Volunteer EMS needs to become non-existent.

[NYMedic828]

Personally, I feel this is one of the biggest factors holding EMS back, especially on an educational and professional level.

For starters, few people will take your work seriously when you tell them you are an EMT and their response is "o that's great my nephew is a volunteer at ____."

How can you be looked at as a professional when half of the certified group is willing to do it
For free as a hobby.

Secondly, it is much easier to advance a group that is mandated by an employer than it is to do so with one that really has no necessary requirements. I can't force you to come to my "training" at the volunteer house, but If you work for me and want to keep your job you damn well better come. Everything is always justified with "what do you expect, we're just volunteers."

MANY, not all, volunteer providers also more inexperienced than those who do it on a daily basis. You can't expect someone who does 2 assessments a month to ever gain competence in any realistic timeframe.

There are obviously other factors but these are just my main thoughts. Keep in mind, I am a volunteer when I am not at work and nothing I see on a regular basis gives me any reason to want to keep volunteer EMS in existence.

 

[rescue1]

I agree with many of your points.
Before this degenerates into yelling and screaming, I will say that while I believe paid EMS is ideal, there are many places in the US that could never afford or justify a paid service. The imaginary town of Redneck, Kansas may have 400 people in it, and may generate 50 EMS runs a year...hardly worth the almost $200,000 a year it would cost to provide 24/7 paid coverage (assuming 6 full time EMT's making 30,000 a year).

My issue is well funded suburban areas or larger towns (like 5000+) that have the resources and call volume to support and justify a paid service but will not. And from an ordinary citizen's viewpoint, why should they? It means more money, and the volunteers have been doing it fine for X number of years. I think a well funded combination department could be the answer there...saves money, provides a professional base, and means that there is greater flexibility in disciplining volunteer members because the fear of them "not showing up when needed" is mitigated by paid staffing.

Of course, all this being said, there are many volunteer agencies that deliver care equal to or better then many paid agencies. I just don't think that they are the majority.

And this wouldn't even be an issue if the minimum standard for EMS was an associates degree.

 

[bahnrokt]

Its all moving that way anyway. In 15 years a 100% vol town will be unheard of.

It's also suicide for local politicians to start messing with the the VFDs and Rescue Squads.

 

[EpiEMS]

MANY, not all, volunteer providers also more inexperienced than those who do it on a daily basis. You can't expect someone who does 2 assessments a month to ever gain competence in any realistic timeframe.

So mandate a certain number of hours per month. Plenty of volley places do that. I was talking to somebody recently whose volley EMS service mandates that they do 24 hours a month. Yes, it's not the same amount of experience as a "professional," but volunteers may have long periods of service where they accumulate lots of experience - or they're medical professionals (PAs and RNs come to mind) who do EMS because they enjoy it. And that's neglecting all the very, very intelligent people who do EMS as an avocation -- you can't seriously be saying me that the computer engineer, or hedge fund guru, or biology PhD candidate that I volunteer with aren't capable of being EMS providers.

 

[rescue1]

Its all moving that way anyway. In 15 years a 100% vol town will be unheard of.

True. I went to visit my old VFD in Maryland, and learned that the county Department of Emergency Services is moving towards putting paid FF/Medics in my station, which runs 750 calls a year (half EMS/half fire) in a fairly rural area of the state. The times they are a changin'.

My pet peeve, though, is all student volunteer ambulances on college campuses. All the inexperience of a volunteer agency, with no older experienced providers to teach the students things they didn't learn in class. I've seen some bad medicine performed there.

 

[Jon]

There are many "paid" EMS systems that are dysfunctional, and many volunteer systems that work great for their community.

There are also plenty of cases where volunteers and/or volunteer politics are holding back EMS as a whole (like NJ).



This isn't a new discussion. It's one we've been having here for as long as I've been around. Many of those threads are locked, and many folks have earned attention from the Community Leader team over their posts.

I'm an optimist, and I think this thread can be successful, but let me make this abundantly clear. The CL team will be even LESS tolerant than we usually are (and we aren't real tolerant of this) when it comes to inflammatory and/or rude posts. This will be your ONLY warning.

 

[sperry]

I would have never been to even explore EMS without the opportunity to volunteer. I don't think volunteers work in every locality but my question is simple. Does it matter if the people showing up at O dark thirty when 911 is called are paid or not? I think someone being there matters more.

Just my $0.02

 

[bigbaldguy]

I think Jon hit the nail on the head with the main drawback to volunteer agencies, politics. Volunteer agencies tend to be run along the lines of "clubs".

In areas with BLS services I can see the OP having a point that providers who work for free reduce the overall number of available paid jobs.
In agencies that run ALS trucks the idea that vollys somehow take jobs away from "serious" professionals doesn't really hold up. Very few volunteer providers are willing to put in the kind of time it takes to become a medic just to volunteer and most ALS agencies aren't going to throw medics on a truck that don't know their job because it's a huge financial liability.

I do think that volly EMS providers need to be held to at least as high a standard as paid providers. This standard is increasing albeit slowly and as it does fewer providers will be willing to put in the effort needed to work for free. However there will always be volunteers. You need only look at MD's to know that regardless of how high you set the bar there will always be those who are willing to give back without asking for anything in return.

 

[WuLabsWuTecH]

Personally, I feel this is one of the biggest factors holding EMS back, especially on an educational and professional level.

For starters, few people will take your work seriously when you tell them you are an EMT and their response is "o that's great my nephew is a volunteer at ____."

How can you be looked at as a professional when half of the certified group is willing to do it
For free as a hobby.

It depends on the skill level of the people there. As someone mentioned before a lot of these people are medically trained and work in the medical field. At one station in particular, I know of 3 MDs, 2 of which are Board Certified in Emergency Med, and one of which is an Emergency Med resident. A handful of ER nurses and some ICU nurses are also present. On top of that, about 30-40% of the volunteers are firefighters/paramedics/EMTs as their primary day job and help out in the evenings, on the weekends, and on days off to supplement this area that does not have the money to pay for a full time staff.

Secondly, it is much easier to advance a group that is mandated by an employer than it is to do so with one that really has no necessary requirements. I can't force you to come to my "training" at the volunteer house, but If you work for me and want to keep your job you damn well better come. Everything is always justified with "what do you expect, we're just volunteers."

This is the statement I disagree with the most in your post. Sure you can! They do for us! Training is provided for free through the department. If you fail to make mandatory trainings that are scheduled in advance, you better have a good reason to do so our your butt is out the door. And depending on the training, you might be placed on inactive status until you make it up with with the training officer or on your own outside at your own cost. You can very easily force people to come to training or else they get booted off--if you wan to keep your volunteer position, "you damn well better come!"

Also, our chief has made it clear that we are volunteers only to the point that we volunteer to join the department. After that, he makes perform right to the same level professional department perform to. Unlike other volunteer organizations, we are required to be in uniforms, have a professionalism requirement, etc. etc. If you break that mentality of, "we are just volunteers" then you can break that culture as well.

MANY, not all, volunteer providers also more inexperienced than those who do it on a daily basis. You can't expect someone who does 2 assessments a month to ever gain competence in any realistic timeframe.

One way we have combated this problem is to require all new members to put in nearly 24 hours a week for the first 6 months. We'll work with you if you can't meet that, but what it allows is for those who don't have a lot of prior experience to really get up to speed pretty quickly during this time. We always have on staff one paid person who is the supervisor but also there to train. No, we'll never have as much experience as a professional who starts at the same time since they can dedicate a lot more hours than we can, but most of us who have been doing it a while aren't that far behind. One again, if you want that level of care, you are going to have to shell out a lot of money for it and people around here have decided that it is not worth the ten-fold increase in cost.

There are obviously other factors but these are just my main thoughts. Keep in mind, I am a volunteer when I am not at work and nothing I see on a regular basis gives me any reason to want to keep volunteer EMS in existence.

That's because you don't see the backroom side of things and what happens in the front office. You see the patients and the care providers, and you evaluate how you can make that better. But it is important to realize that the medic doesn't stock itself, the fuel doesn't magically appear, and the payroll checks are not just printed off the computer. There are costs to everything that happens, many more than you probably realize. For every decision, a cost-benefit analysis must be made, and the benefit to going to 100% full-time in many instances just is not a big enough benefit to justfy the enormous increased cost of hiring a 100% professional department.


Also, as an aside to someone who stated something about suburban departments above.

My issue is well funded suburban areas or larger towns (like 5000+) that have the resources and call volume to support and justify a paid service but will not. And from an ordinary citizen's viewpoint, why should they? It means more money, and the volunteers have been doing it fine for X number of years. I think a well funded combination department could be the answer there...saves money, provides a professional base, and means that there is greater flexibility in disciplining volunteer members because the fear of them "not showing up when needed" is mitigated by paid staffing.

This is exactly what happens at my suburban department. Minimum staffing on all apparatus is filled with paid personnel. A volunteer can ride any other apparatus to help supplement that apparatus' staffing. Once again, like the other department, all volunteers are required to act professionally and are held to the same standards as the professionals. The only difference is that because the volunteer is extra hands, having them on there can only help. It is this point that also makes me highly disagree with the OP's statement that there is no place for Volunteer EMTs. If you have people who want to give back to their community and are willing to do it on a volunteer basis, Why not use them?

 

[rescue1]

I think WuLabsWuTecH perfectly described an ideal volunteer department.
The issue is that not all are ideal, or even close to this ideal. The question is therefore: How do we get most departments to this level, and in doing so, will it make more sense to implement paid staffing?

Again, I'm focused more on areas that have the call volume and resources to implement
this. There are small communities up and down the States that are probably happy just to have an ambulance.

 

[WuLabsWuTecH]

I think WuLabsWuTecH perfectly described an ideal volunteer department.
The issue is that not all are ideal, or even close to this ideal. The question is therefore: How do we get most departments to this level, and in doing so, will it make more sense to implement paid staffing?

Again, I'm focused more on areas that have the call volume and resources to implement
this. There are small communities up and down the States that are probably happy just to have an ambulance.

The way we got this way required some hard pushing. It required an old chief to be removed by the Board of Directors. And it required the Board to find a new chief with a progressive mentality. The change was not easy and we lost a lot of people throughout the process. This was before my time, but I understand that a lot of the old guard left because they didn't want to adapt to new policies. Some left when the uniform policy went into place. It didn't matter that the uniforms were paid for by the department--they had always done EMS in t-shirt and jeans and if they couldn't do it like that they were going to leave. Our Chief wished them well and showed them the door.

One thing that was not planned for well was that when all of these people left, our roster shrank. At one point, if every single person showed up to the stations, we did not have enough people to man all of the equipment--so I would caution anyone who is ready to do overhaul of their department policies on this. But what this meant is that everyone that was a "new hire" was given new expectations, and no one had any old (read: bad) habits from the old days.

Don't get me wrong, it still cost money, but not nearly as much as going 100% full time. To attract more volunteers, they implemented a training program such that if you go to all of the trainings, they guarantee that you will have all of your hours required for recert. Obviously this means hiring instructors. Also, uniforms cost money, and the stipends they offer had to increase in order to attract people to make the trip to Cornfield, Ohio to help out in a rural environment. But once again, it was still relatively cheap. This is how I joined the department. The perks are great, I get great experience working in a rural environment, and there is no cost to me (and most months I actually come out on top by a hundred bucks or so).

It's kind of a paradox in EMS. If you want change, gently nudging things along will never work. Too many people are opposed to change. But push too hard, and there are a lot of costs involved. I think our new chief found a good medium where he got things changed quickly at a low cost, both in terms of money and pissing people off. Mostly he just pissed off the people who needed to go anyway.

I don't claim that our service is perfect in any way, shape, or form. There are still a lot of things we do that are very backwards, and a couple of the guys still have issues with uniforms but for the most part, I think the department came out on top after the shakeup.

 

[DrParasite]

the problem is, the same low quality volunteer providers who get paid will still be low quality providers, just now with a paycheck. Them having a paycheck doesn't make them any better, despite what they might think.

As a volunteer, the last time you volunteered was when you submitted the application, afterwards you became non-compensated employees of the EMS agency, and agreed to follow the rules of the organization. Don't like the rules, then good bye.

I am familiar with quite a few paid EMS agencies that suck... FDNY happens to be on the list (should have never merged NYC*EMS with FDNY), but there are many others. Overworked, under paid, extended response times (if they make it there at all), it happens. Not everyone sucks, but if we are generalizing here, I can tell stories and paint an agency with a broad brush.....

There are some volunteer agencies that suck, but also some that run as good as or better than paid agencies. But they often aren't funded as well as a paid agency, or the AHJ won't allocate the money to have the agency paid 24/7.

I'm not a big fan of volunteer EMS at the present time.... too many old timers stuck in their ways, refusing to change, holding EMS back. Not only that, but people who have the "I'm a volunteer, you can't force me to do anything" attitude, and "we are volunteer, we don't need to be professional" have made me decide that volunteering isn't for me anymore.

I'm not a big fan of paid EMS either, too many young kids who think just because they are paid, now they are better than the volunteers, despite them being volunteer EMTs 3 months ago, and since they are paid, they don't need to do any more training or education other than what is required to do the job. If they don't get paid for the training, or it isn't required, they won't be found doing it.

Again, I am stereotyping, and of course not every agency will fall into the above categories, but it happens all too often.

I would love to see volunteer EMS go away, transition to 100% paid EMS supplemented by volunteers, funded 100% by taxes, staffed with enough units to handle the volume. But I don't want to see those same low quality EMS volunteers now become low quality paid EMS personnel, and the system suffers as a result.

 

[Tigger]

I agree with many of your points.
Before this degenerates into yelling and screaming, I will say that while I believe paid EMS is ideal, there are many places in the US that could never afford or justify a paid service. The imaginary town of Redneck, Kansas may have 400 people in it, and may generate 50 EMS runs a year...hardly worth the almost $200,000 a year it would cost to provide 24/7 paid coverage (assuming 6 full time EMT's making 30,000 a year).

Yep, this is is why it is a challenge to say "volunteer EMS must go away." That said, there are all alternatives. I know of rural areas, both in Colorado and abroad that are covered by paid EMS crews. The drawback is that it might take the crews 30-45 minutes to respond. In the meantime volunteer BLS squads respond, stabilize, and hopefully initiate transport. It's not a perfect system by any means, but if you have many places only producing 100 runs a year, it is certainly an improvement. Of course someone will come and say that there is no money for such a program and that we cannot raise taxes to fund it, so I will leave it by saying that it is up to the individual region (mostly counties in this country) to decide if this is appropriate.

My issue is well funded suburban areas or larger towns (like 5000+) that have the resources and call volume to support and justify a paid service but will not. And from an ordinary citizen's viewpoint, why should they? It means more money, and the volunteers have been doing it fine for X number of years. I think a well funded combination department could be the answer there...saves money, provides a professional base, and means that there is greater flexibility in disciplining volunteer members because the fear of them "not showing up when needed" is mitigated by paid staffing.

I have gotten into it with others before over municipalities that choose not to provide full time EMS despite having the budget and call volume to do so. I see it as a complete disservice to citizens, but maybe that's just me. If you can provide a paid daytime crew, it seems like it's possible to really grow an agency. You have staff to take care of the tasks that volunteers (maybe correctly) loather like truck checks, maintenance, and other administrative tasks. You also have hopefully experienced providers that will train the volunteers and keep them up to date.

Of course, all this being said, there are many volunteer agencies that deliver care equal to or better then many paid agencies. I just don't think that they are the majority.

And this wouldn't even be an issue if the minimum standard for EMS was an associates degree.

The volunteer agencies that are deliver excellent care are, as a rule, well funded. If you cannot fund an EMS agency so that everything is up to "full-time standard" except pay, then your agency is likely going to always remain inferior. Obviously being well funded does not equal a capable agency (NYmedic comes to mind), but at least you get a fighting chance.

In the end though, if you have rural areas with a low call volume volunteers are inevitable, no matter if there are minimum degrees or anything like that. Even countries that we look to as models of progressive EMS (and no, we are not the best in world, and neither is the rest of our healthcare system), all have volunteers practicing at a lower scope.

 

[CANDawg]

Disclaimer: I haven't read the entire thread through yet, I wanted to get my thoughts out as I thought them and before I forgot them.

I think the OP hit the nail on the head by saying it's not reasonable to be viewed as a professional when half of your profession is doing it for free and almost as a hobby. That said, its also unreasonable to completely remove volunteers from the picture. They serve a vital service in areas where a full paid service is financially impossible, or faces some other large impediment.

The answer is to elevate the training, scopes, and profession as a whole. Why are there so many EMT's running around as volunteers in the states? Because it is relatively easy to become one. You can get certified quickly and while you maintain another job, and then hop into a role that will schedule around your schedule. Plus you get to drive around with flashy lights and a loud siren. It's weekend warrior syndrome, EMS style.

If the training requirements were higher to be certified, this would prove to require a higher commitment, and automatically weed out those who may really want to help, but aren't willing to devote more than a shift or two on the weekend. In addition, you get better trained professionals with wider scopes and more leeway to provide excellent patient care. Those individuals who still choose to volunteer would still be showing they are prepared to dedicate a large portion of their lives to the role, even if they aren't needed for a full 40+ a week.

The volunteer problem (Yes, I'll call it a problem) isn't necessarily a direct problem, but a byproduct of a much larger one. Fix the main issue, and you'll see positive ripple effects throughout the industry.

 

[rescue1]

Funding is important, but not essential, nor does funding immediately equate to better volunteer agencies. Does it help? Absolutely. But even a well funded agency requires a certain mindset to be considered a "professional" volunteer EMS agency.

DrParasite makes a good point, though. I would say my one rebuttal is that with paid EMS you can mandate certain training or activities. Obviously, this requires an agency to decide to mandate such things, but it is much easier to say "everyone will do 24 hours of CEUs a month" as the chief of a paid agency then as the elected chief of a volunteer agency where you could lose half your membership with that statement.

 

[RSKS]

I have frequently thought the same thing. My husband used to be a fire fighter, a volunteer one, and that always stumped me. I didn't understand all the hard work he did, to just become a "volunteer". Fire and EMS needs to be as important as sheriffs or police, DPS. Last time I checked, there are no volunteer teachers, principles, loan officers, cashiers... I think you catch my drift. I feel all of these should be paired positions, regardless of the size of the town.

 

[Sandog]

Actually the Volly FD/EMS folks I know do get paid, that is after x hours per month. This is a great way for many young people to add experience to their resume. In the same breath, I do see the points the OP is making and agree with many of them. Quite a quandary

 

[NYMedic828]

It seems this topic is quite the conundrum.

As people as stated, many areas (which I didn't even think of living in the busy area I do) can't possibly afford staffed EMS. Nor is it a practical option for them.

As far as agreeing to do trainings when you sign up, that would be great if that rule was enforced. In my department I can honestly say of our 100+ members (40 EMS), half are totally worthless and nothing would change if we threw them all out. But, we won't do anything about them. Of the 40 EMS members, probably 25/40 are useless and are not even comfortable saying hello to the patient.

Paid agencies are certainly hit or miss. As an employee of FDNY EMS, I can definitely agree with Parasite that a good portion does in fact suck. The main thing FDNY stays on top of is response times. It is all about statistics with FDNY. I have worked with many partners both as an EMT and medic and I can honestly say the while the medic partners are better, I would rather have no partner or at all or work emt/medic. But things are easier enforced when they are mandated upon you. FDNY will get rid of me for not doing my job. The vollies won't.



Also in my area, the amount of volunteer vehicles we have in relation to the need for them is RIDICULOUS. The city of new york, one of the busiest departments in the country, has 5 heavy rescue vehicles for the entire city. My home town has 71... 71!!!! But this i guess is for a different discussion.

 

[Tigger]

Actually the Volly FD/EMS folks I know do get paid, that is after x hours per month. This is a great way for many young people to add experience to their resume. In the same breath, I do see the points the OP is making and agree with many of them. Quite a quandary

If you are paying someone, they are no longer volunteer...

 

[CANDawg]

If you are paying someone, they are no longer volunteer...

I would still say they're volunteer unless the amount they're getting paid is enough to live on. Often, the honorariums volunteers are paid are more to cover travel and out of pocket expenses related to taking shifts than anything else.

EDIT: Make that taking shiFts.