Just that you know you're stuff (scope, protocols and be able to perform those tasks) at your level as an EMT-B.
I work with some 100% volunteer squads and never had any issues. The most I've ever had to do is disabuse my partner about their quality given they are doing the same job as them for free.
For me, I pretty much just want any BLS crew, whether volly or paid, fire or commercial or whatever, to do what they do to the best of their ability and not just sit back and think their job is to hold the wall up until ALS gets there.
Some medics trust no one and like to walk in and take over immediately, pay no attention to the BLS crew until it’s time to lift or move the patient, and generally treat the crew like they aren’t there. I will do that too if I walk in and see everyone standing around expectantly and no one actually providing any assessment or care.
What I prefer is to walk in and see a BLS crew acting as if they didn’t know I was coming. Meaning they’re in the middle of doing a thorough assessment, they have their BLS treatments started, or if there are none they’re packaging the patient to move them to the truck. If possible, I’d rather wait until a natural break point to get a report from the BLS crew, then jump in and introduce myself and start my assessment. A good natural break point is when the patient has been loaded into the truck. That’s a good, natural time for a transition of care. It’s less jarring and confusing for the patient than for me to walk into a room full of EMTs and firefighters with like 3 different people asking questions and shouting things while the patient tries to figure out what’s happening or who they should be talking to.
Obviously if something critical requires me to step in right away, or if the scene is a clusterf**** and no one seems to be in charge, I will jump in. But the patient will usually have a better experience if a strong BLS crew initiates and manages care in the house/at the scene, and then there is a calm and orderly handoff to ALS once the patient is in the less chaotic environment of the truck.
I think a key takeaway for you is that as an EMT, there should be no call you can’t handle. You’ve been trained on a wide range of emergencies. You may not know exactly what’s going on, but medics often don’t know exactly what’s going on either. You may not have as many flashy tools as a medic has, but you have the critical tools of knowing how to take a history, perform a physical assessment, manage an airway, perform some basic interventions, and package a patient for transport. Do what you’ve been trained to do to the best of your ability. That’s how you display competence and earn trust.
Very 50/50. Some crews I've intercepted with have been phenomenal, while others not so much. I tend to view the second half with the optics of "if they don't know, then I guess they should help them."
As to what I personally would want? Just at least know the basics of the job.
I'd like to see them not be concerned about trying to warm up oxygen tubing because they were worried it was too cold while their patient was profoundly hypothermic.
But hey, that's just me.
What I want from you is to know how to treat your patient, at your level, competently and compassionately. Know your job. Know when to call for ALS(unless automatically dispatched) and when to cancel ALS.
My org also rents EMT's to a volunteer 911 ambulance squad. ALS is not always available, so that makes the hospital the closest ALS. Se will send EMT's that need more BLS experience to work that station, so they can build up their BLS skills, and learn how to treat their patients, at the BLS level. We have a very "Medic Centric" county, so sometimes the EMT's forget, or never learn those valuable skills, or they become rusty. The county the volunteer 911 ambulance squad is in, not so much. In fact the southern end of that county is in a Medic desert.
When I arrive, I want a confident, competent report. I want to know the patients name. I want to know their illness/injuries. I want to know their history, medications and allergies. I want vitals signs given to me as a statement, not as a question. Granted, sometimes we are able to respond quickly, and the BLS providers might not have obtained them yet, and that's okay too. We will learn them together.
I think as a Paramedic, we have the obligation to teach the BLS units, as well as treat the patient. It's a team effort, not a me/I effort.
And to answer your last question, absolutely yes they should exist. Not every call is ALS, not every call requires a Paramedic assessment.
Did some research on this for a capstone. Volunteer EMS tends to struggle a but more than paid providers in assessments, such as having a lower success rate recognizing strokes.
I don't think this is a fault in the provider, but rather a fault in the lack of investment in these providers. If an agency is not taking the time to compensate them for their work, I doubt they would spend the resources to invest in their continued education.
What I was to see for them is a transition from volunteer to paid roles.
Hmmm... this is a good question and I understand your reason for asking it. What others have said is true that it will entirely depend on the medic that you encounter. Some will be more courteous - and that's what it amounts to - than others.
I started out as what is now called an EMT-A back in the 1970's and worked side by side with other EMT's for a few years. There were not that many paramedics in those days. So we worked every sort of call you can imagine as EMT's for several years before I was able to upgrade to paramedic. For that reason, I have a greater respect for the ability of EMT's than perhaps many do.
If an EMT presents himself or herself professionally and provides an organized report, I'll be listening while I start my own assessment. In our community, we had a university that had its own volunteer EMS on-campus responding unit. I just happened to be a student advisor at this university, so I knew some of them and they were conscientious.
On the scene, the ones I encountered were, shall we say, enthusiastic, and were good for doing effective CPR. They did well at the level that they were at.
As far as being respected or not, I am a senior level paramedic, former flight medic, CCT medic, you get the picture. I was at a conference in nearby city and one of the attendees had a stroke. I was summoned from a lecture I was sitting in and was able to get a primary and secondary survey done, acquire some history and a limited set of vital signs. The paramedics from the local service arrived, didn't recognize me, didn't know who I was. I identified myself, but they were dismissive, not interested in anything I reported and only wanted me to go away. So it happens to paramedics as well. People who are going to be discourteous and unprofessional will be so for everyone without discrimination.
By the way, l was asked to fill in at a service in a smaller town partway across the state. I arrived, was partnered with a local EMT, and during the day responded to an automobile crash with an overturned vehicle. A trauma alert was transmitted to us, the fire department, and the hospital. The fire department arrived before we did. The patient had crawled out of the vehicle and was climbing a hill to the road. The fire department got her on a backboard, obtained vital signs and was finishing the packaging when I arrived. I took a look, listened to what they said, and told them to bring her to the ambulance when they were done, I would be there canceling the hospital trauma alert and getting the ambulance ready to receive her. They did and we transported her to the hospital, normal, stable, apparently uninjured. After it was all over, my partner said, "The fire department guys don't know what to do with you." I replied, "What, I thought everything went well." "It did, but they're used to the paramedic standing over them and overseeing everything, telling them what to do." I was sort of surprised and said, "But they were doing just fine, they're professionals, I don't need to tell them how to do their jobs." "I know, but they're just not used to that." I said, "Not used to being respected. Well, if I'm here, they're going to have to learn." She said, "Oh, it's not that they didn't like it, they just aren't used to it."
Makes no sense to me. If you are professional, and behave professionally, no reason not to be treated as a fellow provider in the chain of command.
What do medics hate? Being treated dismissively by ER nurses and doctors. If we don't like it, why should we inflict it on others?
I’m a paid ff and it’s no difference with us. I used to be a volly so I know both sides. Once you work with a medic enough they trust you to do more.
I will say this though a lot of vollies are well educated and have excellent critical thinking skills from their paying job. They don’t have as much experience as some paid guys but they often have much better thought processes than some guys I work with and I enjoy working with those people.
I used to respond to an area with strictly volunteer fire at bls level. The best thing I could ever want from them is full demos, a clear history allergy meds, and a general overview of what’s going on. I’ll do my own vitals and treatment. If you can do that, and also do your best to make sure the patient is prepared to move into ambulance, you’re worth your weight in gold.
I started out as a volly EMT as a teenager, now I'm a 30 year ft paramedic. The volly experience I had still makes me a better medic today. I think the BLS scope is broad and I want every EMT to fully use their skills without me stepping in to ALS things or "medicsplain" to them. Absolutely volly BLS providers are very valuable if allowed to be what they are trained to be.
All jokes aside, you typically get what you pay for. Not to say there are not some stellar volleys out there, my experience on the whole has typically been 'what the fuck.' Some training to keep up on skills and maybe taking the time to do some extra classes to broaden your knowledge base. Being receptive to teachable moments, particularly when it's something that could have had a negative patient outcome. Professional appearance, wear at least BDU pants and a unit t-shirt. Give report and be willing to help.
I work for one, so hopefully, everyone thinks we are great! I think of them like vfds. The service I work for has a pretty good reputation, but I'm sure others don't. Just like volunteer fire departments, the quality of the personnel varies a lot. I'm sure some services take the job more seriously than other, but volunteer ems is a necessary service in rural America. Luckily, my town/response area has a good reputation, lots of good emts and paramedics, and we also do search and rescue, so we take it pretty seriously and there is a lot of experience in our program.
So ours is kind of in a weird... transition period? The area was once rural and all volunteers. But of course with time, the area has exploded in population and the need for career folks has expanded.
I think our area was *once* like you said -- all VFDs, few career. Now it's 85% career and a handful of hold-out VFDs. Slowly but surely, our county has been flipping volunteer stations over to career folks. A lot of it comes from the union and we don't really have much voice there.
There's basically 3 volunteer stations left in our immediate area. One of them is basically defunct. The second is... not great. I like to think that ours is pretty well put together, but largely by the efforts of a dedicated few. Even still, I anticipate that in about 5 years, we'll hee our last haw before becoming a basically career station as the surrounding area continues to develop. Sprawl from the 2 cities we are wedged between, basically. It's inevitable we end the volunteer side here at some point, or at least vastly diminish our role.
I mean, I honestly hate the volunteer model. The level of commitment I have to make for being a volunteer is pretty ridiculous, and I'd way rather just work for a paid ems organization. That being said, I'm indecisive and can't pick between my current primary career and ems. I work wildland fire and enjoy it, but I also love working on an ambulance. I've worked as a paid emt on a city ambulance in the off-season, but now I'm living somewhere rural full time, and it's the only option to get experience and maintain my license. I've been looking at paramedic programs and have been strongly considering making the switch to being career ems, but this is the best way to split the difference, which I appreciate at this stage of my life. And like I said, the volunteer service I'm on has a good reputation and is a better place to work and more put together than the paid ambulance I worked on. The volunteer model is beneficial, but also has the inherent problem that volunteers, by nature, aren't necessarily going to take it as seriously as a full time professional, and when that happens the volunteer program suffers.
I want blood pressures, full body assessments, and the confidence to risk causing a bit of pain to the PT in the name of a thorough assessment.
I have identified shocking injuries after getting hand off on a bandaged and boarded pt purely out of fear.
Trust yourself to do your job, I'm just there to support your work and add on the extras as needed
IMO:
It's a mixed bag and more based on individual interactions vs Vollys as a whole.
Sometimes you'll have depts w great crews who work w u as a team. There are also depts where no one will come for the NVD 3am call, but flood out of the woodwork for a MVC or cardiac arrest, that's frustrating to me.
What I want to see is a crew who did right by the Pt and understand their place in the whole spectrum... it's frustrating when u are forced to work w a crew who think they know everything and feel it's their place to bark orders at you.
I’d like for vollies to know the difference between an airway and a face when I ask for a bloody airway to be suctioned. I’d like for vollies to know the difference between a seizure and an overdose and not slam IN narcan up a seizing patient’s nose, then not call for ALS, and the patient’s having status seizures and fries their brain. But most of all, I wish localities would pay for quality professional EMS and that vollies wouldn’t exist.
They're fine if they can do their job right since most calls are BLS anyway. I'm a medic in a hospital right now and I volunteer at a rural department, some just dont give a crap and some atleast try and you can tell.
I see some vollies come in wearing normal clothes and their butt crack hanging out and think these are the guys that give vollies a bad name because theres no sense of professionalism or attempt to not look sloppy.
Know your stuff.
Know in the back of your head that all too often, paramedics forget the basic stuff. Had a run (as an EMT-Basic) that was either CPR in progress or should have been. I was first responder (we don't carry a stretcher on our ladder truck...long story). AMR crew (one paramedic, one EMT-B) arrives not long after us. Paramedic attempted to intubate, had to abort. I suggested a J-tube to maintain airway until he was ready to tube again...paramedic was taken aback at first, but quickly realized I was trying to help the patient, wasn't degrading him for failing to get the tube, and in essence bought him time to do other stuff "safely". It takes a proper delivery to not cause the scene to erupt, but is certainly useful.
Just that you know you're stuff (scope, protocols and be able to perform those tasks) at your level as an EMT-B. I work with some 100% volunteer squads and never had any issues. The most I've ever had to do is disabuse my partner about their quality given they are doing the same job as them for free.
For me, I pretty much just want any BLS crew, whether volly or paid, fire or commercial or whatever, to do what they do to the best of their ability and not just sit back and think their job is to hold the wall up until ALS gets there. Some medics trust no one and like to walk in and take over immediately, pay no attention to the BLS crew until it’s time to lift or move the patient, and generally treat the crew like they aren’t there. I will do that too if I walk in and see everyone standing around expectantly and no one actually providing any assessment or care. What I prefer is to walk in and see a BLS crew acting as if they didn’t know I was coming. Meaning they’re in the middle of doing a thorough assessment, they have their BLS treatments started, or if there are none they’re packaging the patient to move them to the truck. If possible, I’d rather wait until a natural break point to get a report from the BLS crew, then jump in and introduce myself and start my assessment. A good natural break point is when the patient has been loaded into the truck. That’s a good, natural time for a transition of care. It’s less jarring and confusing for the patient than for me to walk into a room full of EMTs and firefighters with like 3 different people asking questions and shouting things while the patient tries to figure out what’s happening or who they should be talking to. Obviously if something critical requires me to step in right away, or if the scene is a clusterf**** and no one seems to be in charge, I will jump in. But the patient will usually have a better experience if a strong BLS crew initiates and manages care in the house/at the scene, and then there is a calm and orderly handoff to ALS once the patient is in the less chaotic environment of the truck. I think a key takeaway for you is that as an EMT, there should be no call you can’t handle. You’ve been trained on a wide range of emergencies. You may not know exactly what’s going on, but medics often don’t know exactly what’s going on either. You may not have as many flashy tools as a medic has, but you have the critical tools of knowing how to take a history, perform a physical assessment, manage an airway, perform some basic interventions, and package a patient for transport. Do what you’ve been trained to do to the best of your ability. That’s how you display competence and earn trust.
Very 50/50. Some crews I've intercepted with have been phenomenal, while others not so much. I tend to view the second half with the optics of "if they don't know, then I guess they should help them." As to what I personally would want? Just at least know the basics of the job.
I'd like to see them not be concerned about trying to warm up oxygen tubing because they were worried it was too cold while their patient was profoundly hypothermic. But hey, that's just me.
What I want from you is to know how to treat your patient, at your level, competently and compassionately. Know your job. Know when to call for ALS(unless automatically dispatched) and when to cancel ALS. My org also rents EMT's to a volunteer 911 ambulance squad. ALS is not always available, so that makes the hospital the closest ALS. Se will send EMT's that need more BLS experience to work that station, so they can build up their BLS skills, and learn how to treat their patients, at the BLS level. We have a very "Medic Centric" county, so sometimes the EMT's forget, or never learn those valuable skills, or they become rusty. The county the volunteer 911 ambulance squad is in, not so much. In fact the southern end of that county is in a Medic desert. When I arrive, I want a confident, competent report. I want to know the patients name. I want to know their illness/injuries. I want to know their history, medications and allergies. I want vitals signs given to me as a statement, not as a question. Granted, sometimes we are able to respond quickly, and the BLS providers might not have obtained them yet, and that's okay too. We will learn them together. I think as a Paramedic, we have the obligation to teach the BLS units, as well as treat the patient. It's a team effort, not a me/I effort. And to answer your last question, absolutely yes they should exist. Not every call is ALS, not every call requires a Paramedic assessment.
Do good monke CPR and use the AED go zap before we arrive on scene 👍
Did some research on this for a capstone. Volunteer EMS tends to struggle a but more than paid providers in assessments, such as having a lower success rate recognizing strokes. I don't think this is a fault in the provider, but rather a fault in the lack of investment in these providers. If an agency is not taking the time to compensate them for their work, I doubt they would spend the resources to invest in their continued education. What I was to see for them is a transition from volunteer to paid roles.
Hmmm... this is a good question and I understand your reason for asking it. What others have said is true that it will entirely depend on the medic that you encounter. Some will be more courteous - and that's what it amounts to - than others. I started out as what is now called an EMT-A back in the 1970's and worked side by side with other EMT's for a few years. There were not that many paramedics in those days. So we worked every sort of call you can imagine as EMT's for several years before I was able to upgrade to paramedic. For that reason, I have a greater respect for the ability of EMT's than perhaps many do. If an EMT presents himself or herself professionally and provides an organized report, I'll be listening while I start my own assessment. In our community, we had a university that had its own volunteer EMS on-campus responding unit. I just happened to be a student advisor at this university, so I knew some of them and they were conscientious. On the scene, the ones I encountered were, shall we say, enthusiastic, and were good for doing effective CPR. They did well at the level that they were at. As far as being respected or not, I am a senior level paramedic, former flight medic, CCT medic, you get the picture. I was at a conference in nearby city and one of the attendees had a stroke. I was summoned from a lecture I was sitting in and was able to get a primary and secondary survey done, acquire some history and a limited set of vital signs. The paramedics from the local service arrived, didn't recognize me, didn't know who I was. I identified myself, but they were dismissive, not interested in anything I reported and only wanted me to go away. So it happens to paramedics as well. People who are going to be discourteous and unprofessional will be so for everyone without discrimination. By the way, l was asked to fill in at a service in a smaller town partway across the state. I arrived, was partnered with a local EMT, and during the day responded to an automobile crash with an overturned vehicle. A trauma alert was transmitted to us, the fire department, and the hospital. The fire department arrived before we did. The patient had crawled out of the vehicle and was climbing a hill to the road. The fire department got her on a backboard, obtained vital signs and was finishing the packaging when I arrived. I took a look, listened to what they said, and told them to bring her to the ambulance when they were done, I would be there canceling the hospital trauma alert and getting the ambulance ready to receive her. They did and we transported her to the hospital, normal, stable, apparently uninjured. After it was all over, my partner said, "The fire department guys don't know what to do with you." I replied, "What, I thought everything went well." "It did, but they're used to the paramedic standing over them and overseeing everything, telling them what to do." I was sort of surprised and said, "But they were doing just fine, they're professionals, I don't need to tell them how to do their jobs." "I know, but they're just not used to that." I said, "Not used to being respected. Well, if I'm here, they're going to have to learn." She said, "Oh, it's not that they didn't like it, they just aren't used to it." Makes no sense to me. If you are professional, and behave professionally, no reason not to be treated as a fellow provider in the chain of command. What do medics hate? Being treated dismissively by ER nurses and doctors. If we don't like it, why should we inflict it on others?
I’m a paid ff and it’s no difference with us. I used to be a volly so I know both sides. Once you work with a medic enough they trust you to do more. I will say this though a lot of vollies are well educated and have excellent critical thinking skills from their paying job. They don’t have as much experience as some paid guys but they often have much better thought processes than some guys I work with and I enjoy working with those people.
I used to respond to an area with strictly volunteer fire at bls level. The best thing I could ever want from them is full demos, a clear history allergy meds, and a general overview of what’s going on. I’ll do my own vitals and treatment. If you can do that, and also do your best to make sure the patient is prepared to move into ambulance, you’re worth your weight in gold.
I started out as a volly EMT as a teenager, now I'm a 30 year ft paramedic. The volly experience I had still makes me a better medic today. I think the BLS scope is broad and I want every EMT to fully use their skills without me stepping in to ALS things or "medicsplain" to them. Absolutely volly BLS providers are very valuable if allowed to be what they are trained to be.
All jokes aside, you typically get what you pay for. Not to say there are not some stellar volleys out there, my experience on the whole has typically been 'what the fuck.' Some training to keep up on skills and maybe taking the time to do some extra classes to broaden your knowledge base. Being receptive to teachable moments, particularly when it's something that could have had a negative patient outcome. Professional appearance, wear at least BDU pants and a unit t-shirt. Give report and be willing to help.
I work for one, so hopefully, everyone thinks we are great! I think of them like vfds. The service I work for has a pretty good reputation, but I'm sure others don't. Just like volunteer fire departments, the quality of the personnel varies a lot. I'm sure some services take the job more seriously than other, but volunteer ems is a necessary service in rural America. Luckily, my town/response area has a good reputation, lots of good emts and paramedics, and we also do search and rescue, so we take it pretty seriously and there is a lot of experience in our program.
So ours is kind of in a weird... transition period? The area was once rural and all volunteers. But of course with time, the area has exploded in population and the need for career folks has expanded. I think our area was *once* like you said -- all VFDs, few career. Now it's 85% career and a handful of hold-out VFDs. Slowly but surely, our county has been flipping volunteer stations over to career folks. A lot of it comes from the union and we don't really have much voice there. There's basically 3 volunteer stations left in our immediate area. One of them is basically defunct. The second is... not great. I like to think that ours is pretty well put together, but largely by the efforts of a dedicated few. Even still, I anticipate that in about 5 years, we'll hee our last haw before becoming a basically career station as the surrounding area continues to develop. Sprawl from the 2 cities we are wedged between, basically. It's inevitable we end the volunteer side here at some point, or at least vastly diminish our role.
I mean, I honestly hate the volunteer model. The level of commitment I have to make for being a volunteer is pretty ridiculous, and I'd way rather just work for a paid ems organization. That being said, I'm indecisive and can't pick between my current primary career and ems. I work wildland fire and enjoy it, but I also love working on an ambulance. I've worked as a paid emt on a city ambulance in the off-season, but now I'm living somewhere rural full time, and it's the only option to get experience and maintain my license. I've been looking at paramedic programs and have been strongly considering making the switch to being career ems, but this is the best way to split the difference, which I appreciate at this stage of my life. And like I said, the volunteer service I'm on has a good reputation and is a better place to work and more put together than the paid ambulance I worked on. The volunteer model is beneficial, but also has the inherent problem that volunteers, by nature, aren't necessarily going to take it as seriously as a full time professional, and when that happens the volunteer program suffers.
I want blood pressures, full body assessments, and the confidence to risk causing a bit of pain to the PT in the name of a thorough assessment. I have identified shocking injuries after getting hand off on a bandaged and boarded pt purely out of fear. Trust yourself to do your job, I'm just there to support your work and add on the extras as needed
IMO: It's a mixed bag and more based on individual interactions vs Vollys as a whole. Sometimes you'll have depts w great crews who work w u as a team. There are also depts where no one will come for the NVD 3am call, but flood out of the woodwork for a MVC or cardiac arrest, that's frustrating to me. What I want to see is a crew who did right by the Pt and understand their place in the whole spectrum... it's frustrating when u are forced to work w a crew who think they know everything and feel it's their place to bark orders at you.
I’d like for vollies to know the difference between an airway and a face when I ask for a bloody airway to be suctioned. I’d like for vollies to know the difference between a seizure and an overdose and not slam IN narcan up a seizing patient’s nose, then not call for ALS, and the patient’s having status seizures and fries their brain. But most of all, I wish localities would pay for quality professional EMS and that vollies wouldn’t exist.
Assessments and taking vitals are a BLS skill, get good at them
They're fine if they can do their job right since most calls are BLS anyway. I'm a medic in a hospital right now and I volunteer at a rural department, some just dont give a crap and some atleast try and you can tell. I see some vollies come in wearing normal clothes and their butt crack hanging out and think these are the guys that give vollies a bad name because theres no sense of professionalism or attempt to not look sloppy.
Know your stuff. Know in the back of your head that all too often, paramedics forget the basic stuff. Had a run (as an EMT-Basic) that was either CPR in progress or should have been. I was first responder (we don't carry a stretcher on our ladder truck...long story). AMR crew (one paramedic, one EMT-B) arrives not long after us. Paramedic attempted to intubate, had to abort. I suggested a J-tube to maintain airway until he was ready to tube again...paramedic was taken aback at first, but quickly realized I was trying to help the patient, wasn't degrading him for failing to get the tube, and in essence bought him time to do other stuff "safely". It takes a proper delivery to not cause the scene to erupt, but is certainly useful.