Volunteerism in Rural EMS

[alpha23958]

de·bate (dĭ-bāt')

v., -bat·ed, -bat·ing, -bates.

v.intr.

1. To consider something; deliberate.

2. To engage in argument by discussing opposing points.

3. To engage in a formal discussion or argument. See synonyms at discuss.

4. Obsolete. To fight or quarrel.

v.tr.

1. To deliberate on; consider.

2. To dispute or argue about.

3. To discuss or argue (a question, for example) formally.

4. Obsolete. To fight or argue for or over.

n.

1. A discussion involving opposing points; an argument.

2. Deliberation; consideration: passed the motion with little debate.

3. A formal contest of argumentation in which two opposing teams defend and attack a given proposition.

4. Obsolete. Conflict; strife.

[Rescue0ne]

Dustdevil, who says volunteers are cheapening our services and our image?Is that your opinion? Do you speak for some organization? You don't speak for me. The rhetorical dissertations you create are meant to impress who? I can't believe you typed that crap. Do you believe it? Maybe a smart guy like yourself needs to reevaluate things. Certainly an educated person such as yourself is intelligent enough to find gainful employment elsewhere. The passive-aggressive responses are great. Try getting real.

Shayne

Daaaayum. Dust got to him more than he did me, originally

I had a whole litany ready to copy/paste here, but decided against it. Dust does a fine job of getting his point across on his own.

Look at it this way, though. Take a registered nurse. He/she didn't go thru 4-6 years of college to give away their services at no charge. They did it so they can earn a decent to comfortable living. Sure, they also might volunteer at the free clinic, maybe. That's in ADDITION to their career . Not in place of it.

Dust and I don't always agree, but I see exactly where he's coming from, and imho, he (and many others here) are correct in that "why should a county/city pay for EMS, when a volunteer organization will do it for free?".

Take the Richmond, Virginia Metropolitan Area, for example. Richmond Ambulance Authority is a joke. Staffed & managed by AMR. There's so many volunteer agencies in that area, there's no real need for the surrounding 4 or 5 counties, or the city for that matter, to pay Medics a living wage. Chesterfield County Fire Dept. Medics staff some of the volunteer squads, due to manpower issues. Henrico County has FireMedics as well. There's no REAL EMS. By REAL, I mean a free-standing municipal agency dedicated to Emergency Medical Services. Why should there be? Volunteer Rescue & the Paid Fire Dept's make it unnecessary. Sure, it may work out well for the city and county...but then why would someone then want to be a paramedic in that area? They'll have to travel a much longer distance to earn a living wage. It's about supply and demand. If there's no demand, then I can't supply it. I WANT to supply it, but I can't, because volunteers are "in the way". Not meant as a slight against volunteers, btw.

Their whole shpiel is about Pre-Hospital Emergency Medicine being recognized as a bonafide profession. To be taken seriously as a profession by the world, I can see their point about volunteers making it that much harder to achieve. "When someones doing it for free, is it a profession, or a hobby?"

FYI: When I do place myself in service as a volunteer, it's usually to fill a gap left open on a volunteer ambulance crew, due to manpower issues, or the volunteer provider not being able to fill their commitment for that shift. I do it so the patient that might need an ambulance will receive one in a timely manner. I know it's not helping EMS as a profession, so to speak, but it's helping make sure that that patient receives care in a timely manner...should someone need it that day. My wife encourages me to do so, occasionally. She'd sure have something to say about it, though, if I did it all the time.

I'm not in it for the cameraderie, or the need to feel like I belong. I don't hang out at the station when I'm not on duty, shooting the proverbial shiot with the "guys". I do it because I can earn a living wage (actually better than that), and provide for my family while doing something that I love. Helping people.

I'm not anti-volunteer...I still do it on occasion. I'm a career EMS provider, first & foremost. My family comes first, which means my paycheck comes first, as far as EMS is concerned.

Oops, looks like I litanized, anyways. Sorrrry :wink:

[Just Plain Ruff]

Forgive this if it's rambling but this is coming from someone who has a severe migraine, can't get to sleep and has taken 2 pain pills that are pretty powerful so disclaimer *If this makes some people mad, or skeptical of me or causes them to question what a strong narcotic can do to someone* I apologize. I may be totally off base and out of my skull but here goes.

I believe that Volunteers serve a valuable service in a community but I hesitate to say that if the only EMS that a community gets is volunteer. Let me clarify my response

I am in agreement that if we give something away for free then there will be no impetous to better yourself. There is no desire by the community to get something better when they will have to pay for it. If there are people(good people) out there that provide their services for free, then communities seldom want to turn around and pay for it.

Doctors do not work for free

Teachers don't work for free

Nurses don't work for free

Trash collectors don't work for free

These are all important jobs. When you look at it, why do we work for free? Is it the I'm a volunteer mentality and I'm doing a important service for the community. That mindset is good until you really look at things differently. Most people will say Cool you volunteer at the local EMS agency but then they say you do this for free, that's noble but how do you support yourself? How do you pay your bills? I for one at one time asked that same question. You have someone who is on every ambulance run and you begin to question why they are doing so much for free. I have worked for services who were assisted by Volunteer first responders or volunteer EMT's or Firefighters. I always wondered what they did for a living when they were giving their services in EMS for free. I would never have done that. My first priority was to make enough money for myself, my family and my lifestyle.

I know that volunteers work in the community but most have jobs where they are able to leave at a moments notice but what happens when there are no volunteers and the community relies on them to be there at the communities beck and call. It's similar to when there are no ambulances available, do you have agreements with surrounding services to respond? Have too many of these none available days and the community begins to question your commitment and starts to look elsewhere.

It's the same as any other community.

The other thing that I'm just brainstorming on is, do members of the community who travel to other areas and see fully staffed stations where someone is stationed there all the time, round the clock. Questions begin to be asked as to would it be better to fund an ambulance service to be on duty 24 hours a day 7 days a week 365 a year? If enough people start to ask that question then your service as volunteer's may be short lived.

I have no doubt that my ramblings on this have muddied the waters and I'm not convinced that volunteers are a bad deal but I think we need to rethink a community being fully covered by a volunteer force.

I do believe that a county run, city run or privately run service that can bill for it's services, provide education to their employees, provide insurance to members if so set up, and put the money that is made after operating expenses into better equipment and more equipment might be a better choice. I'm sure some of you on this board will find fault at what I'm saying but these are just the musings of a long time medic.

I feel for the volunteer services that scrounge by on what they can get for donations and minimal payment and still provide good service for their community - I do applaud that and there are no hard and true answers.

I do know for one thing, I didn't go get my paramedic license and spent over 3500 to get it and then an additional 2500 a year for education classes(I go to lots of classes) in order to give my services away for free. I didn't go to school to get my project management masters degree to give my project management knowledge away for free. I did it to make money to have the things I want and to support my family. Sure I'd volunteer one shift or two a month but when I can get a shift or two at my work place and make money the answer to me is clear.

Hat's off to the volunteers out there.

[rescue25]

Take the Richmond, Virginia Metropolitan Area, for example. Richmond Ambulance Authority is a joke. Staffed & managed by AMR. There's so many volunteer agencies in that area, there's no real need for the surrounding 4 or 5 counties, or the city for that matter, to pay Medics a living wage. Chesterfield County Fire Dept. Medics staff some of the volunteer squads, due to manpower issues. Henrico County has FireMedics as well. There's no REAL EMS. By REAL, I mean a free-standing municipal agency dedicated to Emergency Medical Services. Why should there be? Volunteer Rescue & the Paid Fire Dept's make it unnecessary. Sure, it may work out well for the city and county...but then why would someone then want to be a paramedic in that area? They'll have to travel a much longer distance to earn a living wage.

Although the existence of volunteer agencies in nearby areas probably plays some role in this (fewer overall available jobs), I think you've probably overstated its impact.

In Henrico, volunteer agencies exist, but are far outnumbered by career Fire Medics. There really is no lack of career opportunities in Henrico, but the caveat is you have to be a firefighter. Who wants to become a paramedic only to ride on the engine half the time? In my opinion, this probably has a greater effect than anything volunteers might contribute as it creates a big disincentive for many to seek employment as a medic in Henrico. The upshot is that you get paid a respectable salary with excellent benefits - a direct result of working for a well-funded municipal agency.

It's about supply and demand. If there's no demand, then I can't supply it. I WANT to supply it, but I can't, because volunteers are "in the way".

If volunteers are truly "in the way," then why can Henrico County Fire Medics earn a decent salary even though the volunteer component in Henrico is stronger than that in the city?

I would contend that RAA can get away with paying such low wages primarily because it offers two things that the surrounding counties cannot (or will not):

1. More experience: more trauma, more varied medical calls, (slightly) fewer nursing home runs, higher overall call volume

2. It's EMS - plain and simple: no firefighting requirement, just EMS.

The impact of volunteers on wages is, I think, quite negligible in this particular instance simply because volunteers play an increasingly diminished role in the provision of EMS in this particular area. I do see your overall point, but feel it would probably be more applicable to more rural areas that are heavily or totally dependent on volunteers.

I believe you would see a much greater equalization of pay if the surrounding counties were to move from fire-based EMS to a separate, municipal Emergency Medical Service. It would certainly level the playing field a bit with respect to #2. Elimination of volunteer agencies in these areas would increase the overall number of jobs available - particularly in areas that are still more rural and, thus, more dependent on the volunteer component - but would probably do little to change wages in the City of Richmond. Or even within career fire agencies in those counties (again, maybe some more than others).

I fully agree with Rid, Dust, and others on here when they point out (rather emphatically) that a higher bar for education of pre-hospital medical providers is needed and will take care of weeding out many of today's volunteer agencies - especially those that are poor performers.

[alpha23958]

Doctors do not work for free

Teachers don't work for free

Nurses don't work for free

Trash collectors don't work for free

I'm going to need documented, and notarized proof, that no doctor, no teacher, no nurse, and no trash collector on the globe, does any work at all, and does not get compensated. I will need written proof from every single doctor, teacher, nurse and trash collector, that they either spend their time getting paid, or they spend their time, not donating any of it, to something related to their profession. This also includes all activities on their time off, that would be considered a voluntary position, where any degree of work is being done. Boy/girl scout troops, church functions, litter pick up, PTA, fund raising of any kind, etc.

I feel, that EMS as a whole, would be better off with less a$$holes, than less volunteers. I've seen volunteer crews do a better job, on all levels, than career staffed EMS. You see, EMS has made a baby boom, locally. We have four career EMS teams in the area, 17 paid/staffed ambulances, ALS and BLS. There are eight volunteer ambulances. At least six of the volunteer ambulances take every call, with in a reasonable time. Two haven't responded this year, because paid ambulances are so close. HOWEVER. I hear at least once a day, a volunteer ambulance being called for mutual aid, to a paid service. Why? They can't afford to pay for more people. After the paid service has three ambulances on the road, the other three can only set. All the other manpower is out doing transfers. They realized you can't make enough money, if every ambulance service goes paid. So, they have to do wheelchair and stretcher van transports. So, there the people are, back to waiting for an ambulance. If you eliminate the volunteer service, who bills the same as the paid service, someone has the potential to die, while another paid service drives twenty miles to get to the patient. And we're back to square one.

Paid service was always paid, all three, it started as a business, stayed a business. There were enough calls. Now, there are A LOT of calls. Too many for them to handle, not enough money. You can't get blood from a stone, no matter how much you beat on it, or sue it.

I think, if we push New Jersey into the Atlantic; eliminate volunteer services in Sub-Urban, and Urban Areas; and those that are not up to standard (set a national standard), EMS would be okay. You can't just say, volunteers get paid to create jobs, or get rid of them. Do you know how many people would die, despite your supposed figures, if you replace large volumes of services, with one paid station? We would be back to square one. I wouldn't want to wait a half hour for an ambulance if I had a medical or traumatic emergency, I wouldn't want my family to wait that long, and I wouldn't want or expect any or yours to wait that long. It happens. If your uneducated guess and plans were adopted right now, with out knowing for a fact that every volunteer is under educated, poor, dumb slobs, EMS would fail. People that were five minutes from a competent, well equipped volunteer service, are now forty five minutes from an understaffed and drawn out paid service, and they will be dead, before you even get on the interstate..

I'm not going on facts, but I know where I live. And I know that based on fees from billing, only one service could afford to pay people. If every service folded, and this one service became staffed 24/7, with ALS, it would be great. For people in that town. For the ones that live thirty miles away, that may or may not have had a response from their own ambulance, they aren't much better off.

[Dustdevil]

I'm going to need documented, and notarized proof, that no doctor, no teacher, no nurse, and no trash collector on the globe, does any work at all, and does not get compensated. I will need written proof from every single doctor, teacher, nurse and trash collector, that they either spend their time getting paid, or they spend their time, not donating any of it, to something related to their profession. This also includes all activities on their time off, that would be considered a voluntary position, where any degree of work is being done. Boy/girl scout troops, church functions, litter pick up, PTA, fund raising of any kind, etc..

Ummm.... no. What you are going to "need" is to learn to read. Or at least learn to read entire posts before you go off half-cocked and name calling. Every one of your lame points has already been addressed and debunked. As for your "need," it has also already been stipulated that we are not talking about a couple hours a month a doctor or nurse spends at the free clinic to contribute a little to the community without sacrificing their profession. Therefore, what you thought was such a brilliant point that nobody here but you were smart enough to think of, is old news and totally irrelevant.

[Lone Star]

I'm not going on facts, but I know where I live. And I know that based on fees from billing, only one service could afford to pay people. If every service folded, and this one service became staffed 24/7, with ALS, it would be great. For people in that town. For the ones that live thirty miles away, that may or may not have had a response from their own ambulance, they aren't much better off.

Therein lies the first problem of your whole argument!

From what I've seen in your posts, you're trying to battle logic and facts with knee jerk emotional responses.

I personally wouldn't volunteer my services as a career. Being single, I can't afford to donate that much of my time away from trying to eke out a living.

Giving back to the community is a good thing, its honorable and noble, but it will NOT put bread and butter on the dinner table!

[Just Plain Ruff]

Alpha, I don't need to provide you proof. I am sure that there are some doctors that are retired and have enough money to work for free but you missed my point.

Doctors for the most part do not work for free.

I can probably put good money on the fact that you will never ever ever find a trash collector that works for free.

But you missed my point, and that point I was trying to make was this, as a full time job doctors, nurses and anyone else do not work for free. There is no way to feed them. Sure, some might work for free but in my opinion that's just a silly thing.

I find it just as silly, putting in a lot of hours on a volunteer squad for free when you could be working as a paid provider and providing a higher standard of living.

I will concede that there are some doctors, nurses and trash collectors that work for free but I can bet you that they have one of three main things going for them.

1. They are so wealthy or financially well off that they can afford to work for free.

2. They have a spouse who makes a tremendous amount of money and they can afford to work for free

3. Or for the physician - he/she's a resident getting some extra shifts on the side.

Sorry for the confusion alpha. Did I make myself clearer with this post in what I was trying to say. Plus you apparantly didn't read my disclaimer.

[Rescue0ne]

In Henrico, volunteer agencies exist, but are far outnumbered by career Fire Medics. There really is no lack of career opportunities in Henrico, but the caveat is you have to be a firefighter. Who wants to become a paramedic only to ride on the engine half the time? In my opinion, this probably has a greater effect than anything volunteers might contribute as it creates a big disincentive for many to seek employment as a medic in Henrico. The upshot is that you get paid a respectable salary with excellent benefits - a direct result of working for a well-funded municipal agency.

You're correct...and it really wasn't the best of examples. Like you said, and this was my reason for even mentioning Henrico...and I have no idea how they do it in Hanover...but what self-respecting individual who is already a Paramedic, WANTS to be a firefighter? I'm sure there ARE some out there, albeit probably very few. No slight against FireMedics, btw. I just can't imagine doing it myself.

If volunteers are truly "in the way," then why can Henrico County Fire Medics earn a decent salary even though the volunteer component in Henrico is stronger than that in the city?

I used the "in the way" statement to illustrate an overall point...I didn't really mean that about Henrico, per se. I'm not up to speed on Henrico's numbers, but I'd imagine the call volume is high enough to support volunteer and fire medics at the same time? Educate me on this point, if you're familiar with it, please.

I would contend that RAA can get away with paying such low wages primarily because it offers two things that the surrounding counties cannot (or will not):

1. More experience: more trauma, more varied medical calls, (slightly) fewer nursing home runs, higher overall call volume

2. It's EMS - plain and simple: no firefighting requirement, just EMS.

I believe you would see a much greater equalization of pay if the surrounding counties were to move from fire-based EMS to a separate, municipal Emergency Medical Service. It would certainly level the playing field a bit with respect to #2.

I agree with this 100%, and fully support it. I'm not going to hold my breath, however.

I fully agree with Rid, Dust, and others on here when they point out (rather emphatically) that a higher bar for education of pre-hospital medical providers is needed and will take care of weeding out many of today's volunteer agencies - especially those that are poor performers.

I'm inclined to agree with this statement, because of the edu properties of it...but even if it was accomplished for Paramedics, you know how Virginia is. I feel the OEMS would still maintain the other certs, which would continue to enable the half-assed providers out there (in Va anyway) to continue to practice half-assed EMS.

Thanks for clarifying & bringing me to task concerning Richmond Area. Like I said, it WAS a bad example, but the only one I could think of even coming close, other than the rural problems we're having now. I'll touch on that more later. I had thought about using VA Beach EMS System as an example, but if you're as familiar with them as I am, you know why that's not a good idea.

[BushyFromOz]

Therefore, what you thought was such a brilliant point that nobody here but you were smart enough to think of, is old news and totally irrelevant.

They say he has "True Grit"