Thanks! I'm grateful for having been around to see most of these changes myself. I definitely agree that better call triaging is important, I think that if you really look at the cost/benefit, we're really causing a lot more harm than help with how often we send ambulances lights and sirens.

As for private EMS, I can speak to that. Private EMS has more or less made this bed for themselves through years of consistent and deliberate choices, and now they're having to lie in it. I know that EMS isn't an easy business, and you're not exactly loaded with cash in the best of times, but I've seen (like, literally seen it) ambulance services refuse to make improvements that were free or relatively low cost because they get stuck in the mindset that they pay their employees to come to work to get their behinds kicked. I have to say that there was a large amount of pointless suffering and more or less constant begging for more and more sacrifices, varying by employer, and when it came time to ask the company to reciprocate, you get a big ol' handful of nada. I mean, not every private ambulance company I worked for was awful, some of them truly are wonderful little operations where everyone feels like family, but those were the exception to the rule. I saw my older co-workers, did that calculus, and decided that wasn't sustainable as a career, and I think I'm not the only one. I know that a few companies have finally been provoked into making some changes due to the shortage, but I still get the vibe that most of them are still just sort of waiting for the disposable employee dispenser to start working again.

For everyone's sake, including their own, I hope it doesn't. I hope the private ambulance industry is forced to sit down and actually square themselves with the problem of how to treat employees better and retain people. The ambulance companies will be better off for it, the EMS system and its patients will be better off for it, and the providers will be, too.