Volunteer crews in crisis? State: Yes, Blaine County: Maybe

Reporter's note: Louise Nissen, a member of the Blaine III ambulance crew in Harlem, shared a newspaper clipping about a Montana legislative study committee looking at the status of emergency ambulance service in Montana. Jim DeTienne, EMS and trauma systems section supervisor for Montana's Department of Health and Human Services told the committee, "It (the EMS system) is very fractured. It is very troubled. It is not going to sustain the same way we've built it in the last 30 years for much longer." Much of the problem, the DPHHS official said, had to do with aging EMS volunteers and a lack of new volunteers stepping forward.

To better understand how the volunteer ambulance crews are doing in Blaine County, I sent questionnaires to crew chiefs at each of the three main services. I thank these busy people for responding. Here's a summary of the challenges they are facing to maintain volunteer ambulance service to the areas they serve.

A short history and the challenge in Blaine County

In 1948, Blaine County Ambulance began service. Based in Chinook, the service responded to calls for the entire county. The American Legion in Turner, in 1954, bought the old Chinook ambulance and a second service began serving the Big Flat area. By 1977 a third service had begun in Harlem. It was in the 1970's that county, state and federal regulations changed the way volunteer services could operate and defined new qualifications for crew members to serve.

Now there are three services in Blaine County: Blaine I, in Chinook; Blaine II in the Big Flat area and Blaine III, based in Harlem. At Fort Belknap there is a combination of a service staffed by paid employees, part of Indian Health Services, and a fairly new volunteer group serving the Hays/Lodge Pole area under the auspices of the tribal government.

The three county volunteer groups are funded by a combination of county tax funds, community donations/fundraisers, grants for specific training or equipment and user fees for ambulance transportation. All three ambulance groups noted good financial support from the county and good community support. The billing and collecting for county ambulance service is handled at the county level, but all three groups noted that user fees (paid by individuals or some insurance program) typically did not cover the actual cost of providing transportation to hospitals.

While not a crisis in Blaine County, there is concern about maintaining adequate numbers of trained volunteers to provide crews to provide service 24/7. Crew chiefs noted, "All crew members have full time jobs and other commitments." Add to that aging crew members and fewer new volunteers, it will be, and already is at certain times, a challenge to maintain ambulance service at the present level. That's not unique to Blaine County. The state report noted three quarters of the state (mostly rural areas) is served by volunteer services.

The state of the volunteer crews in the county

With the Chinook crew, there is 24/7 coverage during the week, but no set weekend schedule. The Chinook respondent wrote, "If you are home and available, you're on call during the weekends." In Harlem, the crew has "six consistent, reliable crew members," but noted some formerly active members are slowing down and that could be problematic without new volunteers. Big Flat put it simply: "We aren't in a crisis yet but could be if more people retire."

Active crew members drop from crews for a variety of reasons. Big Flat has maintained the same number of crew members for several years, but the crew is aging and people seem to be getting busier and busier. Chinook lost two crew members who weren't able to complete the 72 hours of continuing education required every two years to maintain their certification. Chinook crew leaders make efforts to provide the training but it doesn't always fit with volunteer's schedules to attend. The Harlem respondent noted, some volunteers just 'burn out.' Dealing with trauma can take an emotional toll, especially in small communities where volunteers know most of the people they treat. Some volunteers develop their own medical issues and that ends their service to a crew.

Requirements to be a volunteer on an ambulance crew

First, a basic emergency medical technician (EMT) course is required. That's a 180 hour in-class program and doesn't count study and prep time for the classes and tests. To keep that basic certification takes another 72 hours of continuing education every two years. Certification to provide more advanced procedures takes additional training.

In Blaine County, all three crews are paid a stipend when they make an ambulance run. The crew members are reimbursed for some training and certification costs-the initial classes, continuing education and licenses all have a cost, often not cheap. At least one crew has a program to replace ruined clothing while on the ambulance.

All survey respondents agreed the biggest requirement is time. The majority of the crew members in Blaine County are females. All crew members have jobs and family obligations. Some crew members live miles away from where an ambulance is based and that can eliminate them from serving at certain times. All three county crews have monthly business and training meetings. The ambulance runs can often take several hours, especially to distant cities.

A big question is: What motivates people to volunteer for an ambulance crew? The respondents couldn't answer for every crew member, but the most common answer was, "They want to help others." One respondent noted, "I got to thinking, if I or a family member needed emergency care, I would want it to happen. Then I decided, "If I won't do it, then who will?"" Other motivators involved the 'social aspects' of getting to know and work with people on a continued basis and the camaraderie that develops among crew members, both locally and throughout the state.

How to meet the challenges

The legislative study committee and others who manage the statewide EMS program are looking for solutions to reduce costs and the time volunteers spend making ambulance calls. One concept being tried in other states is "paramedicine." That idea increases EMS's role in preventive care, with crews making regular, scheduled visits to people with chronic disease. The DPHHS official said, "It makes more sense to see them regularly in the home so we're not getting up at 3 am to transport them to a hospital."

Whatever the solutions, in rural areas the service will still depend on recruiting more volunteers. One local respondent on the survey wrote, "Every volunteer crew in Montana, and nationwide, is asking the same question. How can we attract more volunteers?" Another on the survey noted, "There's a bit of a funnel effect with keeping volunteers. If we recruit 10 volunteers to take the basic class, four might finish all the requirements. If we are lucky, two will join the crew and one of those will be reliable all the time." Like many volunteer-based organizations, it's a numbers game.

For some potential volunteers it might not be the right time in their life to join an EMS crew-too many family obligations or too many demands on their job. One crew chief wrote, "Maybe it's just raising awareness of the need for volunteers. We all assume when we call 911 someone will respond. To meet that expectation, we need people to run the ambulances and provide treatment."

If you are interested in learning more about being a volunteer on an ambulance crew, here are the contacts for the crew chiefs for each ambulance crew: Steve Leitner for Big Flat (Blaine II), 379-2693 or email at bigflatambulance@gmail.com; co-chiefs for Chinook (Blaine I), Jim Doyle, 357-2335 or email at jdoyle@mt.gov and Laurie Huestis, 357-3310 or email at lhuestis@blainecounty-mt.gov. For Harlem (Blaine III), Karensa Calvert, 353-4637 or email at pixelportrait@itstriangle.com.

It could be the toughest job you ever loved. Some crews are in the process of organizing basic EMT courses for new volunteers, now may be your time to help others.