‘In this jurisdiction, it’s a 9-1-1 crapshoot’

The public shouldn’t have to roll the dice about their emergency services, wondering who’s going to show up

The story you are about to read is true. The names have been changed to protect the innocent – and those trying to impact positive change. 

I was talking with a friend of mine about his busy suburban/urban volunteer fire-EMS department having little to no policies – and the ones they do have are pretty much ignored. He described many runs as a “joke,” with everyone doing whatever they want. And mutual-aid runs are even worse.

Other than, in his opinion, him, everyone is comfortable the way things are. After all, if they get too tough, they will lose members. And nothing really too bad has gone wrong. The deviance has been normalized. 

"The focus cannot be about what's best or most comfortable for the volunteers. The focus must be on delivering qualified, very fast emergency service when someone dials 9-1-1," writes Goldfeder. (Photo/Getty Images)

I don't hate much at all, and am not even a fan of that word, but I HATE that excuse: “If we get too tough, if we have to discipline, we will lose members.”

I would argue that if your department HAD clear policy and direction, more members would stay and be engaged. And honestly, if you lost a few because things tightened up, then send them on their way. People – good people, giving up precious time to volunteer – want discipline and leadership. 

The volunteer crisis and confusion in America

Your head is in the sand if you are unaware of the generally ignored crisis related to the failure of the North America's volunteer fire (and EMS) service. As I am writing this, I guarantee you there are volunteer agencies being alerted/toned out … and being re-alerted … and re-alerted. And then their neighboring department gets toned out … and toned out again.

The beat goes on.

It has become a way of life – and astonishingly accepted by leadership because after all, “we are just volunteers.” I HATE that lame excuse as well.

In the same tone, related to someone attempting to fix the problem, the county fire coordinator is proposing a new unified EMS response system of duty crews and closest unit response, but only if the agency can ensure a crew. Of note, there are over 80 fire and EMS services in this county, plus the police run one-person paramedic ambulance crews with cops meeting them on the scene – that’s NOT a typo.

Among the discussion comments about this situation:

  • “We are volunteers, you can’t tell us what to do.”
  • “You have no jurisdiction over us.”
  • “We will opt out.”
  • “Let the cops’ EMS handle it.”

... and a host of similar comments.

Of those in the discussion, ONE person commented that this may be better for the patient or people calling 9-1-1. One person. The rest were all self-focused.

The focus cannot be about what's best or most comfortable for the volunteers. The focus must be on delivering qualified, very fast emergency service when someone dials 9-1-1. The service you would want when you or your family have their worst day. That's the criteria. It is that simple. 

Look, RARELY does anyone in our business purposely cause harm, but we do get “comfortable” and just leave well enough alone. But when the clueless actually take their heads out of the sand for a moment and stop pretending it's 1970, we tend to refocus on responsibility. And so much – SO MUCH! – of the argument is about what's best for those providing the service. And while I am a fan of taking care of those providing the service, they need to actually PROVIDE the service. 

I'm not sure what my friends in that particular area are going to do, at least specific to the EMS “system.” Currently, in this county of 1.3 million people, the ambulance you get depends on numerous factors:

  • Is there a police ambulance available? If so, they may get the run.
  • Does your EMS service want to be notified first, second or third?
  • Does your fire-EMS agency want to respond with the police?
  • Did the caller dial their “local” FD emergency number (those seven-digit emergency numbers that are advertised and encouraged by local FDs), or did they dial 9-1-1?
  • How long do you give the dispatchers for your agency to turnout? Keep in mind there are two dozen different dispatch centers in this particular county, plus there is a county 9-1-1 center run by the police, and a separate county fire dispatch center. 
  • Are there several EMS agencies “protecting” your area? Who gets called? Some of the agencies listen to scanners and jump calls, claiming they received a call.
  • What type of service agency is it – city fire-EMS service, district fire-EMS service, district EMS service, private non-profit contracting fire-EMS service, county police EMS service, paid hospital-based EMS, private nonprofit/non-contracting "freelancing" service? And yes, all of these types are authorized by the state to operate. I promise.
  • If the police get the call and their closest ambulance isn't available, do they call the fire department EMS or do they send one of their ambulances that could be up to 20 minutes away?
  • If the volunteer agency is alerted, who may be responding – an EMT, a medic? No one?

In this area, you could literally be sitting in an EMS-staffed firehouse, available. There could be someone choking on that same block, but because all of the above comes into play, your agency may never know that the person is choking. And odds are, they will die. 

Do you want to use volunteers – yes or no?

Part of my reason for sharing this is that while there are some systems facing this many challenges, this is certainly not the norm. The other reason is to make your response problems seem more manageable. Plus, I think we can all agree that one of the root EMS problems is this nation's healthcare system – a system that allows the absolute abuse of EMS. But until someone fixes the national problem, community leadership needs to decide if they want to be in the emergency service business, using volunteers.

If the answer is yes, then determine what the public expects. For example, if a 20-minute ETA for EMS is OK, then that's your standard. Get community feedback.

If the answer is no, then it is time to change. If you currently respond from home, that won't work anymore; it's in-house duty crew time. Don't like that? Don't volunteer. We cannot operate like we did in the 70s with the occasional call. In suburban (used to be rural) areas, things have changed. Change your organization to meet the community's needs, not to meet your members’ needs. Start here:

  • Establish rules that apply to everyone so that everyone must do their time.
  • Provide training while on that duty time. People's time is precious. Respect their time.
  • Establish policies and procedures for all. ALL.
  • Agree on ONE central dispatch system (or merge their CAD and radio systems for genuine interoperability) so the nearest applicable resources are sent when that person is choking.
  • Establish job descriptions. Does everyone have to have the same certifications? If someone is willing to join as a driver, why can't they be brought on?
  • Make sure your agency is a good place – a place where members want to be. If it's riddled with BS rules, unbalanced discipline, leaders playing favorites, harassment and an unwelcoming environment, then fix it.

If all the above fails, we still have the same problem: We’re not focused on what's best for the public. And if your agency cannot or won't change (not just the senior members – everyone), then it's time to contract, consolidate, merge and hire some full-time people to do the job. 

Gambling with lives

If you go to Las Vegas to gamble, you will probably lose. Absolutely everyone knows the statistics. Once in a while, you get lucky. If someone calls 9-1-1 for an emergency in your area, what do the stats tell you? What are the odds of a qualified crew and units arriving within 3-4 minutes of that 9-1-1 call?

That's the first step in solving the problem. Look at your stats and know the gamble – the unknowing public's gamble. 

Dialing 9-1-1 cannot be a crapshoot, but unfortunately, that’s the reality in many parts of North America. The biggest problem: The public thinks they are going to win. 

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