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About This ManualChapter 2: About This ManualThe purpose of this manual is to identify the various grants and innovative funding alternatives available foremergency medical services (EMS) and fire protection services. Where appropriate, a discussion of the prosand cons of a particular funding source is discussed. In some instances, examples are given to illustrate howalternative funding is being successfully implemented in EMS agencies and fire departments across the country.This report is divided into the following several major sections identifying various sources of availablefunding and revenue options.Local Revenue and Funding AlternativesThe funding alternatives available at the local level vary widely, though the ability of the EMS administrator or fire chief to influence changes in these sources will vary considerably based on local preferences andState and local laws. Many enterprising departments have found new revenue streams through the sale ofservices. The discussion of local revenue sources includes Taxes: These include taxes on real property, personal income, and sales transactions. Other taxesinclude real estate-transfer taxes and utility-user taxes. New taxes can go into a city’s general fundto be divided up by elected officials or can be earmarked specifically for EMS and fire services. Development Impact and User Fees: These fees are charged to ensure that those benefitting froman activity pay their fair share of the costs related to that activity. Fines, Forfeitures, and Citations: Some jurisdictions now issue citations to those who engage inhigh-risk activities that may later require a rescue. Other areas dedicate a portion of fines to fundEMS and fire services. Enterprise Funds and Utility Rates: Local governments may establish an enterprise fund for cityoperated services. Ambulance service, for example, may be run like a municipal business where it isexpected to earn revenue to support its operations. Sale of Assets and Services: Some EMS and fire agencies sell used equipment or services to producerevenue. Benefit Assessments: Special districts may be established for the purpose of supporting EMS andfire services. These districts can assess a benefit assessment similar to a property tax but based onthe “benefit” received by each property. These charges are a way to circumvent property-tax limitations and can also improve the equity of charges for EMS. Borrowing: Cities and towns have a number of options for borrowing revenue needed to purchasecapital equipment and facilities including General Obligation bonds and Certificates of Participation.Not-for-profit organizations may have access to low-cost 501(c)(3) revenue bond financing or maytake out a traditional bank loan.This section also discusses creative ways fire chiefs and EMS administrators have raised revenue for theiragency such as creating private ambulance company contracts to reimburse for fire-based EMS, billing fordepartment-operated ambulance services, offering subscription programs, providing interfacility transport,creating paramedic intercept agreements with surrounding communities, and piloting innovating healthcare programs. The section concludes with time-tested cost-saving strategies and miscellaneous fundraisingideas for rural and volunteer fire and EMS agencies.3

Chapter 2State and Federal Funding ProgramsIn addition to sources of local revenue derived from taxes and other local government financial mechanisms,EMS agencies and fire departments may be able to obtain considerable funding from State and Federal programs. Two chapters list grants available from States and the Federal government.Often, Federal grant funding flows to the local level through the States. However, some States provide direct funding for EMS, especially in rural areas. Many States offer grant aid and low-interest loans for capitalimprovement projects. On the other hand, some States have no funding for local programs. Most StateFire Marshal’s Offices and EMS bureaus offer technical assistance to local agencies and subsidized trainingprograms to first responders.EMS administrators and fire chiefs in States without funding may wish to consider what other States are doing and determine if some of those methods might be feasible in their State. The taxpayers pay for EMS oneway or the other, but some approaches may be more palatable or more equitable than others.Agencies of the Federal government offer thousands of grants and special programs to State and local governments; many of them may apply to EMS. Some programs are not specifically earmarked for fire or EMSbut can be used for those purposes, such as community block grants.Private-Sector SourcesPrivate foundations and corporate-giving programs donate millions of dollars annually for education, arts,and community development, among other projects and programs. Career and volunteer EMS and fire agencies may be able to raise funds for capital purchases or to improve service delivery through these sources,especially in rural communities or poor urban areas. When looking at these options, caution should be takento ensure that accepting donations from these types of programs does not result in the appearance of a corporate preference or conflict of interest. This is of particular importance for EMS and fire organizations thatare government-funded. This is of lesser concern for volunteer organizations that operate outside the directcontrol or funding of their local government. Some public EMS and fire departments establish separate 501(c)(3) nonprofit organizations to accept donations for local causes related to their mission. Among the privatesector sources of giving are Foundations: Some communities are fortunate to have community/public foundations whose fundscan be used for providing special public safety services, starting new programs, helping low-incomeareas, or other services allowed by charter. There are also national independent and corporate foundations that donate to communities across the country. Foundations provide a source of revenuethrough general operating support grants, planning grants, seed money, management assistancegrants, and facilities and equipment grants. Corporate-Giving: Many public safety agencies have been successful in soliciting grants and services from national corporations. Companies are often interested in providing community assistancein cities and towns where they have a corporate presence or where their employees live. Corporategiving has public relations benefits and emergency service administrators should be ready and willing to recognize corporate sponsors whenever possible. Corporate-giving comes in the form of cashdonations, in-kind contributions, and even executive loan programs. Program-Related Investments: In addition to grants, cash, or in-kind donations, foundations andcorporations may be a source of low-interest or zero-interest loans, particularly for capital-improvement projects.4

About This ManualWriting an Effective Grant ProposalThe final chapter of this manual presents fundamentals of developing grant proposals to assist EMS administrators and fire officers in preparing appropriate documentation in pursuit of grants from government and privatesources. While this advice is generally applicable to any grant application, grant seekers must always read, understand, and follow the specific program guidelines for grant opportunity.Implications of Funding ChoicesEach agency providing EMS and fire protection must consider the range of opportunities and the local andState constraints in shaping its funding policy and determining its budget. Funding influences the amountof response resources available and the scope of preventative activities which, in turn, influences patientoutcomes. The funding issue is not one to be left solely to accountants and financial officers; it is a vitalpublic policy issue that deserves community input.The choice of funding approaches also raises fundamental questions about governance and equity. Manyquestions about EMS have become part of the larger national health-care debate: Is EMS solely a privategood where users of prehospital medical services pay for the burden of the services provided to them? Or,is EMS a public good provided by the community to people in need, and the cost spread across society? Perhaps EMS should be treated like insurance, in which the fees charged are a function of the risk presented?Who should provide EMS?These are fundamental questions about our values and the role of government in society and apply to the fireservice as much as they do EMS or any service the government provides. Different communities are takingradically different approaches; many seem uneasy about charging for services beyond the taxes paid, whileothers have found it to be the only way to fund critical public safety services.Providers of emergency services should consider the wide variety of funding alternatives available to financeservices and perhaps improve the equity of paying for the service. Citizens often balk at new fundraising mechanisms. Changing the way public safety is funded can profoundly affect the way government isviewed, and change the unwritten contract between a government and its citizens on major issues such asrepresentation and the purposes and goals of government. EMS and fire leaders must take a collaborativeand participatory approach to addressing complex public policy issues, including discussions about the roleof EMS and fire agencies in the community and how public safety services are funded.Finally, local government charters and State constitutions may limit the extent to which EMS agencies andfire departments can generate revenue. Some States prohibit volunteer ambulance agencies from billing forservices. Others have restricted the amount of development impact fees that can be charged and prohibitedthe adoption of new user fees. Before developing any new cost-recovery program, EMS managers shouldconsult with an attorney to discuss any limitations.ScopeThis manual discusses alternative sources of revenue available to fund EMS and fire protection in all types ofsystems: career or volunteer, urban or rural, advanced life support (ALS), or basic life support (BLS). Whilefire-based EMS agencies and private-sector ambulance companies are an important part of many systems,some of the grants and funding sources contained herein apply only to the fire service. The fire service isthe primary first responder in many communities and many fire departments play a major role in providingEMS. Currently, fire departments with cross-trained dual-role personnel constitute 38 percent of EMS responders in the United States, more than any other single-system type.2 Many of the Federal grants autho2“EMS By the

These include taxes on real property, personal income, and sales transactions. Other taxes include real estate-transfer taxes and utility-user taxes. New taxes can go into a city's general fund to be divided up by elected officials or can be earmarked specifically for EMS and fire services. Development Impact and User Fees: