There are numerous challenges facing this country’s primary emergency responders: the volunteer fire system. Money is tight, and donations are down. Glenn Gaines, deputy U.S. fire administrator at the Federal Emergency Management Agency (FEMA) pointed out that approximately 70 to 75 percent of fire services in the United States are volunteer, and about 60 percent of those are in small communities of less than 2,500 residents. Standards are being increased, and there is constant pressure to bring medical care to the scene faster and more efficiently. At the same time, Gaines said, fire departments are losing members, in part because of the economy. Volunteers are now working part-time jobs or seeking overtime and are no longer available.
MCIs in rural areas are high-risk, low-frequency events. Gaines listed several challenges to operations preparedness, including the absence of skill sets in MCI management, sophisticated equipment, training and skills in triage, advanced trauma care skills and training, and certification and skill sets to implement standing orders when communications channel are poor or lacking. In addition there is a need for improved liaison with local trauma centers or hospital ERs, as there is a lack of routine MCI exercises involving all stakeholders.
To begin to address these challenges, Gaines encouraged expanding recruitment into demographics that already possess the required skill sets. People who are dedicated to the care of others, such as nurses, physician assistants, and physicians, may be interested in giving back to the community beyond their office hours. The goal of the recruitment effort is to raise prehospital skills, and expand standing orders by incorporating personnel qualified to implement them.
The key is education, and Gaines suggested rural fire services seek grants such as those from the Assistance to Firefighters Grant program, the Rural Fire Assistance Program, the Fireman’s Fund, state and regional EMS or medical councils, and local community and state colleges. For volunteer fire departments especially, Allstate and other insurance companies offer specific grants to assist in obtaining equipment. Another approach is to leverage regional peer skills and equipment, consider joint equipment purchases with other local squads, and conduct regional training and exercises. Local physicians and emergency departments could also serve as training resources. Gaines emphasized that broad and creative thinking, in the context of systems integration, were essential to securing new opportunities at the federal, state, and regional levels, as well as in the public, nonprofit, and private sectors.