Comparison of Volunteer and Paid EMS Professionals in the United States

Background: Emergency medical response is provided by volunteer emergency medical services (EMS) professionals in many parts of the United States. However, little is known about those who serve as volunteer EMS professionals, especially as their main EMS job. Our objective was to compare the characteristics of nationally-certified volunteer versus paid EMS professionals in the U.S. Methods: We conducted a cross-sectional evaluation of EMS professionals who recertified their National EMS Certification between October 1, 2017-March 31, 2018 or October 1, 2018-March 31, 2019. Data were obtained from 2 cycles of the biennial National EMS Certification recertification application. We included currently working, nonmilitary EMS professionals aged 18-85 years at the emergency medical technician (EMT) or higher certification level. Volunteer was defined as receiving nominal or no compensation for the provision of EMS services at an agency as the main EMS job. Comparisons were made, accounting for the large sample size, to determine notable differences between volunteer and paid EMS professionals. Results: Of the 154,229 EMS professionals that met inclusion criteria (response rate = 86%), 13% volunteered at their main EMS job. More volunteer than paid EMS professionals were female (38% vs. 22%). There was also a significant difference in certification level between volunteer and paid (EMT: 82% vs. 46%). Three-quarters (74%) of volunteer EMS professionals reported working in rural communities compared to 30% of paid. The states with the largest proportion of volunteers to any currently working EMS professionals who recertified were Vermont (47%) and North Dakota (45%). Conclusion: Approximately 13% of the EMS workforce held a primary job in EMS as a volunteer, and these volunteer EMS professionals differed from their paid counterparts - e.g., volunteers were more likely to be women, have EMT certification, and work in rural areas. We encourage further research to understand motivations for volunteering in EMS.