Volunteers?

[Clare]

I don't know about US but ever since I first stepped foot into the Ambulance Service we have been going through a massive change in clinical development thats cost several million dollars and one of the key aims is to lift the knowledge and skill base of volunteer ambulance officers.

Although Auckland does not use volunteers they are used in almost every other station in the country either paired with a paid officer or as part of a totally volunteer crew.

The new system is basically Paramedic requires Bachelors Degree, Intensive Care Paramedic requires a Graduate Certificate on top of the Degree (or a Masters if you are keen) and volunteers need the Diploma.

Diploma takes about a year from start to finish and covers everything online with various classroom weekends thrown in (I think about 16 all together) plus you must fill in a portfolio showing use of your knowledge and skills and have it signed off plus go through a couple of oral exams, simulation scenarios and a final end of course assessment that takes half a day.

It covers everything from basic first aid right through to the BLS drugs and procedures like LMA, PEEP, GTN, adrenaline, salbutamol, entonox, ondansetron, loratadine et and it is made explicitly clear that this is the minimum requirement, you have two years to complete it from when you join and if you don't or you can't then this is not the place for you.

All the materials are sitting there being used so I don't see why if you are complaining about people not having enough skills or whatever you couldn't do something like this?

 

[Christopher]

All the materials are sitting there being used so I don't see why if you are complaining about people not having enough skills or whatever you couldn't do something like this?

In the US there is no true difference in educational or continuing education standards between paid and volunteer pre-hospital providers. The credentialing requirements are the same regardless of how you get paid.

In North Carolina there is no recognized difference either, all pre-hospital providers must conform to the same State standards in addition to their local standards set by their Medical Director.

The argument that volunteers are not held to the same standard as paid providers is a straw man and patently false (at least in my State). They are being held to the standards imposed by their State, Credentialing agency, and Medical Director, and if these are lacking then there is a problem with the State, Credentialing agency, or the Medical Director.

I believe the only State I'm aware of which has statutory differences in requirements between paid and unpaid providers is New Jersey...or it may just be that their minimums are so low that they are effectively non-existent. I'm not entirely sure.

Basically Clare, this is not an actual issue. I do welcome the changes seen in AU/NZ, and in all likelihood it will not affect the volunteers in my area negatively. Most already are seeking a degree or have a degree (perhaps not in EMS). The issue will be the paid personnel in our area, they will have the most to lose from increased employment standards.

 

[NYMedic828]

Some, not all, volunteer organizations sometimes tend to focus more on department/organization events and parties more than improving upon the services they provide.

What sets volunteer and paid agencies apart is that paid agencies usually focus on their responsibilities and train/practice more. This is obviously not just ems but fire and other disaster response groups as well.

Again, not true for all. But in NY from, it is pretty expected that "extracurricular" activities take the front burner in a large percentage of the volunteer establishments.


My personal volunteer organization shares our area with a paid police based agency. Trouble is for patients is the police charge $1400 for a transport and we charge $0, excluding taxes.

 

[Tigger]

In the US there is no true difference in educational or continuing education standards between paid and volunteer pre-hospital providers. The credentialing requirements are the same regardless of how you get paid.

In North Carolina there is no recognized difference either, all pre-hospital providers must conform to the same State standards in addition to their local standards set by their Medical Director.

The argument that volunteers are not held to the same standard as paid providers is a straw man and patently false (at least in my State). They are being held to the standards imposed by their State, Credentialing agency, and Medical Director, and if these are lacking then there is a problem with the State, Credentialing agency, or the Medical Director.

I believe the only State I'm aware of which has statutory differences in requirements between paid and unpaid providers is New Jersey...or it may just be that their minimums are so low that they are effectively non-existent. I'm not entirely sure.

Basically Clare, this is not an actual issue. I do welcome the changes seen in AU/NZ, and in all likelihood it will not affect the volunteers in my area negatively. Most already are seeking a degree or have a degree (perhaps not in EMS). The issue will be the paid personnel in our area, they will have the most to lose from increased employment standards.

Everything here is correct. It is certainly a strawman to say that volunteers are held to a lower standard.

However, on the whole it seems that there are many more paid providers held to a higher standard than their volunteer counterparts. I think we call agree that the minimum standard of EMS care in this country (again on the whole) is barely adequate. There are however many paid agencies that can ensure they are delivering better care by making it a condition of employment. No doubt there are volunteer agencies that do this too (sounds like your agency is one), but in areas where retention is an issue, it is tougher to ensure that everyone meets something above the minimum standard.

 

[Christopher]

Everything here is correct. It is certainly a strawman to say that volunteers are held to a lower standard.

However, on the whole it seems that there are many more paid providers held to a higher standard than their volunteer counterparts. I think we call agree that the minimum standard of EMS care in this country (again on the whole) is barely adequate. There are however many paid agencies that can ensure they are delivering better care by making it a condition of employment. No doubt there are volunteer agencies that do this too (sounds like your agency is one), but in areas where retention is an issue, it is tougher to ensure that everyone meets something above the minimum standard.

I think my High School's motto was something like, "nobody rises to low expectations".

I don't think you'll find that the standard is higher for paid departments, especially if they're municipal. Just look at DC or LA or any of the larger cities. Hell, Chicago just got 12-Leads! Even podunk volly departments in NC have those.

If you'd like higher standards across the board, just raise the standards.

 

[Veneficus]

I agree that it would be better to replace volunteer agencies with paid providers.

However, rather than rehash reasons why, I would like to point out an important fact.

US EMS is not for the benefit of society. It is for the benefit of the individual.

Unless you are going to mandate (and pay for) universal healthcare, mandating universal EMS and Emergency care id really a bloody dead end.

As we have seen in emergency rooms for decades, mandated, underfunded charity care creates a fiscal nightmare. We have seen long standing charity hospitals close from it. We have seen high caliber teaching hospitals become essentially death traps. We have seen community hospitals go from locally owned and operated establishments to being sold to larger corperations that gut if not abolish nonmoney-making programs like OB.

You can pay your millions of billions to provide ALS EMS to every living soul across the nation. BUt the second they hit the ED and are given temporizing care in the name of efficency and "safety" instead of the (continued) treatment they actually need, you will create an ever growing population reliant on this expensive, inefficent temporizing charity care.

EMS is not public safety. If it was, it would be a mandated right of every citizen, it is not.

EMS is part of the healthcare community and simply changing the way EMS does business without changing the whole community will not have the effect desired.

What I do see as bringing more professionals into the fold is using commmunity paramedicine and public health to demonstrate locally sustainable value above a trasport only service.

It will fall to regional or local governance because federal healthcare spending needs to be sharply reduced. These local areas do not have unlimited deficit spending ability and will require a high level of value for their dollars.

There is more value in a provider who keeps you in your home or gets you to the most economical place than there is a provider who charges well more than a taxi to drive you to the hospital as the only possible outcome for payment.

One of the things not mentioned here is that "professionals" demonstrate value in excess of their cost. That is also very similar to a successful business.

It is not enough to talk about higher standards and all that. Talk is cheap.

Show people the money.

 

[Bullets]

I do. This is my career, not a hobby.

If you poured concrete for a living, would you be upset if a crew of volunteers offered to pour concrete for free, for only the cost of material, to your customers?

Or, if you worked as a plumber and you saw an ad on a a competing plumber's truck that offered to do work on anyone's pipes for free, just because he loved it? Would that be an issue?

It's funny. I don't see volunteer docs in any of the hospitals I frequent. Same with nurses or RTs. Or any other allied health professional. Why should we allow volunteers to negate the worth that we have as professionals? After all, when you give something away, it loses any perceived value.

Cant prevent people fro m doing something for free or for a lower cost. See Handy Men

and then Google Disaster Medical Assistance Team....hint:they are doctors and they volunteer for it

I believe the only State I'm aware of which has statutory differences in requirements between paid and unpaid providers is New Jersey...or it may just be that their minimums are so low that they are effectively non-existent. I'm not entirely sure.

Nope, all EMTs in NJ are trained to the NREMT standard, though some educational sites do have longer courses. Each education site is given the required material they must teach and can add on from that base level.

The difference between paid and volunteer in NJ lies in the licensing of the actual vehicle. Department of Health has a standard by which all billing agencies must adhere to but if you dont bill, its not required. the problem is that as a government agency they have no pull in Trenton, they get walked all over. When dealing with them you must remember their initials are DOH!

 

[NomadicMedic]

Cant prevent people fro m doing something for free or for a lower cost. See Handy Men

and then Google Disaster Medical Assistance Team....hint:they are doctors and they volunteer for it

I have no issue with DMAT or any other DISASTER relief that staffs up with medical professionals who volunteer for a short term deployment. I also don't have issue with a medical professional volunteering for a third world medical mission. Again, these are short usually short term, humanitarian missions. However, I don't think you'll see many volunteer docs working at your local trauma center, which is the point I made.

And I'm not talking about a single handyman who may charge less than a licensed, bonded contractor ... I'm talking about a volunteer. A guy who does the work for free. The work you depend on to feed your family and pay your bills.

 

[Christopher]

And I'm not talking about a single handyman who may charge less than a licensed, bonded contractor ... I'm talking about a volunteer. A guy who does the work for free. The work you depend on to feed your family and pay your bills.

I provide probably 10-15k in free software engineering every year (assuming GE's rate they pay me is what it would be worth to somebody else). Am I keeping somebody else's family from being fed? Only if they're less efficient or provide a lesser service than I am. Again, adapt or die.

Nobody complains when I "bilk" Best Buy's Geek Squad out of thousands of dollars a year in free technical support...how is EMS volunteering any different?

 

[NomadicMedic]

I provide probably 10-15k in free software engineering every year (assuming GE's rate they pay me is what it would be worth to somebody else). Am I keeping somebody else's family from being fed? Only if they're less efficient or provide a lesser service than I am. Again, adapt or die.

Nobody complains when I "bilk" Best Buy's Geek Squad out of thousands of dollars a year in free technical support...how is EMS volunteering any different?

Sure, but what would you say if you boss walked into your office and said to you, "Christopher, we've decided to let all of the paid software engineers go. From now on, we're going to be using volunteers for all of our projects. We've got a great group of guys that write code just because they like to help people out. They're going to work for free, can you believe it? Ha! We can still bill our clients our regular rate, but we don't have to pay these guys anything! We're just going to give them a couple of t-shirts that say "CODE TEAM" on the back..."

...then he hands you a box to put your personal effects in and has security escort you out.

 

[Christopher]

Sure, but what would you say if you boss walked into your office and said to you, "Christopher, we've decided to let all of the paid software engineers go. From now on, we're going to be using volunteers for all of our projects. We've got a great group of guys that write code just because they like to help people out. They're going to work for free, can you believe it? Ha! We can still bill our clients our regular rate, but we don't have to pay these guys anything! We're just going to give them a couple of t-shirts that say "CODE TEAM" on the back..."

...then he hands you a box to put your personal effects in and has security escort you out.

Was waiting for someone to point that out!

Happens all the time in software.

My team is down to ~5 folks because they think it is cheaper to go with other people....err I meant to say "delivers more synergies" or some other thing. But "quality software" is the most important thing if you ask management

Outsourcing. Somebody will quite literally do my work for beans. It's been our reality for at least a decade.

My job has been far more at risk than a paid EMS provider's ever has...and it always will. Currently you can't beam patient care to Islamabad or Monterey (I say currently, because somebody will figure this out).

You either adapt or you will have problems, "feeding your family," as you say. I've adapted and I encourage others to do the same.

That being said, volunteers aren't why we get paid beans. Vene brings up many of the reasons, probably the biggest being how we choose to pay for EMS.

 

[EpiEMS]

That being said, volunteers aren't why we get paid beans. Vene brings up many of the reasons, probably the biggest being how we choose to pay for EMS.

Heck, look at firefighting. The majority of FDs are fully or partially volunteer, but FT FFs aren't hurting for total compensation.

 

[Bullets]

Sure, but what would you say if you boss walked into your office and said to you, "Christopher, we've decided to let all of the paid software engineers go. From now on, we're going to be using volunteers for all of our projects. We've got a great group of guys that write code just because they like to help people out. They're going to work for free, can you believe it? Ha! We can still bill our clients our regular rate, but we don't have to pay these guys anything! We're just going to give them a couple of t-shirts that say "CODE TEAM" on the back..."

...then he hands you a box to put your personal effects in and has security escort you out.

I build houses every year, multiple ones, for free. There are local contractors who dont like it, but thats tough for them.

Happens here all the time, private firm underbids a union and they stand out from of the construction sites and picket.

Volunteers dont "take away" from what i do or how much money i make. I work in a hybrid system with volunteers. Their presence doesnt change a thing. If my boss walked in and told me im fired and being replaced by volunteers, obviously i wasnt doing the job well enough to warrant being kept. That my fault and the constant challenge to prove myself as a exceptional employee

 

[Tigger]

I think my High School's motto was something like, "nobody rises to low expectations".

I don't think you'll find that the standard is higher for paid departments, especially if they're municipal. Just look at DC or LA or any of the larger cities. Hell, Chicago just got 12-Leads! Even podunk volly departments in NC have those.

If you'd like higher standards across the board, just raise the standards.

It's going to take more than calling for the standards to be raised for that to happen. Someone is going to have to do it on their own to show that it is worth raising the standards. We currently have agencies that do that, but many resist on the grounds that doing so would cause a loss of membership.

If the government (state or otherwise) decided that AEMT would be the minimum level needed to practice on an ambulance, I guarantee you that volunteer agencies would protest this much more vocally than paid agencies. The paid place can tell all of its employees to go get a new license or they won't have jobs. Sure they should be helping out with this, but they don't actually have to since for most people a job that brings in less money is better than no job.

Meanwhile, do we think that telling volunteers that they need to get a new license with no help from the agency would go over well? I really do not believe that large number of paid providers would walk away from their jobs if they were required to upgrade, I think most people realize how hard finding a job is so having to invest in one's career is not the end of the world.

 

[Rialaigh]

Heck, look at firefighting. The majority of FDs are fully or partially volunteer, but FT FFs aren't hurting for total compensation.

Just FYI most full time firefighters working a 24 on 48 off schedule (56 hours a week) that I know (small town carolina's) make between 24-30k a year. That is about 11 bucks an hour at the top end....not sure where your from but FF's hurt for compensation much worse than EMS.

But I would also argue that firefighting needs to get rid of volunteers even worse than EMS...

 

[DrParasite]

I believe the only State I'm aware of which has statutory differences in requirements between paid and unpaid providers is New Jersey...or it may just be that their minimums are so low that they are effectively non-existent. I'm not entirely sure.

Are you aware that you have 100% no idea what you are talking about? if not, consider this your friendly notification.

there are 0 statutory differences between paid and unpaid providers in New Jersey. They both have to attend the same EMT program (initially 120 hours, now I think it's up to 160 or 220 hours with the newly updated standards). They both renew their certification the same way. Their continuing education is identical.

In fact, your own state's EMT program is 169 hours, of which 15 of those hours are advanced airway. So without the airway stuff, you only have 154 hours. so who really has low standards?

And I have nothing against volunteers, provided they maintain the same minimum training standards as their paid counterparts, the same response times, and same equipment standards. I have been a volunteer, been a twohatter, been a paid employee, and worked alongside all three. as long as you know what you are doing, and do your job, i could care less if you recieve a paycheck.

 

[DrParasite]

Sure, but what would you say if you boss walked into your office and said to you, "Christopher, we've decided to let all of the paid software engineers go. From now on, we're going to be using volunteers for all of our projects. We've got a great group of guys that write code just because they like to help people out. They're going to work for free, can you believe it? Ha! We can still bill our clients our regular rate, but we don't have to pay these guys anything! We're just going to give them a couple of t-shirts that say "CODE TEAM" on the back..."

...then he hands you a box to put your personal effects in and has security escort you out.

Fair enough. In fact, that's a great argument.

Please cite 1 department where the 100% paid department was replaced with a 100% volunteer one. Not disbanded and merged with a neighbor, but were a 100% volunteer department took the place of the 100% career one. All the guys got pink slips because the unpaid guys were able to do the job better for less.

I bet you can't name 1. I'll wage an adult beverage you can't. Heck, I will wager a full night of drinking next time I am in Delaware that if you can name 1, you can't name 5 departments where this happened. After all, while your argument is valid in theory, in practice I am confident it almost never happened.

Let me also throw this in there: what have you done to show your boss why you shouldn't be replaced by volunteers?

 

[46Young]

Just FYI most full time firefighters working a 24 on 48 off schedule (56 hours a week) that I know (small town carolina's) make between 24-30k a year. That is about 11 bucks an hour at the top end....not sure where your from but FF's hurt for compensation much worse than EMS.

But I would also argue that firefighting needs to get rid of volunteers even worse than EMS...

It's fairly well known that the Southeast doesn't pay well for EMS or fire. I used to work for Charleston County EMS. Cleared crew chiefs (6 months OTJ) made $45k/yr on a 24/48, and local FD's made only $22k-$33k to start, with the same schedule. Many EMS employers have 56 hour schedules, just like fire. When you get out of the Carolinas and into Northern VA, or out west, the FF pay jumps dramatically. I feel that this is due in large part to unionization. It may be true collective bargaining unions, or political unions in right-to-work states (like mine), but I've seen a lot done in our favor since I've been OTJ.

 

[NomadicMedic]

Of course it hasn't happened. But what's to keep the state of Delaware from deciding that they don't want to continue to fund county-based ALS response units. Yes, even though we are a county service we get a significant portion of funding from the state. How about if the Delaware volunteer firefighter Association did some lobbying and all of a sudden it was decided to give ALS and BLS to the volunteer fire departments. "Hey, you guys already have ambulances. Why don't we just put ALS stuff on them."

The volunteer fire service is a strong force to be reckoned with here.

Do I think it's going to happen? No.

Do I think that it's being thought about? All the time.

That's one of the nice things about the Internet, we can disagree.

It is my feeling, my belief, that volunteer EMS providers, those people who perform my job for no compensation reduce the perceived value of our professional occupation. We keep talking about why we don't get paid more, why were not taken seriously as a profession… We lack education, we are seen as blue-collar workers and not medical professionals… Worst of all, there are people that do our job for free. Why buy the cow when the milk is free? The fact that people will continue to volunteer as paramedics damages our ability to ever be taken seriously as a profession and it puts a crimp in our salary negotiations. I'll admit, I like making a decent living. I like the shifts that I work. I'm happy being a paramedic, but I certainly won't do it for free.

 

[Mariemt]

Wow, I am on a volunteer squad with 18 NREMTs and 4 Paramedics.
Of the paramedics, 2 have associate degrees in paramedicine that the State gave a grant for and the other 2. One is and RN that bridged over and then took the NR exam and the other is a BSN who also bridged.

We have training sessions every other meeting.

Our service does bill, not as high as many city services but high enough to have state of the art equipment, ambulances and money to provide ongoing training for us.
we can travel to conferences, take any related classes etc.
my program was actually college credit and spanned over two semesters. It ran almost 250 hours.

We are required to have just as much training as any paid service.