Administration and Leadership, EMS Today Conference, Training

Divvy Up the Cash: Why we must budget & also share the wealth

Issue 7 and Volume 33.

Volunteer„EMS tends to consist of the haves and have-nots when it comes to finance, but money actually may be the root of — and solution to — all of our problems. If your organization doesn’t have enough money to maintain your building, equipment and basic response needs, money is the root of all problems. If, on the flip side, your department enjoys an abundance of cash, the problem is how to spend it appropriately, keep members happy and avoid turning into a commercial entity.„

Very few organizations seem to have found a happy balance, and cash-poor organizations often don’t understand those that are cash-rich, and vice versa. This lack of understanding may hurt our ability to find a balance and run an organization that_s fiscally responsible and provides professional service.

Fiscal responsibility seems to be a new concept in volunteer organizations. This may be because the 21st century requires organizations to provide higher levels of service to larger populations and manage not just emergencies but the organization overall. Thirty or 40 years ago,„EMS was in its infancy and the biggest issues were purchasing a used Cadillac and finding volunteers. But we now live in the age of Medicare and Medicaid, along with the aging baby-boomer population. Not only must we treat patients and provide care, but we must also run our volunteer organizations as businesses, which includes balancing our expenditures and funding.

Organizations aren’t often run this way because, although„EMS professionals may be great at reacting to emergencies, finances cannot be treated as an emergency to react to. Reactionary financing results in living “check to check” — spending money when it comes in or raising funds only when an ambulance breaks or money is needed. Although reactionary financing may be possible in our personal lives, it leaves organizations at the mercy of their local economic climate.„

If you think your organization isn’t reactionary, just watch what happens after a few members attend a show, such as the EMS Today Conference and Exposition. Organizations without money start talking about fundraising to pay for the new shiny gadget that caught their interest, while those that have money are looking for things to buy and end up purchasing a Hummer for their chief, even though all their roads are paved and they get two inches of snow all winter. This type of spending just widens the gap between the haves and have-nots, and doesn’t develop a balance.

Each organization has different factors that contribute to both their expenses and potential funding sources. These factors, such as location, services provided and area served, may demand stricter budgeting requirements or maintaining a closer balance than the average business. Volunteer„EMS organizations can be funded through a variety of sources, including fundraising; fee for services; municipal funding; taxes; federal, state or local grants; or a combination. Each funding source has pros and cons, and just because they’re available doesn’t mean you should take advantage of them. More money isn’t necessarily better because it also means more responsibilities and requirements to the funding sources.

It may sound counterintuitive, but organizations that take in too much funding end up in a “use-it-or-lose-it” situation, placing future funding at risk. This excess of funding comes when departments start grabbing for funds just because they’re there and they don_t want to let the money go.„

A department with a competent grant writer or political connections doesn’t need to always take the funds they obtain.„EMS as a public safety entity has a limited funding source, and we all must take responsibility to ensure those limited funds go to those who really need it, rather than just those who are good at getting it. While one department is out buying Hummers, another is still driving their original Cadillac on calls.

Whenever you take money, a contract (implied or in writing) exists that holds you responsible to whomever you took it from and the community at large to use it wisely and improve service. Federal funds, especially Medicare and Medicaid, come with quite a few requirements, and defrauding the government won_t only lead to bad press, but also imprisonment. For some organizations, their problem is that they_re so cash-rich they have difficulty spending the money and may end up paying their members or inadvertently turning themselves into a paid rather than volunteer professional service.

The solution is to budget your expenditures wisely, keep an adequate safety net and ask only for the funding you need. If this means forgoing federal funds, not billing for services or returning tax money, all the better. Fiscal responsibility is part of patient advocacy, because our patients are ultimately the ones who pay the bills.„

Let’s all make attempts toward responsibility to provide relief on the system as a whole. It_s my hope that if we all budget appropriately we can shrink the gap between the haves and have-nots and improve our profession rather than just our organization.

Jason Zigmont is an„EMS instructor, executive director of the Center for Public Safety Education and the founder of„ He’s also a PhD candidate in adult learning at the„University of„Connecticut. Contact him at„[email protected]