Rural Volunteer EMS Squads Face Staffing Challenges

by Candi Helseth

As EMS evolves and rural populations change in nature, volunteer EMS squads—which once served as the sole emergency responders in many rural areas—appear to be a dying breed.

“We have very few, if any, pure volunteer services any more,” said Kevin McGinnis, a former Maine Emergency Medical Services chief and program developer of Maine EMS pilot projects. “One of the last purely volunteer services in Maine has gone to a system with full-time paid paramedics, using volunteers to augment services. Most of these staffs can’t find enough volunteers any more or they really have a problem responding to calls during the workweek because their volunteers aren’t able to answer these calls.”

Rural Volunteer EMS: Reports from the Field, a 2010 study from the North Carolina Rural Health Research and Policy Analysis Center (NCRHR-PAC), explored the state of rural EMS with interviews of 49 local directors from all-volunteer rural services in 23 states. Sixty-nine percent reported problems recruiting and retaining volunteers, attributing the difficulties to three primary reasons: rural areas have higher numbers of retired or elderly residents who are unlikely to have the physical strength and stamina required for EMS duties; decreased employment opportunities have led many working age residents to take jobs in other communities; and, weekend coverage is difficult because volunteers with families have too many competing demands.

Additionally, according to the NCRHR-PAC report, almost three-quarters of the all-volunteer EMS agencies held fundraising events to obtain necessary financial support, which required further time commitments on the part of their volunteer staffs. Nor were all these providers still purely volunteer agencies. One-half were offering some type of paid compensation, although it was significantly less than the cost of maintaining full-time paid staff.

“I don’t think the EMS volunteer model is sustainable over the long run for a variety of reasons,” commented Nels Sanddal, longtime EMS researcher and Manager of Trauma Systems with the American College of Surgeons (ACS). “The economy has driven more working people to larger communities. Younger people still living in small communities often commute and are unavailable during daytime hours. And employers are reticent to allow an employee to leave work when they realize transports may take that employee away for several hours.”

Twenty percent of EMS leaders in the NCRHR-PAC report were uncertain of their ability to maintain future service and 8 percent were labeled “frankly pessimistic.” They indicated that volunteer recruitment would likely be the largest deciding factor.

“The need for pre-hospital care in small communities continues to be recognized and met by local residents and local officials who stepped up when market-based solutions were not available,” the report concludes. “In a significant number of areas, however, the ability of community volunteers to provide emergency services is being stretched to the breaking point and requires new creativity. Consolidation of local services to benefit recruiting and to increase run volume and revenue must be considered. Although rural volunteer EMS grew locally from local need, the need to work together with other EMS agencies or other health care providers in systems of care is inevitable and offers options to maintain these important services.”

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