Juan A . March Jeffrey D . Ferguson 20 Volunteer EMS Systems

By defi nition, the term volunteer means “without pay.” Thus, a volunteer EMS system is one in which the EMS personnel are not paid.1 There are a multitude of different types and combinations of EMS systems as noted by both the 2006 Institute of Medicine report and the EMS Agenda for the Future.2,3,4 The issues associated with each EMS system can be signifi cantly different between urban and rural, fi re service and third service, or paid and volunteer. Being the medical director of a volunteer EMS system can be a very rewarding experience, but it does present some unique challenges. Indeed, volunteer EMS systems are very different from career, paid systems for many reasons. These differences include education, quality management, system planning and evolution, funding, and medical oversight. One of the greatest distinctions between volunteer and paid systems is the people (see Chapter 37, “Volunteers”.). The mere mention of the term “volunteer” automatically evokes a picture of an EMS system in a rural environment. It is true that most volunteer systems exist outside of urban settings. However, volunteer services are not exclusively confi ned to rural communities. Studies have indicated that approximately 75% of providers in rural areas are volunteers, as are 30% in urban areas.3 Some urban systems employ volunteers in the same way that some rural areas pay for EMS personnel.5 Data suggest that EMS volunteers care for 25% of the U.S. population, although the numbers of volunteers continue to decrease.4 The objective of this chapter is to describe the issues unique to volunteer EMS systems in order to optimize prehospital emergency care.