Is the EMS volunteer extinct? Is it time they become extinct? Is there any advantage to having volunteers run with your squad? What should the role of the volunteer be in a service dedicated to providing quality patient care? Should volunteer EMSers track me down and beat me silly after reading this article?
IN THE BEGINNING
Late 1970s, early 1980s
Life was sure different back in the day. In the late 70s and early 80s, Saturday Night Live was still fresh, funny and new. A young Tom Petty and the Heartbreakers cranked out rock hits with their album (yes, I said album. It’s a round, black, plastic disk with grooves that somehow holds/plays music). “Damn The Torpedos,” amidst a new, yet revolutionary sound called punk rock. God I hated Punk Rock! Jeans were still worn tight and eye glasses were HUGE! God I hated those glasses! I think this is where the word GEEK was invented. Give your Eyes an Extra Kick!
The world of emergency pre-hospital medical was in its infancy. Sure, a lot of communities had an ambulance or two, (most were meat wagons that doubled as the local mortuary’s hearse) and the only perspective most of us had about what a paramedic did for a living came from watching episodes of “Emergency”. An entire generation of ‘whackers’ were created thanks to the exploits of Johnny and Roy. Back then, the public viewed EMS as nothing more than a taxi service for the sick and the injured. Expectations were low. Emergency medicine began after the ambulance arrived at the hospital, after the ankle-high gurney slammed through the large swinging doors onto the black and white square, checked, freezing cold, ER floors and into the closest exam room. By the way, I’ve always wondered why those gurneys were so low. I always feel sorry for those poor ambulance crews on the old TV shows who were forced to bend half way over while climbing up and down flights of stairs with their latest 200 pound patient flopping around. I’ll bet it was one of those ambulance attendants who invented today’s expandable litters. Whoever you are, you are my hero!
Most, if not all of the folks who served on the ambulances back then were volunteers. God bless them, everyone. If it wasn’t for their hard work and dedication, EMS would not be what it is today. It was the beginning of a new and exciting push for better health and treatment and they were on the cutting edge. The people who endured the training and funny looks from white-capped hospital personnel, did not do it to earn a living or make a few extra bucks. They did it to help their fellow man and serve their communities. They did it on top of working their full-time jobs and on top of taking care of their families. And, they did it all for no pay. Allow me to change my previous, hero worship, statement. These pioneers are my true heroes.
￼HOW COULD THEY DO IT?
Life was different.
So how did these dedicated volunteers hold down full-time jobs, take care of raising their families all the while breaking new ground in pre-hospital care?
One reason was the difference in training requirements then verses now. A good friend of mine was one of the first paramedics in our area of Pennsylvania. He used to tell me stories about becoming a medic. Of course they had some practical skill and some classroom work to complete. But the real kicker was his story of how scared he was when, at the end of what little training he had, he was handed a stack of copied sheets of paper from a paramedic course book and told, “ Don’t kill anyone!” Back then, your paramedic certification never expired. Continuing education was not required or at best, was extremely minimal. You still needed the blessing of your squad’s Medical Command doctor to run calls. According to my friend, most were rubber stamped because the expectations were low and if you were willing, so were they.
Family life was also different. The cost of living was much less which meant that most homes could get by with one working parent. That working parent’s take home salary was enough to sustain the expenses of the family, therefore, there was no need to work multiple paying jobs. This is not the case today. Most people that I know who work in EMS as their sole source of income work a minimum of two, but mostly, three or more jobs just to maintain their standard of living. Okay, they could most likely cut back to one or two jobs if they gave up some of their big boy toys like jet skis, boats and motorcycles, but what fun would that be? The point is, that back in the late 70s, volunteerism was affordable.
Another factor that made volunteerism possible in pre-hospital medicine was the element of low expectations by the public. In the late 70s, early 80s, most people didn’t even know there was an emergency ambulance squad in their community. The last thing those people thought of was calling for a red light, siren whining ride to the local hospital. Most communities did not have a 911 system. And even when these emergency call boxes were put in place, most folks would rather die than call. That is until the ever popular “911 Emergency” show hosted by Captain Kirk, I mean William Shatner. Wouldn’t it be great if we could beam certain patients to the ED??? That show changed everything and lead to the flourishing business of EMS that we enjoy today. But again, even when an ambulance was summoned back in the day, the only expectation patients and family had was that the crew would deliver their loved one to the closest hospital safe and sound.
This factor made the job less stressful and made it easier for non-paid personnel to perform at the level of expected care. Let’s face it. It doesn’t take a lot of continued training and research to be able to drive real fast and do minimal patient care while en-route to the hospital.
THE BAR HAS BEEN RAISED
It’s about quality patient care now.
Having said all that, what about now, today, this minute? Well, the honest answer is it depends on where you work. Some EMS squads are all about the scoop and run method. Other squads are more focused on providing quality patient care. The reasons for the differences vary. Some squads pick up most patients only a minute or two from the local hospital. Some have policies that mandate that their on-duty crews get back in service after each call as fast as possible to take the next call. But, when push comes to shove, in a public forum especially, most squad leaders will state that they are all about quality patient care. How could they say anything else?
Today, the public’s expectations are for quality, advanced life saving treatment. Most of us would accept nothing less for our friends and family. If the public knew that a squad was all about the call volume instead of providing quality care, that squad might find themselves out of service, permanently.
Training has increased and become more involved and more intense. In Pennsylvania, it is not enough any longer to complete and pass a paramedic program. You now must pass the National Registry written and practical tests before you earn the coveted patch with the orange “Paramedic” stitched on it. And although your medic still does not expire with the state, if you do not maintain the 18 hours of con-ed requirements every year, then your command is pulled and you are not allowed to practice until the requirements are met. If you want to keep your National Registry status, you must complete a total of 65 to 80 specific con-ed requirements every 3 years. After going through everything they require you to go through to get it, why would you not? ALS (advanced life support) ambulances carry a ton more medications than in the old days, requiring a much broader knowledge base. And some, “cutting edge” squads, with really aggressive Medical Command Physicians, have added even more medications and techniques for their competent Medics and Pre-Hospital care givers to deliver. All of this makes training a full-time commitment.￼
SHOULD VOLUNTEERS BE IN EMS?
Here is the bottom line folks.
In this day and age, should volunteers be involved in pre-hospital medicine?
My opinion, no way! Let me qualify my answer. There is no such thing any longer as a volunteer Paramedic. Okay, there may still be a couple of volunteer Medics in the boonies and back woods somewhere. But in most, thriving metro areas and their surrounding suburbs, Medics are paid, period. So the only volunteers left are the Basic EMTs. This is possible due to the fact that their continuing education requirements are much less than todays Paramedics. These folks can still have a “real job” and volunteer a few hours a week or a month without killing themselves or their families. The problem is that they only perform (and I use that term lightly) the duties and, most importantly, the skills of an EMT in small bits and chunks. As a Paramedic who relies on his Basic EMT partner to provide quality pre-hospital medical care to his patients, this becomes a problem. Most if not all of the volunteer EMTs that I’ve worked with do not have, and do not care to attain, the proper level of skill that is needed in todays EMS environment. This means that the Paramedic ends up needing four hands instead of two to make sure his patient is cared for at the appropriate level.
At my fulltime job we do not use volunteers except to run as a third crew member. All of our Basic EMTs are paid and have committed themselves to a career in emergency pre-hospital medicine. I am hear to tell you, this commitment to the profession makes a huge difference in patient care.
I know all the volunteers are screaming right now about how much money they save their squads by taking the occasional shift. Factor this in…. if Medics “sick out” of their scheduled shifts because they know their partner is an unskilled EMT, does that save you any cash? I know for a fact that this is happening at partial volunteer squads. The pressure placed on the Paramedic is great enough without adding the volunteer partner who cannot hold up his end of things. Instead of dealing with the extra stress, some Medics have decided to call out and avoid the ulcer.
Volunteers still have a place in administration and behind the scenes. But not on the streets where the rubber meets the rode! Our patients deserve, and expect better.