Accountability for Providers

“I’m just a volunteer EMT.”

Have you ever heard anyone say that?  Neither have I.  Just about every volunteer provider that I have encountered in my career, regardless of how long they have been doing it or what their dreams and aspirations actually are take a ton of pride in serving their community.  As many readers already know, I come from a family full of volunteers and an area that up until about ten years ago, the area that I grew up in was almost 100% maintained by volunteer EMS.  Sadly, volunteerism is on a decline, and there are many, many reasons for that.  A few weeks ago, EMS 1 reposted an article and tried to tackle some of those reasons with a few really good articles.

One article cites expanded EMT training for lack of volunteers.  EMS 1 Editor in Chief Art Hsieh then wrote what I feel is an excellent reply pointing out a lack of change and evolution as the culprit.  Both stories make some excellent points.

In the past, I have written rather candidly about the problems as I see them that the New Jersey State First Aid Council presents to EMTs in my home state.  Their organization demands different standards for staffing a volunteer ambulance than a paid ambulance to try and keep volunteer EMS alive.  Essentially, they are trying to create a new level of care that is specific to their services resulting in them keeping the EMS system in New Jersey on life support.

In many states EMT students are expected to learn more than they have ever been asked to before.  They are asked to expand their assessment skills, provide more invasive treatments, and give medications that previously were reserved only for paramedics.  To be able to properly understand how those medications work, a greater knowledge of body systems is also required.

Enough is enough.  Sure, obtaining an EMT certification takes more time now than it did even five years ago, but there is a good reason for that.  No one is trying to circumvent the volunteer system in any state.  The changes instead are in place to improve the level of care that patients receive and bring them closer to the level of care that they deserve.

If a paid service is expected to be on scene in less than ten minutes to an emergency, a volunteer service should be held to the same standard.  If a paid EMT is expected to obtain a certain level of training and they are required to carry certain medications on their truck, then volunteer EMTs should have the same requirements.  At Art Hsieh said, times are changing and systems are evolving.  Regardless of what type of service protects a specific community (fire based, volunteer, hospital based etc) patients utilizing those services should have access to the same level of care as the town next to them.

Accountability depends on the certification patch on your shoulder and not the departmental patch.  Volunteers are just as accountable for patient outcomes as paid personnel, and just because you are a volunteer does not mean that you should get a free pass because you provide negligent care to a patient or have an extremely long response time “just because you do it for free.”  Standards need to be the same across the board.

Evidence based medicine, which is all the rage, has told us that there are things that we do that don’t work as well as we once thought they did.  Look at the evolution of cardiac arrests specifically.  There’s a call for a greater focus on compressions and a deprioritization on things like intubation.  Essentially, what has happened is we have decided that it is not the medic walking in the door with the disco patch on his shoulder that makes a difference in cardiac arrests; it is that EMT on the first arriving unit, and how well they pump on that chest that really saves lives.  Sorry to burst your bubble, my fellow medics, but this is the way it is.

So when we look at EMTs, instead of looking at the service that they work for, take a look at their ability as a provider and how well their service enables to do their job.  When a prehospital provider walks into my home to care for my loved one, I do not care if they are a paid EMT or a volunteer one.  All that really matters to me is that my family gets the best possible care.  That needs to be the priority for every service regardless of whether they are a volunteer service, fire based, private, or municipal.  It is time to set the bar, and set it high.


  1. Scott, I never heard anyone say “I am just a volunteer,” but I sure have heard others state “They are just volley techs.” This usually said in context with several of your points regarding standards and training. I also advocate for the care of the patient being the best it can be regardless of the type of responder. I would however propose a set number of initial training hours, refreshers, CEU’s and all the other requirements do not lead to that happening in any aspect of the field. I believe only proper mentorship by individuals with a true passion for the field and teaching others will lead to the experience needed to drive that level of expected care, each time, every time.

  2. Amy Eisenhauer /

    I have heard people say, “But, I’m just a volunteer.” Unfortunately more than I would like to and it is usually in respect to training, initial and continuing education. I agree with you that the standards for EMTs and Paramedics should be the same across the board for training and operations in any system. I don’t think the schism is volunteer vs paid so much as career vs hobbyist. It deals with what your standards are about: accountability and evolving with EMS vs “this is just something I do”, and not if you are compensated or not. I know lots of volunteers that are stellar providers and continually endeavor to be so and lots of “paid guys” that really should just quit because they are that awful. EMS will only evolve as far as the lowest common denominator allows it to grow and it starts with our mindset as a whole.