# Volunteer EMS needs to become non-existent.



## NYMedic828 (Aug 4, 2012)

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.


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## rescue1 (Aug 4, 2012)

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.


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## bahnrokt (Aug 4, 2012)

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.


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## EpiEMS (Aug 4, 2012)

NYMedic828 said:


> 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.


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## rescue1 (Aug 4, 2012)

bahnrokt said:


> 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.


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## Jon (Aug 4, 2012)

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.


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## sperry (Aug 4, 2012)

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


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## bigbaldguy (Aug 4, 2012)

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.


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## WuLabsWuTecH (Aug 4, 2012)

NYMedic828 said:


> 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 ____."
> 
> ...



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?


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## rescue1 (Aug 4, 2012)

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.


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## WuLabsWuTecH (Aug 4, 2012)

rescue1 said:


> 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.


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## DrParasite (Aug 5, 2012)

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.


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## Tigger (Aug 5, 2012)

rescue1 said:


> 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.


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## CANDawg (Aug 5, 2012)

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.


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## rescue1 (Aug 5, 2012)

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.


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## RSKS (Aug 5, 2012)

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.


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## Sandog (Aug 5, 2012)

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


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## NYMedic828 (Aug 5, 2012)

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.


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## Tigger (Aug 5, 2012)

Sandog said:


> 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...


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## CANDawg (Aug 5, 2012)

Tigger said:


> 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 shi*F*ts.


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## bigbaldguy (Aug 5, 2012)

I would say that unless you're making more than you're spending you would be a volunteer although that might not be the literal definition. If you make 5 dollars a call and run ten calls a day but spend 20 dollars in gas getting there and eat 3 meals out for a total of 50 dollars expenses then it comes out to volunteer work in my opinion.

I'm very pleased with the respectful tone everyone is maintaining. This is one of those hot button topics and it speaks to the maturity of everyone who is posting that is has stayed productive and on topic.


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## DeepFreeze (Aug 5, 2012)

71 Heavy Rescues? Where are you? Dix Hills Strong Island?


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## Jon (Aug 5, 2012)

NYMedic828 said:


> 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.



This is probably a false comparison. Remember, FDNY also has Squads (rescue engines) as well as every Truck (aerial) has basic rescue equipment. That allots to much more than the 5 "Rescues"

But if you're talking about Long Island - yeah, there is a fair amount of apparatus (and station) silliness.


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## rescue1 (Aug 5, 2012)

I was in a town once that had two heavy rescues and a rescue engine...for a town of 4000 people. 

Still, it's easy to see why. The largest expense of a career department is salaries, and a well funded volunteer department is free from those expenses and able to purchase extra equipment. There may be better ways to spend the money, but there have been times when having a spare engine or rescue is nice. It's when it gets into an "apparatus war" that it gets fishy. This is more of a fire side thing, but there are times when a station will buy a brand new ladder because XYZ station down the street just got one, and we can't let XYZ be better then us. This gets into wasteful spending.


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## ffemt8978 (Aug 5, 2012)

Jon said:


> This is probably a false comparison. Remember, FDNY also has Squads (rescue engines) as well as every Truck (aerial) has basic rescue equipment. That allots to much more than the 5 "Rescues"
> 
> But if you're talking about Long Island - yeah, there is a fair amount of apparatus (and station) silliness.



Also, doesn't the NYPD ESU have extrication and some rescue equipment also?


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## bahnrokt (Aug 5, 2012)

rescue1 said:


> I was in a town once that had two heavy rescues and a rescue engine...for a town of 4000 people.
> 
> Still, it's easy to see why. The largest expense of a career department is salaries, and a well funded volunteer department is free from those expenses and able to purchase extra equipment. There may be better ways to spend the money, but there have been times when having a spare engine or rescue is nice. It's when it gets into an "apparatus war" that it gets fishy. This is more of a fire side thing, but there are times when a station will buy a brand new ladder because XYZ station down the street just got one, and we can't let XYZ be better then us. This gets into wasteful spending.



My town is about 5000 people and we have 4.5 VFDS (4 full fire districts and one that straddles the town line) each with a heavy rescue rig, an engine, tanker, fly/chiefs car etc.  One 2 Chiefs actually live in district. Two of the VFDs are less than a 1/2 mile from each other.  Durring the daytime the town may have have man power to staff 1 depts equipment.


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## WuLabsWuTecH (Aug 5, 2012)

rescue1 said:


> 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.



It's about finding a happy medium.  I think if our department said everyone had to do 24 CEUs a month, some of the full-timers would quit much less the volunteers!  But once a month for 2 hours at a time might be reasonable.  The thing is you have to find the balance between everyone quitting and everyone staying.  If you have people who don't think they need to do any training, you want those people out the door anyway.  If they can't dedicate a minimal amount of time to training each month then do you really want them on the street.

The way we have it set up at one of my departments:
Each month there are two trainings, sometimes a third.  One of them is mandatory, and happens at the same time each month.  If you miss it, you need a good excuse unless you live reasonably far away, in which case you need to show proof that you have done some other CEU that month.  The second one is optional, but if you make these two every month, the department will ensure that you have all the CEUs you need to recert.  If for whatever reason you don't have the CEUs and you have made the past 24 trainings, the department pays for you to go get them.  The third one is often just for special interest, and can cover some very obscure topics (one of them was Osteogenesis Imperfecta).  They are generally offered by outside agencies wanting to do outreach.



Tigger said:


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



Not true at all.  I get paid a stipend that covers the cost of me driving nearly an hour to get to the station, uniform expenses, the cost of food while I am down there, and some miscellaneous expenses I might have related to being a member (for example, I wanted a new knife to carry while on duty).


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## rescue1 (Aug 5, 2012)

Is this Pennsylvania we're talking about? PA is famous for having a huge amount of tiny volly departments

EDIT...in response to bahnrokt's post


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## NYMedic828 (Aug 5, 2012)

Jon said:


> This is probably a false comparison. Remember, FDNY also has Squads (rescue engines) as well as every Truck (aerial) has basic rescue equipment. That allots to much more than the 5 "Rescues"
> 
> But if you're talking about Long Island - yeah, there is a fair amount of apparatus (and station) silliness.



LI is the comparison yes.

In my department all of our trucks and engines have every form of equipment. The heavy rescue just has more of them.


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## DrParasite (Aug 5, 2012)

dbo789 said:


> 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.


than please explain how firefighting is considered a profession.





NYMedic828 said:


> 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.


EMS response times, or response times until someone (sometimes a first responder) makes it on scene?  When you have 250+ ambulances, but still need a fire engine to make it there first to "stop the clock," there is a problem. Disclaimer: I know many FDNY Firefighters, know many FDNY EMS people, as well as several who work for the hospitals that do EMS in NYC.  Lots of good guys, some guys who I don't know how they got jobs, and others who I wouldn't trust to assess my worst enemy if they were complaining of a hangnail. I'm just painting everyone with a very broad brush, which is exactly what the OP is doing.





NYMedic828 said:


> FDNY will get rid of me for not doing my job. The vollies won't.


that is true at my places, but the corollary is, FDNY might get rid of you for something stupid knowing there are 100 more who are willing to take your place.  Sadly (depending on your point of view), the volunteer agency doesn't have 100 people to take your spot, so they won't get rid of you that easily.





NYMedic828 said:


> 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.


I call BS on this.  If you have a hometown (not county, just 1 town) with 71 heavy rescues, than I want to see that town, because I don't believe it.

and FDNY might only have 5 heavy rescues.  But as others have mentioned, NYC has quite a few other Rescue trucks.  There are 12 NYPD ESU Heavy Rescues, 40 NYPD ESU Patrol trucks, 7 FDNY Squads, and 144 Truck companies, all of which carry a full assortment of hydraulic rescue tools, and the Truck companies and squads all carry a full set of airbags.  And that's not including Port Authority PD ESU (which I know carries a full set of rescue equipment in their Rescue and their ESU Patrol truck), NJ Transit PD ESU, Amrak PD ESU, and I can't even imagine who else might have rescue equipment.  So now you have a total of 203 emergency vehicles that carry rescue equipment, plus 5 heavy rescues of FDNY, plus the assorted police department ESUs, and you get a real picture of how much equipment your paid departments have when compared to the neighboring volunteers.


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## crazychick (Aug 5, 2012)

This is such a touchy situation for the simple fact is that the bigger your area, the more money can be spent for private ems. I live in a small area, with a lot of farms. We need to have our VFD that runs EMS with it. I feel that we are running calls quite well but we lack the manpower to really do anything. We are correcting that by getting more people on the squad and paying for the education with a contract in place. There are to many times that out in this area, you have a critical patient and have to wait ten min to get an ambulance out there. Plus we are 25 min away from the hospital. VFD's are needed for those calls to start assessing the scene and getting things rolling, saving critical min. 

The system is flawed yes but it works for the most part. 

And me personally will be running with private ems as well as my VFD. When I get my basic I will get my medic through the VFD


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## rescue1 (Aug 5, 2012)

DrParasite said:


> than please explain how firefighting is considered a profession.



The paid/volly debate rages just as hotly on the fire side (just look at some old posts on firehouse.com) as it does here. 

Firefighting, though, has the advantage of having better PR, being around longer, and a long established union. Firefighting also is a fairly independent system. Firefighters and fire inspectors make rules for fire departments and determine standards for how FD's operate.
EMS is run by doctors, EMS officials, private company CEOs, fire departments, police departments, hospital directors...etc. Therefore it's difficult for general consensuses to be made about EMS since it's kind of the red-headed stepchild of public safety agencies, and that ignores the whole "is EMS public safety or healthcare" debate. 

All in my only semi-educated opinion, of course.


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## NYMedic828 (Aug 5, 2012)

Sorry I meant county. Not one town.


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## bigbaldguy (Aug 5, 2012)

For those of us who aren't fire based and have no idea what a heavy rescue vehicle is.

from wiki

A heavy rescue vehicle is a type of specialty firefighting or emergency medical services apparatus. They are primarily designed to provide the specialized equipment necessary for technical rescue situations such as auto accidents requiring vehicle extrication, building collapses, confined space rescue, rope rescues and swiftwater rescues.[1] They carry an array of special equipment such as the Jaws of life, wooden cribbing, generators, winches, hi-lift jacks, cranes, cutting torches, circular saws and other forms of heavy equipment unavailable on standard trucks. 

rest of discription here.
http://en.wikipedia.org/wiki/Heavy_rescue_vehicle


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## Tigger (Aug 5, 2012)

Thought I was more clear, a well funded volunteer department does not by default operate as a well functioning organization on par with career EMS. However without hat funding, a volunteer organization stands little chance of meeting similar standards. Considering that many municipalities use volunteer organizations as a means to cut costs, it should come as no surprise that many volunteer or paid on call organizations struggle. It doesn't matter if it's paid or volunteer, without funding your screwed right?

Also, many "volunteer" organizations would be better classed as "paid on call" as that's what they are. If you get a stipend, you aren't volunteering, at least for tax purposes (the agency and provider's) in many states. Volunteer does have a lot more cachet in the community I suppose, but let's call a rose a rose.


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## SARMedic51 (Aug 5, 2012)

I think the paid vs. volunteer question is valid, but there are many regional factors that apply. I work for two services. One is a full ALS paid ambulance service. The other is a more rural "volunteer" service. I really like the way the volunteer service is run. We get about 3,500 calls a year. We have two crews on 24/7 and a third crew on Fridays and Saturdays (which tend to have more calls). By "on" I mean standing by AT QUARTERS in full uniform. A "full crew" is a BLS and an ALS provider, although sometimes we'll have two ALS providers. Basically, all the EMT-Bs are volunteer while all the ALS providers (Paramedics and AEMT-CCs) are paid. The agency does have some full time ALS providers that work solely at this one agency, but most are part time and work at another paid, private service. The BLS providers are actually very good in my opinion, but, either way, the ALS provider is always very experienced. This way, BLS providers can get volunteer experience. We have a lot of young EMT-Bs who volunteer for a year or two, get some experience, and decide to take a paramedic or AEMT-CC class and work full time somewhere else. Also, the agency is saved the cost of paying EMT-Bs (we generally have no problem finding volunteers) while always having experienced ALS on the crew as well.


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## 46Young (Aug 5, 2012)

My two beefs with volunteer departments are the inconsistent mandatory training/minimum pt contacts to remain active and failure to cover shifts. This is not all departments, but it's a problem enough of the time that it bears mentioning. It's worse in the fire service, since some members can go interior, some can't, some can only drive, etc. 

It's a worthy goal to mandate training and such, but in reality a department can be like a fiefdom, where the chiefs are resistent to any change. It's really hit or miss, and change can be difficult to impossible.

As the volunteer departments continue to see dwindling participation, 
I feel the true value with volunteers will be to upstaff the existing units. This can be third and fourth on the ambulance, or perhaps putting another unit in-service. Volunteers should not be counted on as minimal staffing unless there's absolutely no other recourse as is the case in regions with a poor tax base. It's too risky. The schedule may be covered today, but anything can happen in the coming months and years. This is exactly why there are paid on call volunteer houses that move to M-F 0700-1900 career houses (volunteer at night), that eventually progress to 24/7 career with perhaps supplemental volunteers.

Volunteers are great for extra manpower on a unit, or in the fire service to be fourth/fifth on an engine or truck, to align with national safe staffing recommendations.

As far as the whole "job stealing tick" deal, I'm not sold on that. If the volunteers can truly handle the call volume 24/7/365, are trained the same as a career person, and have similar ongoing education, then that's appropriate. As their shift coverage gaps become more and more evident, career shifts and stations will develop as a matter of necessity. Until then, use that deferred career staffing expenditure to fund local capital projects. If the volunteers are incompetent and refuse to train and educate themselves, then they need to go. I don't want someone staffing the ambulance that comes to my home that rides  just for kicks and giggles or to be part of the social club.

The best is when volunteers tell me how they only go on certain call types, that they don't go on sick jobs and such, like it's beneath them. 

Volunteering for free does not give one the right to cherry pick their roles and responsibilities. That's the main issue IMO.


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## thegreypilgrim (Aug 5, 2012)

The fact that this is still an issue is utterly disappointing.

This problem by no means approaches the level of a conundrum or vexation. It's an easy fix. I guess I should say it's an easy organizational/structural fix. Unfortunately, as evinced by this thread, it's a ridiculous hornet's nest of political nonsense.

Everyone knows we should get rid of volunteers, and transition to professional services but the question of what to do with rural towns with populations below 1000 people. Well, it's obvious. If we insist on burdening local communities with having to finance their own ambulance services this will always be the result. 

So, that's why EMS has to be financed and provided at the state level. To avoid this constant source of needless drama the state governments need to just take over.


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## rescue1 (Aug 5, 2012)

Do you think state tax dollars will be sufficient to provide effective coverage in all areas? Not knocking the idea (though try getting that passed in today's economy...) but something to consider. I'd rather have a volunteer agency that gets to me in 10 minutes then a paid service that takes 20, which could be an issue if the state chooses to understaff an area.


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## Sandog (Aug 5, 2012)

Tigger said:


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



The agency I am speaking of the volunteers must work 'four' 24 hour shifts unpaid per month. If they work more shifts after that initial 96 hours, then they get a small stipend. I would also mention that this agency is roughly an hour or more drive for most of the guys, the gas money being on their dime.


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## ffemt8978 (Aug 5, 2012)

thegreypilgrim said:


> The fact that this is still an issue is utterly disappointing.
> 
> This problem by no means approaches the level of a conundrum or vexation. It's an easy fix. I guess I should say it's an easy organizational/structural fix. Unfortunately, as evinced by this thread, it's a ridiculous hornet's nest of political nonsense.
> 
> ...


The problem with the state funding EMS is that it will allocate it's money to where it is most used (i.e. major population centers) and the rural areas will not receive coverage.  No different than how states allocate their state patrol units.  If you are near a population center, you will have a relatively short wait for a trooper to show up.  If you're out in the boonies, the wait time for a trooper can exceed 45 minutes.

Not to mention that just about every state is experiencing a budget shortfall and is having to cut programs.  Where would this money come from?


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## WestMetroMedic (Aug 6, 2012)

I'm in the middle.  To be fully disclosed, i work full time in Minnesota's largest county, doing a volume of work, that no one in their right mind would ever volunteer for.  I also am what i would consider, a volunteer firefighter in my suburb, meaning, i am paid when i respond to the station after my pager makes annoying noises, but at the end of the month, the approx 300$ that i pull down each month buys dog food and gas, but not much more. 

 I didn't join the fire department to make money, i joined because i believe in the spirit of volunteerism and think that it is important to be involved in my community.  As a department, we hold ourselves to a high standard, and have a definite culture that is proud, and respectful of the fire services 200 years of tradition, but also cognizant of how unsafe and unprofessional blind adherence to tradition can be.  The specifics of how we operate will bore all of us, but the basic tenets are obvious, if we hold the bar high for ourselves, we can reasonably hope that our neighbors shall follow suit, and they do.  Just because it isn't your full time gig, doesn't mean you shouldn't do everything you do with precision.

Back to the conversation at hand, EMS volunteerism.  I recently had an intern from Alaska work with me for 2 months, who, back at home, is on a truly volunteer department that remunerates it's members with only free training.  No stipends, no pension, nada.  They operate a fire department based ALS service in a PSA the size of Jersey and a population of around 800.  They do 60 fire calls a year and 100 medical calls a year.  Surprisingly, the vibe i got regarding the fire and EMS relationship up there is that departments see themselves as an EMS that happens to have fire trucks.  They have a firm understanding of what their mission is and they train accordingly.  Despite their lack of remuneration, they recognize their charge and the responsibilities that come with it.  Although how EMS functions in Alaska is a bit different than the rest of us in the regular daylight cycle part of the world, the basic ideas are the same, but they realize their shortcomings and accommodate them with vigor.

I got my start with university based first response and BLS transport and it opened a lot of doors for me, and i stuck with it for 6 years, but i left out of frustration with the organization over many of the issues and shortcomings of well intentioned people, who lacked relevant professionalism and made it no longer fun.

Volunteerism is alive and with proper support, it can be well, but it is hard (TWSS).  Perhaps, those of us who have the luxury of being paid, need to reach out to those of our peers who serve in areas that can't afford paid EMS and help them set a bar.


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## Jon (Aug 6, 2012)

One of the interesting things - If someone were to find the old Paid vs. Volly threads, I imagine some of us (probably including me) have had our views change over the years.

I work full-time as a paramedic. This is my career, and I love what I do. I consider myself a professional. I take time away from work to attend training classes and conferences, and pay to maintain my own certifications (right now, but that might be changing). I do my best to keep up with the state of the science, and to provide the best care I can to my patients.

I am in the process of joining a local agency as a volunteer medic for a number of reasons - #1 is that in exchange for a reasonable amount of volunteering, certain costs of maintaining my certification will be covered. Additionally, I have many friends I will be running with, and it will be less "work" and more "fun" - even though I will have the same work ethic and patient care standard as I do at work. There are some other, external reasons for this, too - but they aren't really pertinent.

I've worked with plenty of paid AND volunteer EMS providers that didn't take their job seriously. Their patient care, documentation, appearance, and/or work ethic stunk. I've worked with plenty of paid and volunteer that have acceptable (and exceptional - 'cause aren't they almost the same thing?) patient care, documentation, appearance, and work ethic. Whether or not there's a paycheck involved doesn't often correlate with this. It has to do with the person taking themselves seriously - and this is where the world Professional comes into play.

Now, another comment - I don't feel there is a place for hobbyists in EMS. These are folks that work part-time or volunteer, and do something completely different for a day job. Some of these folks manage to be EMS Professionals - they keep up on current research and protocols, they have a good work ethic, and they care. They aren't the problem.

The hobbyist I talk about is the person that comes in for a bi-monthly shift with an armful of laundry, or piles of homework, and complain whenever their duties take them away from it. Or they come in to hang out, and how DARE someone call 911? They do the bare minimum, if that, and if you challenge them, their answer is "I'm just a volunteer" or "I'm part time... no one cares". When they do have a call, they are so rusty it's shameful.

I also concur with the comment that volunteers don't usually take away paid jobs. My primary volunteer role is as Quality Care officer with a college-based First Responder organization. We're all volunteers, and this fall, we'll have 3 active medics on the rolls, because we all want to pitch in a bit to help train the next generation, and to provide care to those we go to school with. We also do it because it's fun, and a "break" from our normal EMS roles. We are a low-volume agency, and there would never be paid staff for this agency.


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## thegreypilgrim (Aug 6, 2012)

ffemt8978 said:


> The problem with the state funding EMS is that it will allocate it's money to where it is most used (i.e. major population centers) and the rural areas will not receive coverage.  No different than how states allocate their state patrol units.  If you are near a population center, you will have a relatively short wait for a trooper to show up.  If you're out in the boonies, the wait time for a trooper can exceed 45 minutes.


 True, and this is rightly so. Implicit in choosing to live in a rural area is acceptance of this risk. It just isn't feasible to reproduce the same accessibility of metropolitan centers in rural communities. However, under this model a town like Independence, CA can at least have a full-time ALS ambulance for the area as opposed to volunteer BLS.



> Not to mention that just about every state is experiencing a budget shortfall and is having to cut programs.  Where would this money come from?


 See this thread for how I suggest they finance it. 

Suffice it to say for the moment that while the causes of state budget deficits are, indeed, varied a common theme is transfers to local governments. That is a significant problem here in California. Contrary to popular understanding, California's state-level revenues are more or less sufficient to cover its expenditures; but, local governments are regularly short in their budgets which require transfers from the state to keep them afloat. I believe a large part of this is the burden of having to finance public safety operations like EMS (whether its fire-based ambulance, "first response", or service fees payable to a private contractor).


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## DrParasite (Aug 6, 2012)

thegreypilgrim said:


> However, under this model a town like Independence, CA can at least have a full-time ALS ambulance for the area as opposed to volunteer BLS..


 Independence Ca has a population of under 700, including a jail, in an area less than 5 square miles.  Outside of having the Jail pay for the ALS ambulance, how do you pay for a full time ALS crew covering just that town 24/7?  what is their call volume?  if it's more than 50 calls a year (again, outside of the jail), i would be shocked.


Jon said:


> I work full-time as a paramedic. This is my career, and I love what I do. I consider myself a professional. I take time away from work to attend training classes and conferences, and pay to maintain my own certifications (right now, but that might be changing). I do my best to keep up with the state of the science, and to provide the best care I can to my patients.
> 
> I am in the process of joining a local agency as a volunteer medic for a number of reasons - #1 is that in exchange for a reasonable amount of volunteering, certain costs of maintaining my certification will be covered. Additionally, I have many friends I will be running with, and it will be less "work" and more "fun" - even though I will have the same work ethic and patient care standard as I do at work. There are some other, external reasons for this, too - but they aren't really pertinent.


I was in the same boat.  working full time for a 100% paid EMS agency, which was very anti volunteer (despite many people volunteering in one way or another, but I digress), in one of the busiest systems in the nation (we definitely put FDNY to shame in our call volumes per truck).  But the local EMS agency was 100% volunteer, needed people and needed experienced people.  When a new captain took over, i decided to join.   I liked the captain, liked his sister, liked his girlfriend, and thought there were some really cool people there.

And I would probably be an officer there if one of the dinosaurs hadn't been harassing me, and the executive board decided not to do anything about it.  


Jon said:


> I've worked with plenty of paid AND volunteer EMS providers that didn't take their job seriously. Their patient care, documentation, appearance, and/or work ethic stunk. I've worked with plenty of paid and volunteer that have acceptable (and exceptional - 'cause aren't they almost the same thing?) patient care, documentation, appearance, and work ethic. Whether or not there's a paycheck involved doesn't often correlate with this. It has to do with the person taking themselves seriously - and this is where the world Professional comes into play.
> 
> Now, another comment - I don't feel there is a place for hobbyists in EMS. These are folks that work part-time or volunteer, and do something completely different for a day job. Some of these folks manage to be EMS Professionals - they keep up on current research and protocols, they have a good work ethic, and they care. They aren't the problem.
> 
> The hobbyist I talk about is the person that comes in for a bi-monthly shift with an armful of laundry, or piles of homework, and complain whenever their duties take them away from it. Or they come in to hang out, and how DARE someone call 911? They do the bare minimum, if that, and if you challenge them, their answer is "I'm just a volunteer" or "I'm part time... no one cares". When they do have a call, they are so rusty it's shameful.


Agree with everything you just said.


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## Chief Complaint (Aug 7, 2012)

This thread has made me appreciate the fact that i dont live in a small town that only has volunteer coverage.  I dont think i ever realized that there were so many places that couldnt afford career staffing.

Sure, there may be places in the country where volunteers know what they are doing and provide good care, but i havent seen them.  If i called 911 for an emergency and a volunteer crew showed up to help me, i'd consider filing a lawsuit against the county.  My tax dollars fund a career department (with support from volunteers).  I only want those who are trained to the highest level to respond to my emergency.

Ive seen the training that the volunteers receive and it is NOTHING compared to what career staff go through.


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## rescue1 (Aug 7, 2012)

NREMT standards are the same for paid and volunteer providers...


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## Chief Complaint (Aug 8, 2012)

rescue1 said:


> NREMT standards are the same for paid and volunteer providers...



And just passing the NR seems to be good enough for many volunteer services to put a provider in the field.  Paid personel here go through quite a bit more training than that.


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## Jon (Aug 8, 2012)

Chief Complaint said:


> And just passing the NR seems to be good enough for many volunteer services to put a provider in the field.  Paid personel here go through quite a bit more training than that.


Oh?

I've my share of EMS jobs. At the BLS level. I don't recall ever getting more than a day or two of "FTO" time. Even my medic jobs - I ran a couple of shifts and was cleared. I did WAYYYYY more to obtain status as a EMT and Driver with a volunteer agency (total hours, total calls, and overall length of program) than I've ever been asked to do to get a BLS job anywhere.

There are career agencies with in-depth FTO programs, but based on my experience, there are plenty of volunteer agencies that have their own high standards.


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## leoemt (Aug 8, 2012)

Both volunteer and paid agencies are only as good as their weakest link. I have seen awesome volunteer organizations and I have seen crappy ones. Same holds true for paid systems. 

I don't believe volunteer needs to become non-exsistent though. it can be effective. 

Volunteer doesn't equal bad EMS. They have the same training and equipment as the paid guys. 

I would do this job for free if I didn't have bills.


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## Chief Complaint (Aug 8, 2012)

Jon said:


> Oh?
> 
> I've my share of EMS jobs. At the BLS level. I don't recall ever getting more than a day or two of "FTO" time. Even my medic jobs - I ran a couple of shifts and was cleared. I did WAYYYYY more to obtain status as a EMT and Driver with a volunteer agency (total hours, total calls, and overall length of program) than I've ever been asked to do to get a BLS job anywhere.
> 
> There are career agencies with in-depth FTO programs, but based on my experience, there are plenty of volunteer agencies that have their own high standards.



Well thats good to hear, because it doesnt exist in my neck of the woods.  Paid personel go through a grueling 6 month academy, volunteers....do not.


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## rescue1 (Aug 8, 2012)

Paid providers around my area usually have more access to ongoing training, but the initial certification is the same.

That 6 month academy...is it firefighter + EMS? Because career firefighting academies are almost always longer and more involved then volunteer FF training is.


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## Bullets (Aug 8, 2012)

In my town

Paid requirements (upon hire)
Emt
ICS 100, 200
NIMS 700, 800
HAZMAT/CBRNE awareness

FTO program: new hires must be observed treating 5 patients sastisfactorly then they are cleared to treat as a second

Must show knowledge of using a paper map and GPS 

Volunteer
Within 1year of joining they must have the same training as the paid staff

They also take a "EMS response to Large scale incidents" class
Rehab treatment and management class
Pulse oximetry
They also offer ITLS/PHTLS
Can not begin drivers training until 6 months after they get their EMT

The volunteers have more robust training program then the paid staff. Volunteers usually ride as seconds or thirds for 12-18 months before they are cleared to be the primary EMT. Paid staff usually ride one shift before they get cleared to be primary


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## Chief Complaint (Aug 8, 2012)

rescue1 said:


> Paid providers around my area usually have more access to ongoing training, but the initial certification is the same.
> 
> That 6 month academy...is it firefighter + EMS? Because career firefighting academies are almost always longer and more involved then volunteer FF training is.



Yes, the academies are for both fire and EMS training.


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## DrParasite (Aug 8, 2012)

Chief Complaint said:


> Ive seen the training that the volunteers receive and it is NOTHING compared to what career staff go through.


the state training is IDENTICAL.  When i went to EMT school in New York, there were people in class who were in it to be paid EMTs.  we were side by side, we attended the same lectures, took the same tests.  Paramedic school in New York State was the same way.  If anything, volunteers have more training than paid staff, because paid agencies have you trained for maybe 4 shifts before putting you out on your own, while volunteers will train and supervise you for several months before cutting you on your own.

I know of many 100% paid agencies that require an EMT cert and a CPR cert to get hired.  Most volunteer agencies require you to have those certifications within a year, and until they you will ride as a 3rd with the crew having an EMT cert and CPR, which are the state requirements.

Some individual agencies have different requirements, and it can all depend.  Some require ICS, PHTLS, Rescue, instructor cert, or whatever they have decided, but the state requirements are the same.

Outside of FDNY EMS, which I think has a 2 or 3 month academy for all their EMS only personnel, I don't know of any job that requires a 6 month academy for their EMS only people.  Those who do fire and EMS might go through the academy, but it's most FF training, and mostly agency specific, not state required.  you are comparing apples and oranges.

btw, you won't win in a lawsuit if a volunteer crew shows up to treat you, regardless of your taxes.  As long as the crew is properly certified, treats you appropriately, and transports you as appropriate, and you don't suffer any harm, your lawsuit will be thrown out as frivolous.


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## Christopher (Aug 8, 2012)

Jon said:


> Now, another comment - I don't feel there is a place for hobbyists in EMS. These are folks that work part-time or volunteer, and do something completely different for a day job. Some of these folks manage to be EMS Professionals - they keep up on current research and protocols, they have a good work ethic, and they care. They aren't the problem.



I'm a volunteer or part-time Paramedic for 3 departments (captain at one, board member at another, and field grunt at the last), teach for 2 CC's, and maintain a full time position as a lead software engineer.

I probably count as a hobbyist, but I don't think hobbyists are the problem.

I don't think career or volunteers are the problem.

I don't think certification standards are the problem.

I think oversight is the problem!

At least at the combined paid/volunteer department I work at, we have structured ourselves as a "training facility" on the volly side. A large number of our volunteers are pre-PA/pre-MD or are new EMT's looking to go full time Paramedic. We focus on education, 100% QI/QA of calls, and providing high quality ALS and BLS care.

Both career and volunteer providers must complete a precepting program prior to being released to practice. They also must complete monthly duty time and continuing education.

If a volunteer department lacks quality oversight, they probably lack quality  providers.

If a paid department lacks quality oversight, they probably lack quality providers.


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## rescue1 (Aug 8, 2012)

Chief Complaint said:


> Yes, the academies are for both fire and EMS training.



In my experience, paid firefighters tend to have better and longer training then the volunteers. They also tend to gain experience faster, since most paid systems will have more calls then volunteer ones. 
But I've never seen a paid EMS agency that requires significantly more initial training then a volunteer one. However, as with firefighters, I've found most paid EMS workers will go on more runs then volunteers, and usually have mandated additional training, so over time they tend to be more experienced and therefore (hopefully) better providers.


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## Jon (Aug 8, 2012)

Christopher said:


> I'm a volunteer or part-time Paramedic for 3 departments (captain at one, board member at another, and field grunt at the last), teach for 2 CC's, and maintain a full time position as a lead software engineer.
> 
> I probably count as a hobbyist, but I don't think hobbyists are the problem.
> 
> ...I think oversight is the problem!...



Christopher - You aren't what I'm thinking of in the least. We've met the last how many years in a row in Baltimore? You care about what you do. The "hobbyist" I was discussing is one that isn't interested in helping educate about EKG's... they are the ones that are whining "why do I need to learn about 12 leads".

I agree that oversight is key. Better training and ongoing QA/QI/Education helps ANY agency - be it a small volly FD first responder agency, or a large PUM EMS agency.


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## Christopher (Aug 9, 2012)

Jon said:


> Christopher - You aren't what I'm thinking of in the least. We've met the last how many years in a row in Baltimore? You care about what you do. The "hobbyist" I was discussing is one that isn't interested in helping educate about EKG's... they are the ones that are whining "why do I need to learn about 12 leads".
> 
> I agree that oversight is key. Better training and ongoing QA/QI/Education helps ANY agency - be it a small volly FD first responder agency, or a large PUM EMS agency.



 I was being a bit tongue in cheek, but I guess I overdid it!

I think in our area, the "bare minimum" expectations are a far bit higher. We're probably lucky as our "hobbyists" complain about _having to learn about identifying STEMI with LBBB_.

A high QA/QI expectation drives folks to excellence.


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## webster44 (Aug 9, 2012)

I agree! Nobody should be allowed to volunteer to help somebody in a medical emergency. 
Only professionals who are trained, and paid have the knowledge and skills to take care of a pt.


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## bahnrokt (Aug 9, 2012)

Careful with the term "hobbyist".  You could make a strong argument that anyone taking the time to post on an EMS forum is a hobbyist. At the minimum we are all "EMS Enthusiasts". 

Personally I think all of the paid EMTs on here have a little bit of envy when they see the Vollies driving around with sweet light bars and strobe lights on their POVs.


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## NomadicMedic (Aug 9, 2012)

webster44 said:


> I agree! Nobody should be allowed to volunteer to help somebody in a medical emergency.
> Only professionals who are trained, and paid have the knowledge and skills to take care of a pt.



Hmmm. I smell sarcasm.


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## bigbaldguy (Aug 9, 2012)

There is one other difference between vollies and paid that I think it is fair to point out. Most true vollies do the job because it's something they enjoy. When they stop enjoying it they stop doing it. If they feel burned out they take a break and can come back to it. If they have drama in their lives they also tend to stop volunteering. People who do it for a living don't have this luxury. Burn out is much higher among paid staff simply because they have to do it day in and day out.

Is an inexperienced EMT worse than a severely burned out one? How about one who's going through a divorce and hasn't seen their kid in 3 months?


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## Anomalous (Aug 26, 2012)

rescue1 said:


> NREMT standards are the same for paid and volunteer providers...



Dang.  I wanted to sign up for a Volunteer Medic Class.


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## joshrunkle35 (Aug 27, 2012)

I do know that 86% of fire in the US is volunteer. EMS is probably similar. Think about the budget constraints if a lot of those really rural counties went paid. They might run two volunteer trucks, but if they went paid, they may only be able to barely equip one truck. If surrounding areas do the same, there wouldn't be much in the way of mutual aid for the big calls. 

At the end of the day it's about patient care. While you want individuals to have higher standards, if everywhere went paid, there may be places where there isn't even a barely competent person to show up. I'd take a barely competent person over no one any day.


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## rescue1 (Aug 27, 2012)

86% of fire might be volunteer, but that 14% protects 65% of the population. I would guess EMS is even more...probably more like 70%+ of the population. The last two places I lived, fire was volunteer while EMS was paid or mostly paid, so I think paid EMS coverage is more common then paid fire.

However, your points are still valid for rural areas.


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## Bullets (Aug 27, 2012)

rescue1 said:


> 86% of fire might be volunteer, but that 14% protects 65% of the population. I would guess EMS is even more...probably more like 70%+ of the population. The last two places I lived, fire was volunteer while EMS was paid or mostly paid, so I think paid EMS coverage is more common then paid fire.
> 
> However, your points are still valid for rural areas.



I think that is a result of cost as well, cheaper to pay 2 emts than 4 firemen


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## DrParasite (Aug 28, 2012)

Bullets said:


> I think that is a result of cost as well, cheaper to pay 2 emts than 4 firemen


and yet, more places are willing to pay 2 firefighters to come off the engine and staff the ambulance than pay for a separate paid EMS system


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## hogwiley (Aug 28, 2012)

Id love it if my volunteer agency was replaced with a private agency and we got paid for what we do, but the reality is theres no money. Thats basically why volunteer agencys exist in the first place, theres no money in EMS.

With communitys across the country in debt, the situation isnt going to change any time soon either. This is why education standards are so low, not just for EMTs but for Paramedics as well. EMS is just not the type of thing people do for a career, it doesnt pay well enough and the jobs just arent there.

Also, I dont really agree with the notion volunteer EMS are a bunch of poorly trained amateur bumpkins. They went through the same training paid EMTs did and passed the same exams, and are often medical professionals in their day job. We have 8 volunteer EMTs with my agency. Two are RNs, one is an LPN, the other a hospital PCT, and one is a radiology tech. The other two are school teachers. Some of us have more medical training and experience than the EMTs with the local paid service, and even some of the Paramedics.


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## EpiEMS (Aug 28, 2012)

DrParasite said:


> and yet, more places are willing to pay 2 firefighters to come off the engine and staff the ambulance than pay for a separate paid EMS system



Eh, it's really just to justify their bloated budgets. Fire-based EMS is an unfortunate consequence of the fact that you can't touch fire budgets, even though the number of fires is way down (see: http://www.nfpa.org/itemDetail.asp?categoryID=953&itemID=52970&URL=Research/Fire%20statistics/The%20U.S.%20fire%20problem) -- not as a result of more firefighters, but as a result of better fire protection systems and better design. And since firefighters respond to more medical calls than fire calls, well, hell, say the bureaucrats, let's give fire the responsibility of handling EMS. A major mistake, I say.


I've posted this before, but it bears repeating:







This too:






The most effective way to handle medical calls is NOT a firetruck. It's a BLS ambulance and possibly an ALS fly-car. ALS ambulances are a valid, if cost-prohibitive, option.


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## Swimfinn (Aug 28, 2012)

the town i live in used to be all volunteer (this was back when my mom and dad were on it). now, 17 years later, it is a paid volunteer. so i guess you get paid to do inhouse call, regardless if there is a call, and then you get paid if you go out on calls? thats my understanding of how the system works. and we have some real proffessional, down to earth, know what the :censored::censored::censored::censored: they are doing people. and just like every department out there (volunteer or paid) we have our share of :censored::censored::censored::censored:nuts as well. stupid people are out there. paid/volunteer really isnt gonna weed that out. 


also i beleive paid or not you are a healthcare proffessional and therefore should be respected as a proffessional


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## DrParasite (Aug 29, 2012)

hogwiley said:


> Id love it if my volunteer agency was replaced with a private agency and we got paid for what we do, but the reality is theres no money. Thats basically why volunteer agencys exist in the first place, theres no money in EMS.


do you have a paid police department?  how about a paid DPW?  do you have paid garbage men?  do you have paid people who fix the traffic and street lights?  if so, than you can have paid EMS!!!

the reality is, there is no money for EMS because no one has ever allocated funding for EMS.  And since EMS has gone decades with minimal funding allocated to it, municipalities now say there is no funding, because the funding has been allocated elsewhere.  How would you pay people?  cut every other town department's budget by 10%, and give it to EMS.  yes, it's a crunch for everyone else, but EMS needs to be funded, and that will give you the money that isn't there presently.

The other reality is there is no money to be MADE in EMS, if you do the job right, and if you are working in an urban or not rich area.  that means properly staffing, not cutting corners, and only doing 911s.  Many private companies have tried, most have failed, and those that succeed are able to offset their losses by a transport division that makes the profits that the 911 service uses to survive.   the only way to make money as a 911-only service is to be supplemented by tax dollars, just like the two biggest black holes in public safety, the police and fire departments.  And the only way to do that, is for the government to both run and fund the EMS system.


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## EpiEMS (Aug 29, 2012)

DrParasite said:


> And the only way to do that, is for the government to both run and fund the EMS system.



That's not necessarily true, but even as libertarian as I am, I do think that PD, FD, and EMS should be provided by government (or a not-for-profit, at the very least). I don't have a problem, per-se with for-profit EMS, but since it is both a public safety and medical organization, EMS ought to be, in a perfect system, funded as a service like public safety, but operate with the mentality of a medical organization -- evidence based.

Part of the problem, as I say often, is the fire services. They seem to think that it makes more sense to send an engine or ladder truck to an EMS call that doesn't require fire suppression or extrication. That is a fundamental misuse of resources. It's cheaper and more efficacious to send a BLS ambulance (EMT/EMT) with an ALS fly-car (EMT-P/EMT). That gives you three people if you need ALS (one EMT can drive the fly-car back).


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