A few years ago, I read a story about a rural Emergency Medical Service in Wyoming which shut its doors, leaving almost 2,000 square miles uncovered by an ambulance. The story told of a single family of heroes who kept the service going for years when no one else volunteered.

The story intended to make the reader sorry for these rural services in the hope to recruit more volunteers.

But why did it come down on the shoulders of one family in an area that prides itself on patriotism and community? 

I’ve served in EMS for 14 years now. Ten of those years included volunteer fire and volunteer medical (EMS). Since retiring from fire, I’ve worked for a rural ambulance service for over three years.

In that time, I’ve observed the dynamics that play out in rural communities and how they impact rural volunteer services.

Many times in the past, I have said more than a few not-so-kind things about small town America, and with good reason. I grew up an outsider within such a community. I live in a town just like that and have lived and worked in several others. I have never been part of the establishment, for lack of a better term.

Is there a seed of revenge in me? Maybe, but I’m just as enamored with the romantic small town ideal as the next guy. So, take what follows for what it’s worth.

What is the establishment anyway? Generally, individuals born in the community and those they find favorable to their culture make up this bunch. The final factor is a pervasive sociopathy. In common terms, they are manipulative, self-centered and power-hungry. 

Over the last three and a half years, I have seen three managers come and go. The last one held the most promise, taking pride both in the agency and the community.

In most rural volunteer organizations, the manager, or chief in the case of a fire department, is overseen by members of the local community. In the interest of checks and balances, they understandably limit the number of service members who can serve on that board. All are voted in by popular ballot.

As a result, members from outside these small communities (transplants) are usually underrepresented and are rarely voted onto the board unless the establishment accepts them. This often means they are weak personalities or are themselves manipulative.

In the case of one organization, It became readily clear to me after a year or so that the board bucked any suggestion of change which might threaten their power. When that manager kept pushing to fix some antiquated systems, the board steadily stopped granting him funding for every big-ticket item, which included upgrading needed equipment. 

Eventually, an application for a new managerial candidate circulated through the board, outside of a meeting which violated their own bylaws. The existing manager got wind of it and quit rather than continue fighting an uphill battle.

The following manager (the one whose application was circulated) met with the same resistance, but instead of continuing to push, this manager knuckled under and just did what everyone wanted done. Seen as spineless, this manager extorted funds which weren’t discovered until after they left citing family issues and burnout. Several members of the establishment still won’t admit they were taken by this person nearly a year later.

After nearly a two-month vacancy, the candidate pool shook out to three total candidates, one of which was an establishment member of the service who had, yes, owned several businesses, but who had never worked for anyone in their life, a.k.a. had not once stood accountable for her actions, including illegal ones. (There are rumors the local sheriff was paid off in favors of varying sorts, none of which are mentionable here.)

More than one person on the service approached me (as a member of the hiring committee) telling me to “do the right thing for the service, “ suggesting very clearly that I should hire the local. 

However, there was no way I’d recommend a vastly under qualified candidate. 

I, and another outsider, convinced the committee to hire the candidate with qualifications that surpassed the previous manager’s with the exception of the licensure which we’d previously agreed to overlook.

This manager was gung-ho to bring the agency up-to-date. Not surprisingly, this manager also met with steep criticism from day one, e.g. the establishment was appalled that he didn’t know the job by the end of his first week.

But unlike the previous two managers, this one did not give up. He revised his proposals and sought input every time he met formal resistance from the board.

So, the establishment started laying traps, over-focussing on his weaknesses (there were a few including lack of citations supporting his arguments and a structure to his presentations), and finally resorting to lies based on the simple fact that the establishment didn’t like him.

He was terminated without warning for things that left the regular staff scratching our heads as to what the establishment was talking about! Coincidentally, this followed a week after a meeting he called together the crew to pitch a new pay plan in the hope of recruiting new members. A mystery member vociferously contributed to this meeting even though we couldn’t remember the last, or first time, she filled in a shift.

This isn’t the only dysfunctional service in this area.

Another agency just down the road is dominated by a husband and wife. Or I should say, the wife since her husband has no opinion of his own. 

My squad is regularly called out to assist this agency. This woman, a farm girl who litterall married the guy next door and has never left the state, stands back and dictates to everyone on scene. 

She holds a basic Emergency Medical Technician license, which is subordinate to that of a Paramedic. She orders Paramedics around, questioning their care decisions as though she were, in fact, the Medical Director, who has the ultimate say in emergency patient care.

Needless to say, that agency is struggling to keep members. My agency covers their district half of every day, and that couple are the only two who show up to calls regularly. Usually, their driver is a volunteer firefighter with nothing better to do.

Another neighboring agency is dominated by a similar personality. Unlike the previous one, this individual has more than a couple hundred patient contacts under her belt and is a decent EMT.

But she broaches no questioning, refuses to entertain ideas offered by other responders and all around wants the status of “lead hero.” This gets dangerous because her standard of practice is out-of-date.

I’ve heard stories of her “friends” being deliberately unprofessional to patients and service members and engaging in risky conduct on scene such as physically shoving people out of their way. These individuals are routinely excused while anyone who is “not her friend” is one wrong tone away from being bad-mouthed out of the service.

Rural fire districts aren’t much better. My former fire squad was taken over by a guy who was either too lazy or too physically broken to endure the training to become a full-time, paid firefighter. In fact, he didn’t even go through EMT school and instead told everyone that his Emergency Medical Responder license was actually an EMT. 

He put a target on me when I refused to date him. Then when I called him out on padding his qualifications, I went from being one step away from lieutenant to a de facto probationary firefighter.

I wasn’t his only victim. One of the others moved to another district. Several others just quit.

As for my local fire squad, every time I’ve attended training with these guys, I get ignored and, at best, cold stares. Once, a member noted the insignia on my old department hoodie and assumed it was my boyfriend’s.

“It’s mine. I earned it,” was all I had to say for him to shut down and retreat back to his buddies, even after I invited him to swap stories. I’m not offended, because, in all likelihood, I surpassed his 15 years of experience in two serving a suburban community. 

I started volunteering in 2009. Since then, I’ve seen a steady decline in the number of folks willing to volunteer as first responders. The nature of first response service already narrows the pool down. It’s not for everyone. Add in the expectation of being on-call 24/7, to get out of your nice warm bed at three in the morning to go haul some drunk out of a ditch in 60 below zero windchill, or sacrificing your summer afternoons with your family because no one else will recover a drowning victim out of a lake brings the pool down to thimble size. 

On top of that, non-service establishment folks think we should do this for free because they don’t want to pay taxes and are sorely mistaken that we earn too much because ambulance bills are so expensive. They don’t know most of that goes to equipment and insurance and the rest goes to cover the uninsured.

September 11, 2001 was the impetus for the last time you will see broad-spectrum volunteerism in the United States. A small blip of that showed up among healthcare workers during the Covid pandemic. That one is currently sustained by high travel pay for nurses only. EMS will see none of that. Burnout is resulting on all sides. Meanwhile, we’ve swung back to just supporting the troops and ignoring those who protect us here at home, law enforcement, fire, EMS and dispatch.

Plenty of promises and praise are thrown around when it’s in vogue. Just as quickly, the promises are broken and first responders fall back to the periphery of society because we are intimate with the secrets the communities we serve wish stated buried. 

Who wants that kind of treatment for nothing in return?

Many small-town residents will read this article and bemoan the facts presented here as unfortunate but will do nothing to help the situation and will forget this article as quickly as they picked it up. I know, because I’ve been on the receiving end of those pitying looks and even derision at the fact I feel I’m important enough to deserve a say.

Which leaves me in an ethical and moral conundrum.

I know the establishment in my community will throw me under the bus to save their fragile egos. For that reason, I would not do this job for free ever again, especially since I sacrifice my time worth three times the pay at the local Walmart.

A part-time job there is financially smart, which is why no fresh blood enters our ranks anymore, but my absence from the ambulance could have a butterfly effect. 

Call it the Star Trek fan in me, but I know that I might have the right stuff to make a difference once in a while. When it comes to life and death, once is all it takes to matter. As pitiful as that might sound, it’s enough for me to still willingly endure this abuse.

At some point, though, my mental health won’t take it anymore. I’ve been burned out more times than I care to admit and resorted to several self-destructive behaviors. I can’t say I would encourage anyone to do what I do for a living.

So what is the solution? I don’t know if there is one beyond actively routing out the sociopaths from these organizations. The last manager I saw get fired called the board out on that very point. The vice-president called him deranged. For the record, the VP was a born and raised local. The manager was from out-of-state.

It also wouldn’t hurt to make public service programs more accessible to volunteers and/or make pay worth the time.

I don’t know if that agency in Wyoming suffered from this sociopathic dysfunction. I just know I’ve read many articles similar to that one over the years, but the situation is far less pitiful and mysterious than those articles make it sound. It’s not out of laziness that people don’t volunteer. It’s out of self-preservation.

The problem flies in the face of our cultural concept of small-town America as this innocent, patriotic, warm, welcoming utopia. It unseats a core understanding of our identity, and these small-town communities plug their ears, close their eyes and hum “Stars and Stripes Forever” to drown out the truth.

Maybe someday they’ll listen. Right now, I’m not holding my breath that they will.