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?
