How are vollys viewed by paid EMT's?

[Level1pedstech]

See, I think your combination department is pretty sweet. It's a great way to blend volunteers and career personnel. However, I think the problem is that you're holding all volunteers to the standard that your combo department does. And the unfortunate fact is there are many areas that have an (all) volunteer agency that is subpar. And many of these areas (I've lived in two) could afford a fully paid or combination EMS service, but don't because the volunteers have always handled it and it saves the municipality money, or because the volunteers get upset at the idea of paid men upsetting the order of things.
And settling for a lesser service because of those reasons is just not OK

Once again the success of a true combination department is dependant upon all staff being held to the same standard. My experience has shown me that the combination model can be a option if everyone is onboard. My experience with the smaller all volunteer department has shown me that we will never be able to get every volunteer to meet the higher standards. Even thinking about having a national standard for volunteers like NREMT has for EMS in my opinion would be a wasted effort. Some people are just not that motivated and for many rural area its next to impossible to get people to volunteer that will strive to meet minimum standards.

The focus is mid to large size departments that are now mostly if not all paid. If these agencies are faced with the loss of career staff I think the combination model could be an option.

My pro volunteer stance does not mean I am pro "whacker". We all want the best trained and the most highly skilled people providing this service. Im realistic and know that many rural agencies will never meet the standar,therefor I have chosen to be an advocate for the combination department.

This volunteer/paid discussion started with the question "how are volunteers viewed by paid EMT's". As usual things get pulled in different directions and we end up with good people making stupid statements. For the most part I think this thread has been constructive and I think the moderators have exercised restraint and allowed us to work past the rough spots.

 

[Level1pedstech]

I belonged to two rural agencies just like you described. The citizens in the one agency (in one county) made a conscious effort to pay for paid ALS ambulances. The other county (next to it) didn't. It shows in the level of service provided and in response times.

Not all rural agencies are created equal.

The paid ALS ambulance option is how my smaller department handeled EMS operations. All fire district personnel were capable of providing BLS,in most cases an EMT would be in district and provide care until our ALS service arrived to provide advanced care and or transport. With extended ETA's due to our very large district,response times ranged from 20 minutes on up to an our or more. Of course life flight was an option if we had a trauma that needed quick removal,weather permitting.

The third party option for ALS and transport works well if a rural community is not able to provide and staff a 24/7/365 ALS or BLS transport. I like the option because it eliminates the administrative nightmare and all operations are managed by the third party. In addition all of the education offered to department staff from BLS/CPR to EMT-B and IV tech was provided at minimal cost by the ALS service. Ongoing education and CE's for recertification was provided by our department.

 

[rescue1]

OK, I see what you're saying, and I agree. My main problem, as I sort of said above, is volunteer agencies that do not provide a reasonable service in an area that could support some form of improvement, whether from higher volunteer standards or from paid staffing.

I heard my EMS chief, when asked about the possibility of keeping a county paramedic in our station 24/7, ask if they and the driver would wait until other volunteers arrived so "they could have a chance to make the call". When the dumbfounded paramedic said no, the chief said he wouldn't do it.

So we had a station that turned down free paid staffing because it meant some people who lived far away couldn't make all the calls...and at the time, it would take (on average) about 8 minutes from dispatch for the ambulance to respond. Since then it's gotten worse, but still no increase in staffing.
That's the sort of thing that turns me off volunteer systems.

 

[Chimpie]

...

I heard my EMS chief, when asked about the possibility of keeping a county paramedic in our station 24/7, ask if they and the driver would wait until other volunteers arrived so "they could have a chance to make the call". When the dumbfounded paramedic said no, the chief said he wouldn't do it.

So we had a station that turned down free paid staffing because it meant some people who lived far away couldn't make all the calls...and at the time, it would take (on average) about 8 minutes from dispatch for the ambulance to respond. Since then it's gotten worse, but still no increase in staffing.
That's the sort of thing that turns me off volunteer systems.

Can you explain these again, maybe in more detail? I'm not understanding.

 

[Level1pedstech]

OK, I see what you're saying, and I agree. My main problem, as I sort of said above, is volunteer agencies that do not provide a reasonable service in an area that could support some form of improvement, whether from higher volunteer standards or from paid staffing.

I heard my EMS chief, when asked about the possibility of keeping a county paramedic in our station 24/7, ask if they and the driver would wait until other volunteers arrived so "they could have a chance to make the call". When the dumbfounded paramedic said no, the chief said he wouldn't do it.

So we had a station that turned down free paid staffing because it meant some people who lived far away couldn't make all the calls...and at the time, it would take (on average) about 8 minutes from dispatch for the ambulance to respond. Since then it's gotten worse, but still no increase in staffing.
That's the sort of thing that turns me off volunteer systems.

Your frustration is shared by all of us who want to see volunteer systems that fuction like paid systems. Like I said its not realistic to think all volunteer services could ever be held to the higher standards. Many of the small all volunteer services just dont have the call volume to justify change. In these rural areas if growth remains steady or even decreases they in all likelihood will continue to operate with what they have. Trying to bring about change in that setting could end up being a waste of time and resources. Focus should be on maintaining service levels for larger agencies that are forced to cut paid staff by implementing the combination model.

Depending on an agencies geographical area less than 8 minutes to get ALS on the road might not be so bad. If its 8 minutes plus another 15 enroute your right at my old departments average for ALS. However if its 8 then another 30 or more enroute your stretching. Of course factors like are there EMT's or other BLS providers on scene that can manage patient care should be considered.

No one in an area serviced by a volunteer agency is expecting or should expect service like you get in large metro areas. My combination departments expectation of service was 5 minutes for first ins and 9 for ALS which I believe is pretty standard.

 

[rescue1]

Can you explain these again, maybe in more detail? I'm not understanding.

Yeah, sure.

The volunteer station is an ambulance service that uses home response, with the exception of a paid driver/EMT on duty from 5a to 5p. ALS is provided by a county chase car coming from about 8 minutes away. The response area is fairly large, maybe 60 square miles, but 60%+ of the calls are in town, which is about 2 square miles. They run about 1,400 calls a year.

Due to the nonavailability of members and distance from the station, the average time from dispatch to response (turnout time) is about 8-9 minutes, with 2-3 minutes of driving time for most in town calls.

There was discussion between a paramedic stopping by after a call and the chief of said department about the possibility of staffing a county paramedic in the station along with the driver to allow for an immediate ALS response. The chief was against this because it meant that the members living 7-8 minutes away would be unable to make the rig and respond.

To me, this is a inexcusable reason to provide less effective patient care, especially since the tax base would easily allow for a staffed 24/7 ALS ambulance in that station.

 

[Chimpie]

Thanks for the clarification.

So you have an EMT staffed at the station between 5-5, but still have to wait for the paramedic to get there before he/she can roll to the call? Of does the medic go directly to the scene?

Does the medic get dispatched to every call or just ALS calls?

How many vehicles do you have at that station?
How many stations does this agency/department have?

 

[Aidey]

Yeah, sure.

The volunteer station is an ambulance service that uses home response, with the exception of a paid driver/EMT on duty from 5a to 5p. ALS is provided by a county chase car coming from about 8 minutes away. The response area is fairly large, maybe 60 square miles, but 60%+ of the calls are in town, which is about 2 square miles. They run about 1,400 calls a year.

Due to the nonavailability of members and distance from the station, the average time from dispatch to response (turnout time) is about 8-9 minutes, with 2-3 minutes of driving time for most in town calls.

There was discussion between a paramedic stopping by after a call and the chief of said department about the possibility of staffing a county paramedic in the station along with the driver to allow for an immediate ALS response. The chief was against this because it meant that the members living 7-8 minutes away would be unable to make the rig and respond.

To me, this is a inexcusable reason to provide less effective patient care, especially since the tax base would easily allow for a staffed 24/7 ALS ambulance in that station.

I've heard this argument too. If a secondary agency is able to respond faster than the primary agency, the primary agency won't respond as much.

 

[rescue1]

Thanks for the clarification.

So you have an EMT staffed at the station between 5-5, but still have to wait for the paramedic to get there before he/she can roll to the call? Of does the medic go directly to the scene?

Does the medic get dispatched to every call or just ALS calls?

How many vehicles do you have at that station?
How many stations does this agency/department have?

The paid EMT must wait until additional volunteers have arrived to fill out the crew. So, at a minimum, he needs one other person to respond. However, SOP states that the crew must hold in quarters until either 3 personnel have arrived or the 8 minute failure mark arrives (when the next due volly ambo will be alerted). The EMT is permitted to respond driver only at the 8 minute mark if no volunteers show (which happens with regularity). When the paid EMT leaves for the day, the same rules apply.
There is one station with 3 ambos and some boats/SUVs.

ALS is a separate entity entirely, dispatched on basically every call because of the high potential for driver-only response from the ambulance. The only calls without an ALS response are lift assist only calls.
They will go directly to the scene in their chase car. They have a station 8 minutes away, and respond in single paramedic units.

 

[rescue1]

I've heard this argument too. If a secondary agency is able to respond faster than the primary agency, the primary agency won't respond as much.

I've heard it a lot, and it can be true. I left the agency I'm describing to go to one a county away. This county had paid ALS ambulances throughout the county, after a several high profile deaths where volunteer ambos failed to respond. Dispatch would therefore dispatch the county medic and the volly ambulance on all calls. Because of this, many volunteer ambulances would only respond on "good" calls like MVCs and arrests, because there was no need for them to respond otherwise with ALS transport responding as well.

Was that good? Maybe not, but I'd rather have the paid ambulances.

 

[Tigger]

For my benefit and those following along would it be possible to get a little insight into your level of experience dealing with rural agencies. More specifically have you ever been associated with an all volunteer agency in a capacity that allowed you insight into the operations aspect of that agency?

When you figure tht one out maybe you could let us who spoon fed you the "citizens choice not to pay" talking point. My guess is you have no idea what your talking about but feel you have enough inight to join a conversation that clearly is above your pay grade. Am I close?

Sure, but it has absolutely no effect on this discussion, especially considering that this discussion extends to areas that are not easily characterized as rural.

See here's the thing, I could care less if you think that this discussion is "above my pay grade." It does not bother me in the slightest that you have no respect for anyone's commentary that doesn't align with yours. I will likely not lose any sleep over being told that I don't know what I am talking about, and I laughed a bit at your poorly worded protestation that I should participate in this discussion which kind of defeats the point of this forum, no?

The ability to look at a problem logically without preexisting prejudices seems to have little merit to you as it seems that you'd rather just call out those who disagree with you with a flurry or emotional and not factually based reasoning. But I digress.

I live in a town with a massive tax base, one that has been proven by the town government to be able to support having paid 24 hour staffing of the town's ambulance or paying for a private company to staff their own ambulance in the town's building. Yet we still have a paid on call ambulance, one that averages an 11+ minute response time in a rural/suburban town of 15 square miles. It's a service that prides itself on town residents being able to give back to the town, and it's are well run with a professional appearance. Yet in several town meetings, the citizens have voted to not allow the funding of a paid EMS system. That's the beauty of town meeting government, you can directly see if a community wants something or not. In this case, the citizens are in fact choosing not to pay for anything besides paid-on-call EMS. It is of course their choice to say that they want an EMS service that has slower response times, delayed access to ALS, and comparatively less experienced providers, but that doesn't make it a good idea.

I do of course understand that this not the case with many places. And as I have said over and over again, there are no doubt places where volunteers are the only answer, be it low call volume or lack of funding. I am not by any stretch of the imagination anti-volunteer, but rather pro-"best delivery of service possible given financial constraints."

 

[ffemt8978]

Play nice

 

[DrParasite]

Yet in several town meetings, the citizens have voted to not allow the funding of a paid EMS system. That's the beauty of town meeting government, you can directly see if a community wants something or not. In this case, the citizens are in fact choosing not to pay for anything besides paid-on-call EMS. It is of course their choice to say that they want an EMS service that has slower response times, delayed access to ALS, and comparatively less experienced providers, but that doesn't make it a good idea.

And there in lies the truth.... despite having the money, the town still doesn't want to properly fund the EMS system.

That doesn't mean volunteers are failing to do the job, but rather the town doesn't want a paid staff. the town is also willing to accept the downsides of having a volunteer ems agency and the financial savings as well.

btw, I know quite a few poor urban areas that have paid staffing 24/7. typically they don't have the proper amount of units to handle the call volume, so they have extended wait times, but they are far from being wealthy communities.

 

[fortsmithman]

Here in the NWT out of 20 or so communities only 7 have EMS and not 1 is ALS all BLS. Of those 7 only 2 are full time our capital city which is fire based or as my trsining officer puts it an ambulance service that does the occassional fire call. and our n2 largest community its a provate and he ****s around his emts so bad that they don't stay around long they end up at pour capital citys EMS. The remaining communities are all volunteer based attached to their volunteer fire departments. With the exception of my town which is a third service. The only time we dont respond to a call is when its on the highway ouside of town when we only have enough memebrs for 1 crew as we cannot leave the town without EMS. The only ALS is our air medevac service.

 

[Level1pedstech]

Sure, but it has absolutely no effect on this discussion, especially considering that this discussion extends to areas that are not easily characterized as rural.

See here's the thing, I could care less if you think that this discussion is "above my pay grade." It does not bother me in the slightest that you have no respect for anyone's commentary that doesn't align with yours. I will likely not lose any sleep over being told that I don't know what I am talking about, and I laughed a bit at your poorly worded protestation that I should participate in this discussion which kind of defeats the point of this forum, no?

The ability to look at a problem logically without preexisting prejudices seems to have little merit to you as it seems that you'd rather just call out those who disagree with you with a flurry or emotional and not factually based reasoning. But I digress.

I live in a town with a massive tax base, one that has been proven by the town government to be able to support having paid 24 hour staffing of the town's ambulance or paying for a private company to staff their own ambulance in the town's building. Yet we still have a paid on call ambulance, one that averages an 11+ minute response time in a rural/suburban town of 15 square miles. It's a service that prides itself on town residents being able to give back to the town, and it's are well run with a professional appearance. Yet in several town meetings, the citizens have voted to not allow the funding of a paid EMS system. That's the beauty of town meeting government, you can directly see if a community wants something or not. In this case, the citizens are in fact choosing not to pay for anything besides paid-on-call EMS. It is of course their choice to say that they want an EMS service that has slower response times, delayed access to ALS, and comparatively less experienced providers, but that doesn't make it a good idea.

I do of course understand that this not the case with many places. And as I have said over and over again, there are no doubt places where volunteers are the only answer, be it low call volume or lack of funding. I am not by any stretch of the imagination anti-volunteer, but rather pro-"best delivery of service possible given financial constraints."

The only disagreement I see is those that are ok with TJ's comment. Like I said he is welcome to his opinion and your welcome to support it. Time to move on and talk about whats important.

From the start of this dicussion I have offered first hand knowledge gained from my association with two very different agencies. No prejudices here,I could find things wrong with both types of agencies and providers. My opinions ond obsevations come from a combined twelve years of experience in fire/EMS,how about yours?

Your town is not the first to turn down a levy or other action that would bring in paid services. Not all communities have the options your town has,for many there simply are no resources available. These communities are the ones I think about when I read comments like TJ's. Once again if your okay with it then I support your right to have that opinion.

As far as how my posts are worded,maybe when your at the end of a six day 80 week your posts might be a little less than outstanding. Guess Im just never going to be a great fit with the "book throwers" and nerds in the group,but then again I always was more of a fire guy. Taking cheap shots is fine,step up to the line and have at it but remember the mods are watching. It might be nice to keep this thread open.

 

[Veneficus]

The enemy to me is not any particular paid agency its the group that advocates or invisions an all paid scenario.

I think this may be a little unfair.

I think the only reasons there is not an all paid system, even in rural areas, is 1. Lack of effective system design
2. Greed.

I will probably be called a socialist for this, but I remember an America where it was not only politically acceptable, but common to help your neighbors in need.

I think that there is a moral obligation to make sure the same consistant level of medical care is available to all.

If that means paying taxes for poor Joe Shmoe down the street, across the state, or across the country, then that is what should be done.

I didn't see people in Iowa or Wisconsin not giving money, goods, and volunteering service in NYC during Sept 11, Hurricane Katrina, or Various California Earthquakes.

Giving a few bucks a day to make sure somebody in Rural America gets effective and consistant EMS seems like a good use of money.

Maybe it doesn't make people feel as good as donating during the big event. But it has been my experience the greatest help is behind the scenes, before a catastophe.

 

[Shishkabob]

Lifting assistance.

People who won't get in my way when I have a job to do (unlike some paid fire departments)

People who I actually enjoy having on my scene as they are eager to help and to learn (unlike some paid fire departments)

People who think they have a more vested interest in the patient than you do simply because they live in the city, as opposed to me, the one who actually not only relies on the job, but on keeping my license.

 

[crashh]

And when the vollies don't respond, and enough people die, maybe your system will consider becoming a real, professional, paid system.

ok, first of all, we ARE a "real" system. We have 3 ALS in our company alone, most of our firefighters are also EMT's. We answer to the same calls you probably do, with the little added funstuff that comes from living in a rural area (chainsaw accidents, etc.), and none EVER go unanswered. We are treating our friends, family, co-workers etc.

Lack of pay does not equate to being unprofessional.

I'm rather surprised at YOUR unprofessionalism. just sayin...

 

[TransportJockey]

ok, first of all, we ARE a "real" system. We have 3 ALS in our company alone, most of our firefighters are also EMT's. We answer to the same calls you probably do, with the little added funstuff that comes from living in a rural area (chainsaw accidents, etc.), and none EVER go unanswered. We are treating our friends, family, co-workers etc.

Lack of pay does not equate to being unprofessional.

I'm rather surprised at YOUR unprofessionalism. just sayin...

First off I'll apologize for the way I said it, but not the message. I had just come off a long shift (almost 30 hours w/ 14 transports, each one being approx 2 hours from start to finish... imagine that, I work in a rural county) where I saw a volunteer rescue (or any volunteers at all) just once. So I was in a nasty mood, but I still think that volunteers that don't respond need to be replaced with a system that DOES respond. I don't care if that's the way it's always been done, or it's tradition. If you have a volunteer agency that doesn't respond, they are helping no one.

So... I actually know all about rural 911. I work for the county transport authority (a private 911 agency in central NM), and get to listen as time after time we have three or four districts called for mutual aid because volunteers decide tehy don't want to answer their calls.
Just because you have a volunteer system that might actually work most of the time, doesn't mean that all of them are like that. More and more of the state of NM is like this, most volly depts I saw in TX were like this and wouldn't respond to anything short of a working structure.

Oh, and I am a volunteer too, as of last week. I'm actually helping get the dept I joined back off the ground. But ya know what? I'm also helping them work out a proposal to get rid of volunteers altogether, since hte majority of them seem like all they want are a badge and a tshirt. I don't care at this point how EMS gets to the patient, (although my preference is paid, third service agencies everywhere, not associated w/ FD) just as long as it DOES get to the patient.

When you have ambulances just sitting at the station because you can't convince any of your volunteers to run because it's not a 'cool call', that's a problem. One that needs to be fixed. Same with the education levels. If your volunteers can't hold themselves to the same standards for education and training that paid services hold their employees to, they don't need to be riding a rescue/bus/ambo/medic unit.

 

[fortsmithman]

Oh, and I am a volunteer too, as of last week. I'm actually helping get the dept I joined back off the ground. But ya know what? I'm also helping them work out a proposal to get rid of volunteers altogether, since hte majority of them seem like all they want are a badge and a tshirt. I don't care at this point how EMS gets to the patient, (although my preference is paid, third service agencies everywhere, not associated w/ FD) just as long as it DOES get to the patient.

When you have ambulances just sitting at the station because you can't convince any of your volunteers to run because it's not a 'cool call', that's a problem. One that needs to be fixed. Same with the education levels. If your volunteers can't hold themselves to the same standards for education and training that paid services hold their employees to, they don't need to be riding a rescue/bus/ambo/medic unit.

My service is volunteer and we respond to every call withing the corporate limits of the town. I have yet to be on a so called cool call. Mostly it's IFT between hospital and nursing homes. As well if the town did convert us to paid full time we would gladly go paid full time. We have corrections officer who will be making less money and other who work in jobs that would pay them more to work EMS. Currently my service has 20 members but with summer vacations and a few of our member who are firefighters with forest management and Parks Canada we are down to 7 members and when we have our weekly changeover and training meetings once a week basically any member who goes is on call My service has 2 BLS units and in the main ambulance is crewed by a minimum of 3 members with 4 going out on average. Our back up ambulance is crewed by 2 members with sometimes 3 going if the primary ambulance is out on a call.
I agree with your statement that if a volly can't or won't commit to the same training levels required of the full time services. When I first joined the main thing was free training. It's the same with volly fire departments they should also train to the extent that paid services do. Because fire and EMS is in the business of saving lives and property. If our training is not up to par with full times services then people will not get the help they need.