Crumbling volunteer infrastructure puts EMS at a crossroads

Does the extent of volunteer shortages correspond to loss of life associated with delayed access to emergency care?


As I have commented many times, the EMS industry is at a crossroads in its development. This story out of Illinois about fewer volunteers joins other recent reports from New York, Pennsylvania, North Dakota, Minnesota, New Jersey, Iowa, Idaho, and other states where the prehospital coverage is failing. I have no doubt that given the extent of the issue, that there is a corresponding loss of life or worsening of morbidity associated with delayed access to emergency care, that hasn’t been widely reported.

It’s only a matter of time before it is.

For the record, I started as a volunteer in New York in the 1980s. Even then, three decades ago, the volunteer system was thinning around its edges – it was routine to respond to the neighboring town on a mutual aid call during the day, as we could field a unit and they could not.

At the time certain parts of the county were known as “Bermuda triangles” – tones would go out for one town's unit, followed five minutes later by the tones for the adjacent town’s ambulance, followed five minutes later by the next town’s unit, and finally repaging for the original agency. Sometimes it might have taken as long as 30 minutes before a unit responded.

Is EMS an essential service?

I’ve asked this question to many people throughout the years. The universal response has always been a resounding “yes!”

Most citizens believe that in the remote chance they might require emergency care and transportation to an emergency department, well-trained and equipped EMS providers will respond promptly. Sadly, in many parts of the country, this simply isn’t so. 

Lack of volunteers is not contained to rural areas. More densely populated towns dependent upon volunteers to provide EMS have seen serious response and staffing issues as well.

No one wants to see their volunteers to go the way of rotary telephones and analog television antennas. Communities are proud of their EMS systems, and rightly so. But then those communities must support the system with real dollars that are needed to put air in the tires and bandages in the unit. Develop hybrid systems that can augment times when volunteer coverage is missing or lacking. Investigate consolidation practices that spread out EMS resources evenly across a region, instead on having multiple little fiefdoms protecting turf for no practical reason.

Make changes. Someone’s life depends upon it.

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