Rural volley EMS services eventually going to paid ... opinions?

[Phlipper]

After working the past few months as both a paid and volley EMTB here in VA I've noticed things about our system that makes me curious about other services and the challenges faced by those who are trying to manage the service. And I've had a number of long-time medics and basics tell me they think rural and small-town volleys will eventually go to paid staff because of the staffing challenges. So I was just curious - for those who work for volleys in small towns or rural areas - do you have to deal with these same issues? Is my service unique or is this just the nature of volleys?

* A small core group always shows up for shifts, stays the entire shift, and works hard as a team while there. A significant number of others seem to only want to show up and socialize, leave by 10:00PM, not show for shifts at all, and barely lift a finger while there, etc. etc. Some new and old members have literally zero motivation.

* There is essentially zero new member training and little orientation time despite management's best intentions otherwise. A new member is either motivated and learns on his own or he doesn't. Likely contributes to the previous issue. No one is minding the store when it comes to guiding/training new members except for maybe two team leaders who are highly motivated and want to change things.

* Operational standardization is a word no one there has ever heard, and cannot pronounce. A lot of ill will is generated when every team leader or medic wants day-to-day ops done a very specific and very different way than the others. I was surprised how bad it was, myself, when I first got there, and how much of an aggravation it can be in addition to safety issues that can come from this.

* Equipment info and check-offs are so bad/aged it takes a page of notes for a new member just to check off the truck because the info is so badly outdated. Anyone offering to fix this for the servivce is met with disbelief. Yet we have had medics raging about something not being on the truck and we had to show them it was not listed on the sheet to be put on the truck. Again, no one is minding the store.

Most of the EMS staff are probably decent people who wanted to serve but have become jaded, perhaps. And the management are great guys but they seem to be totally asleep at the wheel. The worst part of all this is some of the good staff are leavin the volunteer service, citing the exact issues mentioned above as a reason. They're finally giving up after banging their head against the wall. So we seem to be heading toward a situation that is unsustainable. New staff quickly become dissappointed with the system and begin rarely showing or leaving the service altogether, good older staff leaving because they've realized they can't change anything, and us being left with what we called '$hitbirds' in the Army with respect to basic staff (the medics are awesome and are the only reason some stay at all - to learn).

Is this just the nature of volley services? Are they all like this? Do you think it's sustainable with the motivated folks always rotating out? What are your opinions on moving to paid service so management has leverage to enforce discipline?

Just curious how the rest of the world works.

 

[bahnrokt]

I ride with a small rural Volunteer Corps. We have ~350 calls a year and cover a 73 sq mile town with 6000 residents and about 9 miles of interstate with 2 rigs.

We do decent with new member training. We are so starved for active medical members that we jump all over them. We have about 60 members in the Corps, 8-10 active EMTs, ~10 drivers, 3 people in training and about 15 busy bodies that never run calls but want
input on how we operate (drives me nuts). We are very well staffed for calls that come in from 1800-600, but are very thin during the day hours. But still we average only 1-2 calls a month that roll to mutual aid.

Overall I think we do pretty well in terms of operations, equipment and keeping the store. We have several members that are full timers at several paid services, and use them to keep up on industry standards, and equipment. We are also the first Vol service to be moving onto E-PCRs that I know of. We are responsive to new ideas and processes, and fiscally we had a $20k surplus for 2010.

A few nearby counties are 100% paid and even more rural. With the low call volume, they are spread so thin that call response times is far worse than ours and they lean heavily on the Vol FDs out there. There was some talk a few years ago of this town going paid because we had issues with membership. But we have turned things around fairly well but finding people to cover day shifts is rough. We also have no ALS coverage and have to intercept with neighboring agencies.

The general impression I get from paid EMT-Bs here is that they ride with Vol services for fun. We have nicer rigs, better uniforms, better equipment, less protocols and we dont do non-emergency transports.

 

[rescue1]

Our semi-rural EMS is very similar, except that as a mostly unstaffed station, response times can be even longer. We have a single paid EMT/driver during the day, so he handles equipment checks. The issue is, as always, members showing up (or not showing up, in this case). So we'll get days where it could take 8 minutes to get the ambulance out of the station. The members are all nice people, but they're getting old and burnt out. Training is haphazard and sparsly attended.
I forsee either additional paid staff or the county ALS putting transport units in the stations. Hopefully one or the other happens soon.

Now, in my PA station, we have paid and volley staff and everything is peachy. People show up on calls, we have an active membership, and units respond in seconds rather then minutes. We have fire as well though, and the fire service is usually more "exciting" then EMS, and attracts more volunteers. It's easy to wake up for a structure fire at 0300, and hard to wake up for grandma crapping blood at the same time.

All that being said, volunteers, in my opinion, can't be relied on to provide EMS without any paid support in most areas, simply because the age of volunteering is over and less and less people have time for it. I forsee most services going paid over the next decade, though it would be a shame to push volunteers out entirely.
My 2 cents.

 

[Phlipper]

Thanks for the input. I guess it's just the nature of the beast and most volley or hybrid stations are similar. We have incentives for volleys, one of which is paid part-time days for EMT-Bs in good standing. Problem is that the chief still schedules staff for paid hours that won't show for volley shifts or won't lift a finger if they do show, so the 'reward' isn't really motivation to fullfill your volley commitment. People either want to serve the community and be part of a team or they don't. Doesn't seem to be a way to motivate them.

I'd always heard that volleys around here were starving for people, but with MRs and Basics being spit out every few months from all the VA comm colleges it's actually hard to get a slot. But then you wind up with the dregs on the schedule and everyone's scared to get rid of them because they remember when no one was showing for shifts at all. Better the devil you know, I guess. LOL.

I guess I agree with the guys at my station. With the current situation in our city (the hard working team players moving up or leaving altogether) they will have to go to paid nights and weekends at some point if they are to continue to provide essential services. Of course, management might step up and start following thru with real training and with operational stds to keep the good ones around. But I doubt it. :sad:

 

[Minnick27]

I'm not rural, so I can't speak on your situation, only mine. I've been an EMT for 13 years and haven't run on a volley truck for 3. Everybody is going paid, tere are very few people who want to do something for nothing these days. As far as community colleges spitting people out, I see it quite often. But few of the people I see are quality. Most just do it because it's not a hard class to get through and it's not a terrible job an you get better money than mcdonalds. And most of the people I see in IFT are gone in six months