The uncertain future of Volunteer EMS

[trauma74 111]

Let me start off by saying that some of my views listed below may be considered unpopular. I am not here for a popularity contest. I am here to state some facts and some opinions.

I have been a volunteer here in Chester for 12 years. I rose from being a driver to being the Captain. The leadership structure is a lot better then it was 12 years ago, but there has been a decline in membership. Along with this decline, the call volume has increased. We went from having 400-500 calls a year to over 900 calls in 2005. By no means are we the busiest, but we are not the slowest. There are two VACs here in Orange County that get over 2000 calls per year and there is one VAC that only gets about 150 calls per year.

A few years back we knew that we were having a problem covering our day time calls. One of these years (cannot remember the exact year) we missed about 500 out of 850 calls. The membership knew this was a problem and we tried to address it in several ways. They wanted to avoid getting paid staff during the day because then we "would not longer be a volunteer ambulance corps". A few ideas were tossed around, but a solution could not be reached. It was not fair to the residents of my town that they had to wait a long time for a bus to reach them. When we could not crew for a call, a private EMS service (Mobile Life Support Services) would handle our calls. Sometimes it would take 20+ minutes for them to get to the scene.

I was serving as First Lieutenant during this time period and I knew that something needed to be done. Morale was at an all time low because we sucked so bad. We had two options. We could hire EMTs to work during the day or we could enter into a leasing agreement with a commercial service for them to provide EMTs to us for day time coverage. After some long discussions we decided that the best route was to enter into a leasing agreement with a commercial service for daytime EMTs. We started this program and immediately the results were positive. We had already started soft billing a few years prior and we knew that being able to answer our daytime calls would generate enough revenue to cover the cost of the EMTs. To this day I know that this was the best move my organization made. Response times were drastically reduced. The public saw the difference and they were happy. The FD & PD were also pleased. Often times we arrive on scene before the FD or PD.

Now, this is where the problems begin. We are covering our daytime calls. Once in a while a second jobs comes in while the paid crew is on the first job and we cannot assemble a crew, but some surrounding VACs having daytime staff and they provide mutual aid to us. We are begining to miss many of our nighttime calls. I know that it is impossible for us to cover 100% of our calls, but the number of calls we are missing is increasing. We are trying to get our members to cover calls and sign up for shifts on the nights and weekends, but it is up hill battle. We are not the worst VAC when it comes to not covering our calls, but if things continue like this we will work our way up to the top. I do not want to see this happen. I know that the majority my members would not support having paid staff at night and on the weekends. What do I do? I do not want to see us get to the point where we are not a volunteer ambulance corps anymore, but I have a feeling if things progress in this direction we may have no choice.

I do have a small group of very dedicated volunteers, but it is always the same group of people taking the calls and taking shifts. Everytime we get a new member there is another member who leaves for one reason or another. Another problem is that I have members that are being forced to move out of town, out of the county or even out of the state because they cannot afford to live here anymore. The people who are moving into town are not the type of people who want to volunteer. They are buying these huge houses and they have to work their as*ses off just to pay the mortgage. Recently, three of my members had to bite the bullet and move out of state. They moved into Pike County, PA. They are still members here, but they only come down once a week and ride. They used to handle many of our nighttime calls.

I know that we are not the only VAC with this problem. This problem is much bigger then some of us may think. Many VACs turn a blind eye to the problem or they just ignore it. The politicians do not care. It is hard enough to get the funding we need from them. Consolidation is not an option because of big ego problems.

I truly believe that if the EMS community banded together we could probably make things better, but that also seems like a losing battle. Because the individual town, village, city and fire district governments do not want to address the problems I think the counties need to step up to the plate. Putnam County is off to a good start, but they are the minority.

I have come up with several ideas, but without support I am stuck. I know this was an extremely long post, but I want to here from as many people as possible. Maybe something good will come from this. Let me know what you think about the future of Volunteer EMS.

[res6cue 67]

It's been a while since I've been a member of a VAC, but we were having the same issues when I was a member back in the early and mid 90s. We had a paid crew on weekdays from 0700 to 1900. All paid EMTs had to be full members and were required to volunteer a certain amount of hours a week to retain their paid shifts. There was never an issue with that system, it worked out very well actually. Weeknights and weekends were covered by scheduled crews of volunteers. The length of the shifts might vary, depending on who liked to cover what time slot, but there was always at least a two person crew on duty.

In any case, while that all but guaranteed a rig would be on the road for primary calls, the call volume was such that there was trouble getting backup crews on the road. Adding to that problem was having to cover quite a few mutual aid calls for struggling surrounding VACs. It was just after I left, but I know they added a second paid daytime crew to deal with this. I believe to this day they're still volunteer weeknights and weekends.

But to your point, it's more or less the same situation in the fire departments. Membership is down, BS calls are up (which kills morale and interest) and therefore, response times are up and resources making it to the scene are at a bare minimum. I think the problem is a lot more noticeable and serious with EMS though, for a few reasons.

At a false fire alarm run, even if only a Chief or one truck shows up with a skeleton crew, most people don't even notice the terrible response. Not so with EMS. You're usually dealing one on one and when someone is in pain, it seems like hours waiting for that ambulance.

With a fire dept, when a hot job comes in, guys come out of the woodwork. Guys you haven't seen in years are all of a sudden fighting to get trucks out. Sure, there's some of that in EMS, but few and far between. EMS generally doesn't provide the same adrenaline rush firefighting does, save for maybe a trauma job. You'll probably even get a few firemen out of bed at 3am for an automatic alarm, but how many EMTs are going to get up to take in that stubbed toe at the local nursing home...for the 5th time that week? Not many.

I agree though, I think the whole volunteer concept is in big trouble, both EMS and FD. For the reasons stated, I think it's more noticeable and potentially more serious with EMS though. Also, it's presumably quite a bit cheaper to pay 2 EMTs to staff an ambulance than it is to pay a whole fire department. That means there will be much less hesitation for the town or village to close the doors of the VAC and replace them with a paid service, unfortunately.

You mentioned ego being a problem, especially when it comes to consolidation of services, and I would agree with that. Too much pride, too much worrying about "this is OUR turf" going on and it's only hurting, not helping. I see fire depts spending close to a million dollars on state of the art (and generally overkill) apparatus that gets flat spots in the tires from sitting on the apparatus floor. Hey, I'm all for having the best possible equipment, but what's the sense if you don't have the personnel to get it out of the station? Don't even get me started on duplication of services either. Do you really need 10 aerial ladders for 6 depts in an area of around 50 square miles where the actual usage of those trucks is probably less than 2% of combined annual call volume? Doubtful.

I'm not sure how it is elsewhere, but here in Rockland, EMS and FD generally do not mix. Sure, you have guys and gals that vollie for both, but that's not what I mean. Of the county's 26 FDs and 13 VACs (Hatzolah and Rockland Paramedic Services not included) only 1 agency is one in the same, and that is Piermont FD which also has an ambulance and is primary EMS agency for the village (they cover less than 1 square mile, however). Spring Valley FD used to have an ambulance, but that went by the wayside in the 90s. Ironically, that very ambulance from Rockland Hook & Ladder was quite literally one of the first ambulances in the town of Ramapo, predating Spring Hill, Faist and I believe even Ramapo Valley. It was actually members of the Rocklands that got together with some firemen from Hillcrest that started Spring Hill VAC to cover the northern and western sections of Ramapo, rather than having the FD ambulance run all the way to the Haverstraw line.

What is my point? Simple. The VACs and FDs have to start working together to ensure each others long term survival. The whole culture of the two agencies being mutually exclusive is getting old, and it's not benefiting anyone. Not to pick on the VACs, but I think the FDs in general have more resources to offer. More money from the fire districts, more manpower and more apparatus. Would it really be so horrible to start training firefighters as CFR-D or EMT? To recruit fire dept members to help staff ambulances? Perhaps work some sort of cross-agency mutual aid agreement out between EMS and FD? It stands to reason (and from personal experience) that there are usually a few guys hanging around the firehouse when EMS calls are going unanswered. Sure, maybe those guys aren't interested in being members of the VAC, but if you tone them out for an engine or rescue to respond to an EMS run, they'll get on the truck. At least that buys the VAC some time to get out, as the patient is being attended to and packaged for transport.

I'm not suggesting the FD take over EMS, believe me. But I think it's time to help each other out. Having been in EMS for a while, having been in the FD for a long time and even having put myself in the middle MANY times by holding the very unpopular office of Fire Rescue Lieutenant and Captain of my FD (aka EMS Squad), I can say with confidence and certainty that we're not doing each other any good staying divided like we currently are. At the very least, there needs to be some real mutual aid agreements put in place. Maybe start a pilot program where the FD is toned out for serious EMS runs, similar to the way FDNY has the CFR-D engines.

Yes, these opinions are usually extremely unpopular, but what's the alternative? Burying your head in the sand and hoping for the best? Ask some members of VACs or FDs whose doors have been permanently closed if they would've preferred the option to work together over not having a place to work at all, and see what THEIR opinion is now.

Edited May 3, 2006 by res6cue

[grantnet10 1]

If the membership doesn't want paid EMT's then they need to start stepping up for shifts. I hate people who complain and then when it's time to do actual work or ride their shifts, they have excuses.

[Guest]

Our VAC in Connecticut has over 1500 calls per year and is 100% volunteer. We have never missed one call and also have never been unable to staff a backup call. How do we do this with only 45 volunteers? Well, we always have a driver and an EMT down at our station 24/7 and have a group of dedicated people who truly are obsessed with EMS. Every few years we sponsor an EMT class and essentially hand pick the people who demonstrate that they will be available for calls and most importantly show a great enthusiasm for EMS. Each EMT class turns out about 10 dedicated people, and we'd rather have 10 great members than 30 people who never show up for a shift. I'm not sure why other volly agencies have such large problems, but perhaps a recruitment drive with a lot of publicity will produce some dedicated members.

[Firefighter57 0]

Not saying it would help that much but have you tryed a JR Corps.?....i am a JR in the KBHVAC and it sees as though we have been getting pretty dedicated JRs to fill as a crew. They also go on the take emt later and end up being good emts. We have one who is in college who is now going for medic (X JR). We also have a shift system up here. That works good because we have a few people who can leave their jobs durring the day to respond. In the past few months, ive even found it tough to make a bus because everyone on the crew shows up + 1 or 2 people.

[Guest]

Its unfortunate, but VACs just cant seem to provide a consistent level of care to their people and because of this they are beginning to get phased out. While this is a blanket statement, it’s more often the rule than the exception. I work in a combined agency that has a great set of volunteers. Not only do they come out for the jobs, but they actually know what they are doing. As a volunteer I donate my time with some of the best guys around, when we are on duty the community gets their calls covered with the speed, professionalism and knowledge of the best paid system. But, like I said these two examples seem to be the exception, not the rule. More often than not volunteer agencies can’t cover their calls (unless of course it’s the big one, god help the old lady feeling weak and dizzy), the calls that do get covered are covered by who knows.At least with a paid staff have to jump through some hoops and demonstrate some aptitude. This is not saying that paid morons don’t exist, they do, but it’s better than having an open admissions policy. Someone who is obsessed with EMS or more generally gets a “hard-on†for lights and sirens is not welcome on my scene. All they do is get tunnel vision and take up space – my main concern should be the patient and their health, not whether or not they are going lights and sirens for a wrist pain.

Edited May 3, 2006 by 66Alpha1

[Guest]

If the membership doesn't want paid EMT's then they need to start stepping up for shifts.  I hate people who complain and then when it's time to do actual work or ride their shifts, they have excuses.

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Well said G-money!

[mlfcemt093 0]

I'm a member of movac in orange cty I believe every corps in orange cty seems to having this problem 1 way or another the last hold out like walkill have paid daytime crews during the day now. I personaly have moved to middletown and volly in monroe 1 time per week and scheduled weekend shifts i cant afford housing in harriman woodburry or monroe town/village it's insane the prices of the shacks that are out there and i work in the south bronx as a paid tech I and my wife who are emt's would love to be back in monroe but it's impossible to start my life in an area w/ the huge home increases so don't think ur alone in this we definately need to come together and fight this @ the local level or we'll never get to be a volly agency's again. every 1 living here are people from the city and assume we get paid anyway other than that i really don't know what to say, set up mtgs with local corps and bring the problem to the newspaper power in numbers u know feel free to mail me personaly

movac 93

[ex-commish 490]

If the membership doesn't want paid EMT's then they need to start stepping up for shifts.  I hate people who complain and then when it's time to do actual work or ride their shifts, they have excuses.

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This is so true. I think every department/vac has it's " dirty dozen" that you can rely on in the pinch get the job done, never complain unless it is valid, prove themselves by actions, not words. Are there for the pride and want to be part of a team.

Then there are what I call sponges...those who join to soak up what little benefits are there, do little, complain alot and cause trouble usually anonomously. They usually sit in the back of the room and make remarks under thier breath or cry about too much training. They also blame leadership for an organization's problems yet are usually the ones who break rules, sop's etc.

[IzzyEng4 427]

I think there will still always be some sort of VAC or volunteers in an EMS agency as long as there is a concerted effort to maintain it, just like volunteer fire departments. I do however see that in area,especially in my city, that the call volume is too great and interest has waned with some of the members. Ithink havinf a suplimental paid force helps the problem especially in the day time when there is a lack of personnel.

I don't think you'll see VAC's go by the wayside but I do see that larger responses in more suburban and urban areas will see an increase of paid staff in their organizations. And also maintain a volunteer group who are dedicated to serve as EMTs.

[Guest]

If the membership doesn't want paid EMT's then they need to start stepping up for shifts.  I hate people who complain and then when it's time to do actual work or ride their shifts, they have excuses.

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That’s all well and good, but that’s only half the battle. Getting the calls covered is great, but getting calls covered with knowledgeable and professional responders is another story. Just the other week I pulled into Hudson Valley with a patient, and saw about 5 16 year olds hop out of the back of an ambulance. As far as I’m concerned, that doesn’t constitute knowledgeable staffing, and neither do EMTs who cant write a PCR, or attendants (gasp) who cant bag a patient…

Edited May 3, 2006 by 66Alpha1

[Guest]

it is time to realize that things have changed ,times have changed,as far as EMS is concerned. When volunteering began it was a noble thing. There was a problem with people getting to the hospital that is when generous and caring people stepped up to the plate. Times have changed care is much more advanced, the answer is not giving it to a "Company " so they can make a profit or adding it on to an existing agency so as not to spend money. The answer is to have your own EMS agency. One that is trained to provide Pre-hospital care as it's primary mission. Just answer this, If it was your loved one that was sick or injured wouldnt you want the very best for them? Do you want that ambulance to have the latest up to date medications and equipment and that the personel on it have the expierence that comes with it or do you want some one who does it as a secondary job and have a unit that dosent have those things cause it would destroy the profit margin??? The answer is really very simple. I know what I want for the ones I love!! This is not anti anyone or anything. This is just the obvious

[trauma74 111]

I am impressed with the input so far.

[EMS Solutions 0]

The continuing probs with volly only is:

many households now have both members working fulltime jobs. making it hard for daytime coverage.

the types of calls coming in are increasing in the non emergent type , basic trip to the hospital and not the life and death emergency most of us would rather respond to.

in my area i am amazed when i hear tones for an abdominal pain 4 or 5 times during the day - but if a trauma comes in - theres more than enough people for a crew to turn out.

something i always try and stress is that the 911 call is the patients emergency - not ours. to them they needed an ambulance. we shouldnt judge for ourselves what an emergency is and what isnt. we should respond and treat accordingly and stop waiting for the hot jobs.

i would rather a sick call patient that will remember me after i'm gone than the unconc. trauma call who wont recall me or what i did.

hey i want the attention, what can i say.

Jim

[Guest]

I would like to start by giving trauma74 credit for being proactive with this situation. It is obvious that you really care about the people you are charged to serve.

I was a volunteer in the FD and this situation existed twenty five years ago. It was always a core of guys that showed up the chronic activated alarms or a small pile of leaves burning. The demographics of the village changed. Like what was mentioned by others in this discussion, people have to work long hours to pay to live in these areas. Some people catch the train to the city at 0600hrs and don't return to home until after 1800hrs. Through no fault of their own there is no time to volunteer.

Its good to here the situation and avenues for solutions are being addressed.

[trauma74 111]

I would like to start by giving trauma74 credit for being proactive with this situation.  It is obvious that you really care about the people you are charged to serve. 

I was a volunteer in the FD and this situation existed twenty five years ago.  It was always a core of guys that showed up the chronic activated alarms or a small pile of leaves burning.  The demographics of the village changed.  Like what was mentioned by others in this discussion, people have  to work long hours to pay to live in these areas.  Some people catch the train to the city at 0600hrs and don't return to home until after 1800hrs.  Through no fault of their own there is no time to volunteer.

Its good to here the situation and avenues for solutions are being addressed.

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I am very happy to see the situations being addressed here, but it needs to go a lot further then this site to make any difference at all. Do not get me wrong, I love the input from everyone and I may learn something new from what is said here. Thanks for recognizing my proactive approach to situation. I cannot just sit back like many others in the EMS community and wait for things to fall apart before doing a damn thing about it. These problems need to be address now before the Sh!t hits the fan.