocation and policy advocacy to ensure equitable access to care. Transparent communication with stakeholders is crucial in maintaining public trust and aligning services with community needs. Driving community engagement must be a strategic priority for the public. Leaders can improve their organization’s reputation and responsiveness to community needs by actively participating in local health initiatives and forming meaningful partnerships. This engagement builds trust and provides valuable insights for service improvement.

In public services, leadership involves more than just managing operations. It’s about reinforcing the organization’s role as a trusted community partner. Leaders must ensure that their teams are engaged in public health education and disaster preparedness, strengthening community confidence in their services. By doing so, they can maintain and enhance their presence as vital community resources.

Transitioning to fire service EMS from the private sector may seem an anomaly, as many municipalities utilize the private sector to meet this need. This transition involves a careful evaluation of the current EMS system, identifying areas for improvement and implementing changes that align with the organization’s goals and the community’s needs. Public service leaders, while often facing budget constraints, must advocate for strategic investments in the “best service” at the “best costs” for the citizens they serve. Championing technological advancements and innovation, public safety leaders should encourage service operations that ensure better response times at a reasonable cost by adopting new technologies that enhance patient care. Staying ahead of technological trends enables organizations to deliver cutting-edge services and improve patient outcomes, thereby positioning them as industry leaders.

Public service leaders, while often facing budget constraints, must advocate for strategic investments in providing services that not only meet current needs but also consider the future growth and needs of the demographic they serve. With the baby boom generation now beginning to retire (those born in 1963 are now starting to retire), the need for related medical services is apparent not only in ambulance operations but throughout the medical services community. By demonstrating the long-term benefits of such investments, they can secure necessary funding and support, ultimately enhancing service delivery and operational efficiency.

Leaders must develop comprehensive response plans that ensure scalability and coordination during large-scale emergencies. This involves leveraging specialized resources and forming strategic partnerships with public entities that were once outsourced to private industry. Public service leaders must prioritize maintaining robust emergency response systems, ensuring their teams are adequately equipped and trained to handle crises effectively. This includes regular drills and simulations to assess the system’s readiness. Collaboration with private partners can enhance these efforts, creating a resilient, responsive EMS system capable of meeting the demands of any emergency.

Leadership in ambulance services is about integrating innovation with accountability, community engagement with efficiency and preparedness with adaptability. By fostering a collaborative environment that leverages the strengths of both private and public services, leaders can create a healthcare system that is responsive, equitable and capable of meeting the diverse needs of all communities. The goal is to ensure that every leadership decision enhances the quality and accessibility of emergency medical care for everyone.

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Authors: Dereck W. Rickman, Tracy Rickman, Don Mason and Ygnacio Flores. D. Rickman, MPA, is a Navy Veteran and GS-11 with the Federal Government. Dr. Tracy Rickman is an instructor at Tarleton State University. Don Mason, MA and Dr. Ygnacio “Nash” Flores are professors at Rio Hondo College.

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