# Required Reading; The Cost of EMS



## Ridryder911 (Feb 10, 2008)

I will hold comments and my personal discussion until others have read it. 

Located in current issue, on page 74

http://emsmagazine.epubxpress.com/w...QnB3LzZfOFRSSDRGSDIwODA1RjAyUEVBRlM2QjAwSjA!/


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## JPINFV (Feb 10, 2008)

> It's time they realize that our responsibilities are their responsibilities. That we're serious about taking care of the public. That we're not the fire service's junior varsity, and that it's ludicrous to expect good, professional people to provide good, professional emergency medicine for free.



I like this article.


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## Flight-LP (Feb 10, 2008)

Now hold on and wait a darn minute! You mean to tell me that someone actually had the audacity to state that volunteer systems are failing across the country?!?! Is it actually true that the message that some of us have been preaching for some time is a truthful representation?!?!

It is nice to see that views are finally being published and presented in a non biased, yet truthful realistic way. Maybe now more people will truly see the issues with volunteerism and identify the possible solutions. Or maybe people will continue to be egoistic and bullheaded, thus again slowing down the progression of EMS.

I enjoyed the article, hope to see more progressive views in the future.........


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## Epi-do (Feb 10, 2008)

Very good article.  Hopefully it is a small step in the right direction to fixing a system we all know is broken.  It read as unbiased and did a good job of making sound arguments for the problems we face and what we can do to begin to fix those problems.  Now, if only we could quit fighting amongst ourselves and come together as a united group to definatively define who we are, where we want to go as a profession, and figure out the best ways to move in that direction.

Thanks for sharing, Ryd!


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## Topher38 (Feb 11, 2008)

I think volunteer organizations are appreciated, But by the goverment are they? hmmmm thats a book all on its own.

I do see the point when the article stated that most families can't function without 2 incomes. And that is a good point on why being a volunteer is rough. Your doing a job your not getting paid for. Kinda makes me wonder why people volunteer, and why I started volunteering. 

Volunteers are great B)


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## Ridryder911 (Feb 11, 2008)

Topher38 said:


> Kinda makes me wonder why people volunteer, and why I started volunteering.


I believe this was part of the emphasis of the article. Why do volunteers do this? I can understand remote areas, there is NO one else and the chances that professional services is slim to none. In areas that can and could be serviced by a professional service, I believe it is all about egos and tradition 

If EMS was removed, would these same people perform services such as meals on wheels, pick up trash, even dig a hole for the city water line? 
So when volunteers describe how they are only doing it for the community... I say hogwash!



Topher38 said:


> Volunteers are great B)


Apparently, you disagree with the article. Again for those that serve in area that have to depend upon volunteers (such as remote areas) then yes.. they are a Godsend! To others, they are a demise to the EMS profession. Unfortunately, they do not understand that and most do not care.. again, many are more truly concerned about their self satisfaction than the patients and the community. 


R/r 911


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## ffemt8978 (Feb 11, 2008)

Ridryder911 said:


> I believe this was part of the emphasis of the article. Why do volunteers do this? I can understand remote areas, there is NO one else and the chances that professional services is slim to none. In areas that can and could be serviced by a professional service, I believe it is all about egos and tradition
> 
> R/r 911



While you and I rarely see eye to eye on this issue, I completely agree with this statement.  I doubt that we would agree on the definition of "remote areas", though.  Again, it is a case of ideal world vs. real world.


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## skyemt (Feb 11, 2008)

well, for my district and all those neighboring, we are considered rural.

there is not a single paid ems provider for at least 60 miles...

is that considered remote?

communities here have relied on volunteerism historically...

there have been no issues of service provided, as paramedic and numerous ALS are available, albeit also on a volly basis.

and, all calls are answered in a timely fashion, backed up by our mutual aid plan with our neighbors.

does this fit into your "exemption" Rid?


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## Ridryder911 (Feb 11, 2008)

Not really. The problem is most communities want their own EMS. Alike the perception of having an hospital, schools, etc. it is no longer cost effective or productive. It is much better to have consolidation on many things, including EMS. Your area even has a better reason to have a paid service ALS provider in comparrision than larger cities. Why do the U.S. still provide less than ALS care on any EMS responses? Consider this. Many communities receive lower than the care given by the old tv show Emergency. Shameful and inexcusable. It is the priorities that determines upon what is important or not. 

You did not include population. Cities that have over a population of 10-12K  can usually adequately have a paid professional ALS/EMS providers. How is transfers made to regional hospitals? 

Just because one lives in rural area, is not an excuse for having inadequate lower care and for providing the best ALS possible. In fact, some of the most progressive EMS care I worked at was a community of < 8,0000 and about 60 miles from a large metro area. So yes, it can be done... Easy? No, but can be achieved. 

Communities will have to learn and understand that we are just as important as the Sheriff patrol, the County library and the local school bond. This is where the change has to occur. We can and should no longer depend on medical care upon the common laymen. We don't ask for volunteer staff for nursing homes, clinics, county health departments; but we do for EMS? Why are we different? 

Sorry, don't shoot the messenger but it will change. There is no way it can't; the systems is broke and hemorrhaging and unless we take care it, someone else (non EMS) will change it for us. The statistics of the baby boomer will increase the responses by four fold this is not theory but the facts. 

Communities will have to stop getting the milk for free, the cow is dried up. Time to Anni up and be responsible for their citizens. 

Again very.... very rural areas will have to continue upon volunteer EMS. That itself is a different situation. 

R/r 911


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## AZFF/EMT (Feb 11, 2008)

I agree with rid on this one. There can always be a place for volunteers to augment a system and help out, but relying on it by itself is scary to me. Think if the police were all volunteer, or public works. When a water main breaks and it doesn't fit into some of the guys schedule and you get three guys to show up and no one can operate the advanced machinery, and the basic stuff. I think our cities, counties and states should all provide paid professional ALS EMS services. Yes some rural areas just can't but when you have cities back east with 25k residents and a single vollie first aid squad it kinda scary.


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## skyemt (Feb 11, 2008)

well, our town has a population less than 2000....

the other point you don't seem to be hearing, is that is is not bls...

we have ALS on almost every call... they are just volly... 

perhaps that is bothering you because they do the same job for free, but the level of care is NOT less than on "emergency!"...

you are merging two issues into one... 
standard of care, and volly ems...

in our case, the standard of care is met... but by volunteers.


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## AZFF/EMT (Feb 11, 2008)

And in a community of 2000 that system may work good for you. 

How many ALS providers do you have in that 2,000? 
Is it guarenteed that 24hrs a day an ALS provider will be around and able to respond?
What is the average ALS response time? 
Average response time from time of 911 call?
What is your call volume?
Do vollies staff the station or respond from home?
How far is the nearest ER? 
How far is the nearest town and what kind of Mutual/Auto AID systems are in place?
Does your community have Police? Other Public services provided? Are they provided by your town? County? State? Who? and why is EMS considered non-essential or something that vollies should do? 

Standard of Care and Volly EMS is one issue, just because ALS is available, waiting 20+ minutes for ALS or more is not accepatable, or waiting for an intercept. Times have and need to change. Time and training is tissue.


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## Guardian (Feb 11, 2008)

I guess it’s my turn.  The article made some good points.  Usually, I push for the “anti-volunteer” point of view.  This is because a lot of people can’t conceive of anything other than their volunteer system.  This article opens people up to ideas they might not have otherwise considered.  For this reason, I like the article.  But…

A good rule in life is to be suspicious when someone gives you an absolutist opinion, answer, solution, etc.  This article does just that, and it is way too biased.  There are many great arguments for volunteer systems and combination systems.  Let me give an example.  Over the weekend, it was dry and windy.  Any firefighters on here know what that means--brushfires.  So, at my volunteer fire department, we got way more calls than usual.  Because it was a volunteer company, we were able to easily handle the increase in call volume without having to skimp on service or go to another department.  We just had more people respond from home.  Overall, we provide great service.  We save our local government 600K conservatively per year in taxes (our first due area is only 1/5 the size of the county).  Our members live balanced, healthy lives.

So, the article makes some good points, but it forgets to mention all the great volunteer and combination systems that work just fine.  And what was the motivation for writing the article?  Was it to increase quality of care?  If so, great.  However, I suspect it could have also been an attempt to increase jobs, pay, leverage, etc for paid ems providers.  Doing this by destroying functional volunteer agencies isn’t so great.


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## Outbac1 (Feb 11, 2008)

It is interesting to read about the way things are done in the US. I find it interesting that the *public* is not clammoring for better EMS. Not just wanting full time available EMS. But raising the minimum standard of care. You wouldn't expect the nurses and Dr's to volunteer their time at the hospital. 

   I know it can be done. I live in eastern Canada in a small province about the size of West Virgina with half the population. So we have lots of rural. We have a full time government funded EMS system. We are even CAAS acredited. Every one of our approx. 130 ambulances is staffed 24/7 with full time crews. Even the little town of Canso with hardly 1000 people has a small hospital and a full time Paramedic base. It gives eight people a full time job. 

   Our "basic" (Primary Care Paramedic,PCP) paramedic from what I understand from this forum, has about ten times the education hours, a much wider scope of practise. and better pay. Our base rate is about $43,000 per year.  

   No one takes a ambulance home with them, no half pay for night shifts. Every truck has gps and electronic mapping, electronic patient charts, defibs that transmit 12 leads. Its not a mickeymouse system. Nova Scotia is considered by central and western Canada to be a have not province. I beg to differ. Our system cost about $79,000,000 per year including our air ambulance and communications center. With 950,000 people thats about $83.00 each. (2005/2006 http://www.gov.ns.ca/health/ehs/homepage/EHSAnnRep2005-2006.pdf)

   You can have a better system  *IF* you want it and are willing to pay for it. Otherwise its "You Call, we haul. You bleed we speed." I know that system because thats what we had ten years ago.

  Our system is not perfect, but it is light years ahead of what we had.


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## Flight-LP (Feb 12, 2008)

Outbac1 said:


> It is interesting to read about the way things are done in the US. I find it interesting that the *public* is not clammoring for better EMS. Not just wanting full time available EMS. But raising the minimum standard of care. You wouldn't expect the nurses and Dr's to volunteer their time at the hospital.
> 
> I know it can be done. I live in eastern Canada in a small province about the size of West Virgina with half the population. So we have lots of rural. We have a full time government funded EMS system. We are even CAAS acredited. Every one of our approx. 130 ambulances is staffed 24/7 with full time crews. Even the little town of Canso with hardly 1000 people has a small hospital and a full time Paramedic base. It gives eight people a full time job.
> 
> ...



Wonderful post! It is nice to see a representative example of how exactly IT CAN WORK! $83 / year is a very economical rate per person for a professional ALS EMS service. Plus the helicopter is also included, very nice!

Now let the BLS vollie rebuttal of how it wont work for them begin!


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## Flight-LP (Feb 12, 2008)

Guardian said:


> I guess it’s my turn.  The article made some good points.  Usually, I push for the “anti-volunteer” point of view.  This is because a lot of people can’t conceive of anything other than their volunteer system.  This article opens people up to ideas they might not have otherwise considered.  For this reason, I like the article.  But…
> 
> A good rule in life is to be suspicious when someone gives you an absolutist opinion, answer, solution, etc.  This article does just that, and it is way too biased.  There are many great arguments for volunteer systems and combination systems.  Let me give an example.  Over the weekend, it was dry and windy.  Any firefighters on here know what that means--brushfires.  So, at my volunteer fire department, we got way more calls than usual.  Because it was a volunteer company, we were able to easily handle the increase in call volume without having to skimp on service or go to another department.  We just had more people respond from home.  Overall, we provide great service.  We save our local government 600K conservatively per year in taxes (our first due area is only 1/5 the size of the county).  Our members live balanced, healthy lives.
> 
> So, the article makes some good points, but it forgets to mention all the great volunteer and combination systems that work just fine.  And what was the motivation for writing the article?  Was it to increase quality of care?  If so, great.  However, I suspect it could have also been an attempt to increase jobs, pay, leverage, etc for paid ems providers.  Doing this by destroying functional volunteer agencies isn’t so great.



G, you have a valued point, but comparing EMS to Fire is apples to oranges. Volunteer fire is just fine in my personal opinion. Nothing chaps my arse more than a fire department with a multi million dollar tax based budget, brand new trucks, high pay, and yet they sit on their butts all day long doing nothing productive until they get called. Then you have the EMS system that is contracted for the same district and they receive less tax money, have older and more heavily used equipment, and are busting their butts 24 / 7. So I have to ask why? Why am I paying for a service that I do not need, yet potentially cannot get one  that I do? Why does the public place higher value on fire protection vs. EMS protection? (Actually, don't answer that one, I found my next topic to be posted!)? Honestly, I have a pretty decent fire policy, if my home burns,I don't want it stopped, my possessions partially consumed, then have a rebuilt burnt, used house. IF it burns, let it go to the ground, I want the new house!!!!!! Sound warped, maybe. But I want to maximize on my insurance investment, any logical financially prudent person would. In fact, you may be surprised to find the number of folks, including government types who agree with me and are now questioning the financial side of fire. Something to think about.....................


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## DesertRatetteEMT (Feb 12, 2008)

I am glad to know that people are becoming active in seeking more recognition for the hard work done in the EMS. I have been working on raising a fuss about this for some time now, although I haven't even begun a career in the medical field. Go to 
http://www.rallycongress.com/letter2congress/698/ 
to write free letters to congress people regarding these issues. 
I included the link to the EMSmagazine article mentioned here in my letter today. I hope thy will take the time to read it, and I hope that a petition will be successful in raising pay for EMS personnel. I get really mad when I see the adverse effects trauma has on my friends who get paid 50 cents per hour higher than minimum wage, while dispatch gets paid $8 per hour higher. I think EMS personnel deserve a heck of a lot better for all the S%*! they go through to be there for people.


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## Guardian (Feb 12, 2008)

Flight-LP said:


> Honestly, I have a pretty decent fire policy, if my home burns,I don't want it stopped, my possessions partially consumed, then have a rebuilt burnt, used house. IF it burns, let it go to the ground, I want the new house!!!!!!




Believe me, everyone says this except the people whose house is burning down.  I'll save the rest of my fire related comments for another thread.


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## Guardian (Feb 12, 2008)

Instead of arguing every little provincial issue, I’ll just give you my dream for the future of ems.  I think some places would do fine with a 100% volunteer system, whereas others might do better with a combination system or a 100% paid system.  The question is, how do we decide who needs which?  My answer is democracy.  But as we all know, for the people to make the best decision, they must know what they’re getting.  People should know the difference between ALS and BLS.  People should be aware of their hometown ems resources, response times, training levels, etc.  Then, they should decide what they want and need.  The answer is to put volunteer and paid agencies on a politically level playing field.  This will force volunteer agencies to increase quality or die.  This will also force paid (especially governmental) agencies to justify growth and de facto killing of volunteer agencies.  This is an especially big problem in the firefighting side where governmental firefighting departments are expanding unnecessarily.


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## Ridryder911 (Feb 12, 2008)

Vote upon the type of care they should receive? Ridiculous! You mean you should allow of what type of care one can receive by voters? Really want that outcome vote to determine if your child gets an IV for septic shock or maybe no oxygen at all.. (since the public will determine the type of care). You would allow the public to actually consider modalities of treatment? Would you allow them to consider the type of fire suppression attacks that FD can perform. Medical care is not a republic action.  

The public is ignorant and stupid of medical care. They depend an entrust upon us to make the right determination for them. It should be made for the community by the medical community and those educated within it. 

There is *NEVER* an excuse for a BLS unit alone to ever respond upon an emergency call. That is the fact. Period. Patients and citizens deserve an advanced examination and treatment of ALS immediately if needed. Paid or professional will be quickly determined after the continuation of increasing calls and demand for a degree level before allowed to even before licensing to provide patient care.

The communities that have to depend upon volunteerism as previously discussed will always fall through the cracks. Unfortunately, that is part of the risks living in that environment. 

There is no easy answers, but lets not regress. 

R/r 911


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## Guardian (Feb 12, 2008)

Ridryder911 said:


> Vote upon the type of care they should receive? Ridiculous! You mean you should allow of what type of care one can receive by voters? Really want that outcome vote to determine if your child gets an IV for septic shock or maybe no oxygen at all.. (since the public will determine the type of care). You would allow the public to actually consider modalities of treatment? Would you allow them to consider the type of fire suppression attacks that FD can perform. Medical care is not a republic action.
> 
> The public is ignorant and stupid of medical care. They depend an entrust upon us to make the right determination for them. It should be made for the community by the medical community and those educated within it.
> 
> ...



So, democracy isn't your answer, and that is the reason you have failed to be successful.  You forget, we live in a democracy.  Name one public service where public opinion isn't pivotal—just like you described in the fire vs. ems thread.  Keep relying on ems providers to change things and ignore the public, and see where that gets you.  The real policy makers don't care about the paramedics opinion, they care about public opinion.  And that's the way it should be.


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## Meursault (Feb 12, 2008)

Guardian said:


> You forget, we live in a democracy.  Name one public service where public opinion isn't pivotal—just like you described in the fire vs. ems thread.



You forget that the Founding Fathers were wise enough to make the country a republic, and the authors of state constitutions followed their lead.

Public opinion is important. That's why there are people whose job it is to shape it.


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## Guardian (Feb 12, 2008)

MrConspiracy said:


> Public opinion is important. That's why there are people whose job it is to shape it.



Yes, and if you go back and actually read my post, that is exactly what I am suggesting we do.  Because, obviously, our elected representatives are not.  And if you think they will take on this new issue out of the goodness of their heart, then I’ve got some land to sell to you.


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## Ridryder911 (Feb 13, 2008)

Actually I disagree. I can assure you working with law makers this past month, they don't care about the public's opinion, they care about the vote. Totally separate issues. 

To suggest the public in general is responsible enough to make rationale decisions in medical care is asinine. Would we allow them to make decisions upon what procedures should be available to be provided in hospitals? 

We do NOT have a democratic society, we have a republic government. We rarely vote upon most issues. How often or ever have you voted upon the type of services that is provided by municipalities, or medical care? Probably never... one might vote to give additional funding but not to define the type of services provided. Do we allow the public to decide if the Police should have jailers, detectives, or if the FD should have a HazMat unit? No, it is under the determination of operations that the city offer the best for the public that they can afford and provide. 

Public Health Codes, Engineering decisions are never brought up to the public for certain reasons. Mainly, the public is ignorant and entrust those with the speciality to decide for us. 

We only get to vote only very few items and agendas, in fact a petition is usually needed to be able to vote upon items.

R/r 911


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## Guardian (Feb 13, 2008)

Ridryder911 said:


> Actually I disagree. I can assure you working with law makers this past month, they don't care about the public's opinion, they care about the vote. Totally separate issues.
> 
> To suggest the public in general is responsible enough to make rationale decisions in medical care is asinine. Would we allow them to make decisions upon what procedures should be available to be provided in hospitals?
> 
> ...




Obviously (or so I thought) by public opinion, I meant vote--which are in fact one and the same.  But go ahead, keep biting at their heels along with every other little activist without the weight of public opinion, and let me know how that works out for you.  

I’m looking at this on a macro level.  Not what kind of construction should be used for a bridge, but whether or not we should put up a bridge.  Likewise, not whether or not little Suzie should get an IV, but whether or not we should have a paid verses volunteer system.  Big macro decisions can only be made with public backing.  Period.


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## ffemt8978 (Feb 13, 2008)

Never mind...the point has already been made.


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## Outbac1 (Feb 13, 2008)

Flight-lp thank you for the positive reply.

 Public opinion is important. But you need forward thinking politicians and the civil servants behind them to make it an issue. The public will blissfully go on their way ignorant of what they could have until its an issue on the front page and 6 o'clock news. Then everyone can weigh in and push for change, or not. The details of the service should be left to the EMS professionals. The public first has to know that better is available then they can speak, ultimatly with their vote.

 On the fire side I think there is a happy medium. They generally do fewer calls than EMS. But when you need them, you NEED them. Some paid full time members at the station to get the ball rolling I think is good. Then the rest can go directly to the scene. If the house burns to the ground I'll be sad. There is some stuff I'd like to have. If someone is trapped inside I want someone there to suit up and go in PDQ,(pretty damn quick). 

   If you live more rural chances are the volunteers don't all work in the community and will take longer to respond.  Its the price you pay to live where you do. 

  I know that when we head out for a call in one of the rural communities we still often beat the first responders to the scene as we are on duty with a mandated < 59 second chute time 90% of the time.

 Volunteers are important but I think they should supplement required services, not be them.


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## Topher38 (Feb 13, 2008)

AZFF/EMT said:


> I agree with rid on this one. There can always be a place for volunteers to augment a system and help out, but relying on it by itself is scary to me. Think if the police were all volunteer, or public works. When a water main breaks and it doesn't fit into some of the guys schedule and you get three guys to show up and no one can operate the advanced machinery, and the basic stuff. I think our cities, counties and states should all provide paid professional ALS EMS services. Yes some rural areas just can't but when you have cities back east with 25k residents and a single vollie first aid squad it kinda scary.




OHHH, Now I see what you guys are talking about, at first I didnt quite get it after reading the article.

I can see where it is scary, but if you think about it, alot of volunteers in VFDs have the same training as that of a Paid Fire fighter, isn't really the only diffrence the fact that one gets paid and one doesn't? 

*Don't bash me for asking questions* Thank you.


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## BossyCow (Feb 13, 2008)

Ridryder911 said:


> Communities will have to stop getting the milk for free, the cow is dried up. Time to Anni up and be responsible for their citizens.
> 
> Again very.... very rural areas will have to continue upon volunteer EMS. That itself is a different situation.
> 
> R/r 911



First off.. it's ante up not anni up (My name is Annie so I'm sensitive, and yes, Annie IS okay)

Since when is 8,000 population considered rural? We're talking about communities of 1000 or less. 

And to address your comment about will those of us who volunteer with EMS do meal on wheels, clean streets etc.  The answer there is yes. I do a street cleanup twice a year for my adopted area of road, I also have volunteered countless hours with homeless kids, tutoring in schools, sewing costumes for the local high school and college drama department. Coached soccer teams, gave blood, doorbelled for the Cancer Society, and teach first aid and CPR at a local homeless shelter for those who need the cards for potential jobs. 

In really rural areas, we understand that its us or nothing. We rely on each other in so many ways, and we know each other. There is no anonymity in a rural area. Your neighbor's pain affects you personally.

There is also no expectation that the government will provide. There is no expectation that the school will keep going. There is no local food bank, but there is an exchange of garden produce from those who's gardens are extra generous. There is no thrift store, but there is a hand-me-down network of outgrown kids clothes that makes goodwill seem understocked. There is no local nursing home, but there are neighbors who will come over and sit with your elderly mom for you while you run to the store. When someone is terminally ill, the network of meal support, fill in for hospice and neighbors signing up to do everything from walk your dog, to change the pt's diapers is generally longer than the people you need. The school has more parents in the classroom than paid staff. The coaches, art teachers, music teachers, are unpaid parents. Office staff is 50% volunteers. 

I do what I do for my community. Not for myself, not for glory or the measily $7 per call that I get. I do it because the community is willing to pay to train me, and the community gets the benefit of that training. Now, will this tiny community of under 1000 people ever have a full time staffed EMS agency, probably not. Will we have a hospital, doctors clinic or bank? Nope! We don't even have a post office, just a collection of post office boxes in the corner of the general store. 

People who whine because their care isn't the best, ambulance takes to long to show up, takes them to the wrong facility, or doesn't care enough, don't get a lot of pity from me. Sounds like a case of too-high expectations. People die. It happens to all of us. 

In the meantime, a segment of society is going on, taking care of themselves, relying on their neighbors and working together to make a real community. I can't see this as a bad thing. I wouldn't trade being able to get 20 people together to repaint a widow's house for having a faster response from ALS. I wouldn't trade knowing the names of almost every kid I see at the local blackberry festival for having a higher level of Trauma center. I prefer living in a community where we take care of each other, with our own time than one where we work 60 hours a week to be able to pay a stranger to do this for us. What happened to self reliance?


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## Guardian (Feb 13, 2008)

Nevermind...........Please erase


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## Ridryder911 (Feb 13, 2008)

Actually rural is considered and based upon population and location of MSA (Metropolitan Service Areas) so even population of above 10k ca be considered rural. 

Sorry about the ante, I guess when I performed spell check it corrected it. I am glad you provide more volunteer service than EMS. Again, if you read my full text, I described that there will be those in the rural and remote areas that will be and have to be exempted. I know of those areas where there is nobody else, but in comparison of most communities this is not the norm. Again, as I stated I honor those that perform those services in the remote actually technically called frontier areas.  

There is services that provide EMS as volunteer because they choose to not because they have to. Services that only provide BLS and volunteers that have to respond from homes and definitely could have an full time paid ALS but choose not to because of tradition. There is no valid argument that BLS is better for the patient care than ALS, especially when a community could provide it. 

If given the opportunity any community will choose the cheaper one. Again, the community asks us and depend upon us for direction. It is ludicrous for us as health care providers to even suggest or recommend any lower level of care to patients and believe that it would be comparable or sufficient enough. Especially for those communities that could afford differently. Seriously, what type of provider would we be to recommend anything other than the best for the patient? Volunteered or paid is irrelevant. 

Personally, I believe those that continue to associate with agencies and do not attempt to change within the system to have them progress into an ALS or provide a better EMS system is actually a hindrance to EMS. Change can occur much easier from than the inside than from the outside. I would like to see those of are associated with such agencies move forward, it can be done. It would be better than seeing those involved in the EMS do it, rather than someone else do it. 

R/r 911


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## Topher38 (Feb 13, 2008)

I noticed that alot of more experienced people on this site say that when someone says, "I do it for the community" They get bashed for it. I remeber when I was on another EMS site and I stopped posting there because of it, I was bashed for saying that I like helping people and thats why I do it. And they bashed me for saying that. They said I was full of crap and no one does it for that. 

Sorry this is way off topic but I was reading bossycow's comment and it reminded me.


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## Jon (Feb 13, 2008)

Wow.

I read the article too, and think it is mostly non-biased. I like it, and I think it makes its point. 

I think volunteer EMS has a place, and a combination department with a reasonable response time (crews on-station) and a 'professional' group of volunteers can be as good a a group of paid BLS providers. I do agree that ALS is the ideal standard of care.... but some patients DON'T need a medic. Right now, my area doesn't have enough paid medics to have a medic on every call.

I do consider what I do "serving the community" but I also get benifit from it... both experience and ego, to a point. I don't run with the company where I live BECAUSE of petty politics... I'll only put up with so much B.S. before I walk away, whether it is paid or vollie.


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## bonedog (Feb 14, 2008)

Good thought provoking article Rid.

I think the main difference between EMS and Fire protection is money and insurance companies.

As corporations can see a difference in the bottom line if they only have to repair water damage, this is something they can put a dollar value on. 

An employee's life or quality of life isn't something they can quantify with money, so doesn't rate.

Democracy, sadly missing in the free world, other wise we would have vote's on important issues. This would strip the politicians of power and truely give it to the people, so, even though we could all spend a couple of hours a week looking at major intiatives online and vote accordingly, we will never see such a radical idea.

I wonder, would there have been an invasion of Iraq if everyone had a vote on it?

Volunteer ALS makes me wonder, are there volunteer Doctor's also?


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## rgnoon (Feb 14, 2008)

Thanks R/R...I agree with Jon and others that the article you have brought  us is pretty unbiased. I always appreciate a new unbiased look at a part of my world. Its a wonderful way to grow and gain new perspective.


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## Guardian (Feb 15, 2008)

Ridryder911 said:


> Volunteered or paid is irrelevant.



Not according to the article you posted.  It was making an argument that volunteerism in ems was a possible root cause of problems with ems.  How can you write that volunteer or paid is irrelevant and then support an article that says the opposite?

Now are you people starting to see why I think the article is biased?


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## Summit (Feb 16, 2008)

I think volunteer is viable in frontier areas whether that be a 500sqmi county with 2000 residents, no clinic, and regular loss of road access to other counties... or whether it is wilderness medicine provided by SAR.

Otherwise, I definitely see their point on volunteers.

24 hour shifts are good for the right system and not good for other systems.

I was disappointed when the bulk of their suggestions after the long rant with the core of many of our systems were: 
1. love your family
2. don't forget about your family
3. talk to your family
4. love your family
5. don't forget to love your family
6. talk about loving your family
etc etc etc


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