The system USED to work.

Fire-based EMS. We here on the Right Coast, at least in the Northeast, don't have much in the way of EMS. The vast majority of towns near where I live and work are serviced by volunteer first aid squads. For you on the Left side, those would be volly EMS units... Now, I give loads of respect to the people who volunteer; It takes a serious dedication of time and effort to be a volunteer, between training and running calls, CEU's and maintenance of all the "stuff". The system worked, back when people actually lived in the same community where they are employed. Back when an employer could afford to allow their employees to leave for an hour to run an EMS call.

The system USED to work. And in some towns, it still does. However, there are plenty of towns where it doesn't work. I'm thinking of one place in particular, right outside the gates of my little piece of Valhalla. We provide fire-based EMS, sending at least an Engine or Rescue and an ambulance to every EMS call. Being a government installation, we have lots of resources and few medical calls. Outside the gates, though, is a completely different story. The borough of Narrowtown, as I'll call them for their closed-mindedness, has a volunteer EMS system. The ambulance sits at their building, and when a call comes in the responders go pick it up and respond to the call. It's a small town, only a few square miles, so it's not a terrible delay. Provided they actually respond, that is. We, the U.S.F.D. (Uncle Sam's Fire Department) sit and listen to the dispatches day in and day out. "Narrowtown first aid squad, request for an ambulance, Old Folks Care Center, 123 Narrowtown Drive, for a person choking." followed three minutes later by "NFAS, second request for an ambulance...." and another three minutes later, "NFAS, third request for an ambulance, CPR in progress, requesting mutual aid..." This happens all day long. The calls may not be so severe, most aren't. But you get the idea. The example is an actual dispatch. The volunteers never made it out, no Narrowtown ambulance responded to the call. There's at least nine or ten EMS calls in the town, every day. Two or three of those never get an ambulance from NFAS- after three dispatches the town requests mutual aid from their neighbors. We, the U.S.F.D. being obliged to provide for our base, cannot send the ambulance outside the gates. The surrounding towns are all volunteer EMS, except for a scant few.... Do the math: If NFAS is having this problem, aren't all the others? YUP! It's often an hour before an ambulance arrives on scene.

The local Paramedics, operated by a private company, have taken to using ambulances instead of SUV's like the majority of the Northeast ALS providers. They don't act as the primary transport all that often, preferring to wait for the volunteers. But, at least they have the capability. That is, when THEY show up!!! Frequently, we are dispatched to an EMS call, and told, "No medics available" or "Extended ETA for medics". My end of the County is serviced by no more than four Paramedic units. They are spread thinner than butter on a scone in the great depression. Thank god we're close to the hospitals... If we have a critical patient, we haul ass (safely) to the ER providing the best care we can on the way. Sometimes we'll meet the Paramedics en route, which requires we pull over and stop while they get in the back, evaluate the patient, and decide if ALS is warranted. That's a story for another post, though.

Sadly, Narrowtown has the population, both residential and commercial, to warrant a full-time PAID EMS system. They have huge ratable commercial occupancies, an industrial area with a number of major corporations' manufacturing facilities, hotels and shopping, and the only mall for miles and miles.  That, too, is a story for another day. Point is, they could pay for EMS if they wanted to. It's just that the public doesn't know what they are not getting in terms of service until its too late, and the volunteers EGOs are too big to admit they need to do something different. They simply refuse to give up control and do what's right for the public they claim to exist for...

All I can say, in summation, is I'm glad I don't live in Narrowtown. And, I'm glad I only have to touch their roadways for about half a mile before I'm safely in my little piece of Valhalla, protected by a full-time EMS system that actually responds when called.

Enough for now... hope you have a great day!

Stay safe, take care of each other, and take care of the job.
In that order.