Since 1928, the Roanoke Lifesaving and First Aid Crew has been providing EMS for the 98,000 residents of Roanoke, Va. At the crew’s peak in the 1970s, 120 volunteers operated five ambulances 24 hours a day, seven days a week. That began to change in the 1980s, when the crew, along with two other volunteer services that served the city, saw their volunteer rolls begin to dwindle.
In 1989, one volunteer crew disbanded. The Roanoke Lifesaving crew merged with the remaining crew and renamed itself Roanoke Emergency Medical Services. But that wasn’t the end of the transformation. The city soon created an EMS department and began hiring professional paramedics and EMTs. In the mid-90s, the paid and volunteer EMS staffs merged with the fire department, creating a combination system, Roanoke Fire-EMS.
Today, about 25 volunteers are still staffing a single volunteer station, mainly on nights and weekends, says Chris Dean, the volunteer operations chief for Roanoke EMS. (Dean is also a salaried firefighter/paramedic with Roanoke County Fire and Rescue Department.) “When people were joining back in the heyday, either the father or the mother, but usually the mother, stayed at home, while the other went to work and volunteered,” Dean says. “Now, most people are two-income families, and people just don’t have the time.”
Across the United States, EMS and the fire service have a long tradition of relying on volunteers who give up their own time, and sometimes put themselves at risk, to serve their communities. For many, it’s a family tradition passed down from fathers to sons and daughters. Dean, a volunteer for 23 years, followed his father into service.
Longtime volunteers meeting the needs of the community on shoestring budgets has never been easy. But over the past decade, changes in family life, work demands and generational shifts, along with increasing call volume and training requirements, have made it harder than ever to find people who can do the job.
Nearly 70 percent of rural volunteer EMS services struggle to recruit and retain volunteers, according to a recent survey of 49 directors of volunteer rural EMS services in 23 states conducted by the University of North Carolina at Chapel Hill Rural Health Research & Policy Center. One-fifth believe the problem is getting worse.
The struggles have led more departments to rely on some form of payment to volunteers, while others have shifted to combination departments made up of both salaried and volunteer workers.
To address the issues faced by volunteer and combination services, the International Association of Fire Chiefs (IAFC) held a three-day summit in Washington, D.C., in March. The event drew about 130 participants who worked on developing a plan to improve recruitment and retention, strengthen community relationships and shore up finances.
The summit grew out of the IAFC’s 2004 blue ribbon report, “Preserving and Improving the Future of the Volunteer Fire Service,” which details the funding and personnel challenges that volunteer services face.
“What we’re hoping to do is raise the discussion about volunteerism to a national level, including what are the good things about it, what we want to do better, what we are lacking, and what we can influence as far as legislation that hinders us in doing our jobs or that promotes the volunteer service,” says Tim Wall, volunteer fire chief with North Farms Volunteer Fire Department in Wallingford, Conn., and chair of the IAFC’s volunteer and combination officers section.
In and around Roanoke, volunteer departments continue to throw in the towel. In Roanoke County, the 53-yearold Mount Pleasant First Aid Crew recently announced it was dissolving because of too few volunteers and too many calls. Instead, career personnel will now answer 911 calls. “This was the second crew to fold over the past four years in the county,” Dean says.
According to National Fire Protection Association statistics quoted in the Blue Ribbon report, the volunteer fire service had 880,000 members in the mid-’80s. That dropped to 800,000 by 2000, even as the nation’s population increased.
Despite the declines in numbers, the volunteer service remains a major part of delivering fire protection and EMS to much of the country. About 73 percent of the nation’s fire departments are all-volunteer, according to the report, and most of the nation’s geographic areas are covered by volunteers. Not surprisingly, many volunteer departments are in rural areas with small populations, a small tax base and too few calls to support a fulltime force. (According to the survey, the average rural EMS agency answers 163 calls a year, or about one every other day.)
But volunteers also play an integral role in some suburban and even urban areas, including throughout New York state. There, major cities such as New York, Albany and Buffalo have paid fire and EMS departments, but only about 2,200 of 26,000 fire and EMS agencies are staffed entirely by paid employees. The rest are volunteer or combination departments, including Long Island’s Suffolk County, home to more than 1.4 million people, says Robert Delagi, Suffolk County chief of prehospital medical operations and acting director for the division of emergency medical services.
Suffolk County is served by about 110 volunteer ambulance corps and fire districts, which are staffed by some 5,000 certified EMS providers and about 13,000 volunteer firefighters, and are governed by a board of elected commissioners or directors depending on the agency type.
Over the past seven or eight years, many fire districts, which can levy a fire and ambulance tax on residents to pay for equipment—and increasingly, staff— have become combination departments, says Delagi, a volunteer since 1977 and chief of operations since 1997.
Cultural, professional shifts discourage volunteerism Like others, Delagi cites too little time as one factor driving away volunteers, as well as the area’s high cost of living, which means people are working long hours or more than one job just to pay the mortgage. But there are also cultural shifts that have contributed. For instance, children have more sports and social opportunities than they had a few decades ago, and parents must shuttle them to various activities, leaving less time to volunteer. Fathers’ roles also have changed; not only are they coaching their children’s teams, but they’re expected to pitch in with more child care responsibilities, which means more demands on their time.
Demographics, too, are changing. A more mobile population means people are less likely to stay put long enough to become invested in their communities, Delagi says. And there’s a generational shift. The bulk of today’s volunteer force is made up of Baby Boomers, many of whom had fathers and brothers who volunteered and are carrying on the family tradition. The younger volunteers are drawn from Generation X, or those born between about 1965 and 1982, and Generation Y, sometimes called the Millennials, who were born in the 1980s and later. These groups are much different from the “traditionalists,” Delagi says.
“It’s very well documented in the literature,” he says. “The traditionalists are the old timers, or those born from 1925 to 1942. They were often veterans who have respect for rules and authority. They were loyal to institutions, of which the fire service is one. They believe in hard work, have pride in what they do and have a sense of ownership in the community.
“Generation X and Generation Y are the ‘What’s in it for me?’ generation,” Delagi adds. “They want to know, ‘What do I get out of volunteering?’ That could be self-satisfaction, or riding around with red lights and sirens, or being part of a group. But they maintain membership in the organization solely for their own purposes.” Because of these inherent differences, Delagi says today’s EMS leaders need to recognize how to motivate people of diverse generations.
Another huge challenge is that EMS itself is changing, Delagi says. Today’s responders need more hours of training that cover more types of hazards, and more sophisticated equipment, than in the past. That means more time and higher costs to get volunteers trained.
In New York, terrorism weighs heavily on responders’ minds, whether it’s dirty bombs, anthrax or sarin. In the past two years, crews have responded to two instances of people who committed “chemical suicide” by mixing powerful, toxic chemicals in an enclosed space. “The old-timers were providing service in simpler times—you needed less sophisticated training, there was less call volume, fewer types of hazards and threats and less sophisticated levels of care,” Delagi says.
For volunteer firefighters particularly, the aging population means they’re answering far more medical calls than putting out blazes, says Ken Knipper, chairman of the National Volunteer Fire Council’s EMS/rescue section; one of the founders of Silver Grove EMS, a volunteer service in northern Kentucky; and a member of the National EMS Advisory Council (NEMSAC).
“Right now, 80 percent of their runs involve EMS, not fire,” Knipper says. “That puts a different level of demand on a department, and getting volunteers has become much more difficult.”
And though efforts to raise the standards for the care EMS delivers is overall a good thing, Knipper warns there’s a risk that requiring too much expertise or equipment may drive volunteer services out of business.
Read the entire report on rural volunteers at shepscenter.unc.edu/rural/pubs/report/FR99.pdf. The IAFC’s 2004 report is available at vcos.org/resources/ publications/.
“We don’t need a $250,000 vehicle and two paramedics on every call,” he says. “I don’t want our illustrious legislators to take away the opportunity for two housewives to help their neighbor ... I stress that all the time when I sit with the powers-thatbe in Washington. We don’t want to pass laws or regulations that take away the opportunity for people to provide whatever they can provide by saying, ‘We gotta have this’ or demanding certain types of training that maybe will never be used.”
It’s an open question as to whether volunteers should have to have the same credentials, certifications and competencies as the paid force, but that should be determined at the local level based on community needs, expectations, funding and resource availability, says Troy Hagen, director of Ada County Paramedics in Idaho and primary author of the NEMSAC paper, “EMS Makes a Difference.”
“Volunteers and professional staff should not be viewed as competitive, but rather complementary,” Hagen says. “While both groups support advancements in EMS, career professionals do not want the volunteers to hold back progress any more than the volunteers want to be disbanded because of onerous requirements. The solution is balance because there are so many variables driving EMS system design at the local level.”
The future of volunteering
With so many cities and counties strapped for cash, states and the federal government facing budget battles, and the public loathe to pay higher taxes, it’s doubtful more money is going to flow from the government to support fire or EMS. That means despite the challenges, volunteers are, and will remain, a critical part of delivering fire protection and EMS through much of the country—and that, leaders of volunteer departments say, makes it crucial to look for solutions.
In the survey, rural directors suggested that decreasing the time and burden of training, offering incentives for employers to allow employees to answer calls during work hours and improving a service’s visibility in the community would help with recruitment and retainment. Paying volunteers is another incentive, something that one-half of the agencies surveyed are already doing, most often by paying per run. About one-third of those not currently paying are considering it.
New York state has an extensive program to recruit and retain volunteers. State laws have been passed authorizing municipalities to offer a host of benefits to volunteers, including property tax abatements, affordable health insurance plans and Length of Service Award Programs, a state-administered pension plan given to volunteers based on their years of service.
And for the first time, taxpayers had the option to make a voluntary contribution to the Volunteer Firefighter and Volunteer Emergency Services Recruitment and Retention Fund by checking a box on their 2010 state income tax return.
Though merging departments is often seen as a last resort, Delagi urges departments not to be afraid of consolidations. “Pooling specialized resources and personnel leads to a more efficient use of resources and gives greater purchasing power,” he says. “People are against consolidation because they lose their autonomy, but it’s a great way to preserve the volunteer system. It’s much easier to operate one well-funded, well-equipped, well-staffed agency than three neighboring floundering agencies.”
With so many volunteer agencies struggling to find people and resources, you have to wonder: Is the volunteer model doomed? “Volunteerism is not dead,” Delagi says. “The key to successful management is recognizing the issues and reacting to the times, and understanding that the contemporary EMS leader has many more issues that need to be addressed than our forefathers had.”
Wall, whose grandfather and father were both firefighters, along with his brother and a nephew, says: “Is it sustainable? Yes, but volunteer departments need assistance and help.”
According to the survey, about twothirds of rural EMS directors are optimistic about their ability to maintain their service in the future, while 20 percent are uncertain, and 8 percent are pessimistic. Count Chris Dean among the optimistic. “I’m committed to making sure that as long as people are willing to volunteer, there is a place for them to do it,” he says.
