EDITORIAL * EDITORIAL
Recruiting ambulance volunteers: Rural physicians can help Ulysses D. Lahaie, RN, BN ural
demands
are
course.
emergency medical services in Canada in a state of crisis. From Alberta to New Brunswick volunteer ambulance services are closing their doors, their sirens silenced.' Similar problems plague our US neighbours.2'3 Mountain Ambulance Services, in southern Manitoba, periodically suspends operations, as do other rural services in nearby communities. Across Canada, indeed throughout North America, the survival of volunteer ambulance services is jeopardized by a decline in voluntarism. Voluntary work is becoming more demanding. Escalating standards of training and the extra involvement often required in fund-raising, maintenance of buildings andt equipment, and public relations are seen as deterrents.2 Women, traditionally a rich source of volunteers in rural communities, are joining the work force in increasing numbers and are less available now. Employers hesitate to spare employees for community service during work hours. The need for regular continuing education activities is a further constraint on volunteers' time. Moreover, the dynamics of voluntarism are changing: volunteers favour new and different challenges but for shorter periods than before.4 Few organizations rival the ambulance service in its demands for hospital and ambulance internships, regular meetings, drills, recertification examinations, on-call duty and absences from family. Legislation to enhance prehospital care by raising educational standards has increased the level of commitment expected of volunteers and discourages involvement.' In most volunteer ambulance services in Canada lengthy training periods precede active service.6 Manitoba requires 90 hours of training equivalent to 21/2 weeks of full-time work. Such R
may
deter volunteers, who fear failing the
There are also concerns about the duty itself. Potential recruits may be anxious about how they would react in emergencies or about the dangers of handling hazardous or infectious materials. More than anything they dread having to respond to emergency calls involving family or friends. Although few physicians actually manage volunteer ambulance services they are recognized health care leaders, and their expressed concern for volunteer ambulance services can influence potential volunteers. Rural physicians can make important contributions by identifying, recruiting and supporting volunteers. For instance, they may know "dormant" volunteers who lack confidence but will respond favourably if approached by someone they look up to.7
A recent survey of Manitoba's 87 volunteer ambulance services8 revealed that 63% of the volunteers were men, 8% were 18 to 24 years of age, 70% were 25 to 44, 19% were 45 to 54, and 2% were over 54 years old. Over 60% were working full-time. Recruitment strategies could target women, young people (particularly mature high school students), newcomers to the community and older people. Those 40 to 65 years of age are mature, may have free time and are likely to remain in the community; moreover, a Canadian survey has shown that this group has a higher rate of volunteering than other age groups.9 The physician who approaches a potential volunteer can emphasize aspects of volunteer ambulance service that reinforce the person's motivations. Desire to serve the community ranked first in a survey of motivations within our own service, and
Mr. Lahaie is manager, Mountain Ambulance Services, Foyer Notre Dame Inc., Notre Dame de Lourdes, Man.
Reprint requests to: Mr. Ulysses D. Lahaie, PO Box 190, Foyer Notre Dame Inc., Notre Dame de Lourdes, MB ROG JMO For
prescribing information
see
page 1
CAN MED ASSOC J 199 1; 145 (9)
1089
opportunities to develop new skills ranked a close second (unpublished data). Feeling needed is a powerful motivator, as is a desire to help.'0 Volunteers are also attracted by the idea of being a part of the health care team and interacting with health care professionals.8 Concerns about the challenges posed by emergencies and the possibility of having to respond to calls by friends and relatives may be answered by emphasizing the thoroughness of the training and the support that is always available from fellow volunteers. If potential volunteers are concerned about the amount of time on call they may be reminded that the more volunteers there are the less onerous the on-call duty will be. Physicians who work in emergency departments can support volunteers by treating them as professionals. Not surprisingly, a source of dissatisfaction cited by volunteers is lack of respect - for example, hospital personnel throwing away run sheets, making disparaging remarks about ambulance personnel and failing to give feedback on hospital care.'0 Prehospital providers of care rate highest the hospitals in which physicians and nurses treat them as part of the medical team, explaining what will be done to the patient and allowing them to participate occasionally in the hospital care of the patient." Rural physicians may want to be involved in critical incident stress debriefing, a recent form of crisis intervention available in many urban ambulance services but rarely in rural ones. This organized approach to the management of stressful responses that may arise after attending cases of trauma or loss of life involves three stages: ventilation of feelings, discussion of the signs and symptoms of stress, and provision of information, from which a plan of action is designed and referrals are made, if necessary.'2 Finally, rural physicians may support volunteer programs by cooperating with the local instructors in continuing education of volunteers and participating
1090
CAN MED ASSOC J 1991; 145 (9)
in volunteer appreciation events. Volunteers, like Mark Twain, can live for 2 months on a good compliment.
References 1. Olson R: Crisis in the country. Can Emerg News 1990; 13 (8): 24-26
2. Adams R: Crisis time for rural EMS. Can Emerg News 1989; 12 (7): 26-27 3. McHenry SD: Waging war on attrition. J Emerg Serv 1989; 21 (9): 29-30 4. Volunteering: a National Profile, Volunteer Centre, Arlington, Va, 1987
-
The National
5. Sharp B, Sharp A: Volunteerism: a practice in decline. J Emerg Serv 1989; 21 (11): 48-50 6. Rauscher R: A Comparative Study of Certification/Recertification Requirements Across Canada in the Pre-hospital Care Field, Emergency Health and Ambulance Services, Manitoba Health Services Commission, Winnipeg, 1989 7. Arlett A, Philps B, Thompson RW: Canada Gives: Trends and Attitudes Towards Charitable Giving and Voluntarism, Canadian Centre of Philanthropy, Toronto, 1988: 88
8. Assessment of Volunteer Involvement, Emergency Health and Ambulance Services, Manitoba Health Services Commission, Winnipeg, Man, 1989 9. Ross DP, Shillington ER: A Profile of the Canadian Volunteer: a Guide to the 1987 Survey of Volunteer Activity in Canada, Coalition of National Voluntary Organizations, Ottawa, 1989: 9 10. Selig SM, Borton D: Keeping volunteers in EMS. Volunt Action Leadersh 1989; fall: 18-20 11. Parr NA: Too many volunteers? Emerg Med Serv 1989; 18 (5): 14, 20, 22-23
12. Mitchell JT: Development and functions of a critical incident stress debriefing team. J Emerg Med Serv 1988; 13 (12): 4246
LE
jer NOVEMBRE 1991
Recruiting ambulance volunteers: Rural physicians can help Ulysses D. Lahaie, RN, BN ural
demands
are
course.
emergency medical services in Canada in a state of crisis. From Alberta to New Brunswick volunteer ambulance services are closing their doors, their sirens silenced.' Similar problems plague our US neighbours.2'3 Mountain Ambulance Services, in southern Manitoba, periodically suspends operations, as do other rural services in nearby communities. Across Canada, indeed throughout North America, the survival of volunteer ambulance services is jeopardized by a decline in voluntarism. Voluntary work is becoming more demanding. Escalating standards of training and the extra involvement often required in fund-raising, maintenance of buildings andt equipment, and public relations are seen as deterrents.2 Women, traditionally a rich source of volunteers in rural communities, are joining the work force in increasing numbers and are less available now. Employers hesitate to spare employees for community service during work hours. The need for regular continuing education activities is a further constraint on volunteers' time. Moreover, the dynamics of voluntarism are changing: volunteers favour new and different challenges but for shorter periods than before.4 Few organizations rival the ambulance service in its demands for hospital and ambulance internships, regular meetings, drills, recertification examinations, on-call duty and absences from family. Legislation to enhance prehospital care by raising educational standards has increased the level of commitment expected of volunteers and discourages involvement.' In most volunteer ambulance services in Canada lengthy training periods precede active service.6 Manitoba requires 90 hours of training equivalent to 21/2 weeks of full-time work. Such R
may
deter volunteers, who fear failing the
There are also concerns about the duty itself. Potential recruits may be anxious about how they would react in emergencies or about the dangers of handling hazardous or infectious materials. More than anything they dread having to respond to emergency calls involving family or friends. Although few physicians actually manage volunteer ambulance services they are recognized health care leaders, and their expressed concern for volunteer ambulance services can influence potential volunteers. Rural physicians can make important contributions by identifying, recruiting and supporting volunteers. For instance, they may know "dormant" volunteers who lack confidence but will respond favourably if approached by someone they look up to.7
A recent survey of Manitoba's 87 volunteer ambulance services8 revealed that 63% of the volunteers were men, 8% were 18 to 24 years of age, 70% were 25 to 44, 19% were 45 to 54, and 2% were over 54 years old. Over 60% were working full-time. Recruitment strategies could target women, young people (particularly mature high school students), newcomers to the community and older people. Those 40 to 65 years of age are mature, may have free time and are likely to remain in the community; moreover, a Canadian survey has shown that this group has a higher rate of volunteering than other age groups.9 The physician who approaches a potential volunteer can emphasize aspects of volunteer ambulance service that reinforce the person's motivations. Desire to serve the community ranked first in a survey of motivations within our own service, and
Mr. Lahaie is manager, Mountain Ambulance Services, Foyer Notre Dame Inc., Notre Dame de Lourdes, Man.
Reprint requests to: Mr. Ulysses D. Lahaie, PO Box 190, Foyer Notre Dame Inc., Notre Dame de Lourdes, MB ROG JMO For
prescribing information
see
page 1
CAN MED ASSOC J 199 1; 145 (9)
1089
opportunities to develop new skills ranked a close second (unpublished data). Feeling needed is a powerful motivator, as is a desire to help.'0 Volunteers are also attracted by the idea of being a part of the health care team and interacting with health care professionals.8 Concerns about the challenges posed by emergencies and the possibility of having to respond to calls by friends and relatives may be answered by emphasizing the thoroughness of the training and the support that is always available from fellow volunteers. If potential volunteers are concerned about the amount of time on call they may be reminded that the more volunteers there are the less onerous the on-call duty will be. Physicians who work in emergency departments can support volunteers by treating them as professionals. Not surprisingly, a source of dissatisfaction cited by volunteers is lack of respect - for example, hospital personnel throwing away run sheets, making disparaging remarks about ambulance personnel and failing to give feedback on hospital care.'0 Prehospital providers of care rate highest the hospitals in which physicians and nurses treat them as part of the medical team, explaining what will be done to the patient and allowing them to participate occasionally in the hospital care of the patient." Rural physicians may want to be involved in critical incident stress debriefing, a recent form of crisis intervention available in many urban ambulance services but rarely in rural ones. This organized approach to the management of stressful responses that may arise after attending cases of trauma or loss of life involves three stages: ventilation of feelings, discussion of the signs and symptoms of stress, and provision of information, from which a plan of action is designed and referrals are made, if necessary.'2 Finally, rural physicians may support volunteer programs by cooperating with the local instructors in continuing education of volunteers and participating
1090
CAN MED ASSOC J 1991; 145 (9)
in volunteer appreciation events. Volunteers, like Mark Twain, can live for 2 months on a good compliment.
References 1. Olson R: Crisis in the country. Can Emerg News 1990; 13 (8): 24-26
2. Adams R: Crisis time for rural EMS. Can Emerg News 1989; 12 (7): 26-27 3. McHenry SD: Waging war on attrition. J Emerg Serv 1989; 21 (9): 29-30 4. Volunteering: a National Profile, Volunteer Centre, Arlington, Va, 1987
-
The National
5. Sharp B, Sharp A: Volunteerism: a practice in decline. J Emerg Serv 1989; 21 (11): 48-50 6. Rauscher R: A Comparative Study of Certification/Recertification Requirements Across Canada in the Pre-hospital Care Field, Emergency Health and Ambulance Services, Manitoba Health Services Commission, Winnipeg, 1989 7. Arlett A, Philps B, Thompson RW: Canada Gives: Trends and Attitudes Towards Charitable Giving and Voluntarism, Canadian Centre of Philanthropy, Toronto, 1988: 88
8. Assessment of Volunteer Involvement, Emergency Health and Ambulance Services, Manitoba Health Services Commission, Winnipeg, Man, 1989 9. Ross DP, Shillington ER: A Profile of the Canadian Volunteer: a Guide to the 1987 Survey of Volunteer Activity in Canada, Coalition of National Voluntary Organizations, Ottawa, 1989: 9 10. Selig SM, Borton D: Keeping volunteers in EMS. Volunt Action Leadersh 1989; fall: 18-20 11. Parr NA: Too many volunteers? Emerg Med Serv 1989; 18 (5): 14, 20, 22-23
12. Mitchell JT: Development and functions of a critical incident stress debriefing team. J Emerg Med Serv 1988; 13 (12): 4246
LE
jer NOVEMBRE 1991
