Volunteer EMS needs to become non-existent.

[ffemt8978]

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.

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?

 

[WestMetroMedic]

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.

 

[Jon]

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.

 

[thegreypilgrim]

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).

 

[DrParasite]

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.

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.

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.

 

[Chief Complaint]

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.

 

[rescue1]

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

 

[Chief Complaint]

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.

 

[Jon]

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.

 

[leoemt]

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.

 

[Chief Complaint]

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.

 

[rescue1]

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.

 

[Bullets]

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

 

[Chief Complaint]

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.

 

[DrParasite]

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.

 

[Christopher]

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.

 

[rescue1]

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.

 

[Jon]

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.

 

[Christopher]

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.

 

[webster44]

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.