Is adding paid staff to a volunteer agency the beginning of the end or the start of a new future?

Is adding paid staff the beginning of the end for your volunteer agency"

Or is it an opportunity to make your service better, stronger, faster and smarter"

The answer to these questions depends on how the decision to integrate career personnel into your organization is arrived at and managed. What may initially seem overwhelming or an admission of defeat is in reality the opportunity to build a stronger, better, faster, smarter volunteer EMS agency with the capability to provide reliable and excellent medical response to your community.

Commitment to the community
If your agency is considering supplementing volunteer EMT and paramedics with paid EMS providers, chances are good that you already recognize one or more of these problems:

• The schedule is not filled for every shift, every day.
• You are passing calls or abusing mutual aid agreements.
• Multiple tones are needed to scramble a crew resulting in response delays.
• The core group of responders is getting discouraged, resentful and burned out.
• Members have begun to rationalize that occasional failed responses are OK or normal because the surrounding towns have the same problem.

If any of these are true for your department, it is time to get help with staffing.

Failure to do so because of pride, tradition or fear of outsiders staffing the ambulance does not excuse a volunteer service from failing to provide the safety net it has committed to providing the community.

Taking responsibility for employees and the community
Many volunteer ambulance agencies and rescue squads began generations ago with little or no formal planning. Often bylaws, policies, leadership roles and culture have developed piecemeal over the years.

As a result, the organizational structure has likely been built on personalities and emotion rather than sound business principles. The informal, often clannish nature and sometimes questionable operating practices of some agencies may have worked 80 or even 20 years ago with the respect and support of a grateful public, but the world and EMS has changed dramatically. EMS will continue to change at light speed.

As your volunteer agency moves forward with adding paid staff, it needs a clearly defined mission statement, vision statement or strategic plan for the near and distant future. These documents are a foundation that must now be in place to effectively run a modern EMS organization.

Your agency will from now on be in the business of saving lives and providing for the livelihood of EMTs who have chosen to make EMS their vocation. This is a responsibility not to be taken lightly, and the groundwork needs to be in place to manage this change successfully.

Making the transition to paid staff successful
The first step is to hold a special meeting of your members with mandatory attendance. Insist on polite and respectful discourse and stick to the facts:

• There must be scheduled coverage 100 percent of the time.
• Adding paid staff is the morally and ethically responsible thing to do for the community when volunteer participation alone cannot accomplish this.

To achieve buy in, every member must have a voice. If decisions about major changes, including staffing, are made by officers or a board of directors without the input of the membership, there is exactly zero hope of successfully implementing those changes, and likely no hope of salvaging the organization as a volunteer effort for any length of time. Resentment, conflict — a hostile us versus them environment — and the continued attrition of volunteer members is the probable result.

"The most important thing in communication is to hear what isn't being said."
— Peter Drucker

A new beginning for the department
This is a perfect opportunity to reimagine, rethink and redesign your volunteer agency. Strong leadership will be needed to guide the conversation towards focusing on the positive. Ask, "What do we want for the future"" not on, "How do we avoid what we don’t want""

Ask your members to answer the following questions:

• In a perfect world, how will your volunteer squad operate"
• What is preventing a perfect vision from happening today"
• What is the department's role — 911 response, education and prevention, community outreach — in the community"
• What traits and characteristics are you seeking in new paid staff, as well as new volunteers"
• What qualifications are required for paid position applicants"
• Who should lead the new paid staff" Why"
• How can the department take advantage of the opportunity provided by bringing experienced and career-oriented EMS providers in-house to help make those changes"

Focus on creating a partnership
Bringing in the right people is critical to the future success and stability of your squad, regardless of pay status. Be thoughtful, focused and deliberate with the job description and interview process. Look for applicants who will have the patience and experience to mentor new recruits and bring confidence to part-time volunteer members.

Consider hiring a crew chief or operations manager who can provide shift coverage and take care of day-to-day administrative functions including scheduling, inventory management, equipment checks, in-service training and chart review for continuous quality improvement. Having the daily operations taken care of will take a big load off of the volunteer members who have been running the business part-time, and allow those members to focus on the patient care aspect that they originally signed up for.

Be proactive in adding paid staff
Make the decision to add paid staff before being forced to by a sentinel event. Panic hiring just to put meat in the seat because a response failure resulted in a poor outcome or death of a patient, will send your department down a rabbit hole of chaos, shame, resentment and possibly financial ruin.

Managing the change deliberately with a positive outlook, and the support of the membership and community will prevent the division, morale issue and human resource problems that can plague this initiative. Intentionality also honors your department's commitment to the safety of the community.

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