How Three N.J. EMS Agencies Are Bucking the Volunteer Trends

New Jersey is a small but densely populated state with an interesting EMS system. All ALS in the state is provided by hospital-based systems in partnership with private health corporations, and two-person paramedic units are required. There is no volunteer ALS, and local agencies and fire departments do not have ALS capabilities. BLS is provided in New Jersey’s 566 municipalities by a mix of career municipal third services, career fire departments, private corporations, hospital-based services, and volunteer ambulance and rescue squads. While fire departments and police departments are required in New Jersey towns, EMS is not. There used to be well over 600 volunteer units serving the state, but that number today is just a little over 400 and steadily declining.

One of New Jersey’s 21 counties is Essex County, the location of Newark Airport, the fictional home of HBO’s Tony Soprano, and home to nearly 10% of New Jersey 8.8 million residents. Twenty years ago Essex County, consisting of 22 towns, had more than two-thirds of its EMS covered by volunteer EMS squads. In 2020 many of those towns have contracted with private services, started hybrid programs, rely on mutual aid, or have gone out of business. However, there are a few all-volunteer EMS organizations in Essex County that have remained and even thrived, even during the time of COVID-19. This article profiles three of those agencies.

West Essex First Aid Squad

• Towns served—Primary territory is the towns of Caldwell, West Caldwell, Fairfield, Essex Fells, and North Caldwell. Mutual aid provided to neighboring towns;
• Year formed—1937;
• Vehicles—Four BLS ambulances, one rescue truck, one fire rehab unit;
• Active membership—95 members, 60 of whom are EMTs;
• Call volume—Approximately 2,750 calls a year.

David Black has been captain of the West Essex First Aid Squad for several years, and he “couldn’t be prouder” of his agency, especially for the way its handled COVID-19 operations. While the vision of some volunteer agencies is retired folks or homemakers, Black shares that “60% of my active members are under 30 years old. To me this says a lot about younger folks’ commitment to service and volunteerism.”

West Essex is a pretty busy squad as far as Essex County goes, in service around the clock. It does not bill for services. “Funding is tough,” says Black. “We get about 80% from donations from residents and businesses.” The five towns collectively contribute the remaining 20%, but not evenly. “Some of the towns’ governing bodies are more generous than others” says Black. “People don’t realize the squad pays for its own station, landscaping, fuel, vehicles, utilities, medical supplies, uniforms, radios, and insurance.”

West Essex is unique in that it truly is a rescue squad. In the 1960s, ’70s and ’80s, rescue and auto extrication in New Jersey was primarily performed by ambulance and rescue squads. Over the last several decades this role has shifted mostly to fire departments, but West Essex maintains a state-of-the-art rescue truck and trains constantly. The rescue truck responds to all motor vehicle crashes and structure fires in its response area. For the last several years, West Essex has also had a fire rehab vehicle that responds to structure fires with food, drink, and supplies for weary firefighters. “A cup of coffee at a 2 a.m. winter fire is highly appreciated by our volunteer firefighters,” says Black.

COVID-19 has changed the way West Essex operates. “No member goes out on a call without an N95 and PPE,” Black says. “The day I can’t protect my members is the day we stop answering calls.” Additionally, West Essex increased training for all crews, especially for PPE and cleaning. All EMTs have temperature checks and screening checks before every shift. “We clean like crazy!” says Black.

West Essex uses UV lights, transformed one ambulance into a COVID-only vehicle, and overstocked with disinfectant. Some innovative younger members took spare parts and an SCBA tank and made a portable disinfecting machine, saving the squad money and providing the ability to disinfect the ambulance right in the emergency room bay. “The whole thing cost less than $150!” notes Black.

West Essex follows all CDC guidelines for PPE. Going further, leadership reached out to older members and any members who worked in hospitals and allowed them to take leaves of absence. They also contacted parents of younger members who lived at home to make sure they approved of their children going out on COVID calls. Black is proud that because of all these precautions and a strong focus on safety, at this time no squad member has tested positive.

It’s frustrating, though, because as volunteers, his squad has no priority for COVID testing. “We have to stand in the long line like everybody else,” Black says. Despite these challenges, there is still a long waiting list of volunteers who want to join West Essex.

Verona Rescue Squad

• Towns served—Primary territory is the town of Verona. Mutual aid provided to neighboring towns;
• Year formed—1927;
• Vehicles—Three BLS ambulances, one reserve ambulance, one first responder SUV, one chief’s SUV, two EMS electric bikes;
• Active membership—122 on roster (70 EMT, 5 EMR);
• Call volume—Approximately 1,700 calls a year.

Chief Ricky Tempesta has been a longtime member of the Verona Rescue Squad and chief for the last several years. He has seen his agency grow exponentially in volunteers on his watch. What’s the secret? “Work with people. Have multiple classes of membership. Treat it like a job where you have full-time, part-time, and per-diem volunteers. Take whatever time people have to give!” Tempesta says.

During COVID Verona both gained and lost members. The leadership called every member who was in a high-risk class due to age or comorbidities, advised them of the risk, and gave them the option of a leave of absence. While some took it, many continued to ride their shifts. The squad also suspended its high school cadet program. It did gain a great deal of interest, however, and onboarded dozens of new members. A long waiting list of individuals is interested in volunteering.

Verona has modified some operations. “We added a 24/7 road supervisor in a first responder SUV to assist crews on scene, observe crew donning and doffing of PPE for protocol compliance, and help decon the ambulances after jobs,” Tempesta says. The squad suspended mutual aid for a time but is back to both providing it for and receiving it from surrounding towns.

Funding continues to be an area of attention. The team is funded primarily by donations from residents and businesses. Leaders seek grants and corporate donations. The municipal body provides funding for communication equipment, insurance, and fuel.

In response to a perceived uptick in active-shooter incidents, the Verona squad formed a rescue task force that frequently trains jointly with the Verona Police Department. The team has tactical medicine equipment and tactical PPE and runs frequent drills for 24/7 deployment. Additionally, the Verona squad has a pair of electric bicycles for its EMS bike team; these get a lot of use during the scores of standby requests the squad receives. In terms of equipment, every ambulance has a power stretcher and loading system. Each has a BLS vital signs monitor and an automatic CPR device. They carry all medications allowed on BLS units in New Jersey.

Tempesta says one secret to member retention is flexibility: “If they can help us get a call answered and get an ambulance to a person who needs it, especially during the daytime hours, I don’t get caught up in as many rules and regulations as other places.” He also buys his members food—pizzas for training drills, subs during meetings, snacks during standbys.

The squad also equips members with gear and uniforms. “All members who respond get a radio,” Tempesta says. “All members who join get a full custom uniform: EMS pants, an embroidered job shirt, several uniform shirts, t-shirts, reflective jacket, duty boots, and a dress uniform shirt. We want them to feel appreciated and look professional.”

The squad also hosts an annual awards dinner where members are recognized for years of service, unit citations, and lifesaving actions. “It is a chance for the squad and town to say ‘Thank you, you are appreciated,’” Tempesta says. “Treat your people well and take what they can give, but demand professionalism.”

South Orange Rescue Squad

• Towns served—Primary territory is the village of South Orange. Mutual aid provided to neighboring towns, primarily Maplewood, Newark, and Orange;
• Year formed—1951;
• Vehicles—Four BLS ambulances;
• Active membership—40 on roster (all EMTs or in EMT class);
• Call volume—Approximately 1,600 calls a year.

What happens when a thriving volunteer squad is removed from its station by real estate developers and has to set up operations in a one-bedroom apartment with water leaks and rodent issues? According to Capt. Sean Cass, leader of the South Orange Rescue Squad, “Instead of going out of business, you thrive some more.”

The South Orange Rescue Squad (SORS) was founded in 1951 and has been providing free EMS service to the residents and businesses of South Orange for the last 69 years. In 2014 the squad’s longtime headquarters was torn down to make way for a retail space and parking garage. In addition to being relocated to temporary quarters in a small apartment a few blocks away, the squad had to fundraise to pay for a new station.

SORS does not bill. All its funding comes from private donations. The village of South Orange only provides fuel for ambulances and funds a length-of-service awards program for members who qualify. The squad pays for all its own medical supplies, ambulances, uniforms, radio and communication equipment, utilities, and more.

While some organizations would have faltered, SORS expanded service over the past five years. While some veteran EMTs left, the squad acquired several new members who contributed an immense amount of time. In addition to answering 9-1-1 calls for South Orange, the squad also started responding into the neighboring town of Maplewood more frequently, as its volunteer first aid squad had dissolved in 2016. Further, SORS often provides mutual aid into Newark when its busy urban system gets overloaded.

Unlike many volunteer squads, South Orange keeps its crews in-house. “We don’t respond to pagers. Because crews are always together at the station, we typically can have an ambulance out the door moments after the dispatch,” says Cass. “Our five-minute response time is considered outstanding by industry standards.” To keep members engaged on duty, the squad provides free Wi-Fi, several large-screen TVs, a study area, and bunk rooms, and keeps the kitchen drawers well-stocked with snacks.

South Orange drills often to keep EMT skills on the cutting edge. Its goal, according to Cass, is to be “one of the most progressive and advanced BLS squads in the state in every aspect possible.” This is accomplished through a significant emphasis on training, pushing for new medications and protocols, and equipping members with top-of-the-line vehicles and tools. South Orange has partnered with MD-1, New Jersey’s on-scene physician emergency response program, as its medical direction. Through this partnership with Dr. Mark Merlin and his fellows, the ambulances now carry all the current equipment allowed via New Jersey protocols, including CPAP, aspirin, naloxone, EpiPens, PEEP valves, albuterol, and more.

South Orange Rescue Squad has a cadet program where high school students get trained as EMTs and contribute to the organization while training to become senior members. In 2018 the squad took in its largest cadet class ever, 15 members. Many of these teens and 20-somethings are now experienced EMTs riding on weekly crews. In 2017 a team of four cadets won first place in the New Jersey cadet/youth EMT skills competition.

COVID did not leave the SORS team untouched. Along with an uptick in calls came changes in protocols. Ambulances were disinfected after calls with chemicals and UV lights. Crews were provided personal P100 respirators so as not to burn through all the remaining PPE. One ambulance was set up as a permanent COVID ambulance with compartments sealed off and the interior coated in plastic for easier cleaning.

SORS sent a dedicated volunteer crew into Newark multiple days in a row when its system became overloaded in April. Remarkably, rather than losing members, SORS gained them. It still has a waiting list. “The problem, and it is a good problem to have, is I don’t have space on crews for all these new people, as we want to continue to practice good social distancing in the station,” says Cass.

Conclusion

Research has shown that volunteerism is down in recent years. The need to work more jobs or more hours, a rise in two-income families, greater call volume, increased training requirements, and fear of disease have led to many community volunteer ambulance services adding paid employees, beginning billing, or going out of business.

In Essex County, N.J., three 100% volunteer agencies are showing that free BLS ambulance response can be done, and done well, with the right mix of effective leadership, a strong focus on training, and recruiting and retaining interested volunteers.

Barry Bachenheimer, EdD, FF/EMT, is a frequent contributor to EMS World. He is a career educator and university professor with more than 34 years in EMS and fire suppression. He is currently an EMT with the South Orange (N.J.) Rescue Squad, a firefighter with the Roseland (N.J.) Fire Department, an instructor at the National Center for Homeland Security and Preparedness in New York.