“Something’s Got To Be Done”

I saw this headline yesterday in yet another article about a volunteer fire department and a staffing crisis. The article goes on to mention a severe lack of staffing. When these articles get shared on the Book of Faces, the usual suggestions typically arise. Tax incentives to volunteers. Finding the money to get a paid fire department. Comments from some about the volunteer fire service being an antiquated model whose time has long since passed. And occasionally, you’ll read stories about well-meaning elected officials offer a “solution” that involves waiving certification and/or training requirements for volunteer responders, whether fire or EMS.

I’ll never argue that there is NOT a crisis in volunteer fire and/or EMS staffing. What I will argue is that many of these crises are self-inflicted.

More than a few of these departments operate as social clubs that just happen to have cool trucks and equipment. If you want proof of this, look no further than the “hiring process” at many of these organizations. For many places, the hiring process involves coming to several meetings over a period of time and then being “voted in” by either a committee or the entire membership. For all of the talk about volunteers being “unpaid professionals,” tell me how many other businesses select their team members this way, let alone for an organization that performs often dangerous work. And that dangerous work involves caring for the public, for property, and involves the public’s trust. A popularity contest, especially one with black balls, isn’t the way that we should be selecting public servants and public safety professionals, regardless of a paycheck or lack thereof.

Speaking of hiring. It’s hard to hire people if they don’t know you’re looking for help. It continues to amaze me how few volunteer fire and/or EMS organizations tell people they’re looking for help. And if you think that’s a low number, wait until you see how few put an application on their website or provide any information about how to become a member of the department.

Volunteer departments claim they’re desperate for help. But only if the help is the help they think they need. What does this mean? If you can’t work on their coverage schedule, they don’t need you. If you’re not in district, they don’t need you — even if you’re willing to stay at the station and provide coverage. (And that brings up the whole thing with not being able to get fire apparatus or an ambulance moving until someone goes to the station to retrieve it.) And while the paid fire service has its issues, even they are coming to a place based in reality. Namely, the fire service is a medical provider, even if they’re not transporting patients. Many fire departments have started hiring single role paramedics. And more than a few are providing these single role medics a career track. But the volunteer fire world isn’t there yet. And more than a few are actively avoiding such a mindset. I can point to at least one department that doesn’t require any medical training past CPR/AED for potential fire volunteers, but won’t even entertain the possibility of bringing on someone who’s “just” there for medical calls.

We could talk about retention. We could talk about politics. We could talk about the issues involved with going to a paid or a combination department. But right now, like the chiefs in so many places say, “Something’s got to be done.”


Maybe what needs to be done is to recognize that your current models of recruiting and staffing aren’t working and don’t reflect the current realities of life and of emergency services. What may well need doing is changing who’s “leading” volunteer fire and EMS. And this next generation of volunteer leaders needs to understand that some help is better than ideal help that doesn’t exist.

EMTs And “Candy Stripers” Are NOT The Same

Ever since I was a child, I’ve been a big believer in the value of service. Service above self. Service to others. Service to the public. To me, it is part and parcel of being a citizen in the world’s greatest experiment in limited self-governance. It’s been part of my career in government service as an attorney. And it’s one of many reasons that I choose to volunteer my time as a paramedic.

EMS is a noble field, whether or not you’re drawing a paycheck. For many of us, it’s a calling and a passion, regardless of whether or not we get paid. And for the vast, overwhelming majority of paramedics, it’s how they make a living. For that same majority, it’s what they’ve chosen to do as a profession.

For some, EMS is a stop along the way to other fields. Nursing, Physician Assistant, Nurse Practitioner, Physician, or even, God forbid, law. And that’s okay too. We can have a separate discussion in the future about the EMS profession not always finding ways to keep our best and brightest in EMS.

And despite some of my jokes and social media posts, it is possible to have a career as an EMT. For some people, that’s just fine and provides them the life they want.

What should NOT be acceptable to us is using EMS and an EMT certification as little more than a check-off box for an application to medical school or some other form of healthcare education. It cheapens EMS. It cheapens what we do. We are NOT a way station along the path to another degree, license, and career.

As someone who’s spent almost all of their EMS career as a volunteer while maintaining a paid career and license in another field, I’m, I dare say, offended. While I’m obviously a strong advocate for EMS as a form of community and public service, I’m an equally strong opponent of EMS being the modern day equivalent of “community service” that kids of my generation (Gen X, by the way) were told they needed to have on their resume and college application.

As a kid growing up in the late 1980s and early 1990s, I remember being a volunteer at a local hospital. I spent several hours several times a week pushing a cart delivering flowers and greeting cards. I got zero exposure to healthcare.

As I review my EMS career, I’ve had a long history around college students who got their EMS certification and volunteered during college, often because they were told that medical school and other graduate level healthcare education programs looked favorably upon healthcare experience.

Some of these volunteers were great. Several are still my friends. At least one of these people is a physician who I’d be honored to have as my medical director. But like any other field, it’s a mixed bag. Some of these EMS volunteers were clearly not in the right place in their life. (Ask me about several students from a prestigious university near Houston looking wide eyed at the chaotic nature of emergency medicine.) And more than a few were just riding on the ambulance to get their de facto specified hours to satisfy whatever requirement they needed to satisfy.

And just this week, I had an attorney colleague reach out because their son, who’s a pre-med student in college got his EMT certification and “needs someplace to work part time or volunteer” for his medical school application. I had to explain to the attorney that it’s already hard for me, as a paramedic, to find volunteer opportunities.

Throughout my experiences in volunteer EMS leadership and administration, college students would routinely contact me saying they needed to volunteer X number of hours over a limited period, often during summer and/or winter semester breaks, for the purpose of “trying to get into medical school.” I routinely declined such requests. The operational tempo of an EMS agency doesn’t often allow for this. Additionally, it’s hard to justify the time in onboarding a very temporary provider and spending the money on uniforms and other resources for someone who’d be departing after a specified number of hours, shifts, or when school went back in session. Allowing them to do such was not fair to the organization. Nor was it fair to deny my more permanent volunteers a slot on the schedule for this resume padding. Most importantly, it’s not necessarily the best for our patients. Our patients rightfully deserve the attention of a fully committed EMS professional.

Hospitals don’t have volunteer opportunities like they used to. And yep, I’m old enough to remember when hospital volunteers were often called “candy stripers.” (I also have a story about having to buy a “uniform” shirt from the hospital, then needing to go buy white jeans. This contrasts very poorly with my first fire chief who said that you should never have to pay to be a volunteer.)

I’ll say this much. There is a place for volunteers in EMS. But the role and responsibility of being an EMS professional, paid or unpaid, is not just something for community service hours for healthcare education applications. It cheapens EMS. And, in particular, it cheapens volunteerism in EMS.

An EMS certification is not for community service hours. While it may be a way to see if further education in healthcare is for you, it’s not the responsibility of the EMS system to provide you these hours or the opportunity for self-reflection.

If graduate healthcare education has instituted a requirement, whether official or not, to have community service hours in healthcare, they need to make the opportunities available. It’s not the responsibility of an already overworked EMS system to do such. And in the spirit of equity, it’s a form of gatekeeping to keep out those who don’t have the finances to become certified in a field just to get a chance at admission to graduate education.

Stop normalizing EMS as a resume entry for your next degree. And stop requiring it.

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