Does Athens’ for-profit ambulance service meet NFPA 1710 standards? Does it matter?

National EMS paramedics rush emergency medical treatment to tens of thousands of patients a year in Athens, saving lives and ensuring that people receive the best possible care before they reach the hospital. 

But National EMS is also a for-profit company that’s been sharply criticized by whistleblowers and activists for having poor response times and a lack of transparency with the public, while saddling some patients with very large surprise bills [UPDATE 5/30/26: Surprise billing for EMS has been eliminated in Georgia, see below].

In 2019, a newly-elected mayor and commission intervened to bring National EMS under public oversight, but were met with significant resistance. Both Saint Mary’s Hospital and Piedmont-Athens Regional defended National EMS strongly, even as the company refused to share their raw response time data with the public and later were caught making false statements to their own oversight committee.

Yet, in some important ways, today’s National EMS is not the same company that took over Athens’ ambulance services in 2009. Some of the problems which led National EMS to be criticized in the past have been resolved over the years. Others have been partially resolved, while still others are just as problematic today, in the view of public safety advocate Sam Rafal, as they were almost two decades ago.

This article will review what’s improved over the last two decades of EMS in Athens, what’s stayed the same and what the next steps might be for improving this service.

Ambulances in Athens: A quick history

In most counties surrounding Athens, EMS is a government service. While running an ambulance service is a significant expense for these county governments, there is an upside: public EMS operates with full transparency and can be held accountable by government officials and voters.

In Athens, the ambulance service has never been public. Before 2009, each hospital in town operated its own ambulance service with a central dispatching unit shared between them. According to Dee Burkett, vice president of professional services at Piedmont Athens Regional, these services were a financial burden, costing each hospital about $1 million a year.

That’s why the hospitals contracted with National EMS in 2009, partnering with the Athens-Clarke and Oconee County governments to share the expense. Each of the four institutions offered a $100,000 subsidy ($400,000 in total) for National EMS to begin operations. Since then, National EMS has been profitable and has never needed to ask for an increase to their subsidy.

“Profit over patient care”

Retired paramedic Bob Gadd was working for Saint Mary’s Hospital during this transition. He was hired by National EMS to run the same shift as he did for Saint Mary’s, but at much reduced pay. He continued to work for National EMS until 2012, when he quit for ethical reasons and started blowing the whistle.

“What I discovered working there, pretty quickly is that…[National EMS] put profit over patient care,” Gadd told APN in 2019. “They would literally use the last ambulance in the county to take a non-emergency transport.”

Non-emergency transports include things like shuttling patients between hospitals or taking an elderly patient back to their nursing home after a medical procedure, for example. While Gadd said that Saint Mary’s would occasionally offer non-emergency transports, he stressed that these sorts of rides were typically handled by other companies. When National EMS took over, Gadd said he was forced to expand his role in offering non-emergency transportation as a way of making the company money, even if it took 911 ambulances out of emergency service for a time.

Rafal has called this practice “playing Russian roulette” with community health, since you never know when someone will dial 911 with a serious medical issue that requires immediate attention. If an ambulance is not available to respond because it is running a non-emergency transport, the 911 response could be seriously delayed.

Before he resigned, Gadd asked Robby Atkins, one of the original owners of National EMS, to create a non-emergency division to handle these non-emergency transports. This would allow the emergency division to focus solely on 911 calls. According to Gadd, Atkins refused, saying that the company couldn’t afford it. 

“That’s when I quit,” Gadd said. “I can’t do this.”

Things have changed: National EMS is currently owned by Priority Ambulance, a larger company based in Knoxville, Tennessee. Last year, the company announced at a commission work session that National EMS now has a separate division of five ambulances to run non-emergency calls in Athens, as Gadd requested back in 2012.

System saturation

National EMS maintains a fleet of 11 transporting ambulances that launch out of two stations in Athens and two stations in Oconee County. While National EMS says that its emergency division no longer runs non-emergency transports, these 11 ambulances are not enough to handle all emergency calls in Athens in a timely fashion.

At a mayor and commission work session on January 13, Tracey LaFlam, the Operations Manager of National EMS, admitted that there were 12 times from July through September of last year that her agency had no EMS units available to respond to a 911 call. That’s about once a week on average.

In these cases, sometimes an ambulance from the non-emergency division can fill in. But at other times, National EMS would need to ask for assistance from a nearby county, causing the emergency response to be significantly delayed.

Even under normal circumstances, National EMS cannot respond as quickly to emergencies as the ACC Fire Department because the company has only four stations in total serving the two counties. The ACC Fire Department alone has nine stations in Athens which allow it to be the first responder to most calls for emergency medical help. Oconee County has another seven fire stations.

How this could change: National EMS could hire another ambulance crew or transfer one non-emergency crew to the emergency division to help avoid system saturation, but this would make the company less profitable.

Surprise billing

Most people assume that ambulance rides are covered by their health insurance. During an emergency, there generally isn’t time to ask how much it would cost to receive care, either. This can cause some patients to be surprised, and not in a good way, when they receive a bill for thousands of dollars in the mail.

According to Commissioner Melissa Link, some of her constituents have even turned down ambulance rides in the past because of the expense. “I do know people who have turned down [ambulance] service, knowing that they would end up with a $3,500 bill,” Link said at a commission work session last year. 

At the same meeting, Mayor Kelly Girtz asked National EMS to make sure that local government employees were covered or he might recommend withdrawing the county’s $100,000 subsidy.

“Among the prerequisites for me in any partnership is that our own employees are covered,” Girtz told a representative from National EMS. “Our employees are not covered by this operation right now.”

Things have changed: National EMS announced on January 13 that ambulance rides are now “in network” for Blue Cross / Blue Shield insurance as of September 2025. Blue Cross / Blue Shield is the same insurance that the ACC government offers its employees. This will eliminate the extremely large surprise bills for patients who have this type of insurance, at least. LaFlam explained that National EMS is “hoping that other insurance agencies will also follow suit.”

UPDATE 5/30/26: Some good news: all ambulance rides in Georgia will be considered “in network” after January 1, 2027. This happened thanks to the state legislature’s passage of HB 506 this year.

Level of training

Over the years, certain National EMS employees have occasionally been shown to lack needed training that would allow them to better assist patients experiencing health emergencies. For example, not all National EMS ambulances are staffed by paramedics, even today; some are staffed by EMTs only. The training of National EMS dispatchers has also been an issue in the past.

Paramedics or EMTs

On June 4, 2018, Athens resident Saheed Snow was shot in the chest on East Carver Drive in east Athens. Unfortunately, the only unit National EMS had available to respond was a basic life support ambulance that was staffed only by EMTs, not by more highly trained paramedics. Snow was alive when the ambulance arrived but he was pronounced dead at the hospital. 

It’s impossible to know if a paramedic could have saved Snow’s life. But it seems certain that if an advanced life support unit was available, Snow’s odds of living through this trauma could only have improved. 

How things are now: In 2018, there was no public information available about the average level of training of National EMS’ ambulance crews. Today, National EMS gives a quarterly report to the mayor and commission that includes this information. As of September 2025, they reported that 78% of the units in the emergency division included at least one paramedic, whereas the remainder were basic units only.

Dispatchers

A few years ago, people who called 911 for medical emergencies in Athens were forced to explain their emergency twice; once to the 911 operator and a second time to the National EMS dispatcher after their call was transferred. This system was inefficient and confusing for people at the worst possible moment.

Adding injury to insult, not all National EMS dispatchers were well-trained on emergency medical dispatch (EMD), which is an optimized system that allows dispatchers to quickly process medical 911 calls and provide a higher level of care for patients. EMD dispatchers are trained to stay on the call with a patient until the ambulance arrives, allowing them to give medical advice and instructions for how to perform first aid or CPR, for example. EMD also allows paramedics to have more information about what to expect when they arrive on-scene, speeding up the delivery of lifesaving care by crucial seconds.

On November 28, 2017, a couple living near Athens discovered that their infant was not breathing. They got in their car and started heading for Piedmont-Athens Regional. They called 911 en route in Madison County and were transferred from Madison County’s 911 center to the ACC dispatch center as they crossed the county line. From there, they were transferred to National EMS, when the call dropped. They called 911 again and were transferred again to National EMS.

The National EMS dispatcher unfortunately was not trained on emergency medical dispatch, or did not make use of his training. He didn’t give CPR instructions or any other coaching over the phone that could have potentially saved the infant’s life. Unfortunately, the baby did not survive.

Things have changed: In 2023, the ACC 911 center, staffed by professionals in the ACC Police Department, began to handle all 911 calls in Athens, including medical calls. Information about emergency calls is transferred digitally to National EMS, making call transfers unnecessary. Importantly, every ACCPD dispatcher is trained in emergency medical dispatch and will stay on the phone with patients, if needed, until an ambulance arrives.

Response times

Response time is the primary way that EMS agencies have been judged for decades. While this standard has been questioned by medical professionals, it’s still generally true that faster responses are better than slower ones.

In 2018, Rafal managed to obtain the raw response time data from National EMS ambulances in Athens from 2014 through 2017. He found that National responded to 90% of emergencies in under 16-18 minutes, when, according to their agreement with the hospitals, 90% of responses should have been in under 9-12 minutes.

These numbers were sharply disputed by National EMS and by both hospitals. They argued that Rafal had no context for the 911 calls; some calls could have been cancelled, and others may not have been real emergencies at all. The numbers would need to be processed before being used to judge performance. Even so, Rafal’s reveal did provide a piece of evidence that previously had been lacking.

National EMS does not treat each 911 call the same. The company distinguishes between calls based on a priority ranking they assign to each. National EMS also distinguishes between calls based on location; if a call comes from a rural area, they don’t consider a response to be late until after 12 minutes. In urban areas, they give themselves only nine minutes before a response is considered late. These standards were written into the agreement National EMS made with the hospitals when they were hired.

The first time National EMS ever shared an overview of their response time statistics with the mayor and commission was in 2019, when National EMS reported that they responded to 88% of priority-1 urban emergencies in under 9 minutes, not 90% as listed in the contract. 

Burkett, who gave the presentation, wasn’t concerned about this slight deficiency. He stressed that response time statistics alone were not enough to judge the quality of an EMS service.

“No single metric can completely characterize the effectiveness of an EMS service. It just cannot,” Burkett said. “Not one time in ten years have we doubted our decision to have National EMS represent both hospitals in operating our ambulance services.” When pushed on this point, Burkett said that National EMS’ response times gave “superior results” given the relatively small expense to the hospitals.

How things are now: To date, National EMS has never shared their raw response time data with the public. When they report to the mayor and commission, they have continued to make a distinction between rural and urban 911 calls. Yet, they have not explained how they define these terms as they relate to Athens-Clarke County.

During the company’s last report, they indicated that they respond to 90% of urban 911 calls in 8 minutes and 58 seconds, one second shy of their limit. National EMS also indicated that they responded to 90% of rural 911 calls in 11 minutes and 31 seconds. This is much slower than the ACC Fire Department, which reported responding to 90% of all 911 calls across Athens in 7 minutes and 41 seconds – over a minute faster than National EMS responds to only the calls they view as most important within Athens’ urban core.

The ACC Fire Department does not distinguish between 911 call location or priority, since these factors do not change the performance goals listed in the National Fire Protection Association’s 1710 standards, to which they adhere. Unlike National EMS, the ACC Fire Department’s goal is to respond to every emergency call in Athens in under 9 minutes, 90% of the time, which they do with over a minute to spare.

Oversight

Piedmont-Athens Regional and Saint Mary’s Hospitals have at times seemed to resist public oversight of National EMS, a for-profit company with a financial motivation. 

After hiring National EMS, the hospitals set up an oversight committee in 2013 that included representatives from both hospitals and representatives of both local governments that were served (Athens-Clarke and Oconee Counties). These representatives were forced to sign non-disclosure agreements in order to attend the oversight committee meetings, which were closed to the public.

After taking office in 2019, former Commissioner Tim Denson encouraged ACC Attorney Judd Drake to research the legality of holding closed-door oversight committee meetings. Drake drafted a 6-page legal opinion, which he shared with both hospitals. Upon hearing his opinion, oversight committee meetings were abruptly cancelled (rather than allow people like Rafal and Gadd to attend).

After two years, in 2021, the oversight committee still had not met. Furthermore, the hospitals had completely cut off contact with two newly appointed members of the oversight committee (Commissioners Patrick Davenport and Jesse Houle), refusing to answer any questions about it. The oversight committee had been dissolved.

How things are now: Today, the old oversight committee no longer exists. Instead, the ACC government has signed a new agreement with Piedmont-Athens Regional. This agreement describes the government’s expectations that should be met in exchange the $100,000 subsidy that the ACC government provides. This agreement is the reason why National EMS has been reporting their response times and other data to the mayor and commission on a quarterly basis. However, National EMS has yet to share their raw data with the public or the mayor and commission, making true oversight difficult.

Next steps

Commissioner Carol Myers told APN that she will visit the headquarters of National EMS soon as part of her attempts to oversee their operations.

“I will continue to push for transparency and I plan on taking up the local National EMS leadership to visit them at their office later this month or early February,” Myers said. “We were told that they will share raw data, daily paramedic staffing schedules and maps that define their urban / rural areas. My goal is to continue to push them for that data so that we can assure Athenians they are getting the kind of EMS care that I’m sure they expect.”

Rafal also believes that the residents of Athens have high standards for their emergency response providers. “They might be surprised at the disconnect between their expectations and our reality,” Rafal told APN. 

Rafal has a number of recommendations for how emergency responses in Athens can continue to be improved. First, he asks that the local government purchase additional medical equipment and supplies that would allow ACC firefighters to provide more advanced care in the field than they are currently able, despite having advanced training.

Second, he asks that National EMS house their ambulances in ACC fire stations, scattered all around the county, to allow them to respond more quickly to medical emergencies. He also wants all ambulances to include at least one fully-trained paramedic. Finally, he feels that National EMS should be held to the same response time reporting requirements as the ACC Fire Department, saying that distinguishing between urban and rural responses is a form of data “manipulation” by a for-profit company.

Both hospitals disagree with Rafal, saying that response times receive too much focus by policymakers. Some medical experts outside of Athens agree with that assessment.

In the end, it’s up to the hospitals and the mayor and commission to decide what level of risk they are willing to accept regarding EMS performance and how much money they are willing to spend to improve that performance. Holding National EMS to the same standards as the ACC Fire Department may help reduce the risk to patients on a certain number of 911 calls, but at an unacceptable cost to the public in terms of tax dollars.

Regardless of where you fall on this question, you may want to communicate with your commissioner about your opinion on this issue. It’s how our local democracy functions.

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