Rurally Speaking: Are the Days of Rural Volunteer EMS Personnel Numbered?

Carl J. Haddon

In rural areas of the country, more people die from their illnesses or injuries as a result of no or not enough prehospital emergency medical services (EMS) care, than they do from improper emergency care. Is your state, county, or local authority having jurisdiction (AHJ) over EMS making it virtually impossible for your volunteers to get or maintain EMS certification?

Remember when holding certification for EMS meant attending a class for so many weeks, taking a final exam, taking a practical exam, and voila—you got a card? Remember when recertification meant simply maintaining continuing education units (CEUs) or a recertification class? This is no longer the case in many parts of the country. Consequently, the changes and the incessant new hoops to jump through are killing the EMS sector of volunteers across much of rural America. Isn’t recruiting volunteers difficult enough already?

Just for background, I’ve continuously held EMS certification from paramedic to emergency medical responder (EMR) for more than 30 years. Never before have I seen such bureaucratic nonsense and madness associated with folks trying to do the right thing to help serve their communities. Please don’t misunderstand me, as what I speak about here has absolutely nothing to do with patient care or the medical part of EMS. Your basic splinting, bandaging, and recognizing signs and symptoms of injury and illness have all remained relatively the same since the beginning of time. Oxygen is still oxygen, administered at liters per minute with mask or cannula, no? After all, it’s not like we come out with new models of humans every couple of years that we need anatomy and physiology updates on, right?

Added Requirements
What I’m talking about is the incessant time and expense associated with basic EMRs and emergency medical technicians (EMTs) being required to attend things like “transition” and “bridge” (to nowhere) classes. It seems that over the years, the scope of practice for everything from EMR to paramedic has been cut in half, but then some brain trust comes up with the bright idea of adding “additional or enhanced scope modules” of training, like long bone splinting, C-spine precautions and oxygen therapy that were part of the original scope of practice in the first place! OK, rant finished.

The result of all of this added nonsense is not only helping to kill volunteer recruitment, it’s causing our established volunteer EMRs to let their certifications lapse or expire, because “It’s not worth it anymore,” with “it” being the additional commitment of time and expense to be a volunteer responder. How can we blame them? Let’s face it—nonwork hours are precious and few, and there is a limit to how many of those precious and few hours we are willing to spend away from family and friends. To make matters worse, I understand that on the “paid” side of the EMS equation, even in the year 2014, there are many parts of the country—not necessarily rural—where the pay rate for an EMT on a private ambulance, is less than that of someone working the counter for McDonalds.

Is There an Answer?
We’ve defined the problem, but is there an answer? Unfortunately, the lawyers and insurance companies drive this bus. Each EMS provider—volunteer or otherwise—is required to have medical oversight, which is traditionally provided by a physician in the position of medical director. These physicians are responsible for the actions of the personnel of that EMS provider/licensee. The National Registry, state, county, and/or local EMS agencies make the rules and determine the respective scopes of practice for EMS personnel. To a certain degree, insurance companies control the physicians and the regulatory agencies by limiting what they will underwrite insurance coverage for. Let’s face it, no matter how good a person your medical director is or how cool it would be to add real things to our scope of practice, medical directors can only extend their personal/professional liability necks out so far. If the insurance company won’t cover the provision of something—new or old—within our respective scope of practice, we don’t provide it anymore.

Forgive me for sounding like a cynical old medic, but look at how many things and procedures we, especially paramedics, have had “taken away” from what we can do over the years? I understand that some of those things are deemed medically prudent, however there are also many of them that the insurance companies have deemed to “risky” to cover, regardless of how many lives are saved or helped as a result.

In the final analysis, when you look at the differences between what an EMR or EMT with a first aid and CPR card can do and what an EMR or an EMT with basic certification can do for a patient and all of the extra time and training that the latter entails, you’ll find that there isn’t a whole lot of difference between them anymore. Can you blame a volunteer for not wanting to go through all of the added time and trouble for that small a difference? I think it’s time for some common sense and changes from the folks with pay grades far higher than mine.

CARL J. HADDON is a member of the Fire Apparatus & Emergency Equipment editorial advisory board and the director of Five Star Fire Training LLC, which is sponsored, in part, by Volvo North America. He serves as assistant chief and fire commissioner for the North Fork (ID) Fire Department and is a career veteran of more than 25 years in the fire and EMS services in southern California. He is a certified Level 2 fire instructor and an ISFSI member and teaches Five Star Auto Extrication and NFPA 610 classes across the country.

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