Why volunteers are critical to the future of EMS

Volunteer providers are the foundation of EMS in the U.S. and the realities of volunteers don't match the mythology #StopVollieBashing


Listen to Nancy Magee discuss the importance of volunteers on the Inside EMS podcast

Do not believe the headlines. Volunteers remain the foundation of America’s Emergency Medical Services.

EMS volunteers answer close to half of the nation’s 911 calls – possibly up to 90 percent in the most rural states.[1] Eighty percent of volunteer agencies surveyed nationwide report that they are optimistic about the foreseeable future.[1] Of the 20 percent who are uncertain about their future only 8 percent expect to be out of business within five years.[1]

Strength through survival

(Image Nancy Magee)
(Image Nancy Magee)

Like many things in life, survival of the fittest strengthens the overall culture. Recruitment, retention, and rising costs are challenges shared by all models of EMS delivery. The two largest ambulance companies in the U.S. are owned by massive equity holding companies, who will not continue doing business in areas where they incur operational losses. Nor should they; their responsibility is to their shareholders and the people who work for them.

Profit margins in 911 emergency response and transport are slim, and in areas of low volume profit may not exist at all.[2]

In 10 years, half the U.S. population will be over 50 years old. Call volume will continue to increase in even the most rural areas. Costs will continue to rise, and Medicare transports will increase as reimbursement rates remain well short of covering costs.

Municipal and fire department agencies are at the mercy of local government budgets and their ability to collect more revenue from property owners already facing a high tax burden is limited.

Many communities cannot afford to lose local volunteer ambulance and fire services. EMS and fire department volunteers save the U.S. taxpayers billions of dollars annually.

Bullying of volunteers by the EMS community

The overwhelming majority of communities served by volunteers want to keep their local service. State governments are starting to recognize the value of community-based volunteer EMS and are beginning to provide support systems, funding and grants to ensure their survival. Yet volunteers seem to be the victims of the worst bullying in the EMS community.

Myth: “EMTs will never get paid a decent wage as long as people do the job for free.”

Reality: There are many reasons why the pay scale remains low. Reimbursement based on transport instead of readiness leaves little profit margin. There is no shortage of people willing to enter the field knowing that the pay scale is low. Contrary to urban legend, although low Medicare reimbursement rates may contribute to low pay scales, the rates are not artificially low due to free labor provided by volunteers. When CMS set the ambulance fee schedule in the mid-1990s based upon the average cost of providing EMS care nationwide, the survey excluded agencies that did not list personnel costs or did not charge for service.

In fact, the only real money in EMS is in scheduled transports. Dialysis transports and other types of scheduled inter-facility transports can have as much as a 50 to 60 percent greater profit margin than 911 transports. These are the runs that make it possible for many paid providers to receive a paycheck.

Volunteers respond to 911 calls in rural, low-volume areas with few exceptions. Realistically, there is no way to replace their service without significant tax increases or dangerously extended response times. Funding for volunteer service comes from billing, fundraising, grants, and varying amounts of financial support from the communities’ served.

They do not need to make a profit. They just need to break even.

Myth: “EMS will never be recognized as a profession as long as marginally competent EMS hobbyists and weekend warriors are what the public is accustomed to.”

Reality: The public, as a rule, does not know or care who is paid and who is not. They are only concerned with rapid response and treatment by a compassionate provider who can help them breathe, ease their pain, provide reassurance, and offer a safe, comfortable ride to the hospital.

In terms of competence, all EMTs in the U.S. train to the same standard for certification. As far as gaining experience, a paid EMT in a low-volume environment is at the same disadvantage as a volunteer; both need to commit to extra training. A paycheck does not magically make you an expert at handing out aspirin or using a BVM.

EMS has done a great job of teaching the public to call 911 and an abysmal job of educating them on what we do. Patients and their families need to understand that prehospital care brings sophisticated treatment to the patient that was only available in hospital emergency departments 40 years ago. No longer are we just “ambulance attendants.”

All stakeholders need to be educated about the capability of today’s EMS providers. We need to prove that prehospital treatment contributes to better patient outcomes. EMS must be recognized as an essential service delivered by skilled health care providers, regardless of pay status.

How you represent yourself and your agency, including social networks, determines your professionalism. It is an attitude, not something a paycheck can buy.

Myth: “People deserve to be paid for this work. Plumbers and police do not work free! They have families to support!”

Reality: No one is forced to provide free EMS service. Volunteers join their local squad for many reasons. They have chosen other occupations to provide for themselves and their families.

Stand united; #StopVollieBashing

Volunteering is not for everyone. Every EMT has a personal reason for entering this profession. Commercial, municipal, fire or volunteer, EMS providers share a passion, and a collective experience understood only by those who have answered the call. We need to stand united.

“There is no better way to find yourself than in the service of others”- Gandhi                

References

1. Rural Volunteer EMS: Reports from the Field.
http://www.shepscenter.unc.edu/rural/pubs/report/FR99.pdf

2. The Wild West of Ambulance Charges. http://priceonomics.com/the-wild-west-of-ambulance-charges/

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