Should Volunteer Squads Be Eliminated ?

[JakeEMTP]

"rescue25,"

Or your system could just staff an appropriate amount of Ambulances to cover your EMS call volume, then you wouldn't have "a dilution of Fire suppression resources"; and your patients would recieve adequate and timely access to professional medical care. For more on this see here: http://www.cityofmemphis.org/pdf_forms/assessmentOfEMSS.pdf

Hope this helps,

ACE844

That's what I was getting at Ace. If ALS was dispatched in the first place, the need for an expensive engine, complete with a crew would not be required.

[Ridryder 911]

Actually I do believe volunteerism will be a thing in the past for most communities if they try to continue as they are. Exception will be those you mentioned in frontier and very rural areas. The Explorer posts days will soon be gone as well, due to high liability, HIPPA, and basically people expect to have educated professionals working on them. Yes, we will continue to have posts to promote the work force but actual patient care will be decreased or eliminated.

The geriatric population will place such a demand, it will make it near impossible for the hours required to staff. The role of the EMS provider will soon be shifting from transporting all to triaging those will get to be transported. Many of those in EMS laughed at my prophecies, but so far I have been >90% right.

The number of hospital beds, emergency department beds is in no way co-related to the expected number of patients in the next 5 years. ENA, ACEP etc.. has discussed this but media has not made notice. Of course fear would suddenly occur. It is very doubtful the hospitals will build or be able to keep up the the demand as well. Look at articles American Hospital Association (AHA) has referred to. The insurance companies are quite aware of this dilemma as well.

I suggest everyone that has a real interest in the future of EMS look at this months JEMS magazine. For many years I have prophesied that EMS will be summoned as usual, but treatments that had not been routinely performed in the field after consultation with a physician will be accomplished. Physicians will increase their role in EMS as well to improve and broaden & expand the role of the Paramedic, in more of a mobile health care rather than just EMS. Emergency type patients routinely do not pay...where as medical patients have a higher percentage of re-reimbursement ratio. Insurance companies are quite aware that more be performed in the field rather than paying for an expensive taxi ride, and then the ultimate costs of admission(s) . Again, like it or not; it is simple economics... for example 1 chest pain patient: EMS bill $800.00 .. ER bill $2000-3000. ...ICU/Chest Pain Center to rule out $5-10K .. total roughly $9-10,000 in comparison of 1 EMS with physician that does a XII, lead with bedside enzyme(s), portable U/S ... and an HMO Cardiologist tele-video referral conference... $ 3-5,000... now multiply that time number of cardiac calls a day..... Now, if you were the insurance company what would you do ? If you were Medicare which would you rather pay, as well ?

Think this is to futuristic ?... again read this months JEMS .. televideo from EMS to ER in Phoenix... Doc in the box.. future is not that far away.

So how are the volunteers in metropolitan to compete and up-keep ?.. liability, education, etc.... they won't... the same as nursing years ago with the visiting nurse association or public health nursing.. that performed a lot of volunteer services. The demand became to high, technology became intense, and education more involved, that nursing actually became a profession requiring a college degree.

Again, I don't say get rid of the volunteers, but again change their main emphasis and jobs. Emphasis should be placed in a highly trained first response system to accomodate, the EMS and mobile health care. Their role will be essential to prevent time delay in care and to perform BLS skills. The main difference is that role will not be the sole provider but the initial one.

Ask fellow volunteers if they would mind performing the first 5-10 minute care, rather than be with the patient for the full course, I believe you would be surprised. More people would be attracted, and memberships would not dwell so if there was a decreased in time as well as need to have so many on call. Cities would defintely gain as well with reduction in costs, and increased in city healthcare.

For those who might think I am over zealous with my predictions...look in your community of the population ratio and number of elderly housing/nursing homes now multiply that 5... is your community prepared ?

Be safe,

R/R 911

[mediccjh]

I just want to say, too, that I find it unfortunate that there are a lot of people here that are equating volunteer with:

Because that's how most of them are.

I started as a volly in Eastern PA, in a county where the 911 job numbers are going up and up. I sat at the station whenever I was on duty. By myself, since everyone "responded from home". And you had 10 minutes to get a BLS unit out the door.

Nothing like sitting on scene as a paramedic, waiting for BLS to show up, because you can't transport.

Nothing like going enroute, where BLS is screaming for ALS, where not only you have an extended ETA, but the vollies think it's better to sit on scene and wait for you, as opposed to load and go to the hospital which is 2 BLOCKS AWAY.

Nothing like getting called into the office, since the same vollie crew called and bitched after you tried to turn above situation into a learning moment, telling them diplomatically that once you realize you have a patient require ALS, it's better for the patient if you load and go to the hospital.

Those who say call numbers don't justify a paid crew, there is a simple solution - REGIONALIZE. Drop the f--king egos and work together like a real team. If you're really in it to help people, do what's best.

And on top of that, if you wanna see Volunteers Gone Wild, go to Jersey, where if you're part of the NJFAC, you don't even need an EMT on a volly "squad rig" to go to a job.

[SSG G-man]

Yeah, because that paycheck means we don't care. :roll: You sound like you have a hero complex, last time I checked we were all in EMS on this site; you can put that complex to rest.

Do not need to wear ugly jumpsuit of local VFD to get ego stroked!! I get that by wearing the uniform of the military of the greatest country on earth. The quote that was pulled was in response to a statement that volunteers do this for themselves for ego stroking, not out of wanting to help. I do not understand why volunteer means you care less about the patient than if you collect a paycheck. I guess parents should quit volunteering to coach ;little league, the county could hire a coach. Holy cow, I am keep a paid coach from getting a job. This country has a long history of volunteerism, longer than the history of EMS as we know it.

No one on this site knows me, so I resent the Hero complex thing. I do not even travel to a from work in uniform because there are times when I have not been able to pay for food, or gas, etc. So get off your high horse and just realize that because I realized late i life that I am drawn to EMS, but do not want to give up my current career yet does not me I am unskilled, ego maniacal, an have a hero syndrome. It means I found a calling and I am doing the best thing for my family (current career) and my local citizens. As I stated earlier, I plan on being paid to do this once I retire!

Sarge

[Cookie]

I have followed this thread for a few days before attempting a response. I find it disheartening the attitude some of you folks have towards us volunteers.

I live in Iowa where its not mandatory under state law for townships to provide EMS services, currently, that could change in this next year. It is however mandatory for townships to provide fire services.

The area I live in is very Rural Iowa. We have eight communities, a 511 square mile county, with approx 8,000 population, and one community hospital. With that in mind, townships and communities saw the need for EMS services. The only way we could accomplish any of this was through volunteers. People willing to get the training and education needed to provide EMS services. We have paramedics who have their associate’s degree and are volunteers. Then we have the EMT I’s and B’s. We have no paid units in the county, Ems or Fire. There are no monies from local or state governments to fund a paid unit. So we must go with the volunteer force. Our ambulances and equipment are obtained thru grants, fund raisers and donations. There are EMS funds which pay for some training and education, which much of the time the department pays initially and then is refunded sometime or somewhere down the line or the township must pay for the education out of its measly $7,000 to $10,000 a year budget. Currently we do have two ALS units in the county, we have three units who run B units but are not stand alone units, meaning they are tiered with an Intermediate or Paramedic unit.

Yes we respond from home, most people live within a half mile to a 2 mile radius of the Fire Department, many of our volunteers are Firefighters/EMT P, I’s and B’s. Having training in both fields. And yes we do have some volunteers who are closer to the scene and meet us there, and who are able to give us a better idea of the situation at hand, be it an mva or fire above the initial 911 call.

We do it for the need and for the community in which we live. I do not find it heroic in any sense of the word or measure. I find nothing heroic in going out in the middle of a snowstorm to cut someone idiot out of a car off the interstate because he or she could not slow down or use common sense when traveling in inclement weather. I find nothing heroic in trying to save the life of someone who is burned by the anhydrous ammonia he stole for his meth lab. I definitely do not do it to get my “ego stroked”.

Many of you folks live in densely populated areas where you have a tax base in which you are able to have paid public EMS units, or from the private sector Ambulances. And in which case you have had unfortunate experiences with the volley’s as you call them, or just have an attitude that anything you do your going to get paid for it.

So if your in Iowa and have an accident or illness, make absolutely sure you in a large metro area with paid units, and not some Volley unit that cares for the patient and not the paycheck.

[rescue25]

That's what I was getting at Ace. If ALS was dispatched in the first place, the need for an expensive engine, complete with a crew would not be required.

An ALS ambulance is always simultaneously dispatched along with the engine. It's just that the engine has a higher chance of being closer to the call. As I said before, I hope this practice dwindles with the increase in the number of ALS ambulances in the county, but this is the way it's done now. Probably because it helps justify the fire department's budget. Not saying I think it's all that efficient or the best way to do things, but I don't think this setup is terribly uncommon, either.

[nsmedic393]

What rid described earlier is exactly how we do things in my area. We have a provincial ambulance systems and volunteer fire departments. While we don't have an ambulance in each east rubber boot or west podunk town it means that when an ambulance arrives they get a quality crew, usually ALS working with a quality rig and quality gear and a quality QA program.

Since there are alot more fire departments than ambulance bases fire departments run MFR services. They work under protocols similar to EMT-B protocols, they arrive first on the scene and treat the patient until the ambulance arrives. This could be 5mins to 45minutes depending on the area. They do not transport. They have requirements for maintaining their MFR tags and we hold monthly training nights where we give an hour long lecture and then do two hours of skills stations.

If anyone whould like here are the links for the provincial ambulance service

Emergancy Health Services Nova Scotia

and the MFR program

Medical First Response Nova Scotia

[Nate]

Do not need to wear ugly jumpsuit of local VFD to get ego stroked!! I get that by wearing the uniform of the military of the greatest country on earth.

Sarge

Do you want me to give you a cookie or something? Come on, where is the fun in razzing you if you take it serious?

[weasel 108]

I'm finding ( in my area that I live)that there are some paid EMT's and some paramedics that volunteer on the side.Why are they vollying? We complain that we do not get paid well for the service we provide, that EMS needs to be looked at as a medical profession with respect,and that the vollies are taking our jobs,but these same people (who are correct about pay,and medical profession )go and volunteer at other EMS units with paid crews. I think my opinion is that as long as career EMS personnel keep vollying we will never get the things we want.

[SSG G-man]

Do you want me to give you a cookie or something? Come on, where is the fun in razzing you if you take it serious?

What kind of cookie? Girl Scout Thin Mint? Duncan Hines Soft Batch? Sorry, people tell me I need to lighten up.