Author(s): John Montes. Published on January 1, 2020.

Going, Going, Gone 
Rural communities across the United States are facing a crisis in volunteer-run emergency medical services. Can anything be done? 
Imagine someone you love is having a medical emergency. You frantically dial 911, but it just rings. Nobody answers.

It seems inconceivable, but that’s what’s happening in rural areas of the United States, according to a recent report by NBC News. As many 60 million Americans now live in areas where they are at risk of being stranded in a medical emergency, largely because no one is available to help. Or, in some cases, to even answer the phone.

This is a stunning development. Not long ago, volunteer-run emergency medical services (EMS) were incredibly efficient and successful at serving their communities. In many towns, those volunteer positions were coveted spots that you had to earn through training and participation. What happened? More importantly, can we fix it?

A number of issues have contributed to the problem, but at its heart is the fact that the pool of EMS and fire volunteers has rapidly diminished across rural America, leaving agencies struggling to staff shifts. Younger people who would have traditionally filled those roles have moved to urban areas in search of higher paying jobs, and those who remain must often work multiple jobs to make ends meet—it’s tough to ask someone already working 10 to 15 hours a day to donate their time to staff an ambulance or fire engine. On top of that, volunteers must also take classes to maintain proficiency, pay out of their own pockets for training and license renewal, and often must organize department fundraisers for supplies and equipment.

Many of these issues stem from how EMS is funded—or not—in many parts of the country. Currently, only 11 states consider EMS an essential service, meaning there is no legal obligation for communities to provide EMS the way they provide fire and police services. Faced with tight budgets, towns often choose to cut funding for these “nonessential” services, leaving a system that relies solely on the altruism of its citizens to function. But with citizens increasingly unavailable, the system is breaking down. Federal grants for EMS and fire programs have recently experienced cuts, compounding the problem, along with the fact that insurers often don’t pay for the full cost of EMS care. Clearly, something has to give.

A vital first step to fixing the problem would be for more states to declare EMS an essential service. This would force local governments to ensure that EMS is provided to all citizens. Communities would have to come up with creative ways to pay for it or face penalties.
Agencies must also get creative with how they recruit volunteers. When I worked at Santa Clara County EMS in California, we offered free continuing education credits for all levels of medical licensure and dedicated a part-time employee to volunteer recruitment and management. We were able to triple our all-volunteer medical reserve corps in just two years. Not every volunteer organization has the resources to dedicate to these efforts, but the point is that sometimes just a little extra incentive can go a long way. Money-saving efforts such as combining EMS systems, combining EMS with the fire service, and sharing resources with neighboring communities should also be explored.

The bottom line is that we’re long overdue when it comes to acknowledging the critical services provided by our fire, EMS, dispatch, and law-enforcement volunteers nationwide. We can no longer assume that things will magically take care of themselves, and we can’t make our volunteers bear the entire responsibility of devising solutions to fix these problems. Governments—local, state, and federal—must actively take on this challenge, and they must find creative ways to ensure the continuation of these essential services.

John Montes is specialist, emergency services public fire protection, at NFPA. Illustration: Michael Hoeweler