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Philosophical EMS Observation #3,476

EMS volunteer squads are like a battered wife, covered in bruises and scared of her own shadow, stuck in an abusive relationship with Small Town America.*

Because, if you ever suggest that perhaps their town could and should pay them for their services, but never will as long as they're willing to provide them for free, they're all, "B-b-but I love him! Why would I ever leave him? And in his own way, I know he loves me, too! He just has a hard time showing it! A-a-and if I left him, who would take care of the children?"

Discuss amongst yourselves…






*Yeah, I know that doesn't describe your squad's relationship with your town. They're not like that. And you just fall a lot, that's all. We believe you, really.

Comments - Add Yours

  • Anon in LA

    Paid medics are just the same, you can’t say you’ve ever felt pimped out getting sent priority one to some silly horseshit call and then being praised for needlessly transporting them via ambulance because it generates a bill. …but you know your pimp looooovvves you! :)

    • Ambulance_Driver

      LOL, good point.

  • BH

    It’s either us (paid per call with duty shifts in-house) or a no-subsidy contract with a private…. And trust me, the privates here are nothing like the Borg. We’re talking 300,000-mile and up ambulances, no narcotics, state-minimum equipment and drug boxes- which probably wouldn’t be enough even if the ER was 5 minutes away instead of 15-20.

    It’s not a perfect system but it’s better than the alternative.

    • Ambulance_Driver

      I’m not talking about the system as-is. I’m talking about thinking out-of-the box in envisioning EMS of the future.
      Do you think it’s possible to get beyond the volunteer model? If forced to choose what services they will or will not deem essential, will communities find a way to pay for EMS?
      My thinking is that, yes, most of them will.

    • Medic Wicket

      If you’re getting paid per call, how are you a volunteer? I would hope that if your town went with a privately contracted service, I would hope the contract would include staffing, equipment, response time(another discussion), and other minimum standards.

      • Joshua Powell

        it would include those things, but the private service can say they can only do so much and if there are no other proposals, what choice does the city have. If it is a no-subsidy contract, you pay for what you get. No pay, crappy service

        • markmillet

          Then dont make it a no subsidy contract. In todays society, you pay for service. Nothing is free, nor should it be.

          • Joshua Powell

            You have to have a way to pay for that contract if it is going to be a subsidized contract. If the community is not willing to pay those increased taxes, their is no money to pay for a contract. It should not be that way. They should have to pay taxes for ems the same they do for the police, but many areas are just not going to do it. So its no ems, crappy ems or volunteer ems

          • Ambulance_Driver

            Hypothetical question: then why is no EMS an unacceptable choice, then?
            I mean, the community obviously doesn’t want it, so why continue to provide it?
            Kelly Grayson

          • John Deaux

            A bigger question. Is “crappy ems” or substandard ems in any form vol or paid better than no ems at all.
            It’s scary to know the number of people who will answer that question with a yes.

  • Michael Stone

    Why do we always have to bash the volunteers? I am so sick of this crap. I am both a paid paramedic and a volunteer paramedic. I volunteer as a first responder because the paid ambulance is not always at their station. I believe in getting the patient care as quick as possible. As a paid Paramedic, I love my first responders who are all volunteer. They give me extra hands and help out a lot on calls.

    • Ambulance_Driver


      I’ve said this about a hundred bajillion times, but I’ll say it once more.
      I. Am. Not. Bashing. Volunteers.

      I have never, and will never question the heart or the motives of a volunteer, and always treat them with respect.
      I HAVE BEEN a volunteer, and may one day be again.

      But there is a difference between bashing volunteers, and questioning whether volunteerism, as an institution, is good for the EMS profession.

      • Michael Stone

        Well, Kelly I can guarantee you that based on the level of support my department gets from the cities we serve (ie NONE) if they HAD to pay for EMS, there would be NO EMS.

        • Ambulance_Driver

          And how much do you think that is because they know you’re willing to provide it for free?
          That’s my whole point.

          • Michael Stone

            They will just rely on the county provided ambulance and not care about the first responders. They don’t even pay for the fire department.

          • markmillet

            Do you REALLY think there would be no EMS or no fire services? Or would the county actually be forced to start paying for services rendered for Fire and EMS like they do for every other function of government, most of which dont actually have lives on the lines? I mean, nobody will die if they dont pay someone to fill pot holes, yet they probably pay more for routine road repairs than they would for fire/EMS.

          • Divemedic

            So when there is no one that will provide roads, electricity, or telephone service for free, does the city do without, or do they find the money?

  • markmillet

    Why is it that as soon as someone questions the volunteer system that everyone gets up in arms? Lets be honest here for a minute: there are no volunteer hospitals, no volunteer doctors, no volunteer nurses, so why on earth do we have volunteer EMS? Lets not hide behind the argument that if it werent for volunteers that nobody would do the call, the reality is the town/county would be forced to address the situation and actually bring in a paid service, be it municipal or private (i.e. paid professional). There isnt one elected official out there who is going to let his or her constituents live in a community with no ambulance service, however each and every one of them will always take the most inexpensive way out, and free labor is the cheapest way out. Is that bad? Well, if you have to worry about a budget that also has to fund schools, roads, police, etc, it really isnt all bad at all. But at some point, when there is nobody left to provide that service for free, the elected official will have his hand forced, no? So what have we seen over the past few decades in the volunteer world? More calls. Older population. More demand for higher level of service (i.e. paramedic level service). More demands on the paramedics to provide flawless patient care. And our volunteers are, as regular people, being forced to work more and more hours in their regular jobs to make ends meet, so re-tones are becoming more of a problem as staffing becomes more of an issue. Meanwhile, insurance companies, medicare and medicaid have all cut their reimbursements, meaning that salaries have stagnated for those that draw a salary doing this. Do volunteers and their free help contribute in some way to the formula that insurance companies use to figure out the cost of doing a call? I dont know, I suspect perhaps it does.

    If we as a profession want to move forward, it is time to look at every aspect of what we do, and that includes saying no more slave labor. We provide a vital service to our communities, and we should all be compensated accordingly.

    • Ambulance_Driver

      Volunteers do indeed figure into that cost calculation. CMS calculates reimbursement for an ambulance run based on the nationwide average of the cost of that run, including the 60%+ of EMS runs that are done by volunteers.
      Volunteer services, without payroll costs, or not even billing for care at all, drag that average way down. That’s why Meducare reimbursement for EMS is generally 30% below the actual cost of providing the service.

      • markmillet

        I had a feeling that was the case. Glad to know its true. Also sad to know its true.

    • Joshua Powell

      alot of places wont, they would rather go without ems than pay a dime for it

      • Ambulance_Driver

        Then they do without EMS, Joshua.

  • trixie77

    Why does it always have to be one or the other? A model that is working is combination paid/volunteer services. They key is to secure financial support from the community/township. Instead of fear tactics or demands, the services need to approach the BOF with the following math: An EMS fund fee/charge/tax whatever of $50 per person(.14c per day) living in town is needed to ensure 24/7/365 response from our local NOT FOR PROFIT Community ambulance. Nobody will object to this. That money, and the monies received from insurance billing ( in CT at least, the vast majority of volunteer services bill for service) would more than cover cost of supplies, and supplementary staffing with ( for example)- 70% paid/30% volunteer coverage. So the money is there. I believe management of the agencies should be paid by the town to ensure accountability both financially and for performance standards. Working as a 911 response only paid EMT in small town USA is a pretty good gig. Management should be able to be extremely selective in hiring EMTs who are prepared to serve the community with clinical excellence and professionalism and be responsible for mentoring their volunteer peers/partners. Volunteers would then only be accepted as an elite group of altruists who are committed to spending the time on continuing education and skills practice necessary to function in their provider role. They would of course dress professionally and respond from the station, not from home(or wherever) They should be rewarded with tax incentives locally, and pension & paid education by the agency. Having an option to ensure coverage (paid staff) and paid management to be responsible for hiring, training and disciplinary actions would allow the volunteer agency to simply eliminate the” dress like a farmhand, save your ass not kiss, barely competent’ it imbeciles that create the animosity currently seen between career and volunteer agencies. If it sounds simplistic it’s because it is. But it works. The volunteers just need to be willing to face the facts and accept a different way of doing things than “the way we have always done it” which clearly is not working for the vast majority of agencies.

  • emtsgirl

    the place where my dad volunteers has paid paramedics and volunteer emts. it’s a crossover. they have tried year after year to get a tax levy passed and every single year it is voted down. because of that there are some really tough times upon them. the sad thing is that the community thinks they already pay too much for them to be there. life in rural ems

  • Divemedic

    A good example of this is Obion County, Tennessee, where a community voted to have no fire department because they didn’t want to pay the taxes. A fire occurred, and the person called the next county over for assistance. It seems that the next county over would provide fire service to members of the county that had none, as long as the person had paid a fee in advance.
    Since the person with the fire had not paid the fee, they let the fire burn. People accused the firefighters of being cruel, and many firefighters said they would put the fire out anyway, and let the chips fall where they may.
    The residents of that county know that many people feel like this, so they take advantage of people’s generosity and refuse to pay for the fire service, knowing that the volunteers will put it out for free.

  • leaperman

    I disagree with some of that.
    I volunteered for esar as a kid..I earned my eagle scout…my order of the arrow…
    my ESWS….
    Learning to save a life is not just about being paid.
    It’s about saving lives when one can..
    Despite the govt..despite the papers..
    No matter where one’s a DUTY.
    to compare someone like me to someone who is a beaten wife…
    I must have misread what you said.
    I honestly must.

    • Ambulance_Driver

      Yes, you misunderstood.

      We’re not talking about learning CPR or first aid as a civic responsibility, or even providing care as a bystander.
      We’re talking about *volunteer EMS* as part of an organized squad, with an ambulance and a physician medical director, transporting people to the hospital in that ambulance, possibly even billing insurance for their services.

  • leaperman

    I do not expect to be paid.
    If one wants should do it as a full time job.
    Re-read what you wrote.
    and you owe me a book too:)
    for a nurse.
    git on it:)

    GDI Micropoint
    19579 Cordelia Ave Sonora, CA 95370
    Non Sibi Sed Patriae!

  • leaperman

    Over the chapel doors at the United States Naval
    Academy is a simple Latin inscription — Non Sibi Sed Patriae — “Not for self, but
    for country.” Simple, but powerful…. Selflessness takes time to develop.
    Rarely does a man or woman suddenly grow a brain
    and a spine in the middle of an operating room or on a battlefield.
    Likewise, rarely does a person develop a sense
    of selflessness in a single moment in time. Spontaneous selfless acts rarely happen.
    Instead, they are built on a strong moral foundation and then carefully layered by doing
    the right thing … time and time again.

    I thought I misunderstood sir.
    I read your blog..along with several others I respect…and didn’t think it could be any but my misunderstanding.
    Thank you for responding.

    • mpatk

      …and yet, member of the United States Navy are paid, are they not?

      There’s a difference between serving your community and being taken advantage of by that community.

  • leaperman
  • John Deaux

    As long as EMS is a hobby for some we will have this debate. We are at the fork in the road, we can stay a hobby for some or take the path of becoming a true profession. If we take the path to a profession, unfortunately some people will be left on side of the road. Well meaning volunteers have taken a significant role in the development of EMS in the US. Unfortunately
    there may not be a seat on the evolution train as we try to become a profession. We really are not there yet. I know that my comments are hard, are cold and may come across very mean and uncaring but it is real and it is a fact.

    In order to change what many people see as a volunteer hobby we must change ourselves.

    Last thought: If you think change is difficult extinction is permanent. This is where EMS will be if we dont make some difficult choices.

    • markmillet


    • Jeremy Salow

      I do both paid and volunteer. Calling EMS a “hobby” for those who volunteer is untrue and insulting. Not getting paid doesn’t make it a hobby. Many if not most of them take is just as seriously, train just as hard, and run just as many calls as someone getting paid. Just because it’s not the main “day job” for them does not make it a hobby and you and others should be ashamed for dismissing it is such and think about what that means to your fellow EMS providers who take it very seriously.

  • Garrett Kajmowicz

    Speaking as somebody who’s a full-time software engineer and a volunteer EMT on the side with a hybrid paid/volunteer service, I’d like to point out that pay and compensation are two different things.
    Pay is the money you take home.
    Compensation is the benefit you get, which includes pay, but other things as well.
    For example, non-monetary compensation of being an EMT or paramedic include:
    * Prestige
    * Respect
    * Excitement/thrill
    * Experience
    * War stories

    * Sense of doing something valuable/important
    * Sense of family/[brother|sister]hood

    * Ability to Drive Real Fast
    * Ability to park anywhere you want
    * Free coffee (select locations only, some conditions may apply)

    This works out well for me, because when I work an EMS shift, if there aren’t any calls coming in, I can do my full-time job. This means that the personal cost (in terms of time) is even lower than it might otherwise be.
    When the workload/cost drops low enough, the compensation outweighs the costs, even when the pay is 0.

    As to why there are volunteer EMTs and not volunteer Doctors, etc., I’d first refer you to Doctors Without Borders. Next, the cost of becoming an EMT is pretty low: in my state, about 160 hours of classroom instruction. I can manage a full-time job and EMT training in the evenings without much difficulty. I could (but choose not to) do the same thing for Paramedic school. The cost for one is about $400, $2000 for the other. Pretty easy, even if you are working a minimum-wage job.

    You can’t go to medical school part time while holding down a demanding job. (If you could, I’d have MD after my name). Assuming you have a degree, going to medical school will cost you ~$150,000. If you don’t, you probably need to add at least another $20,000 on top of that for a bachelor’s degree. When you come out of school, you work for pay because you *have* to. You can’t afford to service the school debt working as an administrative assistant.

    • Ambulance_Driver

      Good points.

      I would, however, object to using Doctors Without Borders as an example. It’s not even comparing apples to oranges. It’s comparing apples to hand grenades.
      There is a HUGE difference between volunteerism as an institution upon which 60% of a profession is based upon (like EMS), and a handful of US doctors providing volunteer medical care in third-world countries when they’re not earning excellent money as doctors at home.
      Neither do those doctors’ volunteer efforts in Haiti undermine their colleagues’ reimbursement in rural America.
      Volunteer EMS at home does just that.