Paid "Volunteer" Department

[trevor1189]

More and more departments around here are doing this. I should also mention these are all fire/ems departments.
BLS ambulance transport stipend: EMT $20, Driver $15, Additional Crew member $10.
BLS routine stipend: $20/first hour. $8/second hour.

Now considering most transport around here are less than 1 hour from 911 to available for next, it seems like a good deal.

However these are still volunteer departments, ie standby at fire scene/refusals equal no pay.

Ever heard of such a thing? Most people can't make a living off of this, but I don't think it is too terrible. It encourages people to come down for calls, and when you think of how much an ambulance call costs a patient... The company is still getting the majority of the payment.

 

[Hal9000]

The state of Montana has had some issues with volunteer departments being "paid" volunteers while taking some of the special EMS volunteer benefits. Some departments were paying strange things like $50/hour during transport, but still claiming the volunteer benefits given by the state.

I also know of some paid-volunteer systems that are quite out of control. One has two "leaders" that have no jobs, but they "run" for 26 days per month, making around $100 per IFT and $30 per 911. One is around 5' tall and weighs ~325 lbs, and the other is about 240 and 5'6", but perpetually sick from smoking so much. The two make thousands of dollars per year "volunteering," and their education and skills are a shambles. They were also written up during a government contract, disqualifying the service from participating in the contract for some amount of time, as the medical supervisor deemed them to be "emotionally unstable and physically unfit; they are more likely to have a medical emergency than any of the XXXXXXX we are here to serve."

In any case, I believe that this "paid volunteer" status necessitates strict professional behavior and some form of coherent leadership. It's a slippery slope for those out there motivated by money.

 

[DrParasite]

it's not really volunteer.... more like paid on call.

In my mind, volunteer is getting 0 pay. or maybe a minimal stipends of a couple hundred bucks a year for operating expenses (reimbursement for uniforms, equipment, etc).

once you start paying 20 per call or stuff like that, it's not really volunteer. but some places says if yo make less than 2000 a year, it's still volunteer. depends on your state laws.

the reality is most EMS agencies should be billing (because begging for donation suck), and paying their people to be there. with todays economy, it's unfair to ask otherwise.

 

[mycrofft]

Calling EMSLAW

Look up your labor law and regulations about fire depts.

 

[Simusid]

the reality is most EMS agencies should be billing (because begging for donation suck), and paying their people to be there. with todays economy, it's unfair to ask otherwise.

I cannot imagine running an effective service without billing, or having another significant source of revenue. My service is paid/volunteer mix. We send out one solicitation per year and generate about $50K. Our expenses run probably over $80K per month. Volunteers get food and uniforms but no other stipend.

 

[EMSLaw]

it's not really volunteer.... more like paid on call.

In my mind, volunteer is getting 0 pay. or maybe a minimal stipends of a couple hundred bucks a year for operating expenses (reimbursement for uniforms, equipment, etc).

once you start paying 20 per call or stuff like that, it's not really volunteer. but some places says if yo make less than 2000 a year, it's still volunteer. depends on your state laws.

the reality is most EMS agencies should be billing (because begging for donation suck), and paying their people to be there. with todays economy, it's unfair to ask otherwise.

In New Jersey, though, the law is that if you bill for services, you are a paid service, and if you do not, you are volunteer. That's regardless of whether the staff are paid or partially paid. Of course, most volunteers receive nothing for their work other than free training and a few small benefits (like LOSAP, which is something like a small 401(k), and uniforms and the like). But if you did it for the pay and benefits, it wouldn't be volunteer work, now would it?

 

[EMSLaw]

Look up your labor law and regulations about fire depts.

Is there anything in particular, or do you just want me to send you a statute book?

 

[mycrofft]

EMSLAW, naw, I was just ringing your call light.

Every "vollie" dept I've lived around had mixed paid and vollie staff, and one had an arrangement to reimburse per run.
Just thought you were perfect person to reply.

 

[Jon]

I've seen many different arrangements - per shift, per call, per hour on duty... sometimes per call + per shift.

I'm not sure they work. Then again, getting a couple of hundred bucks at the end of the year is nice, especially when you look at what all you really spend to volunteer.

 

[MTEMTB]

Hal the $20 I got at a MVA replaced the c-collar out of my jump kit.
Yes there are some departments that do that but there are still alot that don't.
Some of us volunteers are pretty far out and it is to cover our cost a fuel to get there.

 

[Hal9000]

Hal the $20 I got at a MVA replaced the c-collar out of my jump kit.
Yes there are some departments that do that but there are still alot that don't.
Some of us volunteers are pretty far out and it is to cover our cost a fuel to get there.

That's why I said,
"In any case, I believe that this "paid volunteer" status necessitates strict professional behavior and some form of coherent leadership. It's a slippery slope for those out there motivated by money."

Why did you have to buy your own medical supplies? Is that not unorthodox?

 

[MTEMTB]

The fire company buys the supplies through grants and donations. I just signed the money over to it.
I have heard from quite a few different people scattered all over the state say that some have had to buy their own supplies because the EMS in their county could not afford it.

My fire company pays for my training and I use one of the trucks to go to training.
The money came from an ambulance service.

 

[Hal9000]

Interesting. I know that one long-term goal the state has is to reduce the number of small ambulance licenses while increasing the availability of regional ALS services. When I was in Montana, I worked at a "very large" system relatively, and I also was a "paid volunteer." The volunteer service billed patients while paying the members a very small amount for workman's compensation reasons. The ambulance service was quite capable of purchasing its own supplies and training, but it was also one of the busier volunteer systems around and had a large number of IFTs.

Montana is definitely a frontier state; some of the provisions had for their endorsements are strange indeed. The "monitoring" endorsement in the state is for EMT manual defib because some ambulance services could not afford AEDs.

 

[MTEMTB]

One of the things that is going on right now has a lot of people in the EMS system ticked.
The state is setting up "new" guide lines unless you get all 4 endorsements you will no longer be an EMT-B you will be a QRU/FR.
Now I do not see the fairness in that. In my class we had around 30 people that took it but around 12-15 of us continued on to get that registration as an EMT-B. That was an additional 2-3 weeks once the QRU test was done.

I took the endorsements when they first started offering them at training. My medical director refused to sign off on them.


Now back to the thread on "paid" volunteers.
The one time I asked the ambulance service to help for training I was turned down. Never went back.
I ask the fire company I belong to and there is no problem there.

 

[medic417]

One of the things that is going on right now has a lot of people in the EMS system ticked.
The state is setting up "new" guide lines unless you get all 4 endorsements you will no longer be an EMT-B you will be a QRU/FR.
Now I do not see the fairness in that. In my class we had around 30 people that took it but around 12-15 of us continued on to get that registration as an EMT-B. That was an additional 2-3 weeks once the QRU test was done.

I took the endorsements when they first started offering them at training. My medical director refused to sign off on them.


Now back to the thread on "paid" volunteers.
The one time I asked the ambulance service to help for training I was turned down. Never went back.
I ask the fire company I belong to and there is no problem there.

Oh poor thing 2-3 weeks additional training. See that tiny fiddle between my thumb and index finger it's playing my heart bleeds for you.

I applaud them adding some requirements. Sadly it is still not nearly enough but mejor que nada.

 

[WolfmanHarris]

We have essentially no volunteer EMS in Ontario. Unless you go to the very remote areas where you find some volunteer FR units operating alongside EMS.
Most of our rural FD's though are considered "volunteer."
I can't speak for all of the departments, but any I am aware of pay a stipend for call-outs and some pay a yearly stipend on top of this for training and other committments.
They usually have a paid FT Chief and many have paid deputy chiefs, fire prevention, etc. Composite departments are becoming more common as well.

 

[spinnakr]

Every "vollie" dept I've lived around had mixed paid and vollie staff, and one had an arrangement to reimburse per run.
Just thought you were perfect person to reply.

There is, at least in Ohio, a very important distinction to make between a volunteer department and a volunteer responder.

In Ohio, up to 50% of the department can be paid, and the department still considered volunteer, and qualifies for a number of exemptions - such as complete exemption from ambo registration and inspection by the Ohio Medical Transportation Board.

 

[Hal9000]

One of the things that is going on right now has a lot of people in the EMS system ticked.
The state is setting up "new" guide lines unless you get all 4 endorsements you will no longer be an EMT-B you will be a QRU/FR.
Now I do not see the fairness in that. In my class we had around 30 people that took it but around 12-15 of us continued on to get that registration as an EMT-B. That was an additional 2-3 weeks once the QRU test was done.

I took the endorsements when they first started offering them at training. My medical director refused to sign off on them.


Now back to the thread on "paid" volunteers.
The one time I asked the ambulance service to help for training I was turned down. Never went back.
I ask the fire company I belong to and there is no problem there.

On topic, it's too bad that the EMS organization can't afford the expense; fire departments get most of the grants. EMS in Montana is often very much on a shoestring and needs to be well run, as I mentioned.

Without talking to much about MT's endorsements, you actually have a total of 7 separate listings you can get on your state card. They are: airway, monitoring basic, medications (EMT), IV & IO initiation, IV & IO maintenance, endotracheal intubation, and lead instructor qualification.

From talking with Mr. Threet, I'm under the impression that they're not going to make some people into EMRs. The challenge is moving MT into the new EMS Agenda; many of Montana's instructors don't have any formal college training in medicine, and, in fact, many "train there own" without much medical director involvement. Many of these individuals cannot meet the new requirements easily, if at all, so something needs to be done with them. Mr. Threet did, however, tell me that "some people will just have to be left by the side of the road," in order to advance the state and integrate into the new national system.

As for not being signed off, that might not be a bad thing. Will you have enough opportunities to use these "skills?" Will you have the knowledge to understand some the full scope of what they mean? Were you trained in any collegiate way? Were you given endorsement training by other MT lead instructor Basics who have it themselves? (Very common.) Will you be checked off on all these skills every three months? Did you know that medical directors now have to take a course in order to preside over a service? Did you know that medical directors can no longer just "sign off" on some skills, but instead are directed to another information packet? This occurred due to some legals issues involving EMTs having all these skills "signed off" while the medical director had no idea what they were actually doing in the field, and, in truth, the EMTs didn't have the education to know, either, which led to patient harm.

Having been involved in the system, I've found that many EMTs in rural Montana don't understand what the skills are for, not do they have the education to use them. For example, there was one organization buying and using D50 as EMTs; they had no knowledge of venous necrosis; some were going for over 6 months at a time without starting IVs and then spending 40 minutes within a mile of the hospital trying to start IVs before they gave nitro to cardiac patients. Should the medical director have signed off that they were competent to use these skills? IMO, no, they should not have. This has become an issue recently, and some medical directors are taking more care about what they sign on. Without specific written instruction, the piece of paper being signed off on says that the EMT is capable of everything listed on the endorsement. Without education and the ability to frequently use skills, there's simply no reason for an EMT to be performing ETs and IOs.

I would take another look at your medical director. It sounds like he/she may be an intelligent person who cares for patients.

EDIT: Accidentally deleted a bit.

 

[MTEMTB]

So Hal what you are saying unless we go to college we are not "worthy" of having the NREMT, is that it?
That is the way you are coming across.
There are only 4 endorsements that a basic can have. I should know because I have them.
I have visited with Threet too and listened to him at several different training sessons.
So moving MT forward is better then losing volunteers that can save someone's life? Maybe you should talk to some awesome people I know who cover such a large open area that it takes helicopters over an hour to get to them.
Maybe you should walk in their boots.
Yes alot of us do not get calls every single day, but at least a majority of people I deal with keep up their skills.

As for my medical director I wouldn't trust that person with my life, he is now leaving.

as for your remark about playing the tiniest violen; here is my pinkie it's just the feather your not worth the whole bird.

i'm done with you and this subject, don't know why you are so concerned about MT anyway you already stated you are no longer here.

 

[Hal9000]

Well shucks.

MTEMTB, I'm not trying to be aggressive, so please don't feel any undue need to be defensive. A few 'lil points for you. Please note that any animadversion is not directed toward you! Most of what I say is best when used for thoughtful reflection.

• I didn't make the violin comment.

• No, I do not think that everyone needs a college education to be an EMT. I do believe that education is handy for people performing invasive procedures, especially when they involve pharmacology. I also think that the higher levels of emergency medical professionals-such as the paramedic-should have a college education in medicine.

• I have walked "in those shoes." In Montana, I've been on a rural service and a large, paid service. I've had patients well over an hour from HEMS, too.

• My ladyfriend is manager of a service in Montana; I still have a state license in Montana, and I intermittently educate EMTs in Montana. My family also resides in a small town in Montana, so I want them to have the best emergency care available to them. I'm currently studying medicine in college.

• You're incorrect about the four endorsements. There are more than four; I currently have six EMT endorsements on my Montana licensure card. As I said before, they are "airway, monitoring basic, medications (EMT), IV & IO initiation, IV & IO maintenance, endotracheal intubation, and lead instructor qualification." The medical director must petition the state to have anything removed or added to the allowed scope; for example, a director cannot legally allow one to have "clear" C-spine in the field. The same follows with special changes to the protocols and endorsements. Since some directors weren't involved, leading to legal and medical trouble, the state is working on changing this. I noted this before; it's interesting, even if not applicable to you. Sorry for seeming nosy, and I probably won't prognosticate on the subject of what is happening with them.

• Montana does know what they risk by moving forward. There has been some talk about pulling out of NREMT altogether. I would highly suggest following NASEMSO if you don't already. Montana doesn't have a very proactive EMS base on the state or national level, so the more people that do advocate on behalf of the profession, the better.

Please notice that I'm not being rude to you; that wouldn't be a good way to communicate with you competently. Instead, I'm advocating that we continually better ourselves, and thus also better the experiences our patients have with us. When I first started in EMS, I was offended when I thought my experiences and skills were being belittled; unfortunately, my field training was minimal, and the "policies" of the organization were put forth from within, without medical oversight, and by people with no formal education-that is to say, the medical director was not involved at all. These policies put me in more danger than I realized, and I've seen the same ones at various ambulance services I've visited. For example, I know of at least three services that have a "code on every call, including IFTs" policy.

Over the years, I came to a more holistic conclusion: that professionalism and education improve the outcomes and experiences of my patients, increase hospital professionals' respect for me, and allow me to have quicker, easier, more helpful patient contacts. It was hard to admit at first, but now I'm glad that my unprofessional past has been turned in to a great learning experience for my professional future. Such an attitude is nothing if not salubrious.