Volunteerism in Rural EMS

[Rescue0ne]

First, Let me introduce myself. I'm 32 years old, a career Paramedic, and currently an EMS Administrator.

EMS as a recognized profession? I'm all for it. Should all volunteer EMS providers burn in hell? Of course not. Yet I feel some think otherwise.

I'm not saying our county is different than all the others, and that we have a unique situation. I'm sure it's been there, done that plenty of times. However, do not casually cast our situation in with others, without knowing the specifics.

I have the utmost respect for the majority of the members of EMT City. I agree with you on so many issues.

For some to say that my community is hurt by our EMS providers being volunteers, is an unqualified statement to say the least.

Another member states:

Not only just the money issue, but volleys are held to a lower standard of education *prepares to be attacked*. Ya Ya argue all you want, I am sure "your" dept. is different.

I am surrounded by volleys, great people... poor professionals. We just started getting paid decent on-call wages in our EMS system so we can attract people to our remote area instead of forcing locals to be volunteers or our ambulances will be pulled. Fire should take notes.

Lower standard of education? I'm not going to get into Canadian edu requirements. Virginia paramedics are, at this time, not required to obtain 2/4 years degrees. Many do get the 2 years AS degree, that's just because it comes with the certificate.

Virginia paramedics are educated, yes I said EDUCATED, to the standards of the NREMT Paramedic (and usually beyond those standards). You can debate those standards all you want. I'd be more than happy to go with Dust, ASYSN2, and all the others, and obtain a BS, or even a Masters in Prehospital Emergency Care. The problem is that they currently do not exist.

In lieu of proper edu, there is training...however at the paramedic level, it's more edu than training. Anyway...the EMS Alliance that governs the area that our Squad is located in is, in my opinion, the best in the state. Our EMT-P's and CCEMT-Ps are not slacking in any area. The OMD for our Squad, and many others, is a top-notch Emergency Dept. Physician, in addition to being a paramedic.

It's mighty easy to toss insults and throw jabs. I'd love to get some of you in here to work with us sometime, and I don't just mean the volunteer squad either.

What I'm currently in the middle of is reality. Reality is a certain Paramedic trying to sabotage rescue calls. Reality is dealing with the State EMS Office, and explaining that, "No Ma'am. We have NOT dropped over 30 EMS calls in the last 6 months. That ANONYMOUS letter you received WAS in error. No Ma'am, I'm not positiive who the author of that blatant lie is, but I have a pretty good idea." Note: Paramedic in question is a career medic with a metro FD nearby. He is also a medic with our vol. agency. :x

I'm all for EMTs and Paramedics earning a decent living wage. When the time comes for our county to go career, I'll be the first one lobbying for at at the county "board of supervisors" meeting. Right now isn't the time.

[Asysin2leads]

Rescue, here's the thing. I feel for your situation. I'm sure your department is top notch. It sounds well put together and well run. I myself have many times said that rural areas can utilize volunteers well in areas with low income levels and high coverage areas.

However, I, and the others you speak of, have seen the ugly side of volunteering and do not pull any punches about it. Typically speaking, volunteer EMS attracts many of the wrong people, into doing the wrong things for the wrong reason. For every volunteer service out there who provides professional level service, there are 10 others that the term hit and miss is far from appropriate.

So, when someone comes along stating "Fighting to keep it volunteer!", you'll have to excuse it when people assume its yet another starry eyed hero with a star of life T-shirt, three missing teeth and a couple of tattoos, which unfortunately, compromise a good bulk of volunteer services today.

[hfdff422]

The problem with fighting to keep it volunteer is that at some point down the road you will look around and realize you cannot keep up (due to any of the 100 issues related to 100% volunteer organizations) regardless of professionalism or good intentions. That day will come and you will be too far behind to catch up before the public is hurt by it.

[ladyfirefighter36]

Yes, sometimes volunteer agencies to attract the wrong kind of people. Unfortunately, I know some paid services that also attract the wrong kind of people. Some try very hard to keep up a good reputation, and they are able to do that. But, yes, volunteers take a bad wrap because of some of those "back woods idiots" that love to make it known that they are a volunteer.

Training and education should be foremost whether you are a volunteer or paid ems person. There should be high standards of care for all patients regardless of where they live. Regardless of whether you volunteer or get paid, you should put your best effort in providing excellent patient care. You should keep yourself well trained. We need to respect each other's decision as to whether to volunteer or make it a career. Unfortunately I know some paid personnel that I wouldn't want to treat my family.

[AZCEP]

It would seem the problem is one of generalizing the information to fit everyone with a title.

Some volunteer services are quite valuable, some are a significant drain of resources. The same can obviously be said of career departments as well. I doubt this is the direction you might be looking, but why should your county government pursue the securing of a career department for the provision of EMS while there is still the view that volunteers can mangage the situation? I'm sure they are quite capable, but wouldn't a paid department be able to better support their employees?

This discussion turns quite emotional very quickly. This is not my intention with my questions. I just want to look at the situation as objectively as possible.

[Rescue0ne]

So, when someone comes along stating "Fighting to keep it volunteer!", you'll have to excuse it when people assume its yet another starry eyed hero with a star of life T-shirt, three missing teeth and a couple of tattoos, which unfortunately, compromise a good bulk of volunteer services today.

Well, I've no tattoos to speak of, and managed to retain all of my teeth...so far. I think I'm doing pretty well. Seriously though, I understand exactly where you're coming from. All too often, it all revolves around the individual volunteer, instead of the patient population.

I'll share something with you really quick. Last year, I was tasked to take a county with 6 volunteer EMS agencies, and combine them into one funtional system, under the leadership of a single chief officer, and his staff. You can well imagine the redneck response I was met with by several of those squads. Alot of territorial BS, posturing, and puffed up chests. One agency even forgot to mention their concern for their community, amidst all the other reasons they didn't want this "assimilation" to take place. It was obvious they were in it for themselves, and no one else. I'll mention also, that not one provider in that whole 34 person squad was above the level of EMT-Basic. Reason? None of them wanted anyone else to rise to a level of training & education above their own, so they kept everyone else, as well as their service to their community, in the crapper. My recommendations to the county reflected these concerns, as well.

Sidenote: The above example happens to be the county I actually reside in, myself. The county I speak of in the other posts is my "home" county, where I grew up. That's where I volunteer, not where I live. (About 3 hours away. I just now returned from there, after spending all day today, and half of yesterday working with their BOD, in order to find a solution to their manpower problems.)

My solution to this is...you might want to sit down for this...career EMS providers.

WHAT?!?!?! What'd that arsehole say? What happened to FIGHTING TO KEEP IT VOLUNTEER!?!?

See, I need to qualify that statement. I should have been more forthcoming in my reasons for saying this. I didn't mean NO PAID EMS whatsoever...I meant NO PAID EMS being provided thru a contract by that one particular self-serving, nepotistic paramedic, and his paragod arsehole buddies. Additionally, I found out today that our OMD wouldn't let his buddies operate in our county to begin with...the only reason that 1 medic is able to do so, is because, remember, he's also a provider with our squad (although he only served on 19 calls last year...where other medics served on 300 - 400 calls each.) Yet, this guy knows what's best for our county? Self-serving Arse, imho.

Here's the outline so far:

The shift is 0600 - 1800 hrs, 5 days per week.

Two (2) ALS ambulances staffed by an EMT-B/Driver, and an EMT-I or EMT-P (Preferably P)

One (1) ALS Zone Car (quick response vehicle), staffed by the Duty Officer (Paramedic), who is also a career provider. During the 12 hour shift, this officer has authority over all EMS/Rescue operations, career AND volunteer.

Volunteer staffing back up the career staff during the day, and will assume first due responsibilities during the hours of 1800 - 0600, as well as weekend staffing, 24 hours.

This proposal is, of course, our first rough draft. There will be others.

As you can tell from previous posts, I've no issues with the level of care, and/or education & training of our medic level providers. They are fantastic. The issue with our squad is manpower/staffing. Additionally, no one at the squad ever really took up the recruitment/retention flag. It shows. What we're left with is a bunch of really talented BLS & ALS folks...and the rest are crap (as in, the crap several of you mentioned that always manages to crop up everywhere).

My favorite is the squad member, not yet an EMT-B and not yet off of probationary status, who took it upon himself to buy a leather belt with the squads name & logo on it, where you could see it from the rear while he was wearing it, in addition to one of those bomber-style satin jackets, with the squad logo, and his name, silkscreened across the back of it. Care to guess how long he lasted?

Didn't even make it through EMT class. "It was just too hard" :-({|=

I'm going to bed. Be safe.

[NREMT-Basic]

Im going to fall back on statements I have made time and time again. There is NO direct link between the ability of EMS providers at any level to offer the best level of pre-hospital care and their status as either volunteer or career providers. Some of the best medics I have ever met are vollys. If anyone can show me an article from JEMS or the like demonstrating that across the board volly EMS providers of any level have been PROVEN to be poorly trained, less qualified, etc I would love to see such information. My belief is that these statistics dont exist. I had my life saved by volunteer responders after an MVA in New Mexico..volunteers from a Native American/Reservation based service and I have to say that it was some of the best medical care I have ever received under any circumstances. I have run calls with both volly and so-called "career" services and have found that the same problem exists in both: individuals who are poor providers, not entire services. I recently watched a medic from a career service try to start an IV line 4 times and blow out the vein each time until he gave up, so apparently the skill level is not a 1 to 1 correlation with whether or not the providers on a given service are paid or not. Whats next? The argument that the career services that pay more are better than those that pay less. Its simply not true and there are not facts that Im aware of to back it up. This is an age old argument and not one likely to be solved in an internet forum. But lets start basing our assertions on fact and not anecdotal evidence. That is all.

[AZCEP]

Unless you study every provider, from every service, everywhere, you will never have a truly accurate picture of how each individual system works.

My assertion is, quite simply, if the dedicated volunteer is able to perform at the highest level without the support of a paycheck from a dedicated service, why would they be any less so from a career department that would allow them to have some off time?

Many volunteers a quite capable, and I won't argue that point. The suggestion that it is the best method to provide the service is where my question lies. If it is good to have providers that will respond from home or work in 5-10(or more) minutes, how would it be worse to have them within 1-2 minutes of a response unit?

[Asysin2leads]

First:

I recently watched a medic from a career service try to start an IV line 4 times and blow out the vein each time until he gave up, so apparently the skill level is not a 1 to 1 correlation with whether or not the providers on a given service are paid or not.

THEN:

But lets start basing our assertions on fact and not anecdotal evidence. That is all.

Hate to break it to you Basic, but you just made an assertion based on anecdotal evidence, and not fact. Isn't it ironic, don't you think?

[Rescue0ne]

Off Topic...but Asysin2, who in blazes is that guy on your avatar. I can't place him to save my life, but he looks really familiar. At first, I thought Reagan...but no. Then I thought possibly a singer, like Tony Bennett, or something.