Can Paid and Volunteer EMTs Work Together?

By Sylvie Mulvaney, BSN, RN
Your all-volunteer EMS/rescue squad fought the good fight and held out as long as possible, but it can no longer dodge the bullet. It’s time to surrender to that dreaded four-letter word in volunteer EMS: “paid.” Does hiring paid personnel signal the inevitable demise of the squad’s volunteer support? Not necessarily. As demonstrated by the following New Jersey squads, the hybrid/blended/combination system works well for some. For others, it’s a work in progress. 
Mount Laurel EMS
The all-volunteer Fellowship Emergency Squad in Mount Laurel Township became a hybrid squad in 1986, hiring two paid staffers for 12-hour shifts Monday-Friday. Those staffers became municipal employees in 1990. In 1994, Fellowship merged with the Masonville Emergency Squad to form Mount Laurel EMS. 
Before budget crunching forced Mount Laurel EMS to start billing in December 2007, the municipality paid for everything, according to Fran Pagurek, a life member of the squad and its paid chief for 16 years until retiring earlier this year. 
“Mount Laurel was growing exponentially and the township could afford that,” he said. “The township is very good to the volunteers here.”   
The squad now includes 30 paid employees and 130 volunteers (90 of them active), dispatching seven ambulances – two of them for bariatric patients – from three stations. Volunteers staff the ambulances from 6:30 p.m.-5:30 a.m. Friday-Monday, as well as during sporting and community events when needed, and the arrangement works well, Pagurek said. 
“You can’t tell the difference between the volunteers and the paid staffers,” he said. “It’s one big, happy organization. We have a winning team.”
A South Jersey suburb of Philadelphia, Mount Laurel is home to approximately 42,000 residents in a 22-square-mile area. The population swells to 60,000 if you count daily commuters, Pagurek said. The township also includes two major shopping centers and numerous hotels, as well as busy Routes 73 and 38, and a portion of the New Jersey Turnpike.
A paramedic and licensed practical nurse, Pagurek said that when he assumed the paid EMS chief position in 1999, “the volunteer aspect was dying; I get the value of the volunteer.”  
Mount Laurel EMS volunteers can take advantage of many perks, including:
  • Convenient in-house training
  • Up to $800 in free tuition annually at Burlington County College and nearby Rowan University (after two years of volunteer service)
  • Length of Service Award Programs (LOSAP)
  • Membership in the EMS Council of New Jersey (EMSCNJ), which assists with volunteer-related advocacy issues, education, and public relations, among many other benefits
  • Well-run cadet program
  • When available, opportunities for volunteers to move to paid positions
  • Incentive program that allows volunteers to earn points for staffing tough-to-cover shifts and attending meetings; points can be redeemed for personal apparel or equipment
  • Hot beverages purchased by the township and food purchased by the squad
  • Annual awards banquet
  • Summer and winter socials such as barbeques at the local swimming pool and bowling and games at the local amusement center
The township also reimburses EMTs for the cost of certification upon their successful completion of the course, but they must sign a contract to dedicate at least six hours per week on the squad for two years. The few EMTs who failed to honor the contract were sued successfully in small claims court, Pagurek said.
Half of the squad’s volunteer members come from outside Mount Laurel because it’s so volunteer friendly and a good place to get experience, he said.
He added that after his mandatory one-year post-retirement waiting period, he plans to re-join the squad as an active volunteer. 
Raritan Valley Regional EMS and Lumberton Emergency Squad Station 139
Dan Januseski was instrumental in creating two hybrid squads in New Jersey, first in Edison then in Lumberton.
Edison’s three squads, established in 1935, 1936, and 1951, first hired paid staff in 1996. They merged in 2013 to create Raritan Valley Regional EMS. 
“The township was covering everything for a while,” said Januseski, a life member and part of the RVR EMS special operations team. “But it was overextended and losing money.”
With 100,000 residents in 36 square miles, Edison is the fifth most populous municipality in New Jersey. Total annual call volume is approximately 12,000, with volunteers handling nearly half of them, according to Januseski. Volunteers ride from 7 p.m.-6 a.m. Monday-Friday and all weekend. On the paid side are a supervisor and 16 per diem EMTs with no benefits, affiliated with the local hospital system that holds the Edison Township BLS contract, he said. 
The volunteers had to fight to stay operational and relevant. They now staff one ambulance, on equal footing with the hospital’s two ambulances. The vehicles are dispatched based on geographic location. The volunteers, who are not affiliated with the hospital network, also staff fire call rehab efforts and stand-by events, as well as answer mutual aid calls.
“You have to balance,” Januseski said. “You must have healthy membership and be financially stable.”
Januseski is also president of the Lumberton Emergency Squad Station 139, which used to function on donations and an annual $60,000 contribution from the township. The squad began billing in 2009 when daytime coverage became a problem, he said.
Nine paid EMTs with no benefits cover calls from 7 a.m.-6 p.m. Monday-Friday. Volunteers – including the chief – cover the balance of the 1,300 annual calls. Lumberton, with 13,000 residents, spans approximately 12 square miles.
“It’s worked out well to this point,” Januseski said. “Financially, it’s worked out great.”
Bolstering the case for the necessity of volunteers, he added that a recent call response analysis confirmed that financially, Lumberton could not sustain even one full-time paid EMS crew.
One problem, not surprisingly, is fewer volunteers. The squad has lost nine of 23 active volunteers during the last two years, he said.
Hope Hose Humane Co. No. 1 and Bordentown EMS
A volunteer for most of his nearly four decades in local EMS, Brian Maugeri currently serves as the paid EMS supervisor for Bordentown Township and Bordentown City.  
He said Hope Hose Humane Co. No. 1 in Bordentown City and Bordentown EMS cover the city’s 4,000 residents, the township’s 11,000 residents and nearby Fieldsboro Township’s 550 residents. Township officials do the hiring and pay for everything through subcontracted third-party billing. Full-time and per diem paid EMS staffers are on duty around the clock now, with volunteers helping out whenever possible. 
“For the most part, it does work,” Maugeri said of the paid-volunteer arrangement. “We get along fine and that’s what’s keeping this whole thing going.” 
Still, moving to paid EMS was not the answer to everything, he said: “It’s not a money-making deal. We still depend on municipal funds, as well as letter fund-drive campaigns and other fundraisers. The community and local government are very supportive of our needs.” 
The hybrid squad answers a little more than 2,000 calls annually in a 10-square-mile area, which includes Interstate 295 and Routes 130 and 206. When needed, the squad provides mutual aid on the New Jersey Turnpike and surrounding areas.
The decline in volunteer numbers necessitated the move to 24/7 paid services in 2007, Maugeri said, adding that less than 10 volunteer EMTs and approximately 20 volunteer firefighters remain.
“The volunteers are dwindling away,” he said. “There’s not a whole lot left. The second-rig call after 5 p.m., that’s where we have our problem. Most of the time, it’s hit or miss.”
“You have to work really hard to keep a focus on volunteers,” said Howard Meyer, president of the EMS Council of New Jersey (EMSCNJ). “They need to feel they are an integral part of the process and that they are appreciated. Otherwise, the volunteers tend to go away.”
Representing 20,000 volunteers affiliated with nearly 300 squads — more than 80 percent of the state’s volunteer squads – the EMSCNJ remains the largest organization of its kind throughout the U.S. 
“The dedication is always there,” said Meyer, who is also a member of the National Volunteer Fire Council’s (NVFC) EMS/Rescue Section. “Although many of our members are raising families, working multiple jobs, in school, and honoring other obligations and commitments, they still find time to help their neighbors.” 
“EMS volunteers remain the backbone of many response systems throughout the country, especially in New Jersey,” he continued. “Without this core group of devoted individuals, there is no way the EMS system could handle the volume of calls received daily, never mind during disasters.”
“The decision makers at the top need to work with the volunteers to make EMS programs more accessible, rather than implement complicated policies that only serve to discourage them," Meyer said. “Volunteers are the past, present, and future of EMS.” 
Sylvie Mulvaney, BSN, RN, has been a New Jersey-certified EMT since 1995, serving 10 years as a volunteer. She is an ER nurse at Einstein Medical Center and Jeanes Hospital, both in Philadelphia. She is also the public relations representative for the EMS Council of New Jersey.