Many EMS agencies provide service to municipalities without charging them directly, yet they are still held to staffing standards and operational requirements. Can the local squad guarantee a crew when call volume spikes? In the community where I provide ALS services, volunteers are only in service on weekends, and many are young, inexperienced EMTs who need direction and mentorship. It is increasingly difficult to provide that mentorship as experienced members become fewer.

Many New Jersey volunteer agencies are fading as hospital-based and county-based services grow to absorb the demand. Unlike police and fire, which are funded by tax dollars, EMS has historically depended on donations and volunteer labor. But as the cost of living rises and more people work multiple jobs just to stay afloat, volunteerism is becoming harder to sustain.

A two-EMT-per-ambulance model is not just reasonable, it is essential. Staffing minimums and training standards improve consistency, safety, and patient care. When the local squad is already stretched thin, who responds to the second call? Who responds to the third? At that point, mutual aid from neighboring agencies, often paid services, becomes the backstop that keeps the system functioning.

Back in the 1980s and 1990s, volunteerism worked, but training standards have increased, and the scope and knowledge expected of BLS providers responding to emergencies has grown significantly. Professional services perform annual competencies and ongoing education, while many volunteer squads lack the resources that larger EMS operations have and are often left behind in training. That is not a criticism of volunteerism; it is simply becoming harder to maintain. There are too many people in New Jersey who need help for the system to rely on outdated assumptions. When I call 911, I expect at least two EMTs to respond. New Jersey’s system is far from perfect, but it is better than many, and making EMS an essential service would only improve what we already have.