How Volunteer EMTs Became America’s Last Line of First Response

In Buck Creek, a volunteer is as likely to respond to a 911 call as a paid responder. Concerned citizens helped form the fire department in 1952 and have volunteered to serve in its ranks since. As is often the case with firefighters, all paid or volunteer Buck Creek responders have EMT certifications so they can put out fires and respond to medical emergencies.

It is just one of Indiana’s more than 800 volunteer fire departments, whose members provide their time for free but often at the cost of their personal lives and mental health. These services have helped Indiana deal with more than 46,000 Covid-19 cases and over 2,400 reported deaths.

In early April, as the Buck Creek unit responded to as many as four Covid-19-related calls a day, one of their own contracted a severe case of the virus, putting him out of commission for 48 days. “We felt like we were ambushed,” Sutherlin said.

Until Indiana’s shelter-in-place order was lifted in May, the department couldn’t recruit or train new members. The virus forced Buck Creek’s crew to cancel an annual spring fish fry fundraiser that usually brings in $25,000. Meanwhile, the unit racked up $15,000 in PPE expenses, which allowed responders to suit up for every call, no matter if it was a slip-and-fall, a heart attack, or a potential case of Covid-19. Preparation and decontamination protocols stretch 20-minute hospital rides into multi-hour ordeals. “What we do is take the ER to someone’s living room,” Sutherlin said. During the pandemic’s surge, he said, each call was a “hazmat run.”

Buck Creek’s situation is far from unique. Volunteer departments provide emergency care for about one-third of the U.S. population. Two out of three of the country’s firefighters, and one in eight emergency medical service personnel, are volunteers. Volunteers sustain the medical safety net for underserved rural communities, where hospital closures have widened gaps in health care access, and residents tend to be older, sicker, and poorer. In some regions, the gap in life expectancy between urban and rural residents is as wide as 20 years.

In Idaho, about 200 EMS agencies cover the state’s 84,000 square miles. Volunteers staff about two-thirds of those agencies, said Wayne Denny, who manages the state’s bureau of emergency medical services and preparedness.

Idaho’s largest cities have tax bases to fund professional paramedic services that can dispatch an ambulance within minutes of a 911 call. “You get out beyond that, and it’s almost exclusively volunteer,” Denny said. Geographically, volunteers cover more than 80% of the state, from its vast farmlands to its sagebrush steppes, grassland prairies, and forest-hemmed lakes. They’re often dispatched on back-country missions: pulling people out of rivers and car crashes, applying tourniquets in the field, or conducting search-and-rescue missions by helicopter, horse, boat, or ATV.

Until recently, Idaho’s citizens had been insulated from the coronavirus; to date, there have been 6,100 cases and 92 deaths statewide. But some areas, like Ada County, have seen record-high spikes in recent weeks, causing public officials to roll back plans to reopen.

Volunteer departments provide emergency care for about one-third of the U.S. population

In the months since Covid-19 first swept the country, agencies around the state have stocked up on PPE to prepare for a potential surge in cases. “We couldn’t survive for months and months — but if we had an outbreak, we’ve got enough supplies to get us through it,” Denny said. “That was not the case early on.”

Regardless, Idaho will always depend on volunteers to provide the state’s medical safety net. Otherwise, it would take almost $75 million annually to deploy professional paramedics to all the state’s communities, some of which are home to a few hundred people and may only field one 911 call per week. “We just don’t have the resources to do that,” Denny said.

Across the country, dwindling populations, unstable funding, and recruitment and retention issues have put nearly one-third of rural emergency medical services in “immediate operational jeopardy,” researchers concluded in 2018. In short: They’re doing more and more with less and less.

In late spring, as the virus surged in many places, almost half of all volunteer departments reported they’d been unwilling or unable to respond to calls, according to National Volunteer Fire Council (NVFC) surveys. More than half of respondents cited the inability to train and recruit, and a majority said their stock of PPE was running low or at risk of doing so. In May, as states began to reopen, departments continued to struggle, according to recent NVFC surveys, and some EMTs have resorted to reusing single-use masks. “In a lot of places,” said Dave Finger, the NVFC’s chief of legislative and regulatory affairs, “it is going to be up to the community what they want to do and how they want to pay for it.”

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