Voluntary Commitment

Few people, few calls, big responsibility.

One of the benefits of participating in EMS events is visiting cool places I wouldn’t otherwise have a chance to see. Such was the case in August, when I spoke in Cheyenne at Wyoming’s 42nd annual trauma conference.

I admit I knew little about Wyoming before I started planning my trip. In grade school we spent less time on geography than on dodgeball. If we remembered there were 50 states—uh, I mean 48…no, wait, 49—and that Wyoming was one of them, we were qualified to become a year older.

I do recall watching westerns about Wyoming on a black-and-white TV the size of a small refrigerator. One of those shows, Lawman, starred that actor who looked like Clark Gable (John Russell). Another was named The Virginian, possibly because the producers couldn’t decide what to call someone from Wyoming (The Wyomanian? The Wyomingerer?).

I think I’ve learned enough about Wyoming to assert that most of you are reading this somewhere else. Wyoming is the 10th-largest, but least populous, state in the U.S. If you’re one of the 3,200 EMTs or paramedics certified in Wyoming (the number who practice is much lower), your biggest challenge isn’t the population (568,000), it’s the density of that population: fewer than six citizens per square mile.

Compared to my home state of Tennessee, which averages 154 residents per square mile, Wyoming seems practically deserted. Fortunately that wasn’t the case when I was there; the highlight of my trip was spending an hour with six very dedicated volunteers who routinely overcome topographical and meteorological extremes to deliver emergency medical services.

Approximately three quarters of Wyoming’s EMS providers volunteer. They have issues; not the territoriality I experienced in New York or the firefighter prerequisite that dissuaded me from volunteering in Tennessee, but time, distance and call volume constraints unfamiliar to those of us who’ve answered alarms only in urban or suburban settings.

“Our average call takes about four hours from the time we get paged until we get back home,” one Wyoming EMT told me. “That not only involves our time, but our families’ time. You’re sitting down for dinner, the pager goes off, and you’re gone for the rest of the evening. It’s like the whole family has to volunteer for EMS.”

Extended on-scene and transport times become even more challenging, another responder explained, when agencies have only 30 runs a year.

“Almost all of our practical experience is from training, not from actual calls. You could be a volunteer for decades and have no more experience than someone in a larger department gets in a week. We have the training, we know the people, but we don’t get the day-to-day hands-on practice. We could go a month between calls.”

When those calls do come in, providers often respond from work. If they didn’t, calls might go unanswered for hours.

“Most of our companies allow us to respond during the day—one day a week—but we don’t have enough EMTs. One day can easily turn into two or three days a week. More and more employers aren’t willing to give that much time off.”

One attendee suggested community values have eroded: “Back in the day, there were no (alarm) tones. The horn would go off, and everybody would answer up. The whole town would shut down. If there was nobody left at the bank, they’d lock the door. There was a civic commitment about protecting the town. Some people assume the government will provide that service; well, in these small towns, we are the government.”

Delivering prehospital care is complicated by administrative obstacles, too.

“It’s hard for volunteer squads here to get liability insurance,” said one caregiver. “We finally found a company in New York to do that.”

Another mentioned communications issues. “You can’t be sure who’ll answer when you dial 9-1-1. You might get North Dakota or South Dakota. It’s best to call on a direct line.”

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