I must say that I was quite disappointed in your "*EMS A-Z Series ...."F" First Aid, First Responders? First On Scene*" article on EMSNetwork.org.

Firstly, I will admit that most of this may be colored by a regional system quite different from my own. Here in New Jersey, all Paramedic units must, by law, be directly affiliated with hospitals. For the most part, paid ambulance services are a thing for large cities. In Bergen County, where I live, Paramedics do NOT transport patients. The town's BLS unit is called out and, if ALS is needed, the medics respond in an SUV (Tahoe/Suburban/etc/). If ALS is actually needed, they will transfer their equipment from their truck to the BLS unit, and ride out the call. Most of the town BLS organizations are all volunteer, or have one or two paid crews during the day. Aside from the obvious reality of this - that we're needed if the ALS unit wants the patient to move more than a few feet - I still found a few issues with your article.

You stated that when you refer to first responders, you're talking about people who "may not be as highly trained." Yet, you stated that "highly trained" is referring to persons qualified as "EMT or above". All of the members of my volunteer squad, with the exception of three drivers, are certified as EMT-B's. As I stated, in New Jersey, this is the highest level of certification one may attain without being affiliated with a hospital. All three of our drivers are volunteer firefighters and are no strangers to medical emergencies. Many of our town police officers are, or have been, EMTs, and quite a few are life members of our corps (10+ years of active service).

Many of our approximately 30 members have been active for over 10 years, some for many more decades. Two are RN's and one is a DC (chiropractor) who has been an EMT for 20+ years and hasn't forgotten a bit of his basic med school education. Many of use stay current with the leading edge of prehospital care, even though most of it falls out of our scope of practice.

I take offense to the statement that "many of them wanted to be a police officer or firefighter not an EMS provider." Firstly, I don't know how MY works, but in NJ, you must be an EMT-B for two years before applying to a Paramedic program, and generally this means riding as a volunteer. I know many great medics who still ride for their local squad. Moreover, out of our 30 or so members, aside from the ones who ARE police officers
or firefighters, I don't know of any who had that career aspiration. I'm a Computer Science student and an IT consultant. We have RN's, landscapers, Chiropractors, sanitation workers, accountants, and the list goes on. I fail to see how this impacts on our professionalism. Perhaps it's an issue of history, that the Paramedic culture doesn't have roots like volunteer squads do, that your co-workers don't remember the days 30 years ago of being awakened at home by a telephone call from a dispatcher. Perhaps it's the sense of elitism - which, in my area, disappears relatively quickly as the new medics see their mentors actually paying attention to my assessment.

To clarify, we have no organized "first responder" program. If you have your pager or radio on, and someone codes two streets over, you go. I've never heard of anybody, medics included, complaining about having an extra set of hands if they ask for them, or about someone getting good compressions and ventilation started two minutes earlier.

Perhaps the biggest thing I can say in defense of volunteer, "first responder", organizations is the level - and amount - of contact we have with a specific patient. Maybe when paid ALS units cover a town, they get that level of contact. But in my area, ALS only shows up when a patient needs them. I can't express the interest - sometimes bewilderment - that medics have shown when I walk into a house, greet the family, and proceed to tell the medics the patient's recent hospitalization history, previous problems, and on one occasion, what another ALS unit did for her yesterday.

I appreciate the underlying thought in your article, and perhaps a lot of it is simply covered by a regional stereotype, but there ARE areas where volunteer organizations do a lot more than carry patients and give oxygen. If you were simply talking about First Responders in terms of certification (i.e. DOT FR as opposed to EMT), I deeply resent your use of the terms "volunteer" and "local First Aid Squad" as synonyms.  Even more so, I resent the connotation that Volunteer squads are sub-standard. Yes, some are. But coming form a squad that has been 100% volunteer since 1942, I don't understand this thought process.

There are two last points which I must touch on:

"Nor do they have the day to day experiences that we as a full time EMS providers may have."
Granted, yes, in a town with 600 calls a year, I probably do not have the same day-to-day experiences that you have had. On the other hand, depending on the type of system you work in, how much of a connection do you have with your patients? Do you remember their medications, their birthdays? Do you hear an address and know the name of the patient and her husband and son? More importantly, do you know that one drug allergy she has that she always forgets to mention? And as to the "full-time" aspect, sure we don't see as many patients as you do in a day. When was the last time you rode a 90-hour shift because the usual crews were on duty?

"They are awakened from sleep, interrupted from their job or family and then they respond. They respond willingly and without hesitation and expect to perform the life and death actions they have been trained for. Not the nuances of the everyday EMS provider, i.e. abdominal pains, fevers and other exciting parts of the EMS professional."
I've been a volunteer EMT for two and a half years. Not very long. In that time, I've run about 500 calls (in a town that does 600 a year) and logged over 2,000 duty hours. Maybe it's a side-effect of our average patient age being 65, but I don't hear the pager go off and expect to save someone's life. I expect to be able to comfort someone through a hard time, provide a reassuring smile and a hand to hold and, in some instances, provide some appropriate care. Our average patient does NOT need ALS, and is not critically ill. Most of us stopped expecting to perform "the life and death actions [we] were trained for" long ago.

Most Sincerely,
Jason Antman
EMT-B
MPAC
Midland Park, NJ