Why Volunteer Agencies Can't Be Fast, Reliable and Free
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By Randall Hanifen
Contributor, EDM Digest
Volunteer firefighter and emergency medical technician (EMT) services are based on speed and reliability whenever care is needed. In many communities, these services are expected to be free or nearly free. These organizations often have little to no budget because of a small tax base where they serve.
Nevertheless, the lack of volunteer firefighters and EMTs is creating a nationwide problem. As many young people are heading toward professional, non-labor-oriented professions, the interest in volunteerism has dwindled.
If you Google firefighting, for example, much of what you’ll see involves cancer hazards, heart attacks, and other health and safety issues. Although first responders have started to address these problems, prospective volunteers are put off by them.
Nothing in Life Is Truly Free, Even EMTs and Firefighters
The typical volunteer agency receives very little in funds from the community. Some communities hire private first responder organizations to provide fire and EMS protection. The first responder agency could also be a municipal organization that is managed and funded directly by tax dollars or a quasi-government organization, such as a Joint Fire District.
Such an arrangement means increased funding and greater accountability. Sometimes, the organization might be a private fire or EMS company comprised of community members who are happy with the service they provide.
When extra funds are needed to buy new trucks or gear, they raise the money from the community or from their own group. This type of organization is often managed as a social club or family so there is less oversight.
But once a municipal government becomes involved, especially in regard to oversight, many more rules, regulations and accountability measures come into play. Municipal involvement may also provide first responder organizations with more funding because local governments have the ability to levy tax funds just for fire and EMS service.
However, the volunteers lose their oversight function at this stage of development. The ownership of and ultimate authority for expenditures reside with elected officials. Volunteers are less likely to buy even badly needed equipment due to its high cost.
Today, many volunteer fire and EMS organizations are transitioning from free to paid volunteers. Local governments, however, do not want a big increase in funding or in local taxes, especially when they have never before paid for firefighters and EMT personnel. Some laws and regulations now require fire and EMS personnel to be paid at certain rates and for specified hours.
The availability of volunteers is a two-fold problem. Many organizations will try to hire volunteers who can work during the day. But that is often the time when volunteers are not available.
Should Our Volunteer Agencies Become More Transparent?
Due to an increased demand for transparency, a recently enacted law requires hospitals to list the prices for all services and procedures. Perhaps now is the time to publish the response times and reliability ratings of volunteer responder agencies?
I live in a well-populated, growing suburb. Based on my home’s location in relation to the community’s fire stations, I am at the extreme far end of their response times. I bought my home accepting that fact.
However, many people living in rural areas likely do not think of first responders’ response times. All municipalities should compile response time profiles of their coverage areas, as well as list the response strength and reliability of those local services.
The lion’s share of municipal tax dollars go to first responder services, so their costs should be transparent. Improved transparency by volunteer agencies could be helpful when they request additional funds. Transparency could also increase public awareness of issues involving first responder services.
Funding on a Sliding Scale Is Another Option for First Responder Services
The current school funding model in my state provides more state funds to local school districts that do not have many financial resources. For example, the state does not provide a great amount of funds to my district because we have high local taxes.
But if a neighboring district has a small budget due to fewer local tax dollars, the state sends proportionally more money. The idea is to give a fair chance to all students in the state.
If this funding method works for our state school systems, why couldn’t it work for fire and EMS protection? This funding method would perhaps be a helpful departure from the method used by many fire and EMS organizations.
But the funding problem may actually fix itself in time. Many smaller organizations are disappearing due to a lack of volunteers.
Combining Fire Agencies with Emergency Medical Services
The fire service is one of the largest providers of emergency medical services in the United States, particularly in areas that require more personnel than just volunteers. Smaller communities often have a budget that can pay for a limited number of employees. As a result, fire and EMS duties are often combined.
With volunteer agencies, it is difficult to find personnel trained in both fire and EMS work. It is hard for them to retain their certifications due to the number of required continuing education credit hours.
But within the volunteer ranks, giving CPR training for local firefighters and purchasing an automated external defibrillator (AED) to carry in their vehicles improves response times and increases the availability of personnel who can ensure a fast, reliable response.
Smartphone applications such as Active911 or PulsePoint allow personnel and citizens trained in CPR to respond more quickly to cases of cardiac arrests. They can perform life-saving techniques while the ambulance responds to the 911 call. This improvement in survival has significant benefits to the community.
At What Point Does a Community Need Paid Paramedics?
A recent paper by the International Association of Fire Chiefs opposed a requirement for a college degree for paramedic certification. There are many inherent problems with this requirement, because many EMS services are still volunteer or semi-paid positions.
Can you imagine asking someone to earn an associate degree just to volunteer once or twice a week so that a small town could have emergency medical service?
The paramedic service has a definite value-add for a community. When I started in emergency medical services, the focus was on good basic life support (BLS) care supplemented with paramedic interventions and advanced life support (ALS). After a while, the focus shifted to the need for everyone to be a paramedic and to “field cure” patients through our paramedic skills.
I have witnessed only a few instances when paramedics were able to completely remedy a healthcare problem in the field. The vast majority of injuries must be taken to the hospital for advanced care. In the past few years, however, American Heart Association guidelines have moved back towards good BLS care supplemented by paramedic treatment. I want to see more studies conducted on the actual value-add of paramedics versus their actual cost.
As a Journal of Emergency Medical Services (JEMS) article pointed out, the mortality rate for gunshot victims is no worse for people transported by police in urban areas such as Philadelphia and Sacramento than for victims transported by paramedics. It would be useful for someone to undertake a comprehensive study of different areas and response models for EMS care.
Regionalization and Collaboration Are Key for EMS Delivery
Just as the fire service needs to look at regionalization, emergency medical services should do the same. While many fire agency personnel can exist with as little training as 36 hours in Ohio and no training in some other states, EMS certification is different. It is bound by nationally accredited programs that have a strict, often high number of hours required to be an EMT. In addition, a paramedic must undergo about a year’s worth of training.
Because citizens are not volunteering much time to earn their initial certification, the solution for many communities will be to pay their first responders.
While combining emergency medical and fire services in the same area is the optimal answer, the reality is that the two organizations may be at odds in many small towns. One service is generally seen as superior to the other. In this case, regionalizing the EMS service independent of fire agencies may be a better alternative.
It will create a larger pool of personnel to staff ambulances. Also, funding can be combined to create a large enough budget to place some paid staff at ambulance stations. The reliability of first responders would be increased, but response time could be affected as ambulances would need to cover a larger area.
Ultimately, firefighter and emergency medical services cannot be fast, reliable and free. Until someone figures out a solution, this dilemma will continue.