As fire and rescue volunteerism declines across the state, many localities are changing the way they provide this service. Using paid crews is costly and sometimes controversial, but it’s already been an effective solution for several Southern Virginia counties, and likely will be for many more.
Some localities, like Henry and Franklin counties, have coupled paid staff and volunteers for decades. Others, like Pittsylvania County, are in earlier stages of the transition to what is called a combination model of rescue services.
“We didn’t really have an option,” said Keith Ludeman, deputy chief of public safety in Franklin County. “There was such a rapid decline in volunteer rescue services that the county had no other option but to hire full-time positions.”
Transitioning from volunteer-only to a combination model is a “natural progression,” said Steve Simon, executive director of the Western Virginia Emergency Medical Services Council, which provides support related to EMS coordination and education for 12 counties and six cities in western Virginia.
There are 552 licensed EMS agencies in Virginia, according to the Office of Emergency Medical Services with the Virginia Department of Health. Of those, 261 have a volunteer organizational status, 152 have a career organizational status, and 139 have a combination of volunteer and career crews.
There are several benefits to this combination model, said Marian Hunter, spokesperson for the Office of Emergency Medical Services.
These include improving staffing, more consistent and reliable responses to EMS calls, shortened response times and increased flexibility for EMS responders.
The glory days of volunteerism likely aren’t coming back, said Bryan Fox, chairman of the board of directors for Mount Cross Volunteer Fire and Rescue in Pittsylvania County.
In March, Mount Cross became the second Pittsylvania station in less than a year to announce that it would be ceasing its emergency medical services due to a lack of volunteers, following the Kentuck station in the fall.
“For years it was taboo to talk about paying people to do EMS,” Fox said. “But I think people now understand that it’s necessary. It is the solution, and I use that term very carefully. It’s not a solution. It’s the solution.”
Contending with declining volunteerism
Volunteers are fewer and farther between these days, and not just when it comes to rescue services, Simon said. “There are fewer volunteers in your recreation youth clubs, in your PTA, in your churches,” he said.
And because rescue services are so demanding, this is especially true when it comes to EMTs and firefighters.
“It’s not because people don’t have the desire [to volunteer],” Fox said. “It’s about affording the availability and the time. In the world we live in today, it takes multiple incomes to run one household, so volunteering takes away from time when someone can be doing a job and making money.”
Training requirements for EMTs have also increased in recent years, which means getting certified is a significant time commitment. And unlike firefighters, EMTs need to be recertified every few years.
On top of all of this, call volume is increasing, in large part due to frequent EMS calls for non-emergency situations, Fox said.
Pittsylvania fire chiefs echoed this, saying that people often don’t see a primary care physician unless they have chronic illnesses. And people might call 911 for something that isn’t really an emergency because they think getting to the hospital by ambulance will get them treated faster, which is not the case.
The increased call volume makes it harder for volunteers to continue to provide the same level of service as they used to, especially on weekdays during normal working hours.
These weekday hours are usually where the need for paid crews begins, and it expands from there, said Simon.
“What normally happens is you have a declining volunteer workforce, so the local government starts staffing more hours,” he said. “Before you know it, they’re staffing a 24-hour ambulance.”
The trend likely won’t be reversed, Fox said.
“Combination agencies are going to be inevitable unless we have a change in the economy,” he said. “Unless that aspect changes where people have the time to be able to volunteer.”
Transitioning to a combination model
Two of the major challenges in shifting to a combination model are funding and friction with existing volunteer squads.
The locality usually has to come up with the money for paid positions. This can be a challenge in places where the local government has relied on volunteers for a long time, Simon said.
“There’s a cost involved when you start to provide those career services,” he said. “That’s an expense that the local government has not experienced in the past, so they have to come to terms with how they’re going to fund that.”
And it’s not cheap. A new ambulance with all the necessary equipment is several hundred thousand dollars, and it will still eventually have to be replaced.
Localities usually fund paid crews by raising taxes, Simon said.
Henry County didn’t levy a tax increase when it first introduced career staff, but there have been increases since then, said Matt Tatum, the county’s director of public safety. The county first contracted with a private ambulance service in the 1990s.
“As volunteerism continued to decline, the number of calls that were going to that private company increased,” Tatum said. “It got to the point where the private company was answering about 50% of the calls.”
The company was for-profit, which put a financial burden on patients who had to pay for ambulance services.
“The county started looking at options to supplement the volunteers other than the private company,” Tatum said. “We concluded that the best model was for the county to hire trained firefighters and EMTs to supplement the volunteers.”
The county staffed its first paid EMTs in 2010. In the first few years of the new model, some funding came from the federal SAFER grant program, which provides money to help fire departments with staffing needs to meet industry minimum standards.
The grant expired in 2014. Today, the county relies on several revenue streams to fund its paid crews. Some of the money comes from taxes, and some stations fundraise, Tatum said. About 30% comes from soft-billing of patients, which means that if someone cannot afford to pay some or all of their bill, it will be waived.
The county’s budget for career services for the 2025 fiscal year is $3.26 million, said Tatum.
There are 28 career employees with the county’s public safety department. There are also eight all-volunteer fire departments and four all-volunteer rescue squads, totaling about 150 volunteers in the county.
In 2023, Henry County crews responded to about 7,900 calls; of those, about 5,200 — or 66% — were answered by career staff. Of the almost 2,700 calls that volunteers responded to, career staff assisted with more than a third.
So far, Franklin has been able to allocate existing funds in its budget to pay for full-time rescue services positions, instead of raising taxes.
“I’m not sure how much longer they’re going to be able to do that,” said Ludeman, the public safety director.
The proposed budget for Franklin County for the 2024-2025 fiscal year includes about $5 million for public safety. This department employs 64 career staff, and the county has about 75 volunteers.
A recent survey, conducted by a workgroup established during the 2023 General Assembly session, found that call volume for rescue services has increased by 40% in the last three years, while state-level funding has only increased by 6.67%.
Almost 90% of Virginia’s counties and cities responded to the survey, representing almost 7.5 million residents.
This year, the General Assembly postponed two bills that would have provided more funding for local fire and EMS departments to pay employees.
In addition to funding, another challenge in transitioning to a combination model is introducing paid crews to a locality that is used to volunteers only.
There’s an “old-school mentality” in Pittsylvania — and likely other places, too — that the people riding the ambulances should be volunteers, Fox said.
Pittsylvania’s public safety department began to staff paid crews to supplement volunteers in 2020. Three ambulances based in different parts of the county belong to the public safety department.
The county is in the process of conducting a study with Emergency Services Consulting International to evaluate the current and future needs related to fire and emergency medical services when it comes to both paid and volunteer providers.
There can be a misconception that the shift toward paid staff is a local government’s way of trying to replace volunteer crews, Simon said.
“That’s not the case,” he said. “The whole reason why local governments have to be involved is because the services are no longer being provided or they’re declining to a point where it’s impacting the quality of life.”
In fact, many local governments would probably prefer to keep rescue services volunteer-only, he said, but it’s just not possible.
“If a service can be provided for free or at very reduced costs, they’re going to continue doing that as long as they can,” Simon said. “The only time they want to get involved is when the system becomes fractured to the point where they can’t support the services.”
Fox said he’s seen some volunteers decide to work as career staff once a county begins paying for rescue services. Others adamantly refuse to accept payment, even a stipend for volunteer work.
“If you really enjoy doing it, why not do it for a living?” Fox said. “But there’s nothing stronger than the heart of a volunteer.”
Fox said he encourages volunteers to continue their service, even if they can only run one call a year.
And Tatum said that adding paid crews doesn’t discourage volunteers who still want to invest their time.
“A lot of people will say that when you hire career people, volunteers are going to go away,” he said. “I will push back on that, because what our trends show is that our volunteerism is already on the decline. We’ve added career personnel and the rate of that decline has not changed.”
And the need for volunteers isn’t going to go away either, he said.
“Our system could not function without our volunteers,” Tatum said. “Anytime we lose a volunteer and that’s an extra burden that falls back on to the taxpayer.”
Advice for localities considering a combination model
Communication and transparency goes a long way when shifting to a combination model, Fox said.
“When volunteers know what’s going on and they don’t feel blindsided, then they’re more apt to still participate,” he said. “Make them feel welcome and make sure they understand the door is still open.”
Tatum said Henry County has continued to include volunteers in decision-making about rescue services, and to avoid any double standards between volunteers and paid staff. His advice to counties that are considering a combination model is to keep the volunteers informed and at the table.
“When we added the career staff, we actually had a representative from each of our volunteer rescue squads help us come up with the best plan” for how to incorporate full-time positions, he said.
Henry County also has a revenue-sharing program, where volunteers can receive a portion of the money coming into the station. The county takes a lot of pride in this program, Tatum said, and would recommend it to other localities transitioning to a combination model.
It’s also important to remember that staffing full-time positions isn’t a cure-all. Personnel for rescue services in general — paid and volunteer — is declining.
But at the end of the day, Tatum said, the field is about providing a necessary service to people who need it.
“The bottom line is, the citizen who had the heart attack sees a paramedic come in the door, and they rarely ever pay attention to what color uniform they’re wearing,” he said. “If it’s a career provider or volunteer, the clot causing the heart attack does not care at all.”