Should Volunteer Squads Be Eliminated ?

[Ridryder 911]

There are places in the country that will always have to have a some form of a volunteer system. This is do to locality, population etc. But, these places are very few and rare. I am not upset of volunteers that give their time in this type of situation, it is neighbors taking care of each other, the best they can. Usually they will rendezvous with another EMS if possible. I recognize this system more of a first response system. In the same regards of small clinics that might keep a patient or treat until stabilized to go to a hospital. I would not call that clinic a hospital.

What does upset me is for communities that uses volunteers in lieu of professional paid ALS/EMS. Any township over 15 to 20,000 people can afford a full time ALS/EMS units. It has been proven scientifically, and business wise there is enough tax base, population base for run volume etc. Those communities that deny having it, basically does not give a damn about their citizens well being .... short and simple.

Those that volunteer in EMS for those communities, I believe are doing it for themselves definitely not for the citizens or the patients behalf.

If those that did volunteer, would place as much time and work and interest in getting a full time department by researching on on how to funds, or contract a private EMS, then, I would honor them.

I find it ironic, that we never see postings on local volunteer services becoming a paid one. Is this because volunteers enjoy the status quo ? I am sure the city does, again the cow and milk analogy comes in mind.

As long as we have volunteers that make up a great portion of this job, it will never be considered a profession. It can't be. Volunteers are the death of this profession.. it has been seen and proven.

But, I am not as worried as I used to be... With the population age increasing, it is predicted the run volume will triple within 5 years. Volunteers will be a thing of the past. Volunteer companies are already having hard time recruiting and maintaining rosters and education requirements. Most will not want to respond to 5 or 6 calls after midnight, every night, then go to work the next morning. The "warm and fuzzy" feelings tend to leave a lot faster. Cities might actually have to grow some testicles and take care of their citizens instead of having that golf course manicured.

So now, how can expedite this..? Support increase State education requirements. Make re-certification levels more difficult by increasing education requirements. Increase Q/I requirements as well if they have not met such requirements then mandate remediation of skills in a local hospital(s) . Support professional EMS organizations by becoming very active in leadership in these organizations to focus on increasing professional level only. Suggest studies for cities and communities that are considering or should consider implementing professional EMS. This will not only help eliminate volunteers, but also cleanse a lot of dead wood in our professional level as well.

Be safe,

R/R 911

[bandaidpatrol]

I think there are only about 4,900 residents in our whole county...

[EMS49393]

Before all you volunteer people pull that "You never volunteered, you don't know" crapola on me, I was a volunteer, and I can write this with personal experience.

Eliminating volunteers will protect not only my paycheck but my craft. I have strict training requirements to meet to keep my job. They have optional training requirements. I have a duty to care for my patients to the best of my ability. They have providers that want to call helicopters for respiratory distress instead of waiting three more minutes for a paid ambulance to arrive. I don't want to be a hero, and have warm-fuzzy feelings. I want to do my job, not pick and choose what calls I feel like running based on the dispatch. I am a professional. We don't have hospitals of volunteer physicians, nurses, radiology techs, etc. We shouldn't have volunteer EMS.

Yes, it's about ME... It's about me arriving to a patient in a timely matter with the skills, the education, and the equipment to deliver quality care to them. The ride to the ER is a bonus. 8)

[rescue25]

Let me start off by saying that I'm currently a volunteer EMT-B. My county's EMS system consists of fire department medics as well as 3 independent vollie rescue squads that provide ALS 24/7/365. Up until about 6 years ago, the county (which is suburban and has a population of nearly a quarter million) was entirely dependent on volunteers for 911 transport. The paid FD first responded, but they didn't have any ambulances or ALS providers of their own. Up until recently, this system worked well -- but then the call volume exploded. Now we're a combination system.

As much as I hate to admit it, I realize that there is no way an entirely volunteer system could carry the entire EMS workload these days. Recruitment and retention are, generally speaking, down. Not sharply, but it is noticeable. So I appreciate the fact that we have paid personnel working with us. We've worked hard to establish a good rapport with the career FD/EMS folks.

I feel that some of y'all are being too harsh on volunteers in general. There are certainly valid points raised here, and some areas are far worse than others, but I don't think volunteer EMS - at least in my area - is the death of this profession. Speaking for my squad only, we spend a great deal of time training, taking CE classes, upgrading our certs, etc. We have to be on par with our career colleagues. It ain't a choice here. A relatively high call volume allows us to keep our skills fresh, though. I can see how it would be a problem in rural areas with a low call volume, but unfortunately skill decay wouldn't be confined to vollies in this situation.

Volunteers have to face reality that change is coming - some will be good and some will be painful. Some will be good AND painful. But that's just how it goes. All I'm saying is, there's generally no need to throw the baby out with the bathwater. There will always be bumps in the road, but vollie can work alongside career if everyone works together.

Also -- I don't know how rural volunteer EMS tends to work, but we don't respond from home, by POV, or get to pick and choose which calls we take. We play by the rules of the career system here, or we get shut down. Which is how it should be.

In my opinion, if you want to improve this profession, I say lobby for higher standards for EMT education and training. Speak out to get a paramedicine bachelor's degree, like nursing. If some volunteers bitch because they can't keep up, well, that's too bad. Feel free to disagree with me, but that's the only way I see EMS gaining more respect.

[Ridryder 911]

As for the argument that having 250 volunteers in our county's EMS systems takes away 250 fire department medic jobs: keep dreaming. The county will barely pay to keep the ALS providers they already have. It's constantly a challenge to make sure their firefighters keep their ALS certs because most of these guys want to run fire calls, not ride the ambulance..

Sounds like some re-organization is needed. If there is a county that has and needs >250 volunteers then it is PLENTY of big enough to become professional. Does the county realize you would not probably need but about 30% of the 250 people to provide the service full time, thus remove the need of reimbursement of the additional 150 or more people to keep up their certs.

Again, poor government management skills. Yet, I doubt there are very many rallying to change things either. That number is more than we have 3 full time fire departments and EMS with full time dual Paramedics FTE covering a county of 100,000.

Unfortunately there are very few professional EMS advisers that can discuss with city managers, and county board officials, to improve systems and at the same time probably save the townships money. Setting up EMS correctly with proper billing services and if need be supplemental tax base, it can be definitely cheaper than volunteer services.

R/R 911

[rescue25]

Sounds like some re-organization is needed. If there is a county that has and needs >250 volunteers then it is PLENTY of big enough to become professional. Does the county realize you would not probably need but about 30% of the 250 people to provide the service full time, thus remove the need of reimbursement of the additional 150 or more people to keep up their certs.

Again, poor government management skills. Yet, I doubt there are very many rallying to change things either. That number is more than we have 3 full time fire departments and EMS with full time dual Paramedics FTE covering a county of 100,000.

Unfortunately there are very few professional EMS advisers that can discuss with city managers, and county board officials, to improve systems and at the same time probably save the townships money. Setting up EMS correctly with proper billing services and if need be supplemental tax base, it can be definitely cheaper than volunteer services.

R/R 911

For some reason the paragraph you quoted is gone from my post? At least I'm not dreaming, I was sure I wrote about that. Anyway...

Obviously the scenario I'm presenting is very localized and isn't necessarily applicable to the larger universe of EMS, but just some follow up points to your reply:

• 250 volunteers, but that's what we have. For reference, our squad runs about 7,000 calls per year. The county as a whole answers about 45,000 EMS calls per year. The fire department's budget is $37 million. It costs the county little to nothing to have the volunteers in the system, which leads me to...

[*]I'm not sure what you mean about reimbursement for keeping up certs; the county doesn't subsidize the volunteer squads at all. We operate entirely on donations from the community. We don't get a thing from the county (personally or the squad as a whole)

[*]Actually, the fire department administration has been fairly persistent in trying to kill off the volunteer squads. As I said, we've built good relations with the individual paid professionals, but the administration is a somewhat different story.

[*]911 EMS in my county is "free" to the end user (the fire department medics are paid through property taxes, the volunteers get nothing aside from donations). I personally think this isn't the best system... without any sort of supplemental revenue recovery, you're solely charging county residents for a service that a huge number of non-residents use.

• While I certainly respect your opinion, I also feel that fixating on volunteers as the source of all problems in EMS is missing the point a bit. Volunteer agencies that hold the profession back by crying foul whenever someone brings up higher standards for EMT education ARE part of the problem, but this certainly doesn't represent every service's goals or interests.

[Dustdevil]

For some reason the paragraph you quoted is gone from my post? At least I'm not dreaming, I was sure I wrote about that. Anyway...

I'm sure glad you said that. I thought I was going crazy. :?

[rescue25]

I'm sure glad you said that. I thought I was going crazy. :?

I guess I must have deleted it when I was editing my post for speeeling errors. :?

[paramedicmike]

[*]Actually, the fire department administration has been fairly persistent in trying to kill off the volunteer squads. As I said, we've built good relations with the individual paid professionals, but the administration is a somewhat different story.

That's because the volunteers are a threat to the paid staff. If the county administrators got wind of how extensive the volunteer network is do you think they'd let the paid staff stay on? Hell no! They'd terminate the department and let all you self sufficient volly squads take over.

But what would that get you? A group of people with the same basic training minus the extensive real life experience as the paid staff. It seems the community would lose out in the long run.

Do you really want to be responsible for putting all those guys out of a job while you volunteer guys keep your real jobs and get to play on the ambulance/engine as a hobby?

I understand the point you're making. But let the paid guys earn their money. You have your job, they have theirs.

-be safe.

[rescue25]

I really hate to continue talking about my own county, because I realize our experience may not be representative and it's a bit of a tangent, but that said:

Many of the volunteers here are also paid healthcare providers, either in private transport services, other paid fire departments, or nurses. But they volunteer too; maybe there's something in the water down here and we're all crazy. In the end, though, the vollies aren't much of a threat to the paid guys at this point. I predict we'll be essentially gone in this county, for better or worse, in the next 5-10 years. The county administrators are well aware of their volunteer network, since it's been a strong tradition here for almost half a century. They support us, but times are changing and eventually it will be 100% paid. Such is life. At least being involved in EMS has hooked me into pursuing a career in healthcare. If I still have an opportunity to volunteer after getting my RN, I probably will.

I, too, understand your point, and don't want to take away anyone's paycheck. I guess my overall point is that the fire department has been reluctant to provide the appropriate incentives to recruit and retain paid ALS providers while at the same time trying to get rid of the volunteer system. Here at least, it's never been so much an issue of "well, the volunteers will do it for free, let's pay our guys s**t." The FD would prefer that EMS was all paid and still pay their providers s**t. The net result is that we lose providers... and with no backup in place... there won't be enough trucks to answer the calls. If the FD would provide incentives for their FFs to get or retain their ALS certs and ride the ambulance, it would be less of a problem.

I appreciate the conversation but I've been long-winded enough for one night!

(Oh, and I never claimed we were self-sufficient! In fact, I made a point that the volunteer squads can't, by themselves, address the call volume we currently experience. We need the paid guys, without a doubt.)