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Volunteer EMS: The strongest organizations will survive

The highest performing volunteer EMS organizations set a high bar for success, use their resources and collaborate with other successful agencies


Police, volunteer and paid EMS, and volunteer fire work together at a SADD drill.

Image Olivia Drake, Haddam Volunteer Fire Department

“If you want something new, you need to stop doing something old.” - Peter Drucker

The survival of volunteer EMS agencies in the U.S. depends entirely on their willingness to embrace change.

The challenges most often cited – lack of funding, dwindling membership, increased training and continuing education requirements – are real issues. They are not insurmountable.

For some volunteer EMS agencies, failure to evolve and a willingness to lower standards to the lowest common denominator out of desperation to fill the roster are the beginning of the end. Cultural stagnation and a focus on interpersonal dissent and drama are the hallmarks of a dying organization.

Low expectations become a self-fulfilling prophecy. Negativity, fear mongering, excuses and anger pervade both internal and public meetings. These agencies will not garner community support for funding, attract new members or retain their most dedicated responders. Their days are numbered.

High-performing volunteer EMS organizations

On the other hand, the most successful volunteer services have the highest standards. They do not accept candidates for membership who are not a good fit for EMS or the agency’s culture. They do not allow malcontents or tolerate non-performers in their ranks. Shifts are scheduled 24/7/365.Attendance and participation in meetings and training sessions is expected.

Service above self is the core value of these organizations, leadership is dynamic and engaging, decision making is patient-centric vs egocentric and the safety net they provide the community is both visible and measurable.

Members of high-performing organizations describe their experience as fulfilling, interesting, exciting and even… fun! They are professional in their appearance, attitude, and ability. Their peers and the other health care providers and public safety personnel they interact with respect them.

Which of these describes your service? Dying? Thriving? Or somewhere in between?


What can you do to effect change in a group mired in commitment to past practices and dogma? What if you are in a group that will not change and “can’t afford” training, uniforms, equipment or incentives? How do you move forward when the same three people have rotated the title of “chief, “captain,” or “president” for the past 20 years?

Cultivate new leadership

Change is hard. Positive, dynamic, and progressive leaders are critical in order to guide your membership to a successful future. Without them, your agency may well end up another sad news story when it closes down.

Demand excellence

Refuse to maintain the “status quo” of mediocrity. Do not accept that it is ever acceptable to fit the cliché of the rural responder - unskilled, uninformed and unreliable - the country bumpkin cousin of “real” EMS providers. I guarantee you are not alone. If you truly are committed to the survival of the volunteer system, you must dare to be the force of change.

Volunteer EMS is a business

Very few non-profit EMS agencies remain 100 percent “volunteer.” At least 50 percent report paying some sort of stipend or financial incentive, and an increasing number are integrating paid staff, especially during weekdays.[1,2]

The vast majority of EMS organizations are billing for service. “We don’t charge” should no longer be a badge of honor for non-profits or volunteers. It is unrealistic and foolish to leave insurance money uncollected that could be used to improve the quality and availability of service to your area.

The community served should not underestimate the contribution of volunteer hours. Be prepared to explain that to those who object or question billing. The national average value of a volunteer hour is $22.55.[3] An agency providing an ambulance full crew 24/7/365 is contributing $396,828 to the community in labor cost alone.

Use available resources

Many states have excellent “guidebooks” to aid volunteers in almost every aspect of managing their organization, from system models to recruitment. FEMA has several reports. The guides from the South Dakota and North Carolina Department of Rural Health, for example, are just as useful for Connecticut or Texas in most respects.

Federal and some state grants are available specifically to aid in recruitment, training, and to explore the regionalization of rural EMS

Seek help from the EMS community

Search the internet for articles highlighting successful agencies who have received recognition for achievement or won awards at the local or national level. Contact these organizations and ask how they get things done and to what they attribute their success. Successful people love to share their stories, and EMS is no exception.

If you have determined that your organization will need drastic changes in order to move ahead, consider contacting an EMS consulting firm who caters to rural and nonprofit EMS. Having a professional sort things out and get you on the right track just might be less expensive than trying a haphazard approach on your own, or wasting time re-inventing the wheel. Many initial consultations are at little or no cost.

Join forces

Resource sharing and regionalization are the future in every community, and are working successfully right now in many communities. Regionalization does not have to mean giving up your agency’s identity, autonomy or culture. Group purchasing, combined training, larger-scale fundraising events and even shared staffing are just a few examples.

Remember, “A rising tide lifts all boats.” Volunteer EMS exists to provide emergency care to those in need. There should be no place for competition or protection of individual fiefdoms at the expense of excellence in service. Begin a dialogue to explore the possibilities with your neighboring communities if you have not already done so.

Raise the bar

Excellence breeds success, and success attracts winners. Winners constantly strive to exceed expectations. A winning team has unfailing loyalty and support. Applying these concepts to recruitment, funding and training requirements will go a long way toward securing the future of the volunteer system.

“A volunteer is a person who believes people can make a difference and is willing to prove it.” - Unknown


1. MacKenzie, E.J., & Carlini, A.R. (2013, August). Characterizing local EMS systems. (Report No. DOT HS 811 824). Washington, DC: National Highway Traffic Safety Administration.

2. EMS Workforce for the 21st Century: A National Assessment.

3. Independent Sector’s Value of Volunteer Time.

Nancy Magee combines a business woman’s perspective on marketing, efficiency and customer service with an EMS volunteer’s heart. Nancy, a Connecticut native, now resides in Louisiana and offers her Volunteer Survival Series workshops and consulting services through MEDIC Training Solutions to agencies across the country. Contact Nancy at