When you call them, they still come.
On a recent morning, Vikram Gupta scrambled out of a Charlottesville-Albemarle Rescue Squad ambulance and took two-at-a-time the stairs of a city home where an elderly man fell in a second-story bedroom.
Behind followed driver Madison Floyd, who grabbed equipment from the ambulance, and Virginia Leavell carrying a backpack heavy with medical supplies.
Inside, the crew quickly checked the man over and got his medical history and a recount of what happened.
“I lost my balance and thought I’d steady myself on the arm of the couch,” the man explained as the crew checked his blood pressure and pulse. “I missed the arm and grabbed the lamp instead. It didn’t help much, I’m afraid.”
Despite a dearth of daytime volunteers and elimination of a level of emergency medical training, the Charlottesville-Albemarle Rescue Squad continues its 60-year tradition of answering most of the area’s emergency medical calls.
“We’re the primary basic life support agency for the city,” said Leavell, president of CARS. “Most of our volunteers are emergency medical technicians, and basic calls can be handled by EMTs without a paramedic. That allows us to deploy three ambulances each evening and weekend.”
The nonprofit squad receives some funding from the city and the county but operates mostly on community donations. It also generates money for the city by billing for ambulance services. In the last fiscal year, the squad generated $1.1 million for the city’s general fund, from which it received $441,000.
The squad’s ambulances answered nearly 7,000 calls in the last fiscal year. The volunteer squad ran 60% of all area calls for an ambulance and 75% of all calls that resulted in a patient being taken to a hospital.
CARS ambulances transported 76% of patients in calls for basic life support for which patients were billed. They transferred patients in 77% of more serious calls and 72% of the most serious calls, according to figures compiled by the regional Emergency Communications Center and the rescue squad.
CARS provides to the city at least one basic life support ambulance — called BLS — from 6 a.m. to 6 p.m. Monday through Friday. It provides three BLS ambulances for city and county calls from 6 p.m. to 6 a.m. on weekdays and 24 hours a day on the weekends.
The squad also covers holidays for the county when staffing is reduced. It scrambles emergency medical staff and equipment during mass casualty events such as November’s crash on Interstate 64 between a tractor-trailer and a tour bus.
“Our volunteers are professionals. They achieve the same standards and receive the same training that paid providers receive,” Leavell said. “When you combine volunteers with the city and county full-time crews, you have a solid emergency services plan.”
For decades, the award-winning rescue squad was the primary provider of emergency care in the area. Changes in the requirements for emergency medical staff and in society at large have cut into the volunteer agency’s readiness, however.
“It’s hard to find a job that lets you off during the week to volunteer,” Leavell said. “The old idea of taking a pager to work in case you were needed just doesn’t work anymore. There’s a lot of training and that can be a time burden on people, as well.”
Emergency medical calls are divided into three classifications: ambulance, trauma and medic. The most serious cases are dispatched at the medic level.
Ambulance-level calls may be answered by EMTs, trained in basic skills. Trauma-level calls require an advanced EMT, or AEMT, with additional training including setting up intravenous medications and other more advanced medical procedures.
Medic-level calls require paramedics or EMT-Intermediates, who receive advanced life support, or ALS, training.
“[The] vision is for CARS to be the premier basic life support response agency to both the county of Albemarle and city of Charlottesville,” said squad Chief Noah Hillstrom. “Using advanced life support crews for basic life support [calls] increases the risk for an advanced life support ambulance not being available [when needed].”
The majority of calls are ambulance level, like the one dispatched for the elderly man who fell. Although he never lost consciousness, his wife thought it best if he went to the hospital, considering his age and medical conditions. The ambulance crew and the man agreed.
Securely seated in a chair designed to slide down stairways, the man was carefully maneuvered to the first floor. Outside, he was transferred to a gurney and secured in the ambulance. As Floyd drove, Gupta and Leavell monitored the man and talked with the emergency room.
It was a well-trained crew. Floyd is an EMT, Gupta is an AEMT and Leavell is an EMT-I, the level that national organizations training emergency responders eliminated.
The national shift has limited the number of crew members receiving the advanced training.
“Both career and volunteer agencies relied on the EMT-I certification level for many years as it was more cost-effective and required less time in training than a traditional paramedic program,” Hillstrom said. “Several years ago the EMT-I curriculum was discontinued and, in my opinion, this is the root cause for the rapid decline in volunteer medics.”
While the EMT-I certification process took about a year, after someone had their AEMT certification, paramedic courses are much more time-intensive.
Piedmont Virginia Community College, like many other colleges, offers a paramedic program that requires five semesters of study, including courses in biology, anatomy, psychology and writing.
For volunteers, a years-long college commitment is too much just to work for free.
“A lot of us who volunteer are [University of Virginia] students and spend days in class and we’re awake all night anyway,” laughed Floyd, a UVa student studying public health, after the crew returned to the CARS headquarters at McIntire Road and the U.S. 250 Bypass.
“I was pre-med at the time and we were pressured to be involved in 101 things and this was one of my 101. I stuck with it because I really love all the people here and I’ve met some of my best friends on the squad.”
For Floyd, two years of paramedic courses is not feasible. Gupta, who will enter medical school next year, feels the same way. He moved up from EMT to AEMT and said he would have considered the extra six months of training to be an EMT-I.
“A friend told me I should get involved, and I listened to him and I loved it,” Gupta said. “I’ve gotten more involved in the agency and got my advanced training. If the intermediate level had still been around, I probably would have done that.”
For Leavell, working, serving as president of the squad and being a mother makes tackling a two-year degree for paramedic certification difficult at best.
“It’s the difference between two to three years for the paramedic and a semester or two for the intermediate. That’s a big difference,” she said. “It’s had an impact on the squad being able to provide ALS service. It’s been a while since we’ve been able to reliably staff a medic-level unit during the day.”
The loss of the top-tier responders led the rescue squad and the localities to adjust priorities and schedules to work closer together.
The city fire department has added one full-time ambulance staffed with crew members with advanced emergency medical training. Another ambulance currently runs weekdays but is entirely funded by medic-level personnel working overtime.
The dearth of CARS crews able to run medic-level calls led to the city’s fire department running the weekday ambulance more often, incurring more overtime costs. The city fire department is seeking additional funds to hire more paramedic-level firefighters to staff the ambulances, but the request has not been recommended for approval by city officials.
County fire and rescue officials have retrained personnel and added paramedic staff and equipment to several fire stations in the county and hope to add additional personnel in the next budget season.
Hillstrom supports the moves.
“Consistent volunteer paramedic staffing, unfortunately, is on a rapid decline across our nation, but there are many opportunities for a volunteer agency to still contribute to that level of service,” he said. “For example, many volunteer agencies have hired or contracted their own paramedics to make up the void. Some localities combine their paramedics with volunteer BLS crews, which is by far the most fiscally responsible way to provide ALS service.”
In the meantime, CARS crews will continue coming when the public calls, squad members said.
“We’re a robust BLS agency. We have a lot of great volunteers from the community and especially from the university and we have a lot of applications, so the staffing is there,” Leavell said. “We’re not going away. We will be available when we’re needed.”