News continues to raise the alarm about EMS organizations — both paid and volunteer — that fail to meet response time promises or even respond at all. Some agencies are unable to replace broken down equipment and others fail to meet payroll. Agencies shutting down without warning have become almost commonplace.
EMS is never free
EMS as an institution the United States is floundering. Without state or federal mandates for the provision of ambulance service, the responsibility for ensuring that all citizens have access to EMS remains at the local level.
Keeping EMS local has long been the battle cry of volunteer ambulance agencies and rescue squads. Who better to care for the ill and injured in their time of need than trained and knowledgeable neighbors who know their areas topography, demographics and culture?
A devoted, professionally run nonprofit ambulance agency whose labor cost is offset by the contribution of volunteer labor is by far the most cost-effective way of providing emergency health care services for many areas. But it is time for the communities served by volunteers to understand that EMS is not free, and that the revenue stream available to 911 services — paid or volunteer — is woefully inadequate.
Fundraising is for charity, not essential services
No EMS professional should be standing in the road asking for money to fill a can or a boot to keep an ambulance or fire truck on the road. Fundraising should be reserved for raising money for nonurgent improvements and other types of community charity.
The public needs to be educated to accept that being billed for service is part of modern EMS. Towns need to contribute to shortfalls in funding if they want to benefit from the advantages of having a dedicated, locally run volunteer service. In return, the volunteer agency must own responsibility for meeting the expectations of the community.
911 response must be assured 24/7
A volunteer ambulance service must be absolutely committed to taking responsibility for their designated service area. The first priority of every volunteer service needs to be a timely and guaranteed response to every 911 call.
Whatever it takes to make that happen comes before any other issue. A “sometimes we respond” or even “most of the time response” is not acceptable.
And if the excuse is “We are just volunteers,’” there is an epic failure of leadership and a major change in culture that needs to happen if the service is to survive.
When a volunteer agency accepts the responsibility for the safety of their community, there is an obligation to provide that service that is non-negotiable.
Pure volunteer is not always better
Too often, inadequate staffing becomes the status quo until it is exposed by a response failure resulting in harm or death of a patient. If all attempts to recruit enough members for sufficient staffing are failing, or funding is not available to hire staff and cover schedule, immediate action is required. This could mean becoming a medical first responder service, combining resources with neighboring agencies, or accepting that insurance billing is a survival necessity.
The trend towards combination paid/volunteer agencies and regionalized community EMS will continue. Billing for service in order to pay for staffing, administrative costs, and operational expenses is not a disservice to the community, it is the responsible approach to the business of EMS. Being a pure volunteer agency that does not bill patients or pay any staff is not an honorable claim if the result is failed response, outdated equipment and unreliable apparatus remaining in service.
Something is not better than nothing
Volunteer agencies cannot rationalize a something is better than nothing attitude unless the public served is completely aware, and willing to accept that this is the best level of service they should expect.
A citizenship that accepts a sometimes available level of service also needs to understand that if this is the case, where you live may determine if you live. Honesty, integrity and transparency must be the hallmark of an organization that is dedicated to community service.
Traditions should be built on excellence
There is a mindset among some volunteer agencies that billing for services, and incorporating paid EMTs to cover the schedule is somehow offensive to the concept of a real volunteer EMS agency.
Many long-term volunteers see both issues as giving in, failure or the beginning of the end for their service. Change is difficult, and both billing and adding paid staff have significant challenges. But the days of uncomplicated, well-staffed and relatively autonomous volunteer EMS are gone, and those days are not coming back.
A better future for volunteer EMS
Many of today’s volunteer EMTs are better educated and more aware that while the provision of EMS is local, the business of emergency care is global, and that scientific evidence, economics and an ever-changing society will shape the future of their profession, and not tradition.
The foundation of volunteer EMS should be built on pride in caring for the community, demanding excellence in clinical performance, and the personal satisfaction found in giving a service to others. Accepting this premise as the basis of tradition, and letting go of outdated ideas about what validates the concept of a volunteer EMS agency will allow for forward progress and ultimately, survival.
