VOLUNTEER EMS IN AMERICA
Most of the volunteer ambulance services trace their roots back to the 1940's, 1950's and 1960's. In these cases, suburban and rural Fire departments, civic groups or interested citizens were concerned about the care and/or lengthy response times of a Commercial service coming from cities or local mortuary services. Services were able to develop with little or no outside influence, few local or state governments had standards or regulations, and the public and medical communities' expectations were low.
During the 1970's, the volunteer ambulance services became increasingly sophisticated. Modeled after a national curriculum, EMT (Emergency Medical Technician) courses became more available. Many of the volunteers that staffed these volunteer ambulance services became certified as basic EMT's. The basic EMT course at the time was about 50 hours in length. This same basic EMT course now is about 140 hours in length.
Although pre-hospital advanced life support (ALS) began to be provided in selected areas of the country by the 1970's, many citizens still did benefit from a timely response of ALS. Because of this, preventable mortality and morbidity occurred. Medical researchers continued to document notable reductions in death and disability in areas with access to consistent, high quality EMS.
Housewives, shift-workers and people who were able to leave work staffed calls during the daytime hours in the 1970's. This fact is critical when we discuss the present situation of volunteer EMS in America.
The 1980's saw an increasing problem in the staffing of volunteer ambulance services. Particularly problematic was, and continues to be, the inconsistent daytime coverage. The majority of requests for service are received between the hours of 6 a.m. and 6 p.m. In some areas, two-thirds of the calls are received between these hours. The services that are covering their calls are often relying on a handful of people to accomplish this. This quickly overburdens these people. Pressure comes quickly on these people from family members and/or their employer that is releasing them from work to cover "just an occasional call". Many services have had to abandon providing non-emergency transfers for their residents at some cost in community support.
In some areas, it may be necessary to contact several squads before an ambulance becomes available to respond to life threatening emergencies. This has been affectionately referred to as "volleyball". Ironically, long response time was why many volunteer services were formed in the 1950's and 1960's. Some services are now calling commercial services or relying on inadequately staffed fellow volunteer services to cover calls, but response times are often too lengthy for life-threatening calls.
Additionally, these situations are quite stressful to the police and first response fire services that are put in the position of having to attempt to explain to distraught families and bystanders why there is no ambulance. Equally concerning is that these services are delayed at ambulance calls, and are less available to fulfill their primary mission.
The reasons volunteer ambulance services are now experiencing such difficulties are many. The following are some of the most notable.
INCREASED REQUEST FOR SERVICE
1. Increasing Call Volumes
Over the last few decades, many suburban and some rural areas have experienced tremendous residential and commercial growth. This growth has caused the request for services to increase rapidly. In recent years, many services have seen increases in call volume of 10-20% annually. Daytime coverage of calls is especially problematic for many services.
2. Demographics of the Community
The elderly are the majority users of EMS. With an increasing percentage of the population being elderly, call volumes will continue to increase even if population remains constant. Additionally, the years to come will see a decline in the number of 20-30 year olds--the age groups that typically dominate the staffing of ambulances.
3. Change in the Health Care System
Nationally and statewide, there have been some major changes in health care, which impacts EMS. This results in sicker patients being released from hospitals and more outpatient procedures. Additionally, the 1980's saw over 500 rural hospitals close in America. These factors have resulted in an increased demand for, and sophistication of, ambulance services.
FEWER VOLUNTEERS
1. Competition for Volunteer Time
Over the last 15 years, economics have dictated the need for two wage earners to be able to meet the family expenses. The result is fewer hours available for individuals to volunteer their time. Increasingly, any discretionary time is often spent with family or recreational pursuits rather than volunteering. Additionally, as economics have changed, other types of not-for-profit organizations are competing for volunteers' hours.
2. Changing Job Market
Many areas of the country have experienced a significant decrease in manufacturing jobs, which typically require shift work. Therefore, there are fewer people available to volunteer during daytime hours. For example, in suburban Monroe County, New York where 25 separate volunteer services provide EMS, there was a loss of over 30,000 manufacturing jobs from 1981 to 1990.
3. High Turnover of Members
The loss of volunteer members remains a major area of concern. Surveys of former members have identified "internal conflict" in the organization as the major reason for leaving. Service leaders often lack any experience in human resource management and/or lack the time necessary to be effective personnel managers.
INCREASING EXPECTATIONS
1. Increased Training Hours, Community Expectations and Regulation
The public and medical communities have continually increasing expectations of pre-hospital care providers. Most states have staffing and performance requirements for volunteer services. These, combined with society's inclination to institute litigation, have led to increased efforts in training, continuing education and medical quality assurance. Accordingly, the training hours and expectations for all levels are expected to increase. This strains the volunteer manpower pool.
2. Response Times vs. Patient Outcomes in EMS
Research by the American Heart Association clearly demonstrates a positive relationship between rapid early community intervention, basic life support, advanced life support and the link of this combination to positive patient outcomes. In essence, the earlier the care is available, the better the outcome. A similar positive patient outcome is well documented in the timely care of serious trauma. Saddled with these difficulties, it is clear that if volunteer services are to be successful their leaders must be prepared. People that enter into leading their service without some basic and practical management education are at a disadvantage. The following survey results and information are provided for these managers and their staff.