Should Volunteer Squads Be Eliminated ?

[Ridryder 911]

How long is too long to wait for an Ambulance? Ideally 4- 6 minutes, rural 10 minutes: realistic in rural areas sometimes up 30 minutes.

How far is too far for populations to be from an Ambulance? Any population that has an established community that can show that run volume of 3 calls a day, can pat for a unit. So any population over 1000 in general area

How far is too far for populations to be from a receiving hospital with a certified ER? Certified .. hmm we don't certify ER's here. They have trauma level ratings..but that is all. In metro areas there does not need to be an abundance of Level I Trauma Centers, research & studies has shown not much outcome between Level II and I for the amount of money. I just wished to see ER trained physicians in most communities. Most non- metro areas get what physicians they can get.. usually family practice.

This is not a paid/volunteer question, it applies to every location in the United States. Obviously, in some cities, people wait a long time due to lack of units, caused by "bull Ca Ca" runs. I remember going through a list the whole shift, in a fairly large city, people were on there for hours... everyone. There was no specific order, except cardiac and pediatric patients held priority.

What can be done to free up units from BS calls? Better medical control to consult with. Allow certain Paramedics (i.e. Field Supv.) some creditability to contact & get approval not to transport. Deemed non-life threatening, no need for stretcher transport .. call a taxi

What can be done to prevent patients from being put on waiting lists, excluding times of disaster? Wait list... ?.. Level 0 with no units, we have the field supervisor to respond for assessment until transport truck available or a local squad will maintain until EMS arrives.

Be safe,

R/R 911

[bandaidpatrol]

Unsure what you mean by this. A waiting list for Emergency Care & Transportation to an appropriate Medical Facility?

Not enough ambulances to cover emergency calls, some people have to wait till a unit clears. IMO, for every day operations, no disasters-natural or man made, placing people on waiting lists for ambulances is unacceptable. We called this "Dispatchers Diagnosis", or placing priority with minimal information. The most calls our service ever had "on hold" was 29. Those were the days when people began to use the ambulance as a Taxi.

[zippyRN]

I am not precisely sure what you are trying to say- I think you are trying to get at the township is not an adequate entity to fund services. In many cases that is true, in others it is almost too big.

mno where is 'too big' is the lOndon Ambulance service 'too big' covering a resident population of somethign like 8 million plus the commuter and toursit populatiosn of London?

answering 3- 4 thousand calls a DAY ?

Depends on the area. Where we are at, we are along a transition line (for now, it is growing fast). 10 miles east is basically Indianapolis, 10 miles west is almost purely farm land. There are too many operational municipalities within our county who do too good of a job to hand over their power to the county. Not to mention the county is about the most worthless entity we have.

note i said UK adminstrative county , rather than just 'county' i get the impression the uk concept of county isn't really all that recognsiable in US public adminstration, which has locality adminstrations ( individual settlements or small groups - like a UK district/ town / city council) and the State adminstration ( compares to Uk region but Uk regions have little or no power unless its' Scotland, Wales or Norn Iron)

There are only 35 road deputies for our county and the commisioners don't have a clue why they want more deputies to cover the 420 square miles and 120,000 people.

plus locality police, state police and a variety of federal agents ...

Townships are adequate in our area, as they grow they can afford the needs of the growing population. But for the next county over, it would be more difficult to not depend on some volunteer services, especially as a first response- regardless of whether or not the county would be the primary funding entity as there are too many miles to cover with too few people to justify enough ambulances to be within a 5 minute response.

volunteer FRs aren't a bad idea, in factt hey are a good idea as outside a US city with it's large number of small fire stations it's theonly way unless US model SSM is the way to go ( cue bad back claims from sitting i nthe Ambi all day) - the only full SSM service i nthe Uk uses small fixed bases at the vast majority of standby locations

[zippyRN]

Perhaps we should also focus on the lack of EMS in many places.

Opinions please:

Given what we know, as far as how long it takes for emergencies to go from serious to critical to dead, heart attack, CVA's, cardio-pulmonary arrest, seizures, car accident victims, etc.

How long is too long to wait for an Ambulance?

5 minutes is too long to wait for an FR

need to have Intermediate / paramedic support to FR within 10 minutes

15 -20 minutes for the ambulance assuming transport is required emergently , otherwise within the time fram the Paramedic responder deems clinically approrpaite

How far is too far for populations to be from an Ambulance?

How far is too far for populations to be from a receiving hospital with a certified ER?

30 minutes ? assuming robust first response and if necessary advanced ( more than paramedic) provider to scene systems are in place

This is not a paid/volunteer question, it applies to every location in the United States. Obviously, in some cities, people wait a long time due to lack of units, caused by "bull Ca Ca" runs. I remember going through a list the whole shift, in a fairly large city, people were on there for hours... everyone. There was no specific order, except cardiac and pediatric patients held priority.

What can be done to free up units from BS calls?

train / educate Paramedics on response vehicles to such a levle that they can deny transport to cases which don't need it and can give longer time frames ( i.e. collect witihn 2 hours)/ reduced skill level ( BLS Only or event Transport ambulance only) requirements for transport rather than assuming everything requires an ALS transport

What can be done to prevent patients from being put on waiting lists, excluding times of disaster?

Opinions only, please.

see above - there is no need to feel that a waitign list of none emergent transports is a porlbem unless you are puttign patients who need emergent transport on the list ( other than between arrival of FR or ambulance service responder and next available transporting unit)

[cdemt5710]

As long as we have volunteers that make up a great portion of this job, it will never be considered a profession. It can't be. Volunteers are the death of this profession.. it has been seen and proven.

We could put the shoe on the other foot and say that Paid services are the death of volunteerism and are creating a situation where all us dedicated volunteers are losing opportnities to keep our skills up in a profession where we have also paid out of pocket for our training and spend many hours getting CE credits above and beyond our 40 hr/week jobs.. whew..All a matter of perspective, isn't it... :wink:

As a volunteer I can't be the death of this profession.... it is going to continue to grow at its own pace. Consider the age of EMS as a profession in this country. (And I am referring to volunteer and paid EMTs and Medics as professionals. Whether you are paid or not does not make you a professional.... we've all seen this.) This topic reminds me of my teenagers when they were new drivers. The impatience, the eagerness, the frustration. The unavailbaility of the car was the source of much consternation. What about ditching the blame game. EMS is evolving. Rural departments, such as mine, rely on volunteers due to low call volume. (We cannot afford to staff the station for 5-8 calls/ per week, with many being non-transports or good intent calls etc. etc.) Response times are long, due to the Sq. Mi. we cover. Our town is accepting that they have to pay us something, so we will be paid per call. Maybe that would be the next step for these larger services, which would make the transition to being a paid service more palatable. Early on someone mentioned Grants. There are monies out there to help services take that next step. What I see is an evolution. We will all eventually be paid in areas where the tax base is able to provide the monies. And certainly no volunteer service should keep their heads in the sand about this. That there is such divisiveness between paid EMS and volunteers is a real shame because we are all doing the same job. We all get up out of our nice warm beds to help people we may or may not know. Hopefully we all do this with respect and some compassion. I am very fortunate here in my neck of the woods. We work with many paid departments. Most of the members of those departments volunteer in their own towns. We work together on mutual aid calls. We are members of the same association and we respect each other's work because we have an understanding of the challenges we all face. That is probably the key. Trying to see the other person's point of view. (Kinda like being back in KG and learning how to get along with all the other little kids...)

[Dustdevil]

We could put the shoe on the other foot and say that Paid services are the death of volunteerism and are creating a situation where all us dedicated volunteers are losing opportnities to keep our skills up in a profession where we have also paid out of pocket for our training and spend many hours getting CE credits above and beyond our 40 hr/week jobs.. whew..All a matter of perspective, isn't it...

Uhhh... no. Not at all. :?

You're comparing a hobby to a profession. Totally invalid.

[Nate]

Uhhh... no. Not at all. :?

You're comparing a hobby to a profession. Totally invalid.

Your right, I don't see it as a matter of perspective. What I see is a bunch of people wanting to "play" while I drive 30 miles to the other side of Houston to work for a paid service becasue the one around my house is volunteer based.

[Rescue0ne]

As long as we have volunteers that make up a great portion of this job, it will never be considered a profession. It can't be. Volunteers are the death of this profession.. it has been seen and proven.

ECC: 5710, that would be a negative. Please disregard & mark up as returned & in service.

I'm assuming this is an original statement from cdemt5710? It wasn't shown as quoted, only italicized.

Emergency Medical Services IS a profession. Unless someone almighty decrees that it's not allowed to be, then it will always be so.

Volunteers aren't the death of the EMS profession.

Volunteers don't do transfers...at least not in my area. That's absurd.

Say this with me, "Volunteer EMS Agencies answer 911 calls."

If you work for a career EMS agency, and both your career agency & your local volunteer agency both answer 911 calls...what are the options?

It seems pretty cut & dry from my end. Possibly, it isn't like this in your locality. If I'm off-base with this, by all means, let me know.

Uhhh... no. Not at all. :?

You're comparing a hobby to a profession. Totally invalid.

Well...

I'm a life-long volunteer, and also career EMS.

When I'm wearing my volunteer hat...spending $$ and time for EMS education is out of MY pocket. No one made me do it. I do it because I want to. If a career/paid system is put into place, and is able to provide patient care at the same level, or better, as the volunteer agency...you know what I'd do? I'd try to get a job with that agency. Not piss & moan about my woes.

Don't get me wrong, volunteer EMS is an awesome thing. If it works in your area, and works well, in all aspects...there's no reason to go paid/career. There are those among us who will hate on Volunteer EMS for the rest of their lives, for whatever reasons. Just overlook these people.

If you're of the mind that you should get paid for EMS services, then start your own ambulance service, or apply somewhere that does pay. Don't campaign to shut down a perfectly good, well-oiled machine.

and one last thing...

Dust...for crying out loud. Volunteer EMS is NOT a hobby! Stamp collecting is a hobby. RC Aviation is a hobby. Helping your fellow man in their time of need is not a hobby, in my book. Its an advocation. It's a calling. Just because one doesn't receive a paycheck/direct deposit, does not make them a hobbyist!

That's my $1.99...spend it well.

[Dustdevil]

Dust...for crying out loud. Volunteer EMS is NOT a hobby! Stamp collecting is a hobby. RC Aviation is a hobby. Helping your fellow man in their time of need is not a hobby, in my book. Its an advocation. It's a calling. Just because one doesn't receive a paycheck/direct deposit, does not make them a hobbyist!

The posts in this thread and others on this board say you are wrong. When the vast majority of those volunteers say things like, "I don't have time for all that education or CE," or "I can't afford to go to school or get CE's because I have to work my PROFESSION to feed my family," or "I can't get all that practice that professionals get because I have a job and a family," it is clear beyond a shadow of a doubt that they are hobbyists and not professionals. There is simply no way around that fact except through spin.

Are there professional volunteers out there? Sure. They would be the ones who actually work professionally in EMS and volunteer on the side. Scabs.

Volunteers aren't the death of the EMS profession.

Volunteers don't do transfers...at least not in my area. That's absurd.

More spin. EMS doesn't do transfers either. Without E and M, you don't have EMS. Just an ambulance service.

If volunteers were truly interested in helping people (as they all say they do, which is a big lie) they would run transfers too. But no. That would be a job. They aren't interested in a job. Just a hobby.

Point proven.

[SSG G-man]

I hope I can get this to post this time!!

Volunteer=hobby according to Dust.

So, Paramedic who works for paid department losses his profession when he comes and volunteers? So a doctor who Volunteers with a clinic or Dr's with out Borders is no longer a professional, he is a hobbyist?

IT is how you do your job that determines if you are a professional.

I am a volunteer. I went to EMS Today, how many of you "professionals" were there?

I could make arguments, but I am too tired to defend them right now. See, I have two professions, I am a Soldier and I am a Volunteer EMT. And they keep me busy, along with my third and forth professions, Husband and Father. Oh, I volunteered to be a husband and Father, so those are not professions. I am just a hobbyist. I just get SO sick of this discussion that because I am volunteering until: A) I retire from the military and can do this full time and paid crews take over our county (they have some and they are slowly integrating throughout the county That I am worthless and just having a hobby. I would be willing to bet I study protocols, read related publications, etc more than a lot of the paid folks out there.

Hell, it seems like a lot of Volunteers care enough to come to this site and read and interact in an effort to be better!!

Sarge, out!