Forgive the long comment, and this is very US centered and doesn’t apply to every area in the US. EMS systems vary broadly between states and even municipalities within states…

To put some of that in perspective:

• A new ambulance costs about $250-$400k depending on the type.
• The heart monitors we use are somewhere in the area of $10k-$25k a piece. That’s ONE piece of the equipment that we use, and they need maintenance and replacement every so often.
• There’s all the other equipment, and restock of medical items. Even if something doesn’t get used it has to be on the truck and has to be replaced when it’s outdated.
• Fuel is expensive. The last agency I worked for spent about $400k - $500k a year just on fuel.
• There’s insurance - auto insurance, liability insurance, workman’s comp, etc.
• Keeping an EMS certification active requires ongoing continuing education credits. We take classes constantly to stay current and to be able to renew our cert, which in some states costs money just to renew. I’ve spent hundreds just to be able to work, both in con ed classes and certs. Some agencies will help pay for this cost, and many provide free con ed classes for their providers. This costs money.
• There’s building costs, rent, electric, etc.
• Ongoing vehicle maintenance (ambulances break a LOT)
• administrative costs, and so many more I haven’t listed

And that’s all before you get into paying anyone for their work. You aren’t paying thousands of dollars for YOUR ambulance ride. You’re paying for the fact that the ambulance existed to respond to your emergency in the first place. Many agencies don’t get taxpayer money, and if they do, it’s minimal. My last agency had townships paying them $2k a year to provide 24-7 ambulance service with paid providers. That doesn’t even cover fuel, let alone anything else.

Is it absolutely bullshit that people should have to be bankrupted to pay for an ambulance bill? 100% No one should have to worry about money when they’re having an emergency.

If you don’t like it, advocate for a municipal tax. If every household paid something like $75-$100 a year you could have the best EMS service with well trained, well paid providers using the best, most up to date equipment available and you would never have to worry about an ambulance bill. The places that implement those taxes generally either don’t bill at all or bill insurance and only take what insurance pays them, there’s no balance billing of the patient.

But no one wants extra taxes, even if it could save them thousands of dollars, and for some reason people come out and support funding for the fire departments and the police departments and no one wants to advocate for support and funding for EMS, so instead you get this mess where EMS is somehow expected to hold itself together and be a profitable enough business to self sustain. You end up with a system where providers are underpaid, have to work 70+ hour weeks to survive (and thus are incredibly burnt out and exhausted - you really want a provider who has worked 70 hours in 5 days on 10 hours of total sleep making life or death decisions?), the good providers head to places where they can get better pay, the equipment and ambulances are old and being held together by sheer will of the providers, and patients still have insane bills.

Patients should not fund EMS. Government should fund EMS. It’s a service, not a business, but under the current system in most places, it has to be a business if you want to be able to call 911 and have someone there to respond.

I work in EMS. My advice to students and brand new EMTs is always the same: don’t freak out when your patient is in cardiac arrest. Those are the easy calls. I have to keep people alive and if someone is crashing in front of me I have to figure out why and what I can try to do to stop it so they don’t die. The ones that are already in cardiac arrest aren’t getting any more dead, and the only outcomes are that we improve on that or we don’t. We can’t make them worse. Dead is the most stable condition.

Edit: That said, one of my favorite things about working in EMS is that I don’t have to care about “medically necessary” or insurance companies. If I think my patient needs a treatment and it’s in my protocol to give it, I give it. I don’t have to ask for an insurance company’s approval or get a payment method from my patients, I just get to help people.

It didn’t turn into a fight, we both thought it was hilarious. He was like wait, is it really purple, then we both laughed about it a bunch and I looked up the color blind tests with the numbers hidden in colored dots and he realized that he could see the numbers in most of them but there were a few that he had to ask me if there really was anything there or if it was just plain dots to mess with people. Afterwards there were times he would start arguing with me about colors again and I’d make a comment about my grey sweater and then we’d both just end up laughing.

My ex used to argue with me about colors all the time. It was odd. Then one day he told me he really liked my grey sweater. I was like I don’t own a grey sweater. He said yes you do, and pulled it out of my drawer. It was my light purple sweater. That’s how we found out he was slightly color blind.