Helping Hands

Mike Rubin first wrote about his friend Sal in a column in the April 2009 issue of EMS World Magazine. Here he remembers Sal Signorelli,  who recently passed: "The last time I saw Sal Signorelli, my friend and colleague from Suffolk County (NY) EMS, he and I were hurrying in opposite directions at the 2008 EMS Expo in Las Vegas. We hadn’t seen each other since I’d left Long Island two years earlier. I would have liked to spend that next hour catching up with Sal, but we both had commitments to keep.

The loss was mine. I thought about that on April 14, when I heard Sal had died the day before. He was 79. I served with him for 13 of the 42 years he donated to The Huntington Community First Aid Squad. I saw no better example of selfless community service than Sal’s. Whenever turn-out for 3 am “sick” calls was in doubt, dispatchers knew Sal would deliver 50% of the crew.

Sal’s contributions weren’t limited to the field; he served as HCFAS’s chief, as a member of its board of directors, and as the EVOC instructor most likely to prevent disaster. When you rode with Sal, you knew you were safe.

A sketchy, early memory of Sal is an impromptu counseling session he had with a new EMT who wanted out. Sal wouldn’t allow that.

'You’re not quitting,' Sal insisted. 'It’ll get better–just give it more time.'

Thanks, Sal. It got better."

          I'd like to introduce you to a friend of mine. His name is Sal. Some of your patients may already know him, or someone like him. I hope so.

     Sal isn't a firefighter, a paramedic or an EMT. Nor is he a PA, RN or MD. He isn't a big fan of PDAs, KEDs or AC/DC. I think he's OK with MLB and the AARP.

     Sal is a Marine, because there's no such thing as an ex-Marine. He's been answering alarms for a suburban New York EMS agency for 40 years. Do you know what I was doing 40 years ago? Neither do I. Something involving English or history or algebra, I suppose.

     When Sal started in EMS, ambulance-based ALS was as controversial as billion-dollar bailouts. Sal spent some time as a "para-paramedic" before prehospital levels of practice were well-defined. He enjoyed providing patient care and didn't mind driving those Cadillac hearses. Sal liked EMS so much, he did it every day. For free. Yes, Sal's a volunteer.

     I met Sal in the early '90s when I had no training, but a lot of interest in EMS. He helped convince me there are worse ways to spend one's time than aiding the sick and injured. Sal had to remind me of that many years later when "survival to discharge" became an elusive goal and I contemplated a return to corporate life.

     Like many of you, I participate in Web-based EMS forums. I've read several threads debating the merits of paid versus volunteer personnel. I've rarely seen such a contentious topic. The opinions are familiar to me; as an EMS administrator in suburban New York during the first half of this decade, I worked with dozens of volunteer agencies supplemented by paid staffers. The issues haven't changed.

Training

     I sense a concern that volunteers are not trained to the same standards as paid personnel. Are there states where volunteer is a prefix or suffix appended to EMS certifications? I don't know of any. An EMT is an EMT, whether or not they receive a W-2 form.

     Paid services don't have a monopoly on continuing education, either. The only time I was required to undergo monthly training was as a volunteer. None of my employers insisted on anything more than state-mandated biennial or triennial refreshers. Also, when I decided to upgrade from EMT to paramedic, my volunteer agency paid the bill. That would not have happened at any of my salaried postings.

Competence

     What makes people competent in any field? Education? Experience? Character? Talent? I don't think any of those attributes are restricted to paid personnel. When I was responsible for evaluating thousands of prehospital cases a year, I found no correlation between quality of care and compensation. The most accurate, although certainly not definitive, predictor of performance was experience.

     Do you remember how frustrating it was to apply for your first mortgage, credit card or car loan, only to be told that you need credit to get credit? EMS novices sometimes are victims of a similar catch-22 when they are informed that they won't be hired without experience. Volunteering is a good way to bridge that gap.

     The ways managers of both paid and volunteer EMS agencies facilitate, measure and critique subordinates' exposure to a variety of prehospital conditions contribute even more to competence, I believe, than the number of years practitioners have served in the field.

Encroachment

     Volunteers are seen by some as limiting opportunities for paid providers. The logic is that municipalities have no incentive to add EMS jobs or increase wages if well-meaning citizens are willing to answer alarms for free.

     I agree the public plays a key role in determining the number of employment opportunities, but it's not just about money. The issue should be who can deliver the highest quality of care and best service for the lowest fee. Some jurisdictions have concluded that volunteers offer the most favorable price/performance ratio. I discovered as much when I tried to convince an isolated, well-to-do community at the edge of an all-volunteer district that a dedicated paid service would offer more experienced personnel and faster response. Cost was not a concern for this upper-class enclave, yet the village rejected my proposal because people were satisfied with the care they were getting from unpaid personnel. Perceived value mattered more than provider pedigree.

Attitude

     Let's face it, we have a tendency to generalize. I used to believe volunteers possessed a sense of entitlement their paid colleagues did not. I must admit, though, that I've met many members of both groups who crave respect and privilege to compensate for on-the-job risks and disruption of family life. I'm not sure how many of our foibles are evident to the public, but I know this: I'd rather be treated by a considerate, conscientious rookie than a churlish, more experienced provider with the same certification.

     One of the great healers of the last 2,009 years asserted that charity should be offered anonymously. Thousands of volunteers do this every day. Should their abilities be scrutinized? No more or less so than for the rest of us. However, the existence of EMS as a vocation doesn't diminish the intrinsic goodness of volunteering, nor does it preclude acknowledgment of contributors like Sal.

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.