Saturday, August 9, 2008

Rural EMS... Staffing the Rescue Squads in Rural Areas

The following is a letter that I sent to the St. Albans Messenger, our local daily newspaper in regard to an article they published on Aug. 5th. No further introduction needed I guess. Read on.

Franklin County Fire and Rescue Squads Face Staffing Shortages Too

As an EMT-I with Enosburgh Ambulance, the bold headline on the front page of Tuesday's Messenger caught my eye (Rural fire depts. struggle to recruit). "At last", I thought, "a timely story about a major challenge facing Fire and EMS squads here in Franklin County". I was surprised and disappointed, however, to find that the story was not written from local interviews and research, but was from the AP wire with a dateline of Big Springs, Nebraska.
Recruiting and retaining highly skilled emergency medical, firefighting, and rescue personnel is difficult in all rural areas of the U.S. In fact, the communities in Franklin County and throughout Vermont are facing this issue as well. Why couldn't the Messenger inform its readers of the importance of this issue by looking at the situation right here in Northwestern Vermont?
As the AP story points out, the ranks of rural fire and rescue squads have traditionally been made up of volunteers from the local community. The majority of these services in rural areas still rely on non-paid first responders to fill their fire departments and rescue squads. Significant changes in our society over recent years, however, have made it tough for people to find the time to commit to these essential organizations. Today, many people travel away from their communities to work. Once home, family time is at a premium. While many employers support employees' efforts as firefighters and EMTs, jobs located 30 or more minutes from their town make it impossible for the crewmember to be available to respond to an emergency call during regular work hours. Volunteering, especially in the public safety realm, requires a big time commitment.
The education and training required even at the most basic level is a large time commitment. Scientific and technological advances have made firefighting and pre-hospital emergency care safer, more effective, and more reliable than ever before. Of course the days of the bucket brigade for fighting fires is long gone. Likewise, ambulances are no longer simply transportation to the hospital. The seven ambulance-equipped EMS organizations in Franklin County are all, as required by law, staffed by certified EMTs, many of whom are trained at the advanced level, and provide life-saving care and treatments to patients while en route to the hospital's ER. Getting and maintaining the required State of Vermont certifications involves hours of classroom and hands-on training. EMTs must re-certify every two years by passing written and hands-on exams, and must also have earned a minimum of continuing education. Furthermore, in the aftermath of large-scale tragedies such as 9/11 and Hurricane Katrina, more and more is being asked of your local police, fire, and rescue organizations. In order to effectively manage future large scale incidents, the federal government, through FEMA has mandated that these groups implement specific systems when multiple agencies work together in response to an incident. To put this mandate in place, squad members are required to take classes in command structure and multi-agency interaction. Squads whose members are not compliant risk losing federal monies for equipment and training. Fire, police, and EMS must also periodically work together on large scale training drills aimed at putting the new systems into action. Learning new skills and training to stay proficient at these skills takes a lot of time, usually weeknights and weekends, in order to avoid work-place conflicts.
Of course the reason behind all the study, training, and preparation, is to be ready to climb in the truck and respond when the tones go off. Here in Enosburgh, a typical 911 ambulance call can take two hours, from the initial dispatch, until the crew returns to quarters after transporting the patient to the hospital in St. Albans. Fire departments can spend a whole day or more at a structure fire. While the firefighters and EMTs that I know are passionate about their roles in helping their communities, the candle can only be burned at both ends for so long before something has to give.
If squads can't retain experienced first responders, or recruit enough new ones, how will we assure that these essential services are available when we really need them? As a result of staffing and recruiting shortages, more fire and rescue squads are now starting to pay EMTs and firefighters, either on a per-call basis or as hourly or salaried employees. The EMTs at Enosburgh Ambulance (EAS) work regular shifts and like a handful of EMS organizations in our county, are paid professional rescuers, not volunteers. EAS staffs around-the-clock crews, the majority of whom are certified at the most advanced care level available in our EMS district. In addition to serving Enosburgh, EAS also responds to 911 calls in Sheldon, Berkshire, and Bakersfield. Recent staffing shortages at Montgomery, Richford, and Franklin Rescue have resulted in frequent gaps in coverage for these towns. Enosburgh Ambulance now provides many hours of emergency ambulance coverage, as needed, for these communities as well.
More often than not, small rural towns are run on a very tight budget. Adding the cost of payroll for services that have traditionally been volunteer will likely be a hard adjustment. To make this change even harder to swallow, towns may go days at a time without having to call EMS, and it could prompt some to argue that their tax dollars are paying for nothing. But emergencies can and do happen around the clock The number of calls a squad responds to is generally proportional to the population of their service area. Rural areas experience fewer emergencies than large urban systems, but whether a squad responds to 100 calls a year or 10000, if the call involves you or your loved ones, you want trained first responders to be there quickly. I like to think that I get paid not so much for my skills in first aid or for transporting the sick and injured, but to guarantee that I will available and ready to quickly respond to an emergency.
Thankfully, as individuals we seldom need to call for the fire department or EMTs. But like the insurance we keep on our cars and homes, when we need them we should be confident that they will be there. Having at least a core group of full-time staff on salary is keeping the problem at bay for a good portion of Franklin County, at least for the time being.
This is one of the bigger issues regarding fire departments and EMS in our area. These groups certainly face other challenges. If the citizens of this region could be better informed about the public safety system we have, they will likely be better served in the years to come. Perhaps at some point, the St. Albans Messenger will consider investigating this and giving their readers a story from local sources before they grab something off the wire and plop it on the front page.


Ambulance Mommy said...

Hi, I found your blog through a link in another EMS related blog....
VERY great article. 4 years ago I was one of the top responders in our town, and now I struggle to do the minimum of 12 hours a month commitment. The average call in our town takes about 2 hours too, and if you have a call at 5:50 am, I don't get home in enough time to get to work on time. Which means I'm not able to sign up for any more overnight shifts.

Its a serious problem, and I don't know what the solution will be.

Anonymous said...

Over here in Ely,Mn we can have calls in which we have to get on a USFS float plane into the BWCA. Some of these calls take as much as three hours from dispatch to hospital. We are hospital based BLS. We feel some of the same pain you do. In response times. Nearest Level 2 hospital is two hours away by ground. The only thing that saves use at times is we have two HEMS services 30-60 min away.