The release of the “2016 Montana EMS Report to the Education and Local Government Interim Committee” has spawned the most recent set of alarming news reports on the state of rural EMS, echoing the concerns of Wisconsin, Nebraska, the Dakotas, Indiana, Iowa, Pennsylvania, New Jersey and New York State [1]. All those states rely heavily on volunteer ambulances and volunteer fire department based EMS to provide anywhere from 60 to 90 percent of EMS.
For at least 10 years, multiple studies by federal and state agencies, and those contracted through private consulting firms have all reached the same conclusion: The entire EMS system in the U.S. is fractured, unsustainable, and in danger of an imminent and critical failure, with dire warnings of the impending collapse of the volunteer EMS system.
Volunteer agencies, who have traditionally filled the service void in rural areas, have insufficient call volume or tax base to support full-time municipal or private EMS response. These agencies are being crushed under the weight of increased call volume, skyrocketing expenses, and the need to request more and more time from their often dwindling membership to participate in additional training, administrative functions, and fund raising.
Despite the studies, reports, and warnings the crisis continues without answers to three critical questions:
1. Why is EMS still not an essential service?
Yet despite the recommendations of every study and white paper written in the last 20 years, and efforts by elected officials in several states, EMS is still not defined as an essential service by the federal government or most state governments
2. Where is the money appropriated for EMS?
Most states appropriate funds for trauma systems and EMS through various means such as add-ons to traffic and criminal violations and tobacco taxes. Those funds are often funneled into a general fund or utilized as a slush fund to balance deficits in state budgets, never reaching the EMS initiatives it was intended for [2].
3. Why are citizens resigned to reliance on luck?
The Montana report summary warns that without change the state’s citizens and visitors are reliant on luck. The report states, “We hope government officials and community members in rural Montana are able to identify and implement sustainable solutions before their luck runs out.”
Hope and luck are two words that have no place in a discussion regarding the provision of EMS.
Immediate action required
Many volunteer agencies seem wary of showing their hand to local government out of fear they will be replaced or disciplined.
Don’t be. Bring your financial statements and your heart to the conversation.
The volunteer model for providing EMS is by far the least expensive and the easiest to customize to the individual needs of each community. Volunteer EMS and firefighters save taxpayers $140 Billion dollars a year. [3]
In North Dakota, South Dakota, Nebraska, Iowa, Minnesota, Wyoming and Montana, volunteer EMS collectively saves $240 million each year [4]. Volunteer EMS and fire departments save $7 billion in New York state [5].
Start with local funding
Surveys have showed that the public is clueless about EMS until they need it. Don’t wait for negative press and doom and gloom media presentations to create a bad impression.
The public needs to be educated and supportive, not victims of emotional extortion.
Start public education locally and proactively so the community can make an informed decision about how 911 responses will be guaranteed, what level of service is expected, how much that service will cost and how it will get paid for.
Remove known obstacles to recruitment
Part of the solution is remove barriers to participation. Here are proven solutions:
- Recruit non-medical volunteers to provide daycare or provide funding for daycare services.
- Hire or recruit non EMT personnel to provide administrative and operational functions, including fundraising.
- Subscribe personnel to distance education and online training programs which make initial and continuing education convenient and accessible.
- Ensure that funds appropriated for EMS are in a dedicated fund and prioritize that money to subsidize education costs and health and safety initiatives.
- Use existing PSA’s that show EMS, especially volunteering, in a positive light, and that appeal to your target audience. Check out this video example from the NVFC.
- Debunk the notion that today’s volunteer EMTs are a bunch of decrepit old geezers. Read this inspiring AARP story.
Create meaningful incentives
Retaining capable and experienced volunteers is always easier than recruiting, selecting and training replacements. Consider implementing these incentives to retain the members you already have:
- Ask your town government to offer healthcare benefits. Research shows that upwards of 25 percent of EMT’s do not have healthcare [6].
- Request and lobby for volunteers to get state funded opportunities for free education at local community colleges.
- Subsidize, fully or partially, all EMS education costs for volunteers. No one who gives their time and talent to provide an essential service to the community should be expected to pay for the privilege of doing so.
- Support legislation to provide tax credits for public safety volunteers [7]. Given the amount of money they save the taxpayer this is a fair reward.
Take charge of your future
“The best way to predict the future is to create it”
-Peter Drucker
The foundation of volunteer rescue squads and the volunteer fire departments was built by people who recognized the need for action long before there were actual careers in the field, or any consideration that profit could be made from human suffering or disasters. Why are the problems, as well as the future, of the volunteer service being left up to people on the outside to fix it?
The solution is not to fund more committees, or studies, or focus groups.
In the words of Toby Keith, it is time for “a little less talk and a lot more action.”
References
1. 2016 Montana EMS Report to the Education and Local Government Interim Committee
2. Millions in State Funds Not Reaching Volunteer Fire Departments
4. Rural EMS Faces its own Emergency
