8:40 p.m. EDT, June 12, 2010

Orlando's government is facing a choice between two private ambulance companies battling for a new contract to transport sick and injured patients in the city to hospitals. But there is a third, better option for city leaders: None of the above.

A selection panel of Orlando employees has ranked a subsidiary of Colorado-based American Medical Response higher than its competitor for the contract, Arizona-based Rural/Metro Ambulance. AMR is the biggest private ambulance provider in the country, but Rural/Metro has held the city's contract for emergency hospital transportation since 1983.

Rural/Metro is protesting its lower ranking. It is accusing AMR of offering to pay Orlando what amounts to an illegal kickback, and of having an unfair advantage because its lobbyist also represents the city. AMR rejects those allegations. The dispute could wind up coming before the City Council.

While Orlando sorts through this mess, most other local governments in Central Florida are using their own ambulances and paramedics to transport patients to emergency rooms. And those governments are collecting millions of dollars in transport fees for those trips from government or private insurers.

Under the current system in Orlando, the city Fire Department sends its own ambulances to medical emergencies. Their paramedics are usually first to respond, and they begin treatment. But then they hand off most hospital-bound patients to Rural/Metro, though city ambulances carry the most seriously ill or injured patients to hospitals rather than wait.

In the past, Orlando Mayor Buddy Dyer and his staff have opposed the idea of taking over hospital transport. They have argued the city would need to buy new ambulances and hire more firefighters, and would wind up spending more than it would earn.

The city's firefighters' union — a key supporter of Mr. Dyer in his mayoral campaigns — also has been cool to the idea before. Its leaders were wary of members taking on more duties and getting held up waiting for hospitals to take charge of patients.

Orange County Fire Rescue used to split the job of transporting patients to hospitals with Rural/Metro, but county leaders decided in 2008 to do the whole job in-house. County fire officials say the change has brought in more than enough extra revenue to cover the cost of the additional ambulances and manpower to do it. And waiting times for paramedics at hospitals in the county have been reduced.

But those officials are upbeat about the switch for other reasons, including the continuity of care for patients. The same county paramedics who treat patients at the scene go with them to hospitals and relay the details of their conditions directly to medical staff. Patients are better served, and paramedics can use the hospital feedback to sharpen their skills.

Admittedly, Orlando's Fire Department is not in a strong position lately to take on new services. If not for an $8.3 million federal grant awarded last month, the city was planning to shut down the department's eight ambulance units and lay off 46 firefighters.

But that grant gives the department's ambulance units a two-year reprieve — time to test the feasibility of transporting more patients. It could put off the need to add new units by starting in areas of the city that are closest to hospitals, and letting a private company handle the rest under a short-term contract. If sufficient revenues come in, the department could expand its coverage later.

Other local governments have found it makes financial and medical sense to handle emergency transport themselves. Orlando should get on board.