The End of Volunteer Emergency Services?
by Evelyn Bartin

Calling Milan… Calling Red Hook… Calling Rhinebeck… Calling all the towns in our area! There's a 9-1-1 emergency. And if we wait much longer and continue to do nothing, volunteer emergency services will likely become a thing of the past… very soon.

In the last issue of About Town, I wrote about my personal experience joining Milan's Rescue Squad. My Emergency Medical Technician (EMT) training was arduous and my experience so far has often been challenging. But it's also been fun and almost always rewarding. However at 56 I am the most recent member of Milan's Rescue Squad, the proverbial "new blood!" How can this be? Was 2007 an off year? If not, what does it mean to the future of volunteer Emergency Medical Service (EMS) in Milan and other nearby towns?

Curious about the state of volunteer EMS in our area, I went on a fact-finding mission. I interviewed several long-standing squad members and squad captains (past and present). And I spoke to some of the professional organizations in the field, the Hudson Valley Regional EMS Council prominently among them.

But first here's a bit of national history to set the stage. In the early part of the 20th century, rural and suburban areas with low density populations were concerned with the lengthy response time of commercial emergency services. These services came primarily from cities or local mortuaries which were often many miles away. To answer this dilemma, local fire departments, civic groups and/or interested citizens began to establish their own networks of response. During the 1940s and 1950s these groups became more formalized, but it wasn't until the 1970s that volunteer ambulance services began to evolve into the sophisticated operations they now are, with many of the volunteers becoming certified as basic EMTs. And while paid Advanced Life Support (ALS) service also started providing increased coverage in these areas by then, many citizens continued to benefit from the local EMS squads, who were now highly trained and typically able to be on-scene in a more timely fashion. ALS, then, became the "as needed" back-up for local EMS.

In the 1980s, however, the staffing of volunteer ambulance services began to diminish, a trend that, unfortunately, continues to this day. Daytime coverage in particular started to become problematic (the majority, and in some areas of the country as much as two-thirds, of emergency calls are received between 6 am and 6 pm). As local EMS services dwindled, volunteers became over-burdened and response time suffered. In some areas, it became necessary to contact several squads before an ambulance became available. (In the industry this is called "volleyball.") Ironically, long response time was the reason many volunteer services had been formed in the first place!

So today, commercial paramedics are often dispatched as a matter of course to ensure coverage of potentially life-threatening emergencies. Where once a paid service might be called in only after the local EMS had "triaged" a situation, ALS is now showing up pretty much at the same time, particularly in the case of a "Priority 1" call. And the subsequent transport of the patient to the hospital by the paid service (its bread-and-butter) has also become "a matter of course," when it would have been gratis if performed by the local EMS. As a result, some volunteer squads are becoming relegated to little more than first-aid providers.

What does this mean for us in Northern Dutchess and Southern Columbia? Alas, the outlook is not good. As one of my emergency training instructors was fond of saying, "We're a dying breed." At the time, I thought she was probably exaggerating. Now, I'm convinced she may have been right.

The Problem Is Time
Everyone seems to agree that the main problem for potential volunteers is not having enough time: time to train; time away from home and families when most households have two working parents; time that employers are reluctant to grant employees who might otherwise answer daytime calls; time robbed from sleep when answering nighttime calls; and time to continue the demanding requirements of re-training and re-certifying.

Another challenge is the changing population in our geographical area, with weekenders and part-timers having virtually doubled the population over the past quarter-century while remaining unavailable for full-time volunteer services.

Further complications are apathy among the community, and a "this-is-the-way-we've-always-done-it" attitude among the towns. In the past, individual squads have too often relied on recruiting volunteers using the generational appeal (my grandfather did it, my father did it, I'm doing it, and now my son is doing it). In addition, too many individual town governments assume (incorrectly) that everything's percolating along and that no support, of any kind, is necessary.

Consider these facts about my home town of Milan:

— Only 20 or so years ago, when we had less than three-quarters of our current population, approximately 25 to 30 EMS volunteers went out regularly on an average of fewer than 100 calls per year. For the past three years, Milan's Rescue Squad has answered more than 200 calls per year with only 6 or 7 volunteers.

— Twenty years ago it cost about $8,000 10,000 per year to run an ambulance. Today it costs about $35,000 45,000 (mostly due to the dramatic rise in the "cost of doing business"). So in addition to their medical service, volunteers are also asked to run pancake breakfasts and coin tosses to make up the short-fall in donations.

Now consider this: With the exception of a small stipend from the Fire Department (for insurance and diesel fuel for the ambulance), Milan's Volunteer Rescue Squad operates solely and completely on donations and good will and charges nothing for its services. If it (or any other rescue squad in the area) ceases to exist or gets downgraded to first aid only, the sole recourse will be paid EMS forces (NDP Emergency Medical Services, Alamo, etc.). In fact, as some of the area volunteer services have already folded (Hyde Park and Staatsburgh, among them), these paid services have stepped in for a reported fee of $200,000 300,000 per town. Put that in your tax bracket! As one past squad captain said: "Taxpayers are in for a tremendous shock. Costs are going to be horrendous!" And the shock could get worse—logic suggests that the fate of volunteer fire departments might not be far behind.

Is the Trend Reversible?
Well, of course any trend can be reversed. So how do we get started?

First, be aware there's a problem. It's human nature to want to remain complacent, that is until calamity strikes. Then everyone says: "Why didn't we know? Why didn't anyone say anything?" Well, now you know!

Take some action. First and foremost, volunteer. Make liars of the people who believe that "no one cares anymore." And don't be shy about lobbying your town governments to wake up to the situation and shoot some adrenaline into the picture. Those $300,000 proposed town fee letters from the paid services may already be sitting on your respective town boards' desks. Even if the human aspect doesn't move you, I'm sure the resulting tax bill will!

Don't be intimidated about joining your town's rescue squad. Even if you don't know anyone, even if you never took a blood pressure, you'll be fine. The welcome you'll receive will take care of one; the training you'll receive will take care of the other. In the end, there's no better way to feel part of the community than to join an organization dedicated to saving lives.

If you're not inclined to go on calls, volunteer in other ways. Your squad may need help with recruiting and "marketing"; or fund-raising and financing; or bookkeeping; or supply purchasing; or ambulance maintenance; or driving. While most squads need people who are willing to go out on calls, there are other ways to help as an affiliate or auxiliary member.

Know that your reward will be a thousand-fold greater than the time you invest. There is nothing—nothing!—that feels quite like helping someone in distress, perhaps even helping to save their life. No paycheck could equal the amount of satisfaction you'll feel when that person says thank you.

And if all this isn't enough, you get to ride on an ambulance with lights and sirens! What could be more fun!

Evelyn Bartin lives and runs her home design and construction planning business in Milan.