Do you question those that make your protocols?

[AnthonyM83]

Although I don't mind the idea of driving a little farther for a better working enviroment, I'm sad to say that most of the state has it worse then we do. Leaving the working enviroment would require a larger move then I'm able to do in the next few months. That move is planned next year.

Also, if the job paid more, one could travel farther. There's a fire captain here in LA that commutes by airplane from Arizona (Tuscon, I think?)

[CBEMT]

In all of your statistics you didn't mention how many of those volunteer agencies provide Paramedic level services.

You mean how many of them have paramedics on the truck all the time? None. They don't have to. They just have to provide ALS-level service all the time. Here, there is a difference between "paramedic" and "ALS."

Interestingly enough though, there are more Paramedics responding with volunteer agencies than there are with paid departments. Many of them have full-time jobs out of state, where their P-card matters.

Also, some of the volunteer departments have also gone to a combination system, where they have a handful of paid personnel either during the day or 24/7 that, while also being qualified firefighters should the need arise, are primarily there to make sure the ambulance gets out (99.999% of the paid personnel's duties). Many of these departments have managed to attract paramedics to the paid staff.

Also when I mentioned primary provider, I was speaking about the agency responsible to the "authority having jurisdiction"

I'm not sure how many ways I have to say it, but the volunteer departments of which I speak ARE the "authority having jurisdiction." Their ambulance is the one who shows up when you call 911 in that town. Ok?

In volunteer organizations there is little that can be done to require leaders to have higher certification levels.

As I alluded to before, there's not many paramedics here.... period, paid, volunteer, or otherwise. The only places I know of with medic-level leadership are the two services that actually run 100% paramedic staff.

Considering that most of the remaining agencies don't have much in the way of medics (and the ones that do, the medics have often scored themselves slots on BLS fire companies), I'm not sure it's that important the such an agency's EMS leader be a medic since s/he's not really regulating, QAing, or buying for paramedics.