Why Volunteer Squads Are Dying

The opinions and commentary expressed in “Perspectives” are the sole property of the author and do not necessarily reflect those held by EMS World, its staff members or affiliated organizations.

There’s no better feeling than giving back to your community and knowing you made a difference, but at what cost? Throughout the country the number of volunteer EMS agencies has sharply decreased within the past decade. In fact, more than two-thirds (69%) of rural EMS directors surveyed in 2015 reported having problems recruiting new volunteers.1

The time for saving volunteer agencies is running out. But what is causing their collapse? I’ve observed a few things.

Electronic charting—Although electronic charting can facilitate research that leads to better patient care, it may deter volunteers and hurt EMT retention rates. People donate their time to volunteer squads to make their communities safer and help those in need. They undergo rigorous training to learn how to treat patients in medical emergency. But with more and more states mandating electronic charting, time is shifted away from the patient and toward the computer. While entering a PCR into an electronic database might seem like a simple task, the complexity of these programs can be time-consuming. Time not spent on calls may be better spent doing other work, studying protocols, or even just decompressing after a stressful run. All these pastimes are infringed upon by the time commitment required by electronic charting.

CE requirements—Nearly 40% of EMTs cite their inability to complete the continuing education requirements as a reason why they’re unable to continue riding.2 But I suspect it isn’t the long-standing 48-CEUs-in-three-years requirement contributing to the decrease. Instead it’s the monopolization of the National Registry and its rigorous requirements that are disincentivizing people to become certified in the first place. For example, in New Jersey the number of hours required for recertification is the same as the National Registry, but New Jersey allots three years to attend those classes, whereas the registry only allots two. Familiarity with the most current protocols is essential, but it is clear these new regulations are discouraging new people from volunteering. Perhaps if the National Registry were a bit more lenient with the recertification process, more people would be eager to become certified.

Equipment prices—Over the last decade the price for medicine has increased dramatically, which has been a significant burden to EMS agencies both volunteer and paid. Two of the most prominent medications on the ambulance for BLS providers are nitroglycerine and epinephrine, which respectively have increased 68% and 405% in price.3 These drugs do not single-handedly take a volunteer agency into the red, but these prices represent a sharp increase in costs. With many volunteer squads funded on pure donations, it becomes increasingly difficult to stay afloat.

Although the reasons above only reflect my personal experience, volunteer squads continue to struggle, which is having a large impact on America’s healthcare system. In small rural areas a staggering 53% of EMS is provided by volunteer squads.4 In large rural areas, it’s nearly 30%.4 Needless to say, recruitment has to be a priority.

As I finish my first year and a half riding for a volunteer squad, I can’t begin to describe how rewarding it has been. Having the opportunity to serve my community and make a real impact has opened so many doors for me. Despite the changing industry, our mission remains the same: to make our community a safer place.

And luckily, there is a way to combat some of the challenges volunteer squads face. For starters, volunteering is the most valuable thing you can give to a squad. This doesn’t always require you to hold a certification; contributing time can benefit a squad in many ways. If you are unable to give your time, donating money is another way to make a positive impact. But the easiest thing to do is to spread the word and educate others on the importance of volunteer first aid squads.

References

1. Freeman V, Rutledge S, Hamon M, Slifkin RT. Rural Volunteer EMS: Reports from the Field. North Carolina Rural Health Research & Policy Analysis Center, www.shepscenter.unc.edu/rural/pubs/report/FR99.pdf.

2. Freeman VA, Patterson D, Slifkin RT. Issues in Staffing Emergency Medical Services: A National Survey of Local Rural and Urban EMS Directors. North Carolina Rural Health Research & Policy Analysis Center, www.shepscenter.unc.edu/rural/pubs/report/FR93.pdf.

3. Abes B, Augustine JA. The Next Body Blow: Rising Drug Prices. J Emerg Med Serv, 2017 Oct 18; www.jems.com/2017/10/18/the-next-body-blow-drug-prices-rising/.

4. Patterson DG, Skillman SM, Fordyce MA. Prehospital Emergency Medical Services Personnel in Rural Areas: Results from a Survey in Nine States. Seattle, WA: WWAMI Rural Health Research Center, University of Washington, 2015; https://depts.washington.edu/uwrhrc/uploads/RHRC_FR149_Patterson.pdf.

Ross Bell, EMT-B, serves with the Millburn-Short Hills Volunteer First Aid Squad in Millburn, N.J.