Government, public has to stop treating EMS as a second class public safety

Belief that only volunteerism will work in a community is refuted by the many EMS systems that have transitioned to combination or career systems


Field care and ambulance transport has a long history of volunteerism in the United States. For nearly a hundred years, citizens have stopped whatever they were doing and responded to calls for help from fellow community members. As modern emergency medical services has evolved, many rescue squads have tried to keep up with modernization efforts, purchasing new equipment, ambulances and upgrading the training of their personnel.

But times have changed since the mid-20th century. With most towns being bedroom communities for business and manufacturing hubs, the idea of one working within a couple of miles of the ambulance station has become an anachronism. Even if it were true, most people are unable to leave their jobs at a moment's notice and be gone for a couple of hours or more.

The experience of this Connecticut town is nothing new. Volunteerism in EMS has been on the decline since the late 1970s. Numerous news articles have reported on the difficulty of getting crews to emergency medical calls, often having to send the neighboring jurisdictions' units to the incident. Dispatchers often joke about "Bermuda Triangles," where a call for ambulance response will be sent from one squad to the next, in the hopes that at some point a unit will respond.

You would think that such a situation would be not tolerated by the community. Most citizens expect that if they are having a heart attack or were hit by a car, that an ambulance would arrive at their scene within just a few minutes. Scores of reality and fictional television shows have created that expectation of immediate response. The fact is, in many parts of this country, that simply doesn't exist.

Public doesn't know EMS reality

In fact, that idyllic vision of dedicated community-based medical responders hasn't existed for decades in many communities. It makes me wonder why that's the case. Such a situation would seem to result in some demand by the citizenry to local officials to modernize and improve their medical response system. If only the citizens and elected officials knew more about EMS.

And that's the issue. Most folks don't realize how fragile their EMS system is from personnel departures, funding losses and inadequate reimbursement for patient transport. I don't blame them for being ignorant — most people will live their entire lives without ever having to ride in the back of an ambulance. All they see is a unit roll by them a couple of times a year, with lights flashing and sirens blaring, and believe that they are safe.

When the annual fund drive occurs, many people will throw a few dollars into the bucket or boot. Some even tolerate a tax assessment for public safety, believing that all of those efforts provide them the best medical care and transportation system. With a few exceptions, that's hardly the truth.

Maintaining a social club

That's because in many cases, volunteer squads are really social clubs. Members with similar interests get together and spend their time building a common understanding among each other. They become friends, know each other's families and consider themselves as a big family. Clubs are the epitome of how humans socially engage with one another outside of biological family units.

It's a wonderful system until the social club begins to reinforce malignancy. As volunteerism decays, rather than coming up with solutions that benefit the community, squads try to preserve the past and protect what they have. We'll get more volunteers. We'll incentivize shift staffing. We'll lower the training standard. We'll do anything to keep what we have.

The idea that nothing else will work in their region is refuted by the many EMS systems that have transitioned to combination or career systems. This is where local government officials must work hand-in-hand with failing EMS agencies and develop a long-term solution that works for them. It often means to stop thinking provincially, that every town is its own fiefdom. County and regional systems work well, reducing administrative overhead while providing a stable number of responding units. Whether it's publicly funded, privately contracted or a combination of the two is not relevant. The fact is that an EMS agency needs to be and can be held accountable for its efforts is critical.

I began my career as a volunteer almost 35 years ago. I appreciated and am quite fond of the time I spent volunteering in the community. As I matured in the profession, it became increasingly apparent that I had to move on, in order to remain competent and keep up with the changes in the industry. Volunteer EMS needs to do the same. I agree that in some places in the country, having volunteers is needed because of sheer necessity. But that applies only to very few systems. Most squads must take a hard, long look at what is best for their communities and take steps to strengthen their part of the public safety net.

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