Volunteer EMS

[ChathamVFD9921]

How does your department run its Volunteer EMS side?

I know alot do staffing, alot do on call, but this is strictly for completely VOLUNTEER pager style departments.

Who gets to go on the squad? How many? Who drives? What do you do with regular fireman?

[Bones42]

EMS agency in town is fully volunteer.....and fully separate from FD.

They respond to building from home when there is a call. All members that have valid drivers' license are trained as drivers. Minimum crew is 2 EMT's and they will go with up to 5 members on the rig at times.

[voyager9]

and they will go with up to 5 members on the rig at times.

Holy F.. how do they fit the patient?

Our EMS agency is separate from the FD but, like us, are combination. The volunteer side runs a mixture of duty crews and home response. They seem to be managing a fairly high call volume pretty effectively.

Note, volunteer-based does not necessarily mean things cannot be organized around in-station responses. There can be a lot of benefits for having organized duty crews.

[LaFireEducator]

Unfortuantly volunteer transport is something you don't see in LA at all.

It's either private , with a large chunk of the state being handled by Acadian who provides ground and air transport to much of the southern portion of the state, as well as contract services to Gulf drilling rigs, third service which generally is generally delivered on a parish-wide scale or fire department based in the urban areas.

Where I was in VT before moving down here, most of the volunteer EMS agencies (which was the majority of the units) were seperate entities. When they were run as part of the fire department, they generally had an EMS Chief that functioned right below the department Chief. The members were considered members of the fire department but only functioned on the EMS side and were not subject to supression training requirements, unless they chosed tom function as a firefighter as well.

Many of those volunteer squads has gone to paid day staff, especially in the populated Chittenden County area, by the time I left in the area iin 2002. As I understand it, there have been a few others that have gone that route since 2002 but most still have volunteer administration.

[BoxAlarm187]

At home, the EMS transport is volunteer lead and managed, but does empoly career medics and EMT's that staff two ambulances during the weekdays (one 0500-1700 and the other 0700-1900). Nights and weekends are covered by volunteer EMS personnel that staff at least one, and generally two, ambulances using in-quarters duty crews. The need for additional ambulances will be utilize home response. Ambulances generally roll with three personnel.

We moved into our new fire station last week, and the EMS folks have an ambulance in it. We can operate it as needed, but our primary focus is still on the fire suppression rigs, not the transport unit. When we do operate it, it will operate in one EMT and a driver who may or may not be an EMT. We only have three volunteer ALS providers, so it will generally be a BLS unit.

[ChathamVFD9921]

We have 1 ambulance, 9 EMT's and 1 Paramedic for our township.

The way it works, is when the pager goes off, EMT's and Fireman respond to the station. If we do not have 2 EMT's, we call for mutual aid. My Chief wants every spot in the squad filled when it rolls out (Which i do not agree with).

[tree68]

EMS transport in my district is handled by a non-fire not-for-profit which staffs a paramedic 24/7. Volunteers usually handle driving and additional crew members, but if no volunteers offer up for a shift (all duty is in-station), we have a cadre of part-time paid EMTs who cover the shift.

My fire department runs first responder ahead of the ambulance, but right now we've got just two EMTs, and one rarely does calls (she does volunteer with the ambulance). We have several members with lesser levels of training who may respond if an EMT isn't available. They can serve as pathfinders if necessary (saves the ambulance searching for the address) and can assess the situation and advise the incoming ambulance as needed.

We still have a couple of FD based ambulances in the county, but they are a dying breed.

[BoxAlarm187]

The way it works, is when the pager goes off, EMT's and Fireman respond to the station.

Common across the US.

If we do not have 2 EMT's, we call for mutual aid.

In some places, it's required to have 2 EMT's in order for the ambulance to go, others only require one. Do you wait a certain amount of time before you call for mutual aid? Do individual members have radios so you can confirm who is/isn't responding?

My Chief wants every spot in the squad filled when it rolls out (Which i do not agree with).

This is silly. There's no need to have an ambulance full of people zipping up and down the road. I've been doing EMS since 1992, and have operated hundreds (thousands?) of calls with only myself and one other person. Three is nice, but not required.

As I travel all over the state teaching, I see lots of approaches to staffing in situations like yours. One of the most effective seems to be a calendar at the station where members can sign up for a day, night, or even week that they'll answer calls. It keeps everyone from having to rush to the station when a call is received. Of course, if your chief expects the rig to roll with half-a-dozen people on it, that might be a moot point.

[BoxAlarm187]

We have several members with lesser levels of training who may respond if an EMT isn't available. They can serve as pathfinders if necessary (saves the ambulance searching for the address) and can assess the situation and advise the incoming ambulance as needed.

Semi-related story: well over a decade ago, one of the stations in our county was dispatched to respond with their first-responder unit (Suburban) to assist the volunteer ambulance crew with a breathing difficulty. After a short amount of time, an EMT hadn't arrived, so a well-meaning firefighter responded with the FR unit. He arrived well-ahead of the ambulance to find that the patient was is cardiac arrest, and hysterical family members demanding he do something. He wasn't mentally prepared for the call, thinking he was just going to wave in the ambulance crew or something, and he flipped out. Well, long story short, the family called the local TV station that afternoon and by 11pm, the county fire chief was on the news that evening explaining the lack of action on the FD's part.

As you can imagine, sweeping changes were made in training, accountability, and SOP's to ensure that the situation would never happen again. The biggest one was that members who aren't EMT's can't respond to an EMS call until an EMT is on the scene.

[ChathamVFD9921]

Semi-related story: well over a decade ago, one of the stations in our county was dispatched to respond with their first-responder unit (Suburban) to assist the volunteer ambulance crew with a breathing difficulty. After a short amount of time, an EMT hadn't arrived, so a well-meaning firefighter responded with the FR unit. He arrived well-ahead of the ambulance to find that the patient was is cardiac arrest, and hysterical family members demanding he do something. He wasn't mentally prepared for the call, thinking he was just going to wave in the ambulance crew or something, and he flipped out. Well, long story short, the family called the local TV station that afternoon and by 11pm, the county fire chief was on the news that evening explaining the lack of action on the FD's part.

As you can imagine, sweeping changes were made in training, accountability, and SOP's to ensure that the situation would never happen again. The biggest one was that members who aren't EMT's can't respond to an EMS call until an EMT is on the scene.

This is something i worry we could run into, but we have not yet. One of those "Weve been lucky" situations. We have fireman responding direct on a regular basis because "the pager went off".

[ChathamVFD9921]

In some places, it's required to have 2 EMT's in order for the ambulance to go, others only require one. Do you wait a certain amount of time before you call for mutual aid? Do individual members have radios so you can confirm who is/isn't responding?

Our protocols state we must have 2 EMT's to transport.

We usually wait 5 minutes from acknowledging the page at the station to call for MA if enough EMT's have not shown up. Dispatch does it automatically if we haven't signed on by the third set of tones.

EMT's do have radios to let the base/dispatch know if they are responding.

This is silly. There's no need to have an ambulance full of people zipping up and down the road. I've been doing EMS since 1992, and have operated hundreds (thousands?) of calls with only myself and one other person. Three is nice, but not required.

I agree.

I work for a private EMS company that runs 2 man crews all day (5,000 calls a year, 4 ambulances staffed at all times). Its not a problem for us/me, but our mindset is different because we are getting paid.

..................

[slackjawedyokel]

So you are complaining about too much help ?

[tree68]

So you are complaining about too much help ?

There are those EMS calls when less is better. If the call is unusual (or otherwise interesting), of course, everybody wants to see what's going on.

I can understand wanting the squad fully staffed - the ol' "what if."

The members responding direct to the scene I have an issue with, unless they are EMT's and would have passed the scene on the way to the station.

The rest of the POV squad should head for the station and man the squad.

If the chief is going to mandate the squad is manned, he ought to think about forbidding POV's to the scene.

But I know how that works, too...

[Bones42]

Holy F.. how do they fit the patient?...

You should see our boxes... Rear has 2 bench seats that can (and have) hold backboarded patient, plus the central stretcher. We also have a dual stretcher rig.

One that was recently replaced had 2 stretchers plus a removeable floor mount for a 3rd stretcher. Also had 2 hanging stretchers that could be used. And yes....we did do it...not often, but more than once.

[BoxAlarm187]

So you are complaining about too much help ?

I've run a lot of calls with too much "help."

[ChathamVFD9921]

I've run a lot of calls with too much "help."

Exactly.

In my experience, things run best with 3 EMT's and a fireman. Two of the EMT's work with the patient, while one gathers information, records, and makes the decisions. This is usually the most experienced member on the call. The fireman drives and operates the radio.

Of the two EMT's working on the patient, one usually operates the monitor and does vitals, the other worries about airway and the "problem".

If you add extra people to this equation (not including full arrests), they just get in the way, make a distraction, or try to help "too much" or "too little".

[Eng34FF]

How does your department run its Volunteer EMS side?

I know alot do staffing, alot do on call, but this is strictly for completely VOLUNTEER pager style departments.

Who gets to go on the squad? How many? Who drives? What do you do with regular fireman?

We run both fire and EMS out of the same station. About 2/3 of our calls are EMS.

We staff the ambulance with at least 2, preferably 3, at least one at the EMT level of training. We don't have "regular" firemen. All members run EMS either as EMT, driver or aid. In fact, members are required to get cut loose on the ambulance before they can ride the fire apparatus.

We require that members be at least first responder in their first 2 years. Most get their EMT as the first responder classes are hard to come by.

[slackjawedyokel]

Ive seen both sides -just remember manpower is usually a pendelum -if you are getting too many on a responce - look into duty nights etc. I just would tread lightly on the too much "help" issue

[xchief23]

Honest-to-goodness true story on too much 'help'... QRS call for a male with breathing difficulty. Our Chief and his son go en route, two EMTs in the squad go en route, two EMTs go POV, two other non-EMT firefighters go POV, plus 2-person ambulance crew with a paramedic precept go. EVERYONE is in the house, along with the patient and several family members, when they hear a loud CRACKKKKK!!! All that weight broke a floor joist underneath the kitchen.

[ChathamVFD9921]

Honest-to-goodness true story on too much 'help'... QRS call for a male with breathing difficulty. Our Chief and his son go en route, two EMTs in the squad go en route, two EMTs go POV, two other non-EMT firefighters go POV, plus 2-person ambulance crew with a paramedic precept go. EVERYONE is in the house, along with the patient and several family members, when they hear a loud CRACKKKKK!!! All that weight broke a floor joist underneath the kitchen.

This is a perfect example of too much help.

Fire Departments are not a social club, contrary to popular belief.