When Cost-Cutting Compromises Care: The EMS Undercutting Crisis

EMS has long been regarded as a cornerstone of public health and safety. Yet, a growing crisis now threatens the integrity of the entire profession. Increasingly, EMS companies are locked in a destructive race to the bottom—undercutting one another on price at the expense of patient care, provider sustainability, and community safety.

This environment not only drives reputable EMS providers out of business, but it also creates real and immediate dangers for the public.

The Economics of Undercutting

Across the country, EMS contracts are increasingly awarded through highly competitive bidding processes. On the surface, this seems practical: municipalities want to ensure ambulance coverage while minimizing costs. But the reality is more troubling.

In many cases, EMS providers submit unsustainably low bids—well below the actual cost of delivering high-quality emergency care. These bids rarely account for critical components like maintaining modern, fully-equipped ambulances, offering living wages, ensuring appropriate staffing levels, or funding continuing education for providers.

Organizations that uphold these standards often find themselves unable to compete financially. As a result, communities lose access to trusted, experienced EMS providers and are left with lesser alternatives—services that may lack the resources, expertise, or commitment required to deliver effective prehospital care. The saying holds true: you get what you pay for.

The Cost to Care

When financial survival becomes the primary focus, quality inevitably suffers. Providers operating on razor-thin margins often cut corners, and those decisions come at a cost to patients. Common consequences include:

• Understaffed units, or even “ghost staffing”—the appearance of coverage without actual crews on duty.

• Poorly maintained equipment, including unsafe vehicles and critical system failures (such as faulty brakes or inoperable air conditioning).

• Lower hiring standards, leading to underqualified or undertrained personnel in the field.

• Reduced opportunities for ongoing education and training, diminishing provider competency over time.

These shortcuts jeopardize patient outcomes, compromise safety, and erode trust. What was once a mission-driven profession is increasingly reduced to a volume-driven business focused on short-term survival.

Workforce at a Breaking Point

Behind every ambulance is a team of individuals tasked with making life-saving decisions under pressure. Yet, when wages stagnate, training budgets shrink, and staffing remains inadequate, EMTs and paramedics are left overworked, undervalued, and vulnerable to burnout.

This cycle leads to higher turnover, increased errors, and a thinning pool of experienced professionals—all of which further degrade the quality of care and the reputation of the profession.

A Broken System with No Oversight

This crisis is fueled by a system that not only allows—but often incentivizes—substandard service delivery. Once a provider secures a municipal contract, there’s often little to no accountability. Oversight is minimal or nonexistent, enabling some companies to cut corners without fear of losing their contracts.

Unlike hospitals and fire departments, EMS—especially private services—operate in a fragmented regulatory environment. There is no consistent national standard for staffing, equipment, or training requirements. This regulatory gray area puts patients at risk and undermines any effort to elevate the profession.

What Needs to Change

The solution lies in restructuring how we value and regulate EMS. We must shift away from a “lowest bidder wins” model and toward one that prioritizes quality, sustainability, and patient safety. Specifically:

• Contract Reform: Contracts should be awarded based on a weighted scoring system that considers not just cost, but service quality, reputation, employee treatment, and compliance history.

• Enforceable Standards: There must be enforceable minimums for staffing levels, equipment condition, and continuing education—applied to all providers, public and private.

• Public Awareness: Communities must understand that cheaper EMS service often means lower quality. Informed citizens can push local officials to prioritize safety over savings.

• Support for EMS Professionals: Retaining skilled providers requires fair wages, strong training programs, and meaningful recognition. One bad hire can cost more than just morale—it can cost lives.

Conclusion

The EMS industry stands at a crossroads. Continuing down the current path of cost-cutting and deregulation will only deepen the crisis. But with bold reforms, better oversight, and a renewed focus on patient-centered care, we can rebuild an EMS system that delivers not just fast service—but the right service.

Andrew Perry is a seasoned EMT with over a decade of field experience and a passion for EMS education, humor, and news. He combines his frontline knowledge with a strong background in marketing and administration to bring fresh, insightful perspectives to the EMS community. Andrew currently serves as the public relations director for Riverside Ambulance, where he leads outreach and communication efforts. His writing aims to inform, entertain, and support EMS professionals at all stages of their careers.