Endangered Species

So, I recently read an article online in Fire Apparatus Magazine bemoaning the state of EMS. Because, as we all know, the most current information on emergency medicine comes from a magazine that shows pictures of big red shiny trucks.

When you go through the article (I’m not going to link it because I don’t want to give this guy any more legitimacy), he raises the standard argument that fire chiefs and large EMS system managers always use as their stalking horse in their arguments to keep EMS educational standards low — or even lower them. Yep, that’s right. The mythical rural EMS volunteer who will disappear if we change the science and/or add one more bit of knowledge to their already overflowing brain.

I feel more than qualified to address this issue. I’ve spent the majority of my EMS career as a volunteer at both the EMT and paramedic levels with both fire-based systems and third service models. I’ve worked urban, suburban, and rural. The majority of my experience has been in combination departments where paid and volunteer medics work side-by-side. And to the premise of this article, I say, “BULL.” Well, I said more, but this is a family-friendly blog.

I’m more than tired of using the overworked rural volunteer provider as a straw man. First, regardless of whether you draw a paycheck or not, an EMT or paramedic certification is the same. In many states, you can’t say the same for a paid versus unpaid firefighter. Second, in my experience, volunteers are some of the most motivated people out there when it comes to seeking continuing education and opportunities to advance their medicine. In the rural service where I currently volunteer, we have an active continuing education program consisting of monthly online classes as well as a full panoply of “card courses” covering resuscitation, cardiac care, medicine, trauma, pediatrics, and tactical medicine. Our medics, at all levels, routinely exceed state mandated training requirements. I’d further note that several of our paramedics are volunteers who work in outside professions and maintain licensure in those professions as well. Furthermore, come to any of the big EMS conferences. There, you’ll notice a disproportionate number of volunteer providers, especially compared to those employed in large EMS systems.

In short, Chief Haddon of the North Fork, Idaho Fire Department is wrong. Volunteer EMS providers can, will, and do exceed educational requirements and expectations. Give them a chance and you’ll find out. And if you don’t believe me, I’m extending a personal invitation to come down to Texas. I’d be happy to introduce you to some volunteers who actively seek to improve themselves professionally for the benefit of their patient. Heck, I’ll even treat to BBQ.

I’m not expecting a visit, though. It’s a lot easier to use the myth of the overworked, overwhelmed volunteer EMS provider who will go away if we add one more class. Sadly, this “don’t need to know it mentality” usually only benefits the “mongo mentality” of “you call, we haul” that seems to hold back EMS. The worst part is that the same departments and administrators who bemoan increased EMS education can be seen at all of the structural fire conferences. Maybe its time to have more volunteer EMS systems and less volunteer fire systems?

Comments

  1. You are so on the money!! Volunteers are extremely dedicated and should be commended!

  2. hi,
    i am one of those EMT “volunteers who actively seek to improve themselves professionally for the benefit of their patient.” doing a university degree to get my Paramedic qualification but when i look at the last group of volunteers currently at first responder level and how keen they are to learn more and be better i can see apprehension and questioning about the more classroom and learning to be an EMT . they are all a bit scared about it. Hopefully they will all do it but sadly we usually lose a few in the process .. and i forgot we have weekly training session on station organised by one of the 2 paid paramedic or by one of the volunteers EMT

  3. J. Collins says

    I’m inclined to agree with you at some levels but also inclined to disagree. I will disclose that I have not searched nor read the offending article. I have experience in urban/suburban/ruralish(probably not as rural as you) commercial EMS. I also volunteer for a suburban ALS transport fire company.
    I have had one unsuccessful attempt at paramedic involving 3-5x/week round trips of 60 miles that I did for the “vollies”. The amount of time I had to spend away from home on top of working full time + overtime to support my family almost lead to divorce. What it did lead to was me falling behind on a program that had a heavy emphasis on clinicals. Most of them were a complete waste of time but that it neither here nor that. This is the “local” program.
    I just spent 15 months completing a 160 mile round trip, twice per week commute to attain my Paramedic certification. Not including the four months when I was driving that four times per week, while working full time plus and attempting to see my(larger) family. This program was hands down superior and the clinicals actually all meant something. Oh and did I mention that I went inactive at my volunteer company because I just didn’t have the time?
    The last 15 months were the most physically exhausting and emotionally demanding experience of my life(the Army didn’t want me). I feel that I am a better paramedic from it and I would recommend this program in a heartbeat to anyone regardless of the commute.
    So yes, attempting to have volunteer providers advance ahead to Paramedic has been unsuccessful. Indeed I am only the fourth person to attain paramedic in my service and this was selfishly to advance my paid career. The first two did it years ago when the requirements were much less than what they are now.
    I don’t know if the requirements are much more lax for your EMTs to move up in Texas but here it is neigh impossible without tuition assistance/scholarship as well as employers bending over backwards to accommodate the scheduling. Very very very few people who attend Paramedic here are volunteer only.

  4. I have seen a lot of places where the volunteer base is dwindling and I would venture that it is not the educational standards that is driving people away from volunteer EMS.

    I think part of it is the call volume, which even in a lot of rural areas is going up. When I gave up volunteering 15 years ago, the call volume was increasing to the point is was hard to go to work the next day after answering three, four, and five calls during the night, most after midnight.

    But I think the main thing is the lack of opportunity in many of the small communities that rely on volunteers. I can go all around the countryside here close to home and see empty factories and businesses. The jobs left and so did the people.

    It is a lot easier to blame the lack of volunteers on something the person may or may not be able to control. If you complain long enough, and enough uninformed people agree with you, you, too, can effect a change such as lowering EMS educational standards. I guess that would be a lot easier in answering the questions as to why all of those jobs (and the people) went away…

  5. David Chudd says

    Yeah… ask the New Jersey First Aid council about the crux of your argument. Where I come from we are just volunteers and cant be expected to do that is the most popular song on itunes.

  6. So, has anyone thought of the other end of this spectrum that isn’t addressed in this article? And yes, I know that it isn’t always the case what I’m going to present, but it certainly seems prevalent.

    That is to say, what about the for profit services that are small, large, and borg like? Why wouldn’t they push for less education? It’d certainly keep their costs down.

    Keep the “paramedic” closer to an EMT-I and they don’t have to spend as much on so many levels and they get to keep getting paramedic level medicare reimbursements? Therefore more profits, which I’m sure would be either given to the providers, or back into better equipment. Or something like that. Yeah, that’s it.

    • Are you sure that they don’t? The commercial services that is.
      As I recall, back when the 1994 curriculum revision was being done for EMTs, one of the constraints was that the new course could not be longer than the existing course. Where did that pressure come from? The volunteer community.

      Maybe that’s changed in the 20 years since then, but I don’t know that.