This is post #2 in a series. You can read post #1 here and you can read post #3 here

Before you can solve a problem, you need to understand what the actual problem is. In order to do that, you need to understand the good and the bad of who/what the problem is afflicting.

In this case, we’ll be talking about the volunteer EMS agencies in New York City who face alot of challenges operating in this environment. Some of the challenges come from the evolution of EMS in the city, and some of those challenges are self-made. So let’s take a look at both sides of the fence:

The Good

There are definitely good things about the NYC vollies that should absolutely not be overlooked:

• Volunteers – the people who take the time to volunteer are dedicated individuals with a sincere desire to provide a service to others. Being a volunteer gives them the opportunity to gain experience and training that can lead them to a career as a professional EMS provider
• Community based – these agencies have strong connections to their community, with many of them having existed for over 30, 40, and 50 years. Their inception occurred at a time when a city EMS was non-existent and it was up to the citizens to provide care to one another. This fine tradition of helping others in their greatest hour of need is the very core of what EMS is about
• Regulated – the agencies are all regulated by the NYSDOH and are required to be certified in order to operate. This enforces that the volunteers be on equal standing with the other agencies in the area, depending on their level of service

The Bad

There is of course always the bad that goes hand in hand with the good:

• Volunteers – because these agencies are dependent on volunteers who are donating their time when they are available, they are hard pressed to deliver guaranteed in service times
• Community based – each agency is issued a Certificate of Need (CoN) that specifies their permitted response area, and usually coincides with the boundaries of their community. In essence this sets up a system of fiefdoms across a geographical area where borders can literally be the difference between the north side and the south side of a single street. Agencies instinctively become territorial and protective over their “area”, which more often leads to conflict and strife instead of compromise and understanding. Let there be no mistake about it, personal egos that rage unchecked help to contribute to this dilemma that never truly has the best interest of the patient in focus
• Regulated – not only is the regulation responsible for the negative aspect of the agencies being community based, but it also helps narrow down the volunteer pool by requiring certification. Sure people want to volunteer their time, but the time commitment taking and passing an EMT class is not something everyone is ready or able to do. While most organizations wisely have positions for non-certified volunteers, a certified volunteer becomes that much more in demand

Unfortunately these problems, along with a few others, will lead to the extinction of the NYC Vollies within the next 10 years if not resolved. There have already been a number of agencies that have shut their doors.

A Few Nearly Instant Actionable Solutions

There are quite a few things that the NYC Vollies can do immediately to avoid extinction:

• Volunteers – These are the very lifeblood of the organization. While you may think that these agencies would be focused on this, more often than not they have fallen into a rut and need to re-evaluate how they handle this essential ingredient to success
  1. NYC Vollies need to be more aggressive with their recruitment. It is important to have a clearly defined recruitment process in place and dedicated people running it
  2. There is a finite source of valuable resources in the form of volunteers interested in working on an ambulance. Recruitment efforts should be broader than for just EMTs and drivers. Everyone willing to volunteer and donate their time has value
  3. Every agency needs to treat each volunteer for what they are, a huge priceless asset. Too many times volunteer agencies will say this, but not live it. There are many reasons why people volunteer. It is important that leaders figure out what drives each person, and do their best to deliver it
• Community based – One of the biggest challenges of any vollie agency is the fact that the community around them is changing both financially and demographically. Those changes don’t always continue to coincide with the agency’s original 30 year old mission. While the organization can’t change the community’s transition around it, the way they relate to the changing community can be changed. This is one of the hardest things to transform about an organization so rooted in its community, yet a failure to change will result in an organization being made obsolete…
  1. The agency needs to literally re-learn their community. They can do this by some basic research through the US Census Bureau, or take it to the next level and send out a survey. The community has changed around them and they need to learn who their community is now so they know better how to re-introduce themselves
  2. The agency needs to ask itself “What can we uniquely provide to our community?” The answer in NYC is not emergent ambulance service, because the 911 system is already doing that on a daily basis
  3. Learn to effectively communicate value using tools such as Social Media. The truth is that this change made by FDNY did not happen recently, it happened last year. If the volunteers were able to effectively communicate value to their communities AND to FDNY, then there would be better communication and understanding all around
• Regulation – There’s not really anything the Vollies can do regarding regulation, or changing it, instantaneously. What they can change is how they interact with that regulation and the regulatory agency
  1. Stop inundating the regulating agency with petty complaints about other volunteer agencies. This is one of the most annoying thing about the NYC vollies… their petty politics. If agencies cannot find a way to effectively communicate and compromise with their fellow volunteers, what hope do they have of effectively communicating and serving their community?
  2. Don’t use the regulation as a goal to attain, use it as the base to start from. In New York State for a certified ambulance to operate it requires one NYS Certified EMT. Due to the shortage, most volunteers will allow non-certified drivers or attendants. There are some agencies that require everyone onboard to at least be certified in CPR, and some volunteers have indeed instituted a two EMT policy for which I commend them. I know this is hard, but I think it’s important if the vollies are going to continue to provide any sort of ambulance service… which for the right now they will have to in order to stay funded through the third part billing
  3. Carefully select and choose what types of “experimental” or “trial” programs you want to participate in. Usually when one of these becomes available, every vollie jumps at the chance to join it so they can proudly proclaim that they are doing something “new” and “unique”. In reality all they are doing is expending energy on something that may be detrimental to the actual study

The Big Idea

Tomorrow I’m going to outline what my “big idea” is regarding the long term survival of the NYC Vollies. It’s an idea that I cannot claim originating, but its been percolating in my mind for quite awhile… and for the first time it will be fleshed out in writing.

Until then though, as you can see I listed the problems that I see and offered some solutions. If you’re a NYC Vollie, what problems do you see and what do you think will be able to fix it? If you’re not a NYC Vollie, does your agency have or has had the same problems? If so, what are they doing or did do to fix it? Did it work?

Inquiring minds want to know…

Full Disclosure: I am a member of the Forest Hills Volunteer Ambulance Corps in Forest Hills, Queens and have been a member of that Corps since 1994