Emergency Services in Australia and New Zealand: Problems and Prospects for Volunteer

Ambulance Officers.

Report of the Stand Up and Be Counted Project

May 2002

University Department of Rural Health, Tasmania

Emergency Services in Australia and New

Zealand: Problems and Prospects For Volunteer Ambulance Officers.

Report of the Stand Up and Be Counted Project : A national strategic planning framework for recruitment, retention and training for

Volunteer Ambulance Officers.

Undertaken by staff from the University Department of Rural Health, Tasmania, with close collaboration with the Convention of Ambulance Authorities. Sponsored by the Commonwealth Government through the Emergency Management Australia Projects Program 2001/2002.

University Department of Rural Health, Tasmania

Emergency Services in Australia and New Zealand: Problems and Prospects for Volunteer Ambulance Officers Christine Fahey and Professor Judi Walker ISBN 1 86295 034 2 Cover graphic courtesy of Vern Richardson Other graphics courtesy of SA Ambulance service and the Volunteer Ambulance Officers Association of Tasmania Incorporated. Prepared and Produced by the University Department of Rural Health, Tasmania Locked Bag 1-372 Launceston TAS 7250 Copyright 2002 University Department of Rural Health, Tasmania University of Tasmania The Commonwealth as a sponsor of this project (EMA 19/2001), accepts no responsibility for the accuracy, currency, reliability or completeness of any information contained herein and recommends that users exercise their own skill and care with respect to its use.

CONTENTS

ACKNOWLEDGEMENTS I

GLOSSARY II

EXECUTIVE SUMMARY IV

RECOMMENDATIONS V

SECTION 1 1

INTRODUCTION 3

THE STAND UP AND BE COUNTED PROJECT 4 Project Overview 4 Methodology 5

PARTICIPATING AMBULANCE SERVICES 8 Tasmanian Ambulance Service 8 St John Ambulance Western Australian Ambulance Service Incorporated. 9 St John Ambulance Northern Territory Incorporated 10 Queensland Ambulance Services 11 Rural Ambulance Victoria 11 SA Ambulance Service 13 St John New Zealand 14

BACKGROUND 15 The evolving role of Ambulance Services and VAO 15 Health status and socio-demographic changes in rural areas. 17 Volunteers 17

SECTION 2 21

WHO VOLUNTEERS? 23 1.1 Findings 23 1.2 Discussion 24 1.3 Recommendations 25

WHAT IS THE VALUE OF THE TIME VAO CONTRIBUTE? 26 2.1 Findings 26 2.2 Discussion 26 2.3 Recommendation 28

WHAT MOTIVATES VAO TO VOLUNTEER? 29 3.1 Findings 29 3.2 Discussion 30 3.3 Recommendation 31

WHAT FACTORS AFFECT RETENTION? 32 4.1 Findings 32 4.2 Discussion 35 4.3 Recommendation 36

WHICH MANAGEMENT AND SUPPORT SERVICES ARE VALUED BY VAO? 37

5.1 Findings 37 5.2 Discussion 39 5.3 Recommendation 40

WHAT ABOUT VAO TRAINING? 41 6.1 Findings 41 6.2 Discussion 45 6.3 Recommendation 47

SECTION 3 49

FUTURE DIRECTIONS 51

RECOMMENDATIONS 53

REFERENCES 55

SECTION 4 59 Appendix 1: A National Agenda on Volunteering: 61 Beyond the International Year of Volunteers 61 Appendix 2: SA Model for estimating VAO dollar value Appendix 3: Additional data 70 Appendix 3: Additional data 71 Appendix 4: Stand Up and Be Counted Survey 73

Tables Table 1: Final Sampling Frame for the Stand Up and Be Counted Project..................6 Table 2: Sex Profile of Australian and New Zealand VAO. ........................................23 Table 3: Age groups of Australian and New Zealand Volunteers ...............................23 Table 4: VAO motivations for volunteering.................................................................29 Table 5: VAO motivations for joining an ambulance service......................................29 Table 6: Activities enjoyed by VAO .............................................................................32 Table 7: Factors that make VAO work difficult..........................................................33 Table 8: Importance to VAO of management support. ................................................37 Table 9: Importance to VAO of support services.........................................................38 Table 10: VAO training frequency per jurisdiction. ....................................................41 Table 11: VAO rating of frequency of training events.................................................41 Table 12: VAO desired changes in frequency of training events.................................42 Table 13: VAO rating of training sessions. .................................................................43 Table 14: VAO rating of training of services/ facilities...............................................43 Table 15: Summary of key issues. ................................................................................52

Figures Figure 1: Population size of respondent’s town ..........................................................24 Figure 2: Years as a VAO............................................................................................33 Figure 3: Respondents self-rated frequency of adequate ambulance roster cover for local community. ..........................................................................................................34 Figure 4: Chart showing desired training changes per current training amount. ......42 Figure 5: VAO rate between occupational groupings. ................................................71 Figure 6: VAO labour force status. .............................................................................71

Acknowledgements The Stand Up and Be Counted Project is a collaboration between members of the Convention of Ambulance Authorities and the University Department of Rural Health, Tasmania and is sponsored by the Commonwealth Government through the Emergency Management Australia Projects Program 2001/2002. The authors would like to extend their thanks and appreciation to all who have supported the project. Particularly: All Volunteer Ambulance Officers who completed and returned surveys. Each ambulance service, for their assistance in working with key stakeholders was invaluable, as was their knowledge of major issues, and commitment to both projects: Tasmanian Ambulance Service: Mr Grant Lennox, Mr Ted Preshaw and Ms Dianne Coon, for their collaboration and assistance with both the More than a Band-Aid Project and the Stand Up and Be Counted Project. Queensland Ambulance Service: Dr Gerry Fitzgerald and Mr Kevin Rapley Rural Ambulance Victoria: Mr Stephen Gough and Mr Geoff Thomson St John Ambulance Western Australia Ambulance Service Incorporated: Mr Ian Kay-Eddie and Mr Tony Ahern St John Ambulance Northern Territory Incorporated: Mr David Baker and Mr Ross Coburn SA Ambulance Service: Mr Chris Lemmer, Mr Tony Vaughan and Ms Helen Elix St John New Zealand: Mr Tony Blaber and Mr Tom Dodd

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Glossary In this report the following terms are used

VAO: Volunteer Ambulance Officers. The term is used to refer to all Australian and New Zealand: • Volunteer Ambulance Officers • Retained Ambulance Officers • Honorary Ambulance Officers • Ambulance Community Officers

CAA: The Convention of Ambulance Authorities. The term is used to cover the ambulance organisations involved in the survey. The organisations included in the term will be: • Queensland Ambulance Services (QAS) • Rural Ambulance Service of Victoria (RAV) • SA Ambulance Services (SAAS) • St John Ambulance Australia WA Ambulance Service Inc (WA) • St John Ambulance Australia NT Inc (NT) • St John New Zealand (NZ) • Tasmanian Ambulance Services (TAS) Volunteer Group or Unit: The term used to refer to all Ambulance jurisdictions’ volunteer groups, including: • Sub-centre • Volunteer Unit • Other

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Executive Summary This report has been written with two main audiences in mind: Volunteer Ambulance Officers (VAO) and emergency service management. The report collates the information provided by VAO throughout Australia and New Zealand through participation in the survey. It therefore provides VAO with feedback from the survey and assists them to see how they and their ambulance organisation fit into a broader picture of VAO. This will give VAO an understanding of their connection to a larger national and international group of emergency service volunteers who do have some regional differences, but more often strong similarities. This identification as a larger regional group give VAO a stronger presence and voice in the political arena, where they need to deal with the competing funding, training and legislative stresses. This report provides ambulance service management and other emergency services with important information and a tool. Information on the motivations and support needs of VAO, and the demographics of the VAO population are needed if recruitment and retention problems are to be addressed at an organisational level. The impact of training on VAO needs to be understood in light of the trend towards Vocational Education and Training (VET) programs, and other more formalised training systems. The report as a tool will allow insight into future directions and provide the necessary data to work cohesively on volunteer issues. It aims to assist attempts to address VAO issues at a national and Australasian level. The study surveyed over 2,500 VAO throughout Western Australia, South Australia, Victoria, Tasmania, Queensland, Northern Territory, and New Zealand and had an overall return rate of 38%. Our findings suggest the monetary value of the VAO contribution is at least $29 million in Australia, but could be as much as three times this figure. This figure only accounts for the time contribution of VAO, and fails to measure the value of their contributions in terms of petrol, training materials and lost earnings, very real issues for some VAO. The study findings provide a clear picture of the common characteristics and needs of VAO. Most VAO juggle paid employment and family commitments to provide this largely rural service. Volunteer rates differ slightly between male and females, with women making up 55% of the VAO population and men 45%. Ambulance services are experiencing difficulties associated with providing a volunteer service, with a rapid turnover of VAO and at times inadequate roster cover. Recruitment and retention strategies are both important in addressing these difficulties, but retention should be given priority by ensuring VAO motivations are reinforced and the volunteer experience within the organisation is satisfying. One of the major motivations for VAO is the desire to assist the community, and ambulance services need to reinforce the benefits of community engagement and strengthening social capital. Training is the other major tool for emergency services to reinforce motivations. Emergency services training in Australia is in a state of transition, moving from standards established at a jurisdictional level to come under the Australian Quality Training Framework. This provides its own challenges, but the findings show that VAO want high quality, flexible, competency based training, and that such training will be a strong motivator for recruitment and retention.

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VAO numbers and other pressures are increasing the stresses on the VAO role and highlight the importance of ambulance services providing volunteers with a supportive environment. The findings show that clinical support systems that assist VAO to provide an effective service, such as training, equipment, paramedic assistance, occupational health and safety and case debriefing are highly valued by volunteers. Ambulance services must provide VAO with clinical support, communications and a work environment that is professional. When VAO are assisted to provide a professional ambulance service to their communities, motivations are strongly reinforced. VAO also want communication systems and cultures within ambulance services that respect their contribution. Services need to ensure VAO are represented at all levels of management, given systems that allow feedback and clear communication channels. Ambulance services must ensure that they have a culture that values VAO contributions and that this is supported by appropriate systems and training for management who deal with volunteers. Relationship factors impact on VAO experiences, and if unsatisfactory, will result in high turnover rates as dissatisfied VAO leave. This report provides recommendations for the future directions of ambulance services utilising volunteers. They are broad due to the diverse nature of ambulance organisations in Australia and New Zealand, but this should not devalue them. There is an urgent need for ambulance services to improve the working environment for VAO. To do this they must understand how this can be done and then develop best practice guidelines. Sharing of information is critical to this process amongst volunteers, ambulance services and other emergency services, and so is the formation of a group or forum, who accept responsibility for moving the process forward by addressing the recommendations. Government and communities also have an important role in recognising the value of VAO by supporting them financially and publicly.

Recommendations 1. VAO should recognize they form a distinct group of emergency service

volunteers. Within each jurisdiction VAO should establish mechanisms for representation of their collective interests in matters of policy and change at organisational, state, national and international levels.

2. The Convention of Ambulance Authorities (CAA) should provide a forum to

address VAO issues at the national level that includes VAO representation. This forum to monitor and contribute to national events affecting emergency service volunteers, such as tax issues, legislation, and insurance, and support and provide representation to Australian Emergency Management Volunteer Forum.

3. Ambulance services should ensure they collect and analyse data on volunteers

using a standardised format. These data should include volunteer demographics, volunteer motivations, and attitudes to rewards, and be reported through the CAA to enable strategic planning.

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4. The CAA and governments should publicly recognise VAO as a valuable part of the ambulance services. This recognition needs the development of a standardised method for calculating the cost/benefit of VAO contributions, development of equitable tax deductions and/or rebates for VAO, and long-term funding arrangements that acknowledge the costs of supporting VAO.

5. Governments should recognise the valuable contribution of VAO to health and

emergency services, and adequately fund and support necessary organisational systems to ensure the long-term survival of volunteering in ambulance services.

6. The ambulance services should work to reinforce VAO motivations and provide a

reciprocal relationship with VAO. This would require creating stronger links with communities, assisting VAO to learn new skills, ensuring the VAO role provides a sense of achievement, and continued research.

7. The CAA should acknowledge that VAO have characteristics and needs in

common with other volunteers and endorse the National Agenda on Volunteering prepared by Volunteering Australia Incorporated. This Agenda represents the interests of all volunteers within Australia (Appendix 1).

8. The CAA should take action to urgently address retention and recruitment issues

at a national level, which would include but not be limited to: • Developing best practice guidelines for VAO management to assist retention by

developing a supportive organisational culture. • Monitoring and reviewing the impact of legislation on the VAO role. • Developing best practice guidelines for recruitment of VAO. • Monitoring the level of ambulance service coverage provided by VAO for rural

and remote areas throughout Australia.

9. The members of CAA should share information regarding the success and failure of management support initiatives for VAO to develop best practice guidelines for VAO management. These guidelines should include clinical support services that provide equity in the treatment of VAO and full time paid staff, good communication practices, and forms of recognition that validate VAO service.

10. The CAA’s Ambulance Education Council should support a comprehensive

program of training support for volunteers that encompass national standards, a focus on competency and utilises flexible training delivery methods. Ambulance services must simultaneously work to ensure VAO are not subjected to onerous bureaucratic processes, but instead are assisted in navigating and meeting the range of administrative requirements as members of large organisations..

11. Ambulance services should share available resources for delivering training to

VAO recognised under the Australian Quality Training Framework, such as web based training packages, to enhance flexibility and increase cost efficiencies.

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Introduction and Background

Section 1

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Introduction This report describes the current status and needs of Volunteer Ambulance Officers (VAO) in Australian and New Zealand as revealed by the research project Stand Up and Be Counted. The project was established to develop strategies to improve recruitment, retention, training and support for VAO in Australia and New Zealand. The report is divided into three parts: the background; the findings and their implications; and future directions. The background section explains the setting for the development of the Stand Up and Be Counted Project, and the research methods used. The recent increased awareness of rural and remote health differentials and issues, coinciding with an increased understanding of the importance of emergency service volunteers, are described. The findings and their implications section has six parts based on six questions asked of the data:

• Who Volunteers? • What is the value of the time VAO contribute? • What motivates VAO to volunteer? • What factors affect retention? • Which management and support services are valued by VAO? • What about VAO training? • This section will present the findings and relate them to the body of

knowledge on volunteer issues and the current situation. The future directions section brings together all parts of the report to provide a picture of the way forward. Broad recommendations are presented that will provide a map through the competing issues and needs of VAO. These avoided being too prescriptive due to the varying nature of participating ambulance services.

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The Stand Up and Be Counted Project Project Overview Emergency Management Australia funded The More Than a Band-Aid Project in 2000 in the belief that there are some significant information gaps and questions about VAO. Particularly, that project set out to ask VAO about the issues which where important to them and was a collaboration between Tasmanian Ambulance Services, Volunteer Ambulance Officers Association of Tasmania and the University Department of Rural Health, Tasmania. This was extended to cover all Australian and New Zealand VAO through the Stand Up and Be Counted Project. This project covered all jurisdictions using VAO in the two countries, which are:

• Queensland Ambulance Service • Rural Ambulance Service of Victoria • St John Ambulance Australia Northern Territory Incorporated • St John New Zealand • St John Ambulance WA Ambulance Service Incorporated • SA Ambulance Service • Tasmanian Ambulance Service

The objectives were: • To gain a clearer understanding of the factors that affect volunteer recruitment and

retention. • To assist ambulance services to devise strategies to recruit, retain, train and

support volunteers in Australia and New Zealand. • To raise the profile of VAO. • To disseminate the findings of this project widely.

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• To influence future government policy relevant to emergency services provision utilising volunteers.

Research Methods The design was based on a descriptive research model using a survey to gather information on the current situation for VAO and what is important to them. The project steps included formation of an Advisory Committee, literature review and survey tool development, survey dissemination, and data entry and analysis. The More Than a Band-Aid Project was considered a pilot for the Stand Up and Be Counted Project and the literature reviewed was updated, but not repeated. The survey was adjusted according to the new requirements from additional services and lessons learned from the pilot.

Advisory Committee The Advisory Committee was set up to provide advice on the progress and direction of the project. The members represented the views of their organisations, in Australia and New Zealand, and ensured effective communication to appropriate people within their organisation. All major Ambulance Authorities within Australia and New Zealand, with Volunteer Ambulance Officers/Honoraries, were invited to nominate a representative. The following organisations and groups were represented on the Advisory Committee along with other key stakeholders: • Queensland Ambulance Service • Rural Ambulance Service of Victoria • St John Ambulance Australia, • St John Ambulance Australia Northern Territory Incorporated • St John New Zealand • St John Ambulance WA Ambulance Service Incorporated • SA Ambulance Service • Tasmanian Ambulance Service • University Department of Rural Health, Tasmania • Victorian Country Fire Authority • Volunteer Ambulance Officers Association of Tasmania

Methodology Review of the Literature The project scope defined the literature reviewed. To develop strategies, it is necessary to understand the internal and external environments affecting VAO. However, the project brief of addressing VAO recruitment, retention, training and support focused the study on the internal environment of volunteer group effectiveness and organisational management. The following keywords were used to identify relevant literature for review:

• Volunteer/s, volunteering, volunteerism, ambulance officers, paramedic, collective action.

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• Ambulance, ambulance services, emergency medical services, emergency services, recruitment, retention, fire services.

The literature reviewed considered current understanding of the necessary elements for effective volunteer groups. The majority of the literature that was specific to VAO was American based and non-academic in origin and purpose. Most was written around the management issues of how to retain and recruit volunteers. This information was useful in identifying the management best practices used elsewhere when managing volunteers, and for highlighting the issues that are particular to the VAO role.

Survey Instrument The survey instrument (Appendix 4) was developed and piloted during the More Than a Band-Aid Project. Significant changes were made to the training section following the piloting, along with changes to allow the demographic data to be collected within categories used by Australian Bureau of Statistics (ABS) and to cater for the addition of extra ambulance services. Consequently, data from the Tasmanian VAO are not always represented in the graphs and table, as these were omitted if the phrasing of the question had changed.

Data collection The VAO in Australia and New Zealand were surveyed using a random sample where possible, however there were several variations. Table 1 shows the final sampling frame and return rate. The different sample sizes do not reflect the number of VAO as a percentage of the Australian population, but the enthusiasm and ease of participation of each jurisdiction with the project. Despite WA appearing to be underrepresented in the survey sample, due to having the most VAO, their system is the most decentralised and in many ways different from the other services, to the point of requiring some adaptations to the WA survey. Too many responses from WA would have skewed the data. The sample reflects a contribution from all ambulance services and return rates varied, but the average was 38%. Table 1: Final Sampling Frame for the Stand Up and Be Counted Project

State/Territory /Country Dispersal Method

Number of surveys distributed

Number of volunteer sampling population

Number of Returns

% Return Rate

Northern Territory

Mail –out to all volunteers

41 41 7 17%

Queensland Mail out to all in 4 out of 7 regions

200 360 65 33%

Rural Victoria Initial mail out had poor response, send out with trainers.

80 350 33 41%

South Australia Mail out to random sample

500 1400 256 51%

Western Australia

Mail out to random sample of units

250 2160 87 35%

New Zealand Random sample mail-out

1000 2000 360 36%

Tasmania Mail out to all VAO 380 380 206 55%

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Data analysis Data were entered into an Excel spreadsheet then imported into SPSS for analysis. Measures of central tendency used for scale data were mean, mode and median. Data were analysed with frequency tables and investigated for relationships with age, sex, location, and participation in paid employment. A data entry audit found only 3 errors in 1640 entries.

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Participating Ambulance Services This chapter describes key characteristics of VAO management from the ambulance services that collaborated with the Stand Up and Be Counted Project. Neither New South Wales nor the Australian Capitol Territory employ VAO in ambulance service, and were therefore not part of the project. This information has been provided by management of participating ambulance services and presents the standards, and policies of the organisations. However, it must be acknowledged that this information presents the ideal, and the reality for VAO may not match this. Results from the focus groups from the More Than a Band Aid project found that delivery of organisational support for VAO did not match the ideal, and there is a strong likelihood that this situation exists for other services as well, particularly affecting groups in remote areas. Australian ambulance services have developed organisationally over the last hundred years, changing from small local and regional organisational enterprises into larger state based organisations. St John Ambulance was the original provider of much of Australia’s first-aid response services. St John Ambulance still provide ambulance services in Western Australia, and Northern Territory, but apart from other small pockets of ambulance activity, have left ambulance service provision to state authorities in other territories and states, but maintained a strong base in first-aid services throughout Australia. St John Ambulance is the major provider of New Zealand’s ambulance services. Funding arrangements vary between services, but all rely in part or whole on government funding. In Australia's federal system this is a state government funding responsibility. Training, management and support of VAO is unique to each jurisdiction, but there are also many similar approaches. All services provide training and require a minimum standard be achieved before active service, but training courses and standards vary. All services provide uniforms, but have different levels of provision. Reimbursement of expenses and other management support are the areas of most diversity. Following are details of each services overall structure; use and classification of volunteers; training and other support provided; and system of management.

Tasmanian Ambulance Service The Tasmanian Ambulance Service (TAS) is a state government organisation and the largest provider of ambulance services in Tasmania. Tasmania has a small but decentralised population, with only 41% of the population residing in the capital of Hobart (Convention of Ambulance Authorities 2000 p.24). There are 19 wholly volunteer ambulance units and 13 units where paramedics work alongside VAO. In addition the Tasmanian Ambulance Service coordinates the tasking, training and other operational and financial support to four othewhich utilise VAO.

r independent units,

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Volunteer Ambulance Officer (VAO) classifications are Level 1, Level 2 and Level 3 and these require completion for a Volunteer to receive the Certificate 11 in Ambulance Services (Volunteer Ambulance Officer). Self-training occurs when volunteers assist volunteers, and groups may practice using equipment, or run through a scenario. VAO should attend at least twelve training meetings per annum where they are formally assessed and their logbooks signed off in order to continue to meet reaccreditation requirements. Certified trainers run these training sessions. Reaccreditation is required every two years for the level gained (evidenced by the signed log book), and annually for Aided External Defibrillation (Lennox 2002). Other training may be undertaken by paid ambulance officers or other volunteers. TAS provides VAO with a uniform allowance of one jumpsuit, a warm coat, and pair of boots and sunglasses per volunteer, with shared wet weather gear. TAS policies also provide for petrol reimbursement and meal reimbursement. TAS operates as three regions with each VAO unit having a volunteer coordinator who reports to Supervisors (responsible to both paid and volunteer staff) who are responsible to a Superintendent. Some VAO units have a paid ambulance officer attached who may be responsible for several units and form part of the management chain (Lennox 2002).

St John Ambulance Western Australian Ambulance Service Incorporated. Western Australians are serviced by St John Ambulance WA Ambulance Service Inc, which is recognised by the state government as the principal provider of ambulance services (Convention of Ambulance Authorities 2000 p.16). Western Australian ambulance services cover the greatest land area and utilise the largest number of volunteers in Australia (approximately 2160). Volunteer only units are found in 146 country locations and 3 outer metro locations and 8 locations are mixed. WA is of interest because it has a different system of VAO management, with the local community responsible for initial fund-raising to establish an ambulance Sub-Centre and buy an ambulance, and then ongoing local management of the Sub-Centre.

There are two classifications of VAO in WA. VAO Grade One must complete a 64 hour Primary Ambulance Care Course that covers all the basic first aid and management procedures. VAO Grade 2 must complete a further two weekends that cover more advanced skills and a number of medications. Both VAO courses are taught to volunteers through the Ambulance Officers Training Centre. St John WA also offers additional subjects through distance learning that enable volunteers to attain Certificate III and IV in Health Science (both nationally accredited). Reaccreditation is required every three years by attending a refresher course conducted over one or two weekends. A skill, knowledge and maintenance programme (10 modules per annum) complements the initial training, and by completing an annual logbook for three consecutive years, volunteers can be reaccredited at the end of that period in just one weekend. Trainers are trained in planning, conducting and reviewing assessment and training small groups. Training managers are trained to Certificate IV in Assessment and Workplace Training (Ahern 2002).

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There are no set roster requirements to remain current. The volunteers come under the same supervisory/management structure as the paid staff in Metropolitan Region and Country Region. The Country Region department provides support and guidance to more than a hundred Sub-Centres within five country regions. Each region has a regional officer who helps Sub-Centres operate effectively by liaising with local committees, hospitals, shires, police and members of parliament. Regional officers also contribute at volunteer skills nights, which are held regularly. St John supports Sub-Centres with administration, accounting, tax compliance, OHS, and training (St John Ambulance Australia WA 2002). Each Sub-Centre has a local Committee with office bearers, i.e. Chairman, Secretary, treasurer who provide local management. This management means WA possibly have the most diversity between local groups in Australia. For instance, the Sub-Centre Committee decides the number of uniform items to be provided though generally St John provides all uniform requirements. Sub-Centres also use different methods of payment, some actually reimburse expenses as incurred whereas others calculate the average expense, such as meals, then work out an average per case, or average per shift and reimburse that amount. Some Sub-Centres provide volunteer honorariums, which can only be provided as a reimbursement of expenses (Ahern 2002). There are no other payment arrangements. There are honours and awards for length of service provided through the St John Ambulance organisation, as well as Commandery Commendations and Priory Vote of Thanks for outstanding service. Volunteers can also be rewarded with Membership of the Order of St John.

St John Ambulance Northern Territory Incorporated St John Ambulance (NT) Inc took over the permanent responsibility for the delivery of Northern Territory ambulance services in 1974 (Convention of Ambulance Authorities 2000 p. 29). Services are provided over vast distances using paid and volunteer staff. VAO are classified under the same system as paid ambulance staff, and have access to an Advanced Diploma in Paramedic Studies, which is unusual in Australia as this level of training is not available to VAO in other Australian services. The Northern Territory has the smallest ambulance service with only 41 VAO. VAO must complete the Ambulance Studies Training Program as a minimum requirement to practice, and St John Ambulance provides all training annually. To retain accreditation VAO must participate in the annual Ambulance Service Quality Assurance/Professional Development Program; undertake ambulance duties to the satisfaction of the operations manager; and remain efficient members of the operations branch. Training is provided by those with Ambulance Paramedic status who have completed a Certificate IV in Assessment and Workplace Training (Baker 2002). St John Ambulance Australia (NT) Inc provides VAO with a uniform, which was the same as that for paid staff until recently. In future VAO will retain the ST John uniform and paid staff will receive a new uniform. There are no reimbursement provisions for volunteers and no formal incentives offered (Baker 2002).

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VAO work under the supervision of the Service, reporting regionally to an Officer-in-Charge, who reports to a Deputy Operations Manager or Operations Manager.

Queensland Ambulance Services Queensland Ambulance Service (QAS) is a state government run service with 360 VAO classified as Honorary Ambulance Officers and trained to “Ambulance attendant” level. These operate alone in some rural and remote locations, but mixed crews also operate in some urban and rural areas. In some remote areas there are Hospital Based Ambulance Services utilising local health employees. Training requirements are Certificate III in Health Science (Emergency Care) plus Basic Life Support Skills & Auto External Defibrillation competency (both offered by QAS). Trainers are Paramedics with an Associated Diploma or Diploma of Applied Science plus a mandatory Certificate IV in Assessment and Workplace Training. Training is provided quarterly at a regional level and then as frequently as required at a local level (Fitzgerald 2002). VAO must achieve 150 hours of patient care contact time in 12 months to remain active and pass an annual skills re-accreditation - involving skill stations testing Basic Life Support competencies. Continuing education sessions under QAS Clinical Quality Improvement strategy are also offered. Volunteers operate within the main structure of the organisation and as such come under the jurisdiction of the local Station Officer-In-Charge or Area Manager (Fitzgerald 2002). VAO are provided with full uniform entitlements (including safety clothing and equipment) as per permanent staff specifications. They receive some reimbursement of pre-approved incidental expenses and casual employment can be offered from time to time. A local Ambulance Committee and local Station Officer are responsible for incentives and motivation (Fitzgerald 2002).

Rural Ambulance Victoria Victorian ambulance services are divided into metropolitan and rural services. Rural Ambulance Victoria (RAV) have 450 Ambulance Community Officers (ACO) and 12 Community Emergency Response Team Officers (CERT). CERT Officers provide first response emergency care within their communities until the ambulance arrives but have no transport capacity. Level 1 ACO act as second officer and are able to provide basic life support and assistance to a Level 2 ACO or Qualified Ambulance or Intensive care Paramedic. Level 2 ACO provide primary care in rural and remote areas of Victoria. One major difference with RAV VAO is that ACO who volunteer their availability to respond are paid at a nominal rate (less than full time staff) for the actual time worked. CERT receive no payment for any work undertaken (Gough and Thomson 2002).

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CERT Officers are required to complete 80 hours training for the Certificate II in Health (Emergency Medical Responder) course. Level 1 ACO are required to complete module 1 of the Certificate II in Ambulance Services (Community Ambulance officer) course. Level 2 ACO are required to complete module 1 and 2 of the Certificate II in Ambulance Services (Community Ambulance Officer) course. Each module has a nominal duration of approximately 80 hours. RAV is moving toward the introduction of the Certificate IV in Health (Basic Emergency Care) for Ambulance Community Officers as per the National Health Training package from 2003 onwards. Training is provided by RAV at designated locations throughout rural Victoria and trainers and courses are certified by Monash University Center for Ambulance and Paramedic Studies (Gough and Thomson 2002). There is a mandatory 30 hour annual standardised Continuing Education Program for all ACO and CERT officers. A Driver Standards Program is also incorporated into primary and continuing training. Three professional development weekend conferences per annum are held for ACO and CERT officers. Occupational Health and Safety training is provided as per the RAV Certified Agreement. Continuing education is provided for each branch once a month for three hours. Trainers are Ambulance Officers or Intensive Care Paramedics with assessor qualifications operating under the supervision of Area Clinical Managers who hold Certificate IV in Assessment and Workplace Training (Gough and Thomson 2002). Attendance at minimum 30 hours continuing education per annum and scenario based reaccreditations in core clinical skills are required for re-accreditation. Completion of these requirements results in issue of annual “Authority to Practice” certification, which is a mandatory requirement to be an active volunteer with RAV. VAO are also required to provide an average 20 hours availability per month. Each unit has a nominated “team leader” who is responsible the Area Manager. Some Areas also provide a cluster approach with a local Station Officer providing management support to a group of surrounding volunteer units. VAO are provided with uniform and insignia that distinguishes their clinical level and is identifiable by the community. Uniform includes overalls and boots, and cold climate uniform where necessary. In addition Personal Protective Equipment (PPE) when appropriate to the performance of their duties is provided in the same manner as for full time officers. The amount of uniform is consistent with the volume of ambulance work being undertaken by ACO / CERT Officers on an individual or branch basis. RAV do not offer reimbursement but ACO are paid for the actual time worked when responded to an event. No payment is made for the availability hours volunteered on roster by the ACO or CERT group/s. Other than provision of training no other incentives are offered by RAV (Gough and Thomson 2002).

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SA Ambulance Service SA Ambulance Service (SAAS) is mandated under the Ambulance Services Act 1992 (SA). SAAS provides a statewide service serviced by a mix of VAO and paid staff. VAO operate from around 70 rural centres and paid staff from urban and major regional centres. Volunteers and career staff are not rostered together but do work with career teams at the scene of an emergency and often ‘split crews’ to ensure the best possible patient care outcomes. There are three levels of clinical practice within SAAS: Ambulance Officer, Paramedic and Intensive Care Paramedic. The majority of voluntqualified to the Ambulance Officer level, which requires completion of Cin Community Studies. This is completed over a 6 –12 month period throuprovided by SAAS in 5 weekends, 6 x 3-hour sessions, plus 21 sessions wown team. Volunteers can also progress to complete an Advance Care moallows volunteers to use extra skills (defibrillation) and use drugs under cSAAS Medical Officer (Vaughan 2002). These formalised sessions are facilitated by Medical Officers, IC ParamedParamedics, Volunteer Coordinators, Clinical Team Leaders (CTL), RegiLeaders (RTL) and Managers, and conducted on a yearly basis for each tetraining is usually conducted in a centralised location so that several teambenefit. All trainers are encouraged to have a Certificate IV in WorkplaceAssessment but this is not compulsory (Vaughan 2002). To reaccredit volunteers must complete 12 Core Topics set by the organis12-month period. These Core Topics are designed to ensure competency aAmbulance Officer level. There is not a set number of shifts for each indithe team is required to have a crew available 24 hours a day, 7 days a weeVolunteers who are absent from rostered duties for more than 6 months arto demonstrate that are competent prior to being rostered for shift. RTLs visit each volunteer team at least monthly for the purpose of educatsupport. All volunteer teams have a Volunteer Team Leader (VTL) and a Coordinator (TC). The VTL report to the Regional Manager as do the CTteams. Volunteers also have a network of Branch Committees and Zone Cwhich are made up of operational and non-operational volunteers. They hresponsibility to ensure service provision to the community is supported. representatives from each zone form a committee know as the Country AmService Advisory Committee (CASAC). This committee’s role is to advisAmbulance Board on issues that effect volunteers. The Ambulance Boardtwo volunteer representatives usually nominated from the CASAC (Vaug Volunteers are given one complete uniform whilst they are completing thCertificate IV Community Studies (Ambulance Officer). After completioncourse they are given another complete uniform. Most teams share wet wejackets and various sizes and quantities are available at each station. Voluthe same uniform as career staff. All uniforms are supplied at no cost to thSAAS also provides a comprehensive range of reimbursements to VAO; f

eers are ertificate IV gh training ithin their dule, which onsult with a

ics, onal Team am. This s can Training &

ation over a t

vidual but k. e required

ion and Training L of paid ommittees,

ave Two

bulance e the also has han 2002).

eir of the ather

nteers wear e volunteer. ar more

13

than other services, which include meals, travel for call-outs and training, medicals, lost income (including for self-employed) and childcare.

St John New Zealand Ambulance New Zealand represents the collective interests of the ambulance service operators in New Zealand, though 90% of New Zealand ambulance services are provided by St John New Zealand, with a few other smaller operators working in certain geographic regions. St John is divided into five regions for management of services and has 2000 VAO providing ambulance services working either in units with only VAO or alongside paid staff. As with the Northern Territory VAO are classified using the same structure as paid staff. The classifications are: • Primary Care • National Certificate in Ambulance • Intermediate Care Officer • National Diploma in Ambulance (paramedic) VAO are expected to meet roster requirements, which vary between regions, with some expecting one twelve-hour shift per week, and others one or two shifts per month. These requirements are stated, but not rigorously enforced (Dodd 2002). St John New Zealand provides training based on classroom block courses, extramural study and on the job training. Trainees gain credits and the National Certificate in Ambulance requires the equivalent of one year full-time study. Most staff join St John with the pre-requisite first-aid certificate, and gain qualifications as they increase their volunteer experience. The National Diploma in Ambulance is “reserved generally, not exclusively, for paid staff” in metropolitan areas who have exposure to sufficient work experience to maintain skills (Dodd 2002 p 1). In addition to this certification VAO must complete annual clinical skills validation, maintain professional standards, and attend twelve training meetings per annum. Trainers are generally expected to have current ambulance officer qualifications, as well as adult teaching and assessment qualifications. This can vary between regions, and some remote stations may run their own training. In these cases VAO need to attend a major centre for regular courses. A uniform is mandatory for VAO, though provision by the service can vary by region, and VAO may be expected to provide some part of their uniform. Wet weather gear is shared. Reimbursement policies also vary according to region, and local committees may not have the funds to implement policies (Dodd 2002 p 3). The service offers meals as an incentive and also discounted Healthcare Insurance, though anecdotal evidence suggests this may not be commonly known. Volunteer and paid ambulance officers work under the same management structure with a Team/ Watch Manager (paid or volunteer) being responsible to a Station Manager (paid or volunteer), who are responsible to an Area/District Manager, and then the Regional Services Manager.

14

Background

The evolving role of Ambulance Services and VAO The provision of ambulance services in Australia is the responsibility of State and Territory governments, resulting in several different models of delivery of ambulance services throughout Australia. New Zealand ambulance services are largely provided by a single ambulance service – St John New Zealand’s Ambulance Service. In the last one hundred years ambulance services have grown along with other health services into organisations responsible for providing pre-hospital medical emergency care and transportation for people who require intervention due to accident or illness. Service provision encompasses the traditional ambulance, but may also include helicopter retrieval, and Royal Flying Doctor Service for emergency medical evacuations. It wasn’t until the mid 1960’s that the more formal pre-hospital care systems we know began with the initiation of emergency technician and paramedic training programs, and formalised trauma care systems. Since that time attempts to improve outcomes for trauma victims and medical emergencies have increased the focus on the pre-hospital care and speed of delivery to appropriate medical care. This has seen the role of ambulance personnel increase in complexity and responsibility concurrently with increasingly sophisticated ambulances. In the early 1900s an ambulance was basically a taxi that might be a simple two wheeled 'Ashford litter' pushed along the road by four men, or a horse drawn carriage. The earliest motorised vehicles were designed to provide basic first-aid, and “would have held two stretchers with rubber mattresses, a box of bandages and splints, a bottle of brandy and a bottle of smelling salts” (The Order of St John ). Now an ambulance is an advanced life support facility able to sustain life, with most ambulance services considering helicopters as an invaluable method of transferring patients quickly from the scene of an emergency to a hospital.

Problems for VAO Anecdotal evidence suggests that there are significant problems for VAO in ambulance services including: • High time requirements for training as VAO work

requires a high level of training to cope with a wide range

• cies than other

•

• ents to major regional base hospitals for definitive care.

of medical emergencies, Greater frequency of call outs for emergenemergency services reliant on volunteers, High likelihood of response to emergencies involving friends, relatives and neighbors, and Long call out times to transport injured pati

The evolving role of the ambulance officer, due to medical and technological advances, increasing community expectations and the threat of litigation, have

15

contributed to the increased training requirements. Ambulance officers must now holsome formal qualification, with levels ranging from a basic qualification through to advanced paramedic status. Their level of training strictly regulates their acambulance services set their own training standards and so standards vary. Advancements in pre-hospital patient care particularly for medical emergeas cardiac arrest and asthma have had an impact on the training and skill requirements of VAO. For example, the introduction of semi-automated defibrillatohas provided VAO with technology that allows them to defibrillate patients in the field, but bring with them requirements for extra training and regular reaccrediThe rapid advances in medical care in the last half century have also changed community expectations. When complica

d

tions, but

ncies such

rs

tation.

tions arise, or a person dies many in the ommunity look for someone to blame.

d

t

e litigation threat may increasingly be a deterrent to potential or existing olunteers.

r

with

ed

ired, but they aim to

rovide workplace focused, competency training with flexible provision (Stone 2001

r ding, as do many of the other external pressures on volunteers in emergency

ervices, such as sociodemographic changes, are beyond the control of ambulance services.

c The threat of liability is very real for the volunteer and throughout the western worland one recognised by the United States Congress in 1997 with the introduction of The Volunteer Protection Act (Smith and Dunlop 2001 p.5). Congress acknowledged that the threat of litigation was a deterrent to volunteers and was creating recruitmenand retention difficulties for volunteer organisations. Threats from legal liability in Australia can come from several directions including negligence, trespass, Occupational, Health and Safety laws (OH&S) and criminal prosecution (Smith and Dunlop 2001). Whilst the legal system in Australia is seen as sympathetic to volunteers thv The changing environment has increased the need for VAO training. Some services have the same training categories foVAO as paid staff and others have a minimal level that allows volunteers to drive the ambulance and assist equipment and support type activities from ambulance to patient. There is little comparison or understanding of whichmethod is better or more sustainable, but the external pressures have gradually driven all services to increasstandards. Some ambulance services have taken up the Australian Qualifications Framework, which has refocused over the last ten years to a more competency based, nationally consistent and recognised training (Stone 2001 p.6). Other services are still working towards incorporating training within this national framework. The use of training packages are still new to emergency andambulance services and a lot of further work appears to be requpp.7). Training requirements and the threat of litigation are only two of the many pressures impacting on VAO and causing changes in their roles, risks and expectations. These changes may be impacting on the recruitment and retention of VAO and need furtheunderstans

16

Health status and socio-demographic changes in rural areas. An important external pressure on emergency services is the phenomenon of rural decline, marked by economic difficulties, decreasing services and shifting populations. Rural ambulance services though, remain important, as people living in regional, rural and remote areas account for 30% of Australia’s population. Over three-quarters of these live outside large towns in scattered small towns and settlements (National Rural Health Policy Forum and National Rural Health Alliance 1999). Those living in rural and remote areas have poorer health than those living in metropolitan areas. “Mortality and illness levels increase as the distance from metropolitan centers increases” (Australian Institute of Health & Welfare 2000 p.223) Rural populations tend to have higher rates of health risk factors and death rates that “show a graduated increase with increasing remoteness” (Australian Institute of Health & Welfare 2000 p.225). Of particular note are the higher incidences of admission to hospital, and of death, related to injury, asthma, and suicide. The rate of avoidable deaths in rural areas is 40% greater than in urban areas (Bryant and Strasser 1999). This higher evidence of illness and disease is not the only problem for rural communities Demographic changes are also impacting on rural communities. An ageing population that has a higher incidence of disability as a result of longer life is pressuring health services (Hugo 2001 p.6) Rural communities have seen closures of banks, schools and hospitals in the current climate of economic restructuring. Increased pressure for maximum productivity have meant many employers, once supportive of emergency service volunteers, now cannot afford to have employees abandoning work to provide emergency services. There is much talk of the rural decline, and changes in the employment base of farming communities have impacted on the age structure in rural communities by leaving little employment for younger people. Societal changes over the last half-century mean that most individuals have less leisure time, and/ or more leisure time options. More women are employed outside the home and the population is more mobile lessening the support available from the extended family. All these factors combine to pressure the volunteering sector and change the traditional face of volunteering. But some argue that volunteering is not in decline, but in fact on the increase (Australian Bureau of Statistics 2001). If this is so, then it may be that volunteering is shifting focus, not declining, and it is important that emergency services shift with the volunteer workforce to prevent declining numbers.

Volunteers The definition of a volunteer can be problematic, but a commonly accepted definition will include the key points that volunteers act of their own free will, without pay, to contribute something to society. A common example of an overarching definition is this.

“Volunteering is the commitment of time and energy, for the benefit of society, local communities, individuals outside the immediate family, the environment or other causes.

17

Voluntary activities are undertaken of a person’s own free will, without payment, except for the reimbursement of out-of-pocket expenses. “ (Volunteering Ireland 2001).

This definition, though, can be too broad, capturing those individuals who act in a neighbourly manner, for example regularly put out the garbage for an elderly neighbour. This project used the more exclusive definition of formal volunteering:

Formal volunteering is an activity which takes place in not for profit organisations or projects and is undertaken: to be of benefit to the community and the volunteer; of the volunteer's own free will and without coercion; for no financial payment; and in designated volunteer positions only(Volunteering Australia Inc 2002).

Despite lack of payment being considered a key part of the volunteer definition this project included those ambulance officers from RAV who are paid a small amount for call-out, as in all other respects their situation is similar to other VAO.

Organisations use volunteers, as by definition, they do not demand any payment for the work that they do. Volunteer involvement allows organisations to extend their limited budgets, or allows the provision of services in situations that would otherwise not be viable. Emergency services like other volunteer-based organisations are struggling to maintain their capacity and capability to service communities in need. Recruitment of new volunteers is difficult and there are problems retaining existing volunteers because of a variety of factors. Those such as the impact of socio-demographic changes are known but internal factors such as training and support needs have a role in retaining and recruiting volunteers. The lack of data on volunteers involved in emergency services limits the ability of organisations to understand basic trends and to plan strategically (Reinholdt and Smith 1998). For example, despite the majority of emergency service organisations claiming their databases were adequate most could not provide information on the male to female ratio, or the composition of volunteer membership over the last ten years (Reinholdt and Smith 1998). This lack of data regarding emergency service volunteers is very real, with estimates of the number of emergency service volunteers in Australia ranging from 200,000 to 400,000 (Australasian Fire Authorities Council 2001 p.14). Correct information is essential if Emergency Services Managers are to plan strategically for the maintenance of capacity and capability into the future. Research, and capacity building, depend heavily on reliable and accessible data. The lack of emergency services data, when combined with the expected drop in volunteering (Emergency Management Australia 1999) could seriously impair Australia’s capacity to be prepared for, and respond to, emergencies.

Successful Volunteer Groups A volunteer group can be defined as “the aggregate of all individuals who have a positive interest in some collective good” (Marwell and Oliver 1993 p.18). It is important to understand the dynamics and interactions that affect the functioning of these groups as a whole because this allows development of strategies aimed at

18

strengthening volunteer groups. “Interdependence, communication, organisations, and social processes are central to collective action” (Marwell and Oliver 1993 p.52). Individuals acting in isolation will never adequately provide public goods, such as ambulance services. An important component of volunteer action is group efficacy, which refers not only to the effectiveness of the group, but the feelings that arise from contributing to an effective group. Marwell and Oliver identified three core elements of successful volunteer group: motivations, organisers and resources (Marwell and Oliver 1993). These elements need to blend to allow the viable functioning of volunteer groups. In any group there are those who are more committed than others, some are passionate, others half-hearted. Many volunteer groups survive because of the “sheer will and perseverance” of a few key members (Fitch 1994 p.41). These key members will act as coordinators who maintain the communication links between members of the group, and therefore ensure the continuing functioning of the less committed. Ambulance services all rely on the volunteer coordinator role. Research has highlighted the importance of the social networks and organisational resources of the most interested members of a group (organisers), to the health of the whole group (Marwell and Oliver 1993). If these key members have a high level of motivation, ample resources of time, money and skills, and the social connections to act together, then the whole group will benefit. However, if these key members have limited resources and only moderate levels of motivation, the group will suffer (Marwell and Oliver 1993). Overall, with a committed coordinator, high levels of motivation, and adequate resources, a volunteer group can function well.

Volunteer Support Organisations Volunteer support bodies within Australia, and internationally, are entering a stage of consolidation and cooperation. They are working with governments to develop partnerships that provide supportive environments that prevent exploitative practices within volunteer organisations. It is becoming clear that volunteers must have reciprocation if they are to continue giving freely of their time and labour. The exchange relationship hinges on providing volunteers with the things that motivate them and a supportive environment. Volunteering Australia is the peak volunteering organisation in Australia representing all volunteers, with each state and territory having a state volunteering body. VAO organisations though are few and have yet to develop to a national focus. VAO in Tasmania and Western Australia have Associations of Volunteer Ambulance Officers to represent all VAO at a state level. SAAS does not have an association, but has a unique committee structure that allows volunteer representation at all levels of management, including two representatives on the Ambulance Board. The International Year of the Volunteer 2001 provided an impetus for addressing volunteer issues. Volunteering Australia carried out an extensive consultation process in 2001 to prepare an agenda for volunteering into the future (Volunteering Australia Inc 2001). This document is not organisation or sector specific, but highlights significant volunteer issues that cross organisational and sectoral boundaries. Emergency Management Australia organised and financed a summit on volunteer issues for all sectors of the emergency services with key issues identified as legislation/protection, training, funding and recognition (Emergency Management

19

Australia 2001 p.3). This important summit has led to the formation of a peak body to represent all emergency service volunteers and address issues at a national level.

Summary Changes in sociodemographics, cultural expectations and volunteering are focusing emergency service managers’ attention on supporting volunteers. Increasing pressures and training requirements have arisen for VAO because of the developments in health care, technology and community expectations. Ambulance services need information to enable strategic planning to assist VAO recruitment, retention, training and support.

20

Research Findings and Implications

Section 2

21

22

Who Volunteers? 1.1 Findings Volunteer rates differ slightly between male and females, with women making up 55% of the VAO population and men 45% (See Table 2). People of all ages from 18 years up work as volunteers, with 60% being in their 30s and 40s (See Table 3). The majority are married/partnered (81%) with dependents (54%). Table 2: Sex Profile of Australian and New Zealand VAO.

Sex

452 45.0

553 55.0

1007 100.0

SexMale

Female

Total

Frequency %

Table 3: Age groups of Australian and New Zealand Volunteers

he majority of VAO are employed, with 54% working full-time and 29% working r

Age

34 4.4

64 8.3

94 12.1

112 14.5

127 16.4

128 16.5

104 13.4

56 7.2

55 7.1

774 100.0

Age18-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

>60

Total

Frequency %

Tpart-time. Only 2% identified they were unemployed, and 14% were not in the labouforce. The largest industry category identified by employed respondents was ‘other’ (31%), followed by business/professional (21%), health (19%), environment/farming(13%) and education/training (9%) (See Figure 6 appendix 3).

23

Thirty-six per cent of respondents had completed high school, 16% completed HSC, 17% completed a trade certificate, 23% completed a diploma/degree and 6% completed postgraduate study (See Figure 7 appendix 3). The majority of respondents come from towns with populations of fewer than 5,000 (64%), though the Australian result of 79% was significantly higher than New Zealand’s result of 47% (See Figure 1 for the overall result). This reflects the more prevalent use of volunteers in rural areas compared to urban areas.

How many people live in your town?

How many people live in your town?

> 100,00025,000-99,999

10,001-24,9995,000-10,000

< 5000

Perc

ent

70

60

50

40

30

20

10

0

Figure 1: Population size of respondent’s town

VAO are also active in other services, with 33% volunteering for a second emergency service, and 7% volunteering for a third emergency services.

1.2 Discussion VAO have similar characteristics to Australia’s general volunteer population, perhaps more than with other emergency services. Women are more strongly represented than men and those in paid employment are more likely to volunteer than those who are unemployed or not in the labour force (Australian Bureau of Statistics 2001 p.2). Australian volunteers have the highest rate of volunteering between the ages of 35-44 years, which reflects involvement with school and sport volunteering activity. VAO also have this as their highest participating age group, closely followed by ages 45-54 years. By understanding the characteristics of VAO, ambulance services can plan strategically to service the current population of VAO, as managers now understand that most VAO are juggling jobs and families. Expectations such as committing all annual leave to training can look unrealistic and unsustainable in light of such knowledge. VAO throughout Australia and New Zealand have many similar

24

characteristics giving them strong identity as a group. This information allows management to plan strategic recruitment activities, such as identifying potential recruitment targets from under-represented population groups. Management needs to understand why young adults, unemployed people, and older retirees, are not attracted to VAO work. What could ambulance services offer these groups in return for volunteer work? Are there elements within the VAO system that exclude these people? By understanding the VAO population management are able to plan strategically for recruitment and retention.

1.3 Recommendations VAO should recognize they form a distinct group of emergency service volunteers. Within each jurisdiction VAO should establish mechanisms for representation of their collective interests in matters of policy and change at organisational, state, national and international levels. The Convention of Ambulance Authorities (CAA) should provide a forum to address VAO issues at the national level that includes VAO representation. This forum could monitor and contribute to national events affecting emergency service volunteers, such as tax issues, legislation, and insurance, and support and provide representation to Australian Emergency Management Volunteer Forum. Ambulance services should ensure they collect and analyse data on volunteers using a standardised format. These data should include volunteer demographics, volunteer motivations, and attitudes to rewards, and be reported through the CAA to enable strategic planning.

25

What is the value of the time VAO contribute?

2.1 Findings The median number of hours per month that respondents volunteered for ambulance services are as listed:

• Training = 6 • On Call = 96 • Call-out = 10 • Administration = 1 (mean = 4, but 40% of VAO do zero hours of

administration)

2.2 Discussion The estimated hours of commitment provided by VAO allow us to begin the process of defining the economic value of VAO to ambulance services, governments and communities. The median hours of service provided by VAO every month, when multiplied by 12 provide an average figure per VAO for hours in training (72), on-call (1152), and responding to call-outs (120). A total of 1,344 hours per annum compared against the ABS figure for general volunteers of 75 hours (ABS 4441.0 p.5) shows that VAO contribute time well above other volunteers. This major contribution to the health and wellbeing of our communities is well worth recognition, and yet has remained a hidden contribution until now. There is an increasing understanding that volunteers are a valuable asset within communities, and consequently a need to define volunteers in monetary terms.

An international comparative study found that in 22 industrialised countries the non-profit sector accounted for 5% of total paid employment, and in addition had “10.4 million full time employees as volunteers” (Anheier 2000 p.3). In Australia efforts to calculate the cost benefit of volunteers are limited by the confusion around the definition of a volunteer and the lack of data. Stringer suggests the total economic benefit of emergency service volunteers to Australia is more than three billion dollars per annum (p4). Ambulance services have begun to look at formulas for estimating the benefit of using VAO in service provision, whilst calculating the cost of volunteers, but have not yet agreed on a formula. TAS, using one model, has calculated the cost of paying VAO for current services to be $2.3 million per annum (Lennox 2002), and SAAS have estimated the cost of replacing VAO services with fully paid staff at $27 million per annum (Lemmer 2002). RAV developed two models to calculate the value of paying or replacing VAO with results of $6 million and $17 million respectively. St John Ambulance WA estimates that its ambulance volunteers provide just less than three million hours of volunteer time per annum (WA 2002). Obviously VAO contributions are significant, even though services have no shared method for measuring their value.

Using the median VAO hours contributed per annum gained from the survey we developed a method for estimating the overall monetary value of the VAO input in Australia. This method calculates paying VAO at the lowest ambulance officer rate for the time committed as per the survey results and was based on that used by TAS in

26

its economic assessment (Lennox 2002). This method was chosen over others as it was made possible by the data collected in the survey, but the method choice was a contentious issue.

The steps were:

1. An average of the lowest ambulance service pay rates was calculated.

2. This figure was given a 40% loading for call-out to include penalty rates, payroll tax, and superannuation ($21.59), for training a 20% loading was applied to the averaged hourly rate ($18.50), and an on-call rate of $1.97 per hour was used (the same proportion of the hourly rate as for TAS).

3. These figures were then multiplied by the annual hourly contribution of VAO times the number of VAO per jurisdiction. Annual values per jurisdiction divided into training, call-out (case attendance) and on call are:

RAV Training ($466,200); Call-out ($906,780); and On-call ($794,304) = Total ($2,167,284)

TAS Training ($532,800); Call-out ($1,036,320); and On-call ($907,776) = Total ($2,476,896)

QLD Training ($479,520); Call-out ($932,688); and On-call ($816,998) = Total ($2,229,206)

NT Training (54,612); Call-out ($106,222); and On-call ($93,047) = Total ($253,881)

WA Training ($2,877,120); Call-out ($5,596,128); and On-call ($4,901,990) = Total ($13,375,238)

SA Training ($1,864,800); Call-out ($3,627,120; and On-call ($3,177,216) = Total ($8,669,136)

AUSTRALIA TOTAL =AUD$ 29,171,641

Total figures for all jurisdictions value VAO contributions of time in Australia at $27 million per annum. More detailed economic analysis would no doubt show these figures to be inexact, and we believe these to be modest estimates, as they do not calculate the monetary contribution of VAO for such things as petrol, training books, and lost earnings. This method may be criticised as being an underestimation of the value of VAO services, and we acknowledge they represent the minimum value of VAO. The monetary value of the VAO contribution could be far more as a comparison of our method (less than $9 million for SA) with the SAAS method ($27 million for SA) shows (details of the SAAS method Appendix 2). If the SAAS method had been used then the monetary value of VAO would be three times our calculations, for Australia that is $90 million. This highlights the need for a consistent approach to valuing VAO contributions.

Understanding the economic contribution of VAO to their countries is an important form of recognition. However, it is extremely important when talking about the financial value of volunteer contributions to remember that volunteers are not free, though they provide good value (Brown 1993)). Emergency volunteers are poorly resourced and the three levels of government do not effectively coordinate financial support (Australasian Fire Authorities Council 2001 p.6). The cost of supporting VAO is often poorly recognised in service budgets, and lost amongst the provision of support to paid staff. If ambulance services can calculate the cost/benefit of VAO, then governments and communities will be able to clearly see the benefits in funding adequate training and support. VAO contributions must be calculated and publicised.

27

2.3 Recommendation The CAA and governments should publicly recognise VAO as a valuable part of the ambulance services. This recognition needs the development of a standardised method for calculating the cost/benefit of VAO contributions, development of equitable tax deductions and/or rebates for VAO, and long-term funding arrangements that acknowledge the costs of supporting VAO. Governments should recognise the valuable contribution of VAO to health and emergency services, and adequately fund and support necessary organisational systems to ensure the long-term survival of volunteering in ambulance services.

28

What motivates VAO to volunteer? 3.1 Findings VAO become volunteers for a variety of reasons, but ‘assisting the community’, ‘gaining a sense of achievement’ and ‘learning new skills’ are identified as the strongest motivations for the majority of respondents (Table 4). Table 4: VAO motivations for volunteering.

or joining an ambulance service (Table

able 5: VAO motivations for joining an ambulance service

tial for

.8 3.0 8.6 22.5 64.9 1011

6.4 13.2 30.0 27.5 22.6 1002

26.9 17.3 21.3 13.3 21.2 988

1.3 2.3 9.9 27.4 59.0 1003

.1 .4 5.7 16.5 77.0 1015

20.9 21.6 27.8 17.9 11.7 983

4.8 10.9 26.4 30.2 27.5 1000

9.0 12.0 22.6 26.1 30.1 1007

Learning new skills

Meeting new people

Improving employmentprospects

A sense of achievement

Assisting thecommunity/helping others

Excitement

Being part of group/friendship

Gaining self-esteem

%

Not at all

%

Not

%

Average

%

Above

%

Very

Frequency

Total

Responses to the question about motivations f5) reinforce the volunteering motivations, as interest in the first-aid/medical field and ‘the station needed more volunteers to continue’ were the most important motivations for the majority of respondents. T

Comments from VAO also reinforced the major motivations as helping the

22.4 21.5 28.9 14.6 12.6 915

45.0 20.6 18.1 7.8 8.4 916

54.4 10.7 10.8 10.1 13.7 917

46.8 7.7 9.2 13.6 22.5 927

44.8 10.5 13.1 11.9 19.6 908

25.3 8.1 12.3 17.2 36.9 935

2.8 4.2 12.9 19.7 60.2 989

The local ambulance groupstood out in the community

I has seen the VAO in actionand it prompted me to join

I had friends or family whowere members

A representative of theorganisation asked me to join

The organisation advertisedfor volunteers

The station needed morevolunteers to continue

I am interested in themedical/first-aid field

%

Not at all

%

Not

%

Average

%

Above

%

Very

Frequency

Total

community, gaining skills and contributing to an effective service. The potenVAO to progress to paid employment was also highlighted by the comments section,showing that though the majority do not volunteer for this purpose, it is an important motivation to some. As a motivation it was particularly noticeable in the comments

29

section coming from jurisdictions that offer more opportunities for paid employmentsuch as Queensland. Some comments that highlight the motivation elements are reported below.

,

oined service to contribute to small community, and found it more personally

well-run ambulance service is important for our small town with ageing population.

oined because of community need.

feel privileged that I am able to be part of an organisation that makes a difference.

s a volunteer full-time employment should be more obtainable if you have proven

eople belong because of what the organisation does for the community and an

3.2 Discussion ve often been the basis of volunteer theory and research, and

rt

aslow’s Hierarchy of Need Theory is often used by volunteer managers to explain

helter, ns

owever, the major motivation identified by VAO is assisting the community, and

d work

ir

t

Jrewarding than had expected. A J I Acompetent. Pinterest in the medical field.

Volunteer motivations hain emergency medical services it is felt that if motivations can be understood then organisations will be able to attract more recruits (Olson 1965, Marwell and Oliver1993, Reinholdt and Smith 1998, Aitken 1999). The mix of motivations identified byVAO show that individuals have more than one reason for contributing their time and effort to ambulance services, and it is unrealistic to look for a single motivation. It seems probable that different motivations reinforce each other. The findings suppothe changing views of volunteer motivation, which in the past assumed that volunteerswere meeting their own needs. More recently civic participation is being recognised as a major motivation. Mvolunteer motivations within a framework of personal gain and meeting personal needs (Swan 1991 p.47). Maslow’s theory represents individual needs in a hierarchical structure moving from food and water through to the need for saffection, self-esteem and self-actualisation (Kaplan and Sadock p.189). Motivatiosuch as learning new skills, gaining self-esteem and a sense of achievement fit within this structure. Hthis needs stronger acknowledgment by ambulance management. Community engagement allows individuals to identify as part of the broader community anfor the benefit of others (Bell 1999, Phillips n.d.) and provides individuals with the sense that individual action is important. Whilst it is important that volunteers and their organisation have a good image within the community to assist recruitment it seems that it is also important that they have interaction with, and support from, thelocal community to improve retention. Aitken (1999, p. 21) identifies that volunteer fire brigades within Western Australia that have close links to, and a high profile within their local community, have fewer retention problems. Philips identifies tha

30

the sense of engagement with the community is an important motivator (Phillips n.d.It seems to be important that local communities have ownership of their local volunteer groups, and that networking and linkages occur with local municipaland other groups to reinforce motivations and provide recognition.

).

ities

otivation will be reinforced by the ability of the group to effectively achieve its e

ith

3.3 Recommendation

bulance services should work to reinforce VAO motivations and provide a

Mgoals and management must assist this process. VAO who feel they are assisting thcommunity by learning new skills are as a result gaining a sense of achievement. All these motivations will be reinforced by the provision of an effective ambulance service by VAO who are happy with their role. This requires a sense of linkage wthe community, provision of appropriate training and other important forms of organisational support.

The amreciprocal relationship with VAO. This would require creating stronger links with communities, assisting VAO to learn new skills, ensuring the VAO role provides asense of achievement, and continued research.

31

What factors affect retention? 4.1 Findings The activities enjoyed by respondents were thematically coded and are listed with numbers representing the count of times they were cited (Table 6). They showed that training and skills maintenance were the most frequently cited type of enjoyable activity. Comments around helping people and patients were the second most frequently cited activity. Table 6: Activities enjoyed by VAO

O activities difficult’ were coded and are listed

624 29.4

376 17.6

264 12.4

246 11.5

141 6.6

114 5.4

84 3.9

77 3.6

68 3.3

53 2.5

36 1.7

35 1.6

10 .5

2129 100.0

Activities Enjoyed by VAOTraining and skills maintenance

Helping people, patients

Call-outs, on road work

Friendship and being member of a group

Meeting members of the public as a VAO

Social events

Drving, work around the station

Other

Job satisfaction and sense of achievement

Coordinating operations and leadership

Case discussion and medical interest

Adventure and challenge

Getting qualifications and improving employment prospects

Total

Frequency %

Factors that ‘make involvement in VAin Table 7. Time commitments and poor relationships, were the most frequently cited difficulties. A new category was added for ‘lack of volunteers’ (Table 7) as this showed up as an issue during review of the data.

32

Table 7: Factors that make VAO work difficult.

cator of retention. Figure 2 shows a

587 37.9

174 11.2

118 7.6

113 7.3

105 6.8

54 3.5

52 3.4

43 2.7

35 2.4

19 1.2

247 16.0

1547 100.0

Factors that make VAO involvement difficultTime commitments

Poor relationships

Lack of organisational support

Inadequate provision of resources

Isolation (lack of training, professional support)

Lack of volunteers

Aggressive patients and distressing situations

Restricitons of being on call

Lack of support and rcogntion

No difficulties

Other

Total

Frequency %

The length of service of VAO is an important indihistogram of the Years as a VAO for respondents. After 2.5 years there is a decline in the length of volunteering, indicating that the peak period of attrition may begin shortly after this time.

How many years as VAO?

45.042.5

40.037.5

35.032.5

30.027.5

25.022.5

20.017.5

15.012.5

10.07.5

5.02.5

0.0

How many years as VAO?

Freq

uenc

y

400

300

200

100

0

Std. Dev = 7.18 Mean = 6.9

N = 1007.00

igure 2: Years as a VAO

nother indicator of problems with VAO recruitment and retention is the number of

F

AVAO indicating inadequate roster cover for the community. Only 32% of respondents always had adequate roster cover. The combination of VAO length of service and

33

inadequate roster cover information indicate a problem that is impacting on provision of ambulance services.

Adequate roster cover for the community

Adequate roster cover for the community

AlwaysOftenSometimesNever

Perc

ent

40

30

20

10

0

Figure 3: Respondents self-rated frequency of adequate ambulance roster cover for local community.

The comments were largely focused on issues that affect recruitment and retention, but training and support matters will be discussed in the following sections. Lack of VAO was a theme, and was further reflected in comments about VAO being pressured to contribute more time. My station officer expects too much time from the volunteers – most of us have families and work and we don’t need to feel guilty if we can’t cover every shift. Station in small country town struggles to get enough volunteer members. What is going to happen to the ambulance service when nobody volunteers anymore? In my town we have reached that point and our nearest backup is one hour away. It worries me! Fifty-six years old and just started training to keep service going – lack of volunteers. In tough economic times people have less time to volunteer. There is constant pressure from AO colleagues to volunteer more time, which intrudes on life outside the ambulance service. At busy times in small country areas great strain can be placed on families. Also stress on volunteers in tragic cases when most victims are known to the volunteer.

34

Another theme was of changing environment impacting on VAO roles and expectation, recruitment and retention. Some issues have been identified in the literature but VAO identify that changing expectations of the VAO role can cause difficulties. However, many comments reflected that VAO work is satisfying. Volunteers have become little more that fetch and carry people in the eyes of management…Some areas where volunteers have been devalued over recent years – Volunteers no longer able to fly in helicopters. Volunteers no longer able to drive ‘code one’ to jobs. Volunteers not permitted to answer telephone at station. I would suggest that the only way to overcome the [recruitment and retention] situation is to eliminate the concept of volunteers and replace it with a system of part time paid staff. It is a shame that volunteering for the satisfaction of the work is changing to the attitude of “I must be and should be paid for what I do”. Been fully committed and fulfilled since joining ambulance. Never been more driven to do anything.

4.2 Discussion The findings have identified that ambulance services do have recruitment and retention difficulties, which add to the stress for some VAO as they are asked to commit more time than they would like. The high turnover of VAO should be of concern to ambulance services as it increases the cost of providing a volunteer service. It is this that suggests ambulance services should give retention priority above recruitment, though both are important. Retention is an outcome of the volunteer experience within the organisation. This experience will be defined by the structures and behaviours, which typify the organisational culture, and despite its importance for volunteer retention, has received little attention from researchers (Reinholdt and Smith 1998 p.27). Retention of current volunteers benefits organisations by retaining expertise. “Recruitment would be a non-issue in many departments if they had good volunteer retention programs” (Halpin 1998 p.62). Whilst natural attrition is to be expected, many organisations in the United States are realising that retention is a major part of the solution to lower volunteer numbers (Federal Emergency Management Agency 1995, 1998, Halpin 1998). It is important to ensure that current volunteers are happy with their role to improve retention and recruitment, and VAO have identified that the training, helping people and call-outs are enjoyable aspects of the role. Ambulance services must be careful when making changes or decisions, that they understand how they impact on the VAO role. Poor relationships were also an important issue for some services, as one individual with inadequate interpersonal skills can cause a lot of discontent, particularly if they are in a volunteer management or coordinator role. Exit interviews, feedback mechanisms, and people skills training may all assist services in understanding and managing this issue, along with clear definition of roles. All personnel dealing with volunteers in a supervisory or management role should have training in volunteer

35

management. Relationship factors impact directly on VAO ambulance experiences, and if unsatisfactory, will be reflected in high turnover rates as dissatisfied VAO leave. VAO indicated that time commitments were the main issue that make VAO work difficult. This information along with the comments about expectations from the services, suggest that pressuring VAO to cover roster gaps is counter-productive and may cause VAO to leave the services. Management attention should focus instead on assisting recruitment. The most commonly used recruitment methods are word of mouth in Australia and New Zealand, though management literature suggest public displays; unpaid publicity; print media; and family contacts can be important (Hudgings 1988, Swan 1991, Federal Emergency Management Agency 1995, Reinholdt and Smith 1998). It is important that ambulance services have a recruitment plan that includes clearly defining the volunteers role, marketing the role, facilitating a quick response to individuals who express interest in volunteering, and ensuring prompt training and inclusion of volunteers who are signed up (Hudgings 1988, Morisey 1993, Halpin 1998, Glatfelter 1999, McDowell 1999). Marwell and Oliver use a model to highlight the benefits of gathering data that can increase the selectivity of recruitment (Marwell and Oliver 1993). Theoretically ambulance services will gain a greater return by recruiting fewer individuals, if resources target those likely to make a greater contribution. Activities that recruit large numbers of volunteers, such as the mass media, must be used alongside activities that target those who are likely to have the most interest and resources (Marwell and Oliver 1993, CyberVPM.com 2000). But to do this management must learn who these people are. Ambulance services are experiencing a high turnover of VAO, and are unable to provide adequate roster cover for all communities, all the time. This is causing increased pressure on VAO to contribute more time. Ambulance services must allocate funds to strategically and actively address retention and recruitment problems.

4.3 Recommendation The CAA should acknowledge that VAO have characteristics and needs in common with other volunteers and endorse the National Agenda on Volunteering prepared by Volunteering Australia Incorporated. This Agenda represents the interests of all volunteers within Australia (Appendix 1). The CAA should take action to urgently address retention and recruitment issues at a national level, which would include but not be limited to: • Developing best practice guidelines for VAO management to assist retention by

developing a supportive organisational culture. • Monitoring and reviewing the impact of legislation on the VAO role. • Developing best practice guidelines for recruitment of VAO. • Monitoring the level of ambulance service coverage provided by VAO for rural

and remote areas throughout Australia.

36

Which management and support services are valued by VAO?

5.1 Findings To understand which forms of support are most valued by VAO, the survey asked respondents to rate the level of importance of some well recognized management methods of recognising the importance of volunteers, and forms of organisational communication (Table 8). Responses were more evenly distributed across the methods for the management questions than for the support service questions (Table 9). A management contact person who is available and supportive was the one factor of above average importance to more than half of respondents. The opportunity to provide feedback to management and receiving training certificates were also very important to many respondents. Table 8: Importance to VAO of management support.

rvices. Adequate resources and

2.7 4.0 14.7 29.7 48.9

6.7 10.8 22.2 23.1 36.9

5.1 8.2 24.1 32.8 29.6

4.8 9.4 26.4 32.7 26.6

7.6 12.4 28.9 26.5 24.7

7.3 11.9 24.9 31.6 24.2

15.1 16.1 25.3 20.8 22.8

19.0 16.8 25.8 17.8 20.6

12.3 14.6 31.0 22.0 19.8

15.1 18.5 26.6 20.8 19.1

13.7 16.8 26.5 24.0 19.1

8.6 15.6 32.3 27.4 16.2

Management contact person isavailable and supportive

Receive training certificate

The opportunity to providefeedback to management

Receive organisationalinformation

Management staff visitvolunteer group

Public relations work withinlocal area

Receive letter ofcommendation

Receive National orAmbulance Medal

Receive some other form ofappreciation

Receive thank-you letter

Publicity in media regardingAmbulance Organisation

Social events organsied bymanagement/volunteers

%

Not at all

%

Not

%

Average

%

Above

%

Very

Table 9 shows the ratings for importance of support setraining are highly valued by the majority of respondents, but most support services are well valued, particularly those providing clinical support and occupational healthand safety.

37

Table 9: Importance to VAO of support services.

n relating to management support.

and

e

.1 .4 2.0 12.1 85.5 811

.4 .1 3.1 17.0 79.5 814

1.4 3.3 12.4 23.9 58.9 806

.9 1.7 7.9 30.7 58.5 810

2.0 3.0 11.7 28.0 55.4 813

3.5 5.2 15.5 22.0 53.7 806

4.6 6.5 18.0 22.8 48.1 813

3.2 8.2 21.4 26.9 40.3 807

10.2 14.0 25.1 19.6 31.1 810

52.4 9.4 11.9 8.1 18.1 712

Adequate equipment

Training

Paramedic assistance

Clinical feedback onsignificant cases

Adequate uniforms

Critical Incident StressManagement

Counselling services

Occupational Health andSafety

Reimbursement ofphone/meals/travel costs

Childcare

%

Not at all

%

Not

%

Average

%

Above

%

Very

Frequency

Total

Several themes emerged from the comments sectioThey showed that VAO want to be valued as an important part of the ambulance service, with their skills, achievements and effort recognised. They wish to be recognised promptly for the level of training attained, for qualifications within outside the organisation, for skills and for years of service. There were comments across most services about disappointment with the level of recognition given in thYear of the Volunteer to VAO. VAO indicated they want a genuine respect and wish to be treated equitably with paid staff, particularly in services where qualifications arethe same. Genuine recognition and valuing were seen in terms of attitudes from management and paid staff that valued the VAO role. eed integration of volunteer and career staff. Better recognition of prior learning (I

ome paid staff criticise volunteers in front of other people. “Look down their noses.”

think the paramedic’s attitude should be different; we’re all there for the community,

am not alone in being very disappointed about how little acknowledgment there was

he average citizen does not ever think about the fact that they are being helped by

ommunication was the other major theme emerging from the comments. Many

d

Nam a doctor yet cannot perform many paramedic level skills while in the service, many nurses in the same position). S I not ourselves, glory or excitement. We all help the public. I for vollie ambos in 2001 – the year of the volunteer. Tvery well trained volunteers – I feel it should be brought to their attention. Ccomments centred on VAO wanting management to communicate with VAO more and to assist feedback. Communication needs centred on the need for more personalmanagement, the need for performance management for paid and supervisory staff, and the need for management to understand VAO perspectives. Some VAO indicate

38

they were happy to participate in the survey as it was a form of feedback, for some, their first opportunity to provide an opinion, and many were interested in feedback from the survey. I have observed that the biggest single factor in maintaining skills and sense of

tation officers need to do a management course on how to be a manager and how to

hank you for taking the time and effort to ask.

raining for 1 year but don’t know if volunteer ambulance officer yet – no certificate

AO identified that clinical support services where the most important matters for

n

5.2 Discussion

he VAO have identified that it is the provision of professional support services that

l

re. to

anagement support services were less likely to be rated as very important by VAO,

nagers

lpin

r ,

r

purpose and achievement is to have supportive/available line managers. Shandle staff before they are appointed. T Tor confirmation. Vthem, but few comments related to these issues. The major clinical issue mentioned was gaining clinical experience by working with city ambulances, with some mentioalso of adequate uniforms and reimbursement.

Tthey most value after adequate equipment and training. These important support services maintain group efficacy and function, and require financial and personneresources from the volunteer organisation. Paramedic assistance and clinical debriefing, all help the VAO to perform their role and provide professional caThese data support the importance to VAO of providing good ambulance servicestheir communities, but also indicates organisational cultural factors that impact on theVAO experience. Mbut factors related to communication within the organisation were still rated as important by the majority of VAO, particularly access to support personnel. Maneed to ensure that VAO are included in the communication loop of the organisation. Good communications validate VAO as an important part of the ambulance service, and consequently are an important form of recognition. Management literature identifies that managers must ensure volunteers are appreciated and receive the recognition they deserve from within the organisation and the community (Garza1991, Swan 1991, 1991, Federal Emergency Management Agency 1995, 1998, Ha1998, Howard 1999). Recognition can reinforce a volunteer’s motivation and provide a return, by giving praise and a feeling of increased self-esteem. Recognition is discussed in terms of saying ‘thank you’, certificates of achievement, publicity, oeven schemes such as ‘volunteer of the month’ and progressive awards (Swan 19881991, Bernier 1995). However, VAO identify these as less important than having access to supportive management staff and co-workers, who value the role of the VAO. Recognition programmes should focus first on valuing the role of the VAO within the organisation, and addressing VAO concerns. Having key contact staff fo

39

volunteers who will treat the volunteers with respect and dignity will assist this process. Good communication with volunteers should not be a top-down feeding of

ests in

t are

he most commonly offered reimbursements are phone call; travel costs; meals; d of

Agency

olunteers have many support needs such as clear guidelines, job descriptions, and

ion.

5.3 Recommendation

he members of CAA should share information regarding the success and failure of

information, but have mechanisms that include the volunteers and their interorganisational planning and management (Federal Emergency Management Agency1995, Aitken 1999, Howard 1999). VAO need systems for regular feedback to management, as face-to-face opportunities for communication with managemenlimited. Poor communication increases the problems of isolation, which in turn lessens the VAO feelings of involvement in a successful environment. Tinjuries; postage; training, and uniforms. Further understanding needs to be gainewhich are the most valued services and reimbursements, ensuring VAO can easily access these, and the impact of reimbursement policies on the volunteering ethos. Recognition, community engagement, incentives, and reimbursement are all recognised retention strategies (Swan 1991, Federal Emergency Management1995, Halpin 1998). Vstandard operating procedures, to ensure high standards of care (Howard 1999). But our findings highlight the importance of communication and clinical support that ensure VAO have good experiences while volunteering, which will improve retentManagers need clear policies and standards; national competencies for volunteer management and the appropriate organisational systems to ensure VAO have a recognised place in ambulance organisations into the future.

Tmanagement support initiatives for VAO to develop best practice guidelines for VAOmanagement. These guidelines should include clinical support services that provide equity in the treatment of VAO and full time paid staff, good communication practices, and forms of recognition that validate VAO service.

40

What about VAO training? 6.1 Findings The major motivations and activities enjoyed by VAO highlight the importance of training to VAO. The training section of the survey aimed to establish the elements present in training, the frequency of training for VAO, whether training meets the basic needs of VAO, and whether VAO would like changes. Table 10: VAO training frequency per jurisdiction.

ach jurisdiction receive training.

able 11: VAO rating of frequency of training events.

olunteer trainers training volunteers having the highest percentage wanting a in

wanted

debriefing, and internet access.

Location * Training frequency Crosstabulation

% within Location

100.0%

3.0% 97.0%

9.5% 14.3% 23.8% 52.4%

83.9% 16.1%

9.5% 70.2% 16.7% 3.6%

33.3% 43.4% 11.2% 11.8%

44.1% 33.1% 12.8% 9.7%

NT

Vic

Qld

SA

WA

NZ

Location

Total

Weekly Fortnightly Monthly Other

Training frequency

Table 10 shows how often VAO respondents in eMost receive training weekly or fortnightly, other than Victorian VAO (97% train monthly), and Queensland (52% indicated ‘other’). Table 11 shows the relative frequency of training events. T

Only a few VAO wished to have less frequent training in specified events, with

4.2 37.7 29.4 28.2 795

5.4 20.9 43.0 30.5 783

1.0 22.6 52.5 23.7 798

3.9 34.0 43.1 19.0 794

10.2 55.9 24.7 9.0 785

7.0 59.8 23.5 9.6 782

Formal training with a qualifiedtrainer

Volunteers training/assistingvolunteers

Equipment practice

Skill checking/competencyassessment

Station paperwork and business

Socialising

%

Never

%

Sometimes

%

Often

%

Always

Frequency

Total

vdecrease (15.3%). Instead VAO wanted either more training or the same amount almost equal proportion in most training areas. The exceptions were that VAO the same amount of volunteers training volunteers (67.1%) and socialising (68.4%) (Table 12). Table 12 shows that around half of the VAO respondents would like more formal training, equipment practice, skills maintenance training, along with case

41

Table 12: VAO desired changes in frequency of training events

Less

The figures per jurisdiction will be provided to the relevant ambulance managembut Table 12 provides an average of VAO training changes desired. These results

.3 42.8 56.7 794

15.3 67.1 17.7 780

.1 49.3 50.4 797

.9 49.2 48.9 786

.5 48.9 49.4 783

5.0 68.4 25.1 773

.9 46.1 51.5 777

4.0 39.4 55.6 719

Formal training with aqualified trainer

Volunteers training volunteers

Equipment practice

Skills checking

Skills maintenance training

Socialising

Case debriefing

Internet access

Same Amount More Total

% % % Count

ent,

ow some marked differences per jurisdiction, and clear patterns showing the match

l

shbetween frequency of event and desire for change. For example 84.8% of Victorian VAO indicated they always have formal training with a qualified trainer, and 84.8%indicated they wished the same amount of formal training. A breakdown of the data for formal training show that 97% of those who never have formal training, and 75.4% of those who only had formal training sometimes wished for more formal training. Of those who had formal training often, 45% wished for more, but 55% wished for the same amount. Of those who always had formal training 37.5% stilwished for more, 62.5% wished for the same amount and none wanted less formaltraining (Figure 4). This pattern also existed for skills maintenance training and equipment practice.

300

Changes = desired frequency changes to training with qualified trainer

Currently training with a qualified trainer

AlwaysOftenSometimesNever

Cou

nt

200

100

0

Changes

Less

Same Amount

More

Figure 4: Chart showing desired training changes per current training amount.

42

Table 13: VAO rating of training sessions.

Information regarding the frequency of other components of training is shown in Table 14. The low level of internet and videoconferencing use for delivery of training materials would suggest modern technologies are underused for delivering training to remote and rural locations. Almost half (48.2%) of the respondents indicated that

.8 37.2 42.2 19.7 796

12.6 42.2 26.8 18.3 791

1.0 16.0 32.1 50.9 795

Offer new information

Allow me to upgrade myqualifications

Have the necessary equipment

induction training is never or sometimes offered to new recruits within four monthand this should be a cause for concern for management in light of the understanding of the importance of engaging new recruits promptly. Table 14: VAO rating of training of services/ facilities

s,

s were g.

Many of the comments were based on training issues or suggestions for improvement and showed some polarisation. This polarisation appears to have three main origins: different training systems per jurisdiction; some units are better serviced than others; and individuals have different expectations and capacities. Themes that were

4.2 28.6 37.5 29.6 794

10.8 29.4 27.1 32.7 793

53.3 21.2 10.4 14.9 756

82.2 10.6 4.6 2.6 764

14.2 34.0 22.2 29.4 751

3.3 26.2 37.3 33.0 786

11.4 49.0 23.0 16.4 787

5.9 27.0 39.7 27.1 790

needs

Assessment that proves mycompetency

A training plan

Internet access to trainingmaterials

Videoconferencing orteleconferencing

Induction training for new recruitswithin 4 months

Skills maintenance training

Case debriefing

Training at times and locationsthat suit me

polarised were expectations of training standards, assessment and reaccreditations. Services that offer the least training, and limited the level a VAO could aspire to, hadcomments from individuals wishing to obtain higher standards. Services with high training requirements had comments from individuals who felt the expectationtoo high, but would also have a few comments from those who wanted more traininAssessment and reaccreditation comments also showed the polarisation. However,

3.0 26.3 37.5 32.8 805Training that is appropriate for my

% %

Never Sometimes

%

Often

%

Always

Count

Total

1.3 25.7 48.5 24.2 793% %

Are interesting

Never Sometimes

%

Often

%

Always

Count

Total

43

VAO also want consistent standards and expectations, but some comments showed that methods of achieving this could be offensive. Too much emphasis on reassessment has led to resignations – especially as assessedby different people and no consistency in requireme

nts. Training and assessment

ould have national standards, and active duty needs to be taken into consideration

evel of service as city.

to absorb

still be in own time and at own expense.

ects volunteers to train to termediate level but not all volunteers want that much commitment.

cond. . Feel our area

not considered very much when planning training sessions – often get very short

ing accredited soon.

around training was that many VAO felt training should be more flexible.

omplement it.

uggest quality training through Satellite Network – sites at every town where there is

nference, videoconferencing.

re never checked, but I am the highest ualified on all my shifts. This for me is an issue – one of safety. Something needs to

shas part of assessment. Higher qualifications for volunteers who wish to advance further to provide community with same l Training standards and technology at standard of amateur doctor – difficult on a part-time basis. Desperately need access to tertiary courses, which are denied as not full time ambo – tertiary courses would Our training is more often than not given by officers who need training themselves. Not enough on the spot help and practical advice. Management at training level have become dictatorial and this attitude will cause volunteers to leave the service. The service now expin Spent hours on two assignments last year and received one back but not the seWe were told we were having a practical session but nothing happenedisnotice. Currently training to be an ambulance officer, enjoying every minute. Look forwardto becom

Another major theme emerging

Training needs to have set outcomes, with the steps on the way and practical /theoretical scenarios to c Difficult for country vollies to get to city for courses. Sa hospital. Formal training structure so don’t have to rely on the unit, e.g. internet, CD-Rom, video, teleco Training is a big issue for me. What is offered at local station level is catering for induction level. My skills and competency aq

44

be put in place for annual reassessments. Further formal training would take all mannual leave for the next two years, and is for me unjustifiable. However, if this training were offered at nights and weekends, with videoconferencing it would be achievable. Another them

y

e was the approach to new recruits. Services with high training quirements had a strong theme of losing new recruits through the length of time ken for recruits to become active, and the high training as a disincentive to join.

y waited

most 1/3 of our volunteers are now ‘observers’.

ne of the major findings from the survey is that training is very important to VAO. It motivation to recruiting and retaining VAO, but it must be portant link in the efforts of VAO to help the community, as

d

o

ar are successful strategies (Federal Emergency Management gency 1995). VAO have identified that high training expectations of new recruits

ederal

nd

dards of training when applied niversally. Ensuring volunteers have reached a certain level of competency is seen

ls of

retaServices with less frequent training had comments about losing recruits as thetoo long to receive training. We have a serious shortage of volunteers and it takes typically 8-12 months for a new recruit to become trained. Al Work is rewarding and valuable, however high expectations of new volunteers may be off-putting.

6.2 Discussion Ocan provide an importantdone well. It forms an imwell as an important form of reciprocation from ambulance services to VAO. The survey also highlights that training needs to be flexible to meet the needs of VAO, anmust have standards both set and met. Not all VAO want to achieve high levels of formal ambulance officer qualification, but many do, and if this group were found tbe more committed then it may be cost effective for services to provide this training, or facilitate access to it. Retention of new volunteers is also important, and prompt orientation programs and mentoring for the first yeA(for some services) is a factor in the high turnover, and that leaving recruits as ‘observers’ for extended periods (either because of high training requirements or lack of training opportunities) leads to a rapid loss of motivation. Considering the importance of providing appropriate induction training promptly (Swan 1991, FEmergency Management Agency 1995, 1998, Howard 1999) there is room for improvement in most services. New volunteers respond to an early induction atraining that allow them to participate in activities and with many VAO indicating that rosters are inadequately covered and that time pressure is one of their major difficulties, prompt induction may benefit all. Australia has moved towards utilising national competency standards for emergency service volunteers, which will increase the stanuby Aitken, as part of the ‘duty of care’ (Aitken 1999 p.22), and while it is not recommended that new recruits are sent out unprepared, the use of various levetraining seems to work well for some services.

45

Once VAO have attained the required qualification, training needs to assist them to maintain skill levels (Hudgings 1988), and progress further if they are so motivated.

roviding appropriate training, equipment and support for VAO requires a substantial n

st

lunteers.

resented and equipped training session, held at suitable times and locations. It is

ement

ot have

training provision ay be a part of the organisations ‘duty of care’ to the volunteers and the public and

rvice, and the health profile of the rural population. The tility of training to VAO is an important finding as ambulance services are

rvices s

tool for

Pfinancial investment. Both these functions will add to self-esteem and resumés (Swa1991) thereby providing a potentially strong motivational reinforcement. Maintainingstandards requires VAO undergo re-assessment, and comments from VAO show they understand the importance of re-assessment to maintain competency. However, heavy-handed application of reaccreditation requirements is unappreciated by VAO, and may appear as an imposition. With increasing training and accreditation requirements management must adopt flexible and encouraging programs to assiVAO to meet these obligations. Onerous and dictatorial approaches must be avoided to prevent training and reassessment requirements becoming a deterrent to vo Similarly, it becomes even more important to provide interesting and varied training. Volunteer time is a valuable resource and therefore volunteers deserve a well-pmanagement’s role to ensure training is adequately resourced, presentation is appropriate and varied, and sessions are accessible (Federal Emergency ManagAgency 1995). On the whole, many volunteers felt these factors were present in training sessions, but management cannot afford to ignore those units that do nadequate training, as these are likely to be the most isolated groups. Training can be an important incentive to emergency service volunteers as it ensures they are competent, and assists them to feel confident. Appropriate mis likely to be management’s most powerful recruitment and retention tool. Providing appropriate training for VAO requires a substantial financial investment, and ambulance services may be wary of over training volunteers who may not stay within the ambulance service. However, services must acknowledge that VAO donate time but are not cost free. One cost required to sustain the VAO workforce is timely, consistent, quality training. Such training has benefits that far outweigh the actual cost of not providing it – high staff turnovers, limited skills and dwindling emergency capacity. The question now becomes 'can ambulance services afford not to provide adequate training for volunteers?'. Our study indicates that the answer is ‘no’ – any savings arising from cutbacks or cancellations of VAO training would be illusory. Emergency services aiming to recruit and retain volunteers should investigate the flexibility, quality and timeliness of the training they deliver to ensure it reinforces the motivations of their workforce. Barriers to provision of such training need to be identified and removed. The role of VAO in health and emergency services is important because of the numbers reliant on this seuexperiencing difficulties with recruiting and retaining volunteers. Ambulance semust not be afraid that training standards are a deterrent to potential volunteers. It iclear that appropriate training will act as a powerful recruitment and retentionVAO if provided in a timely and suitable manner. Poorly delivered or inflexible training is a disincentive to VAO.

46

6.3 Recommendation The CAA’s Amof training support for volunt

bulance Education Council should support a comprehensive program eers that encompass national standards, a focus on

aining delivery methods. Ambulance services must ultaneously work to ensure VAO are not subjected to onerous bureaucratic

competency and utilises flexible trsimprocesses, but instead are assisted in navigating and meeting the range of administrative requirements as members of large organisations.. Ambulance services should share available resources for delivering training to VAO recognised under the Australian Quality Training Framework, such as web basedtraining packages, to enhance flexibility and increase cost efficiencies.

47

48

Future Directions

Section 3

49

50

Future Directions VAO make a significant contribution of time to Australia and New Zealand’s health services. The dollar value of this lies somewhere between $30–90 million in Australia, and $16-48 million in New Zealand. The contribution of VAO to the social capital of rural communities is a further unmeasured benefit. This significant contribution by VAO needs to adequately measured and valued by ambulance services, and recognised by governments and communities through financial and other support.

VAO are operating within a managed environment (i.e. through an organisation) and are found within non-government (non-profit) organisations and the public sector. These have become a major economic force in recent years and have consequently borrowed management styles from the business world (Anheier 2000 p.2). Volunteers belonging to government entities tend to have public sector management styles applied to them. Volunteer organisations must address the issue of identifying the appropriate management style for volunteers, if they wish to ensure the survival of volunteering.

It is clear that Australian and New Zealand ambulance services are experiencing difficulty with recruitment and retention of VAO. To address this it is important to understand and reinforce volunteer motivations to create a reciprocal relationship with VAO that will assist retention. As VAO identify that assisting the community is a major motivation, ambulance services should facilitate a sense of connection with the local community, and avoid centralised policies that inhibit this. Learning new skills is another major motivation and the provision of appropriate training, and the public promotion of such training could be a strong recruitment tool. Finally most VAO want a sense of achievement from volunteering and management must ensure not only that the VAO role can provide this, but also that ambulance services recognise the value of VAO work. Valuing means not only the dollar value, but also ensuring volunteers are appreciated and receive the recognition they deserve from within the organisation and the community. Support services are vital to the effective functioning of volunteer groups. VAO have identified that communication with management and clinical and emotional support are important support functions. However all types of support were important to some VAO, and management may need to be sensitive to minority groups who may need support services such as childcare assistance, or petrol reimbursement to enable participation. The research findings were presented to ambulance service management at a meeting in March 2002. The key issues were organised under the following headings and divided into agency level issues and national issues. This provides a quick reference table of the major issues for VAO (Table 15). In summary, this report provides management with important information for delivering appropriate VAO support services. VAO provide a vital and valuable service in both Australia and New Zealand but are threatened by a changing environment. Ambulance services, governments and communities must act to provide extra assistance to VAO if ambulance services in regional, rural and remote areas are to be maintained. Responsibility for moving VAO issues forward rest largely with

51

ambulance services, but VAO have a responsibility to continue communicating their needs and situation to management, government and each other. Table 15: Summary of key issues. Issue Agency National Training • Provision of high quality

training • Flexible methods of training

delivery and assessment • Career pathways • Time commitments

• National Standards • Shared training resources

Clinical Support • Professional delivery of support services

• Uniforms • Recognition • CISD debriefing • Community engagement • VAO legitimacy

• VAO legitimacy • Best practice management

guidelines

Finance/Legislative

• Record/budget the cost of supporting VAO

• Reimbursement of out of pocket expenses

• Incentives

• Value the economic benefit of VAO

• Tax breaks • Support the national

agenda on volunteering • Ensuring adequate state

legislation Human resource issues

• Upgrade dealing with VAO to be on par with paid staff including OH&S support and position descriptions

• Understand required VAO numbers and work to maintain

• Exit interviews • Improve retention • Targeted recruitment • Understand and reinforce

motivation • Roster coverage

• Share data to maintain a national understanding of VAO

• Best practice guidelines for retention and recruitment.

Communication • Address relationships with paid staff

• People management training for those managing volunteers

• Feedback mechanisms in place

• Good communication flow to VAO

• Support linkages with local community

• Find out what community needs and wants

• Define VAO role in the rural health service

• Consider the impact of policies and legislation on the relationship between VAO and communities

• Give VAO visibility within the services

52

Recommendations 1. VAO should recognise they form a distinct group of emergency service

volunteers. Within each jurisdiction VAO should establish mechanisms for representation of their collective interests in matters of policy and change at organisational, state, national and international levels.

2. The Convention of Ambulance Authorities (CAA) should provide a forum to

address VAO issues at the national level that includes VAO representation. This forum to monitor and contribute to national events affecting emergency service volunteers, such as tax issues, legislation, and insurance, and support and provide representation to Australian Emergency Management Volunteer Forum.

3. Ambulance services should ensure they collect and analyse data on volunteers

using a standardised format. These data should include volunteer demographics, volunteer motivations, and attitudes to rewards, and be reported through the CAA to enable strategic planning.

4. The CAA and governments should publicly recognise VAO as a valuable part of

the ambulance services. This recognition needs the development of a standardised method for calculating the cost/benefit of VAO contributions, development of equitable tax deductions and/or rebates for VAO, and long-term funding arrangements that acknowledge the costs of supporting VAO.

5. Governments should recognise the valuable contribution of VAO to health and

emergency services, and adequately fund and support necessary organisational systems to ensure the long-term survival of volunteering in ambulance services.

6. The ambulance services should work to reinforce VAO motivations and provide a

reciprocal relationship with VAO. This would require creating stronger links with communities, assisting VAO to learn new skills, ensuring the VAO role provides a sense of achievement, and continued research.

7. The CAA should acknowledge that VAO have characteristics and needs in

common with other volunteers and endorse the National Agenda on Volunteering prepared by Volunteering Australia Incorporated. This Agenda represents the interests of all volunteers within Australia (Appendix 1).

8. The CAA should take action to urgently address retention and recruitment issues

at a national level, which would include but not be limited to: • Developing best practice guidelines for VAO management to assist

retention by developing a supportive organisational culture. • Monitoring and reviewing the impact of legislation on the VAO role. • Developing best practice guidelines for recruitment of VAO. • Monitoring the level of ambulance service coverage provided by VAO for

rural and remote areas throughout Australia.

9. The members of CAA should share information regarding the success and failure of management support initiatives for VAO to develop best practice guidelines for

53

VAO management. These guidelines should include clinical support services that provide equity in the treatment of VAO and full time paid staff, good communication practices, and forms of recognition that validate VAO service.

10. The CAA’s Ambulance Education Council should support a comprehensive

program of training support for volunteers that encompass national standards, a focus on competency and utilises flexible training delivery methods. Ambulance services must simultaneously work to ensure VAO are not subjected to onerous bureaucratic processes, but instead are assisted in navigating and meeting the range of administrative requirements as members of large organisations..

11. Ambulance services should share available resources for delivering training to

VAO recognised under the Australian Quality Training Framework, such as web based training packages, to enhance flexibility and increase cost efficiencies.

54

References Ahern T. 2002 Personal communication, April 2002

Aitken A. 1999 'Identifying key issues affecting the retention of emergency service volunteers.'. Australian Journal of Emergency Management, Winter:16.

Anheier H. 2000 Managing non-profit organisations: Towards a new approach, London School of Economics: London.

Australasian Fire Authorities Council. 2001 Sustaining Volunteerism in the Emergency Services: Funding, Emergency Management Australia: Canberra.

Australian Bureau of Statistics. 2001 Voluntary Work, Australia, Australian Bureau of Statistics, Date Accessed 11th April 2002, www.abs.gov.au/ausstats/abs@.nsf/Lookup/NT0001AA0E.

Australian Institute of Health & Welfare. 2000 Australia's Health 2000, AIHW: Canberra.

Baker D. 2002 Personal Communication, March 2002

Bell M. 1999 Volunteering Underpinning Social Action in Civil Society for the New Millenium, Kumarian Press Inc., Date Accessed 8th May 2002, http://www.iyv2001.org/infobase/articles/VolUnderpinSocAction.pdf.

Bernier E. 1995 Maximising Volunteers. Emergency, December:41.

Brown R. 1993 Volunteer programs that work. Emergency, June: 42.

Bryant D L and Strasser P R. 1999 The delivery of sustainable rural and remote health services, Regional Australia Summit Unit, Date Accessed 8th May 2002,http://www.dotrs.gov.au/regional/summit/program/background/bryant_strasser.htm.

Convention of Ambulance Authorities. 2000 Ambulance Services Report 1999/2000, Convention of Ambulance Authorities:

CyberVPM.com. 2000 Four Typical Basic Motivators of Volunteers, CyberVPM.com, Date Accessed 25th May 2001, www.cybervpm.com/supervision/motivators.htm.

Dodd T. 2002 Personal Communication, March 2002

Emergency Management Australia. 1999 Record of the Dennis Mileti Workshop 25-26 August 1999, E. M. A: Mt Macedon.

Emergency Management Australia. 2001 Value Your Volunteers. Summit Faces, 1:1-4.

Federal Emergency Management Agency. 1995 Emergency Medical Services Recruitment and Retention Manual, Federal Emergency Management Agency:

Federal Emergency Management Agency. 1998 Recruitment and Retention in the Volunteer Fire Service, Problems and Solutions, Federal Emergency Management Agency:

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Fitch J. 1994 Endangered Species: Volunteers. Emergency Medical Services, November:38.

Fitzgerald G. 2002 Personal communication, April 2002

Garza M. 1991 'Money talks, nobody walks: Financial incentives for volunteers'. Journal of Emergency Medical Services, February:58-61.

Glatfelter A. 1999 Calling all volunteers. Emergency Medical Services, 24-25.

Gough S and Thomson G. 2002 Personal communication, March 2002

Halpin T. 1998 Recruitment and retention of volunteers: Find 'em, keep 'em. Obstacle or opportunity? Journal of Emergency Medical Services, 58-72.

Howard B. 1999 Managing Volunteers. Australian Journal of Emergency Management, 37-38.

Hudgings E. 1988 Volunteer incentives; Solving recruitment and attrition problems. Journal of Emergency Medical Services, 58-61.

Hugo G. 2001 Population Centenary Article - A century of population change in Australia (Year Book Australia, 2001), Australian Bureau of Statistics, Date Accessed 26th April 2002, www.abs.gov.au/ausstats/abs@nsf/Lookup/NT0001768A.

Kaplan H and Sadock B. Synopsis of Psychiatry - Behavioural Sciences, Clinical Psychiatry, Willuams and Wilkins: Baltimore.

Lemmer C. 2002 Personal communication, 8th April 2002

Lennox G. 2002 Personal communication, 28th April 2002

Marwell G and Oliver P. 1993 The Critical Mass in Collective Action: A Micro-Social Theory, Cambridge University Press: Cambridge.

McDowell D. 1999 Love 'Em or They'll Leave: Motivating Volunteers. Emergency Medical Services, 70.

Morisey J. 1993 Here to stay?': Recruiting EMS volunteers. Journal of Emergency Medical Services, 53-58.

National Rural Health Policy Forum and National Rural Health Alliance. 1999 Healthy Horizons: A Framework for Improving the Health of Regional and Remote Australians, Australian Health Ministers Conference, Date Accessed 8th May 2002, http://www.ruralhealth.org.au/hh.htm.

Olson M. 1965 The Logic of Collective Action: Public Goods and the Theory of Groups, Harvard University Press: Cambridge.

Phillips S. n.d Redefining Government Relationships with the Voluntary Sector: On Great Expectations and Sense and Sensibility, Carleton University, Date Accessed 18th April 2002, www.vsr-trsb.net/publications/phillips-e.html.

Reinholdt S and Smith P. 1998 Directions in Volunteer Development in Australian Emergency Services, Country Fire Authority and Emergency Management Australia: Victoria.

Smith P J and Dunlop C. 2001 Volunteers Obtaining Protection from legal Liability, Emergency Management Australia: Canberra.

56

St John Ambulance Australia WA. 2002 Country Ambulance Services, St John Ambulance Australia WA, Access Date 8th May 2002, http://www.ambulance.net.au/.

Stone R. 2001 Training for a Safer Community: Volunteer Development within the Australian Quality Training Framework, Emergency Management Australia: Canberra.

Swan T. 1988 Keeping Volunteers in Service. Journal of Emergency Medical Services, 55.

Swan T. 1991 Correcting poor performance. Emergency, 21.

Swan T. 1991 Great Expectations: What do EMS volunteers want from management? Journal of Emergency Medical Services, 47.

Swan T. 1991 No-cost benefits and incentives. Emergency, 21.

Swan T. 1991 Recruiting support staff. Emergency, 20.

The Order of St John. An extraordinary history, St John New Zealand, Date Accessed 11th April 2002, http://www.stjohn.org.nz/about/history.asp.

Vaughan T. 2002 Personal communication, March 2002

Volunteering Australia Inc. 2001 A National Agenda on Volunteering: Beyond the International Year of Volunteers, Volunteering Australia Inc, Date Accessed 10th February 2002, http://www.iyv2001.net/agenda.doc.

Volunteering Australia Inc. 2002 Definition and Principles of Volunteering, Volunteering Australia, Date Accessed 29th Aprill 2002, http://www.volunteeringaustralia.org/.

Volunteering Ireland. 2001 The Basics, Date Accessed 4th May 2002, http://www.volunteeringireland.com/Frameset_TheBasics.htm.

WA S J A A. 2002 The Commandery in Western Australia 109th Annual Report 2000/01, St John Ambulance WA, Date Accessed 8th May 2002, http://www.ambulance.net.au/pdf/SJAREPO1.PDF.

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58

Appendices

Section 4

59

60

Appendix 1: A National Agenda on Volunteering: Beyond the International Year of Volunteers

Definition and Principles_______________ Definition of formal volunteering Formal volunteering in Australia is defined as an activity which takes place through not for profit organisations or projects and is undertaken: • to be of benefit to the community; • of the volunteer’s own free will and without coercion; • for no financial payment; and • in designated volunteer positions only.

Principles of volunteering • Volunteering benefits the community and the volunteer. • Volunteer work is unpaid. • Volunteering is always a matter of choice. • Volunteering is not compulsorily undertaken to receive pensions or

government allowances. • Volunteering is a legitimate way in which citizens can participate in the

activities of their community. • Volunteering is a vehicle for individuals or groups to address human,

environmental and social needs. • Volunteering is an activity performed in the not for profit sector only. • Volunteering is not a substitute for paid work. • Volunteers do not replace paid workers nor constitute a threat to the job

security of paid workers. • Volunteering respects the rights, dignity and culture of others. • Volunteering promotes human rights and equality. * The definition and principles were developed in 1997 by Volunteering Australia Inc through consultation with the volunteer sector, the unions and government.

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Introduction______________________________ The International Year of Volunteers was declared by the General Assembly of the United Nations in 1997. Australia and in particular the 4,500 member organisations of the Volunteering Australia network, played a significant role in petitioning for the year. In June 2000 the two Australian lead community agencies for the International Year of Volunteers established a National Community Council of Advice to ensure that the community voice in the International Year of Volunteers was strong and influential. Over 300 national organisations were invited to join the Council. One of the Council’s most important decisions was to conduct a national consultation to identify the major issues facing volunteers and volunteer-involving organisations in Australia and the outcomes they would like to see as a legacy of this most important year. Face to face consultations were conducted in every state and territory and over 15,000 questionnaires were distributed. A National Agenda on Volunteering: Beyond the International Year of Volunteers is the result of those consultations. Australian volunteers – key facts • In Australia nearly 4.4 million people over the age of 18 years are volunteers,

representing an impressive 32% of the civilian population of the same age. • There is an almost equal representation of women and men. • The majority of people who volunteer are under the age of forty-four. • In 1995 an estimated 3,189,900 people volunteered representing 24% of the

Australian population over the age of 18. • In 2000 volunteers contributed 704.1 million hours of volunteer work to the

Australian community. • A growth in volunteer rates has occurred for both sexes and all age groups. • Particular growth has occurred in the 18-24 age group from 17% in 1995 to

27% in 2000. • The 55-64 age group showed growth from 24% in 1995 to 32% in 20001 • Volunteering in Australia has an estimated dollar value of $42 billion per

annum2. Scope of Australian volunteering Volunteers work in all spheres of community and across many sectors including health and welfare, emergency services, arts and culture, heritage, environment and conservation, sport and recreation, education, overseas aid, religious, animal welfare, human rights and youth development. Volunteers work in all types of environments and under different conditions. Sometimes their issues are unique to the sector within which they work, more often than not the issue is shared across all sectors. 1 Key facts are taken from the ABS national survey Voluntary Work Australia ABS

Catalogue 4441.0 2000 2 Duncan Ironmonger's estimates of the dollar value of volunteering are based on ABS

Time Use data.

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The Agenda__________________________ The community, volunteer-involving organisations, business and government is called upon to work together to: 1. Publicly respect and value, in enduring, formal, and tangible ways, the essential contribution that volunteers make to building and sustaining the Australian community. From its beginnings as a settled colony and before, Australians have assisted each other in times of need and hardship. Throughout our documented history we have examples of volunteer effort and its result. What we do not have as a nation is a commitment to accurately measure and value this activity. The ABS estimates that nearly 4.4 million Australians provided 704.1 million hours of voluntary service to the community in 2000. The monetary value of all volunteer work, both formal and informal is estimated to be a massive $42 billion per annum. We hope that after this International Year of Volunteers, Australia publicly acknowledges this contribution in, at least, the following ways: Outcomes Sought • A permanent inclusion of a volunteer question in the Census of the Australian

Population. • A regular collection of volunteer data by the Australian Bureau of Statistics

(ABS). • The economic value of volunteering quantified and included in the national

accounts published quarterly by the ABS. • Volunteer-involving organisations acknowledge the work of volunteers and

quantify its economic value in their Annual Reports. • Funding for research into issues that affect volunteers and volunteering. • A specific Volunteer Medal in the Order of Australia awards. • Recognition by corporate sponsors that volunteer projects of all sizes and the

infrastructure to support volunteers, merits funding. • Excellence Awards for volunteer projects, programs or services that involve,

manage and deploy volunteers according to excellence criteria.

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2. Ensure that volunteers have legal status and are afforded protection through every piece of legislation and public policy that affects them and their work. Australian volunteers work in many settings and under a variety of conditions. Some work alongside paid employees and under identical circumstances, others work alone or as a group in situations that are less than safe. Unlike paid staff, volunteers are not always covered by legislation that protects or compensates within the work place. Many volunteers are exposed to risk, injury, discrimination or prejudice in the absence of explicit mention in relevant legislation. Others carry huge financial responsibility or are exposed to legal liability. It is in the interests of all Australians that volunteers are protected under law. Outcomes Sought • State governments specifically include volunteer protection in the relevant

Occupational Health and Safety Act(s). • The Equal Opportunity Acts around Australia overtly protect the rights of all

volunteers, as with paid workers, to be ‘employed’ in accordance with non-discriminatory practices.

• The various workers compensation legislation around Australia is consistent in the level of compensation offered to volunteers injured in the course of their voluntary work.

• Anti-discrimination Acts explicitly mention volunteers. • An intergovernmental working group that identifies all of the relevant existing

legislation across all jurisdictions and a methodology to address the process of legislative change and amendments.

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3. Ensure that all new legislation, bi-laws and public policies, developed at any level of government, which may effect volunteers and their work, works only to facilitate and sustain volunteering. Volunteering has, over a number of years, developed into a significant and important social movement that is recognised worldwide. It is generally accepted that volunteering is underpinned by a set of principles and guidelines that are designed to protect not only the individual volunteer but also volunteering. Implicit in the principles from around the world, and particularly in Australia, is the notion that volunteering gains strength only if it remains a non-exploitative expression of citizenship based on free will. In Australia the Principles of Volunteering were developed through consultation with the sector, government and the unions. And whilst individuals may at times work outside the principles, it is the principles which provide the framework that has assured the long-term viability of the volunteer movement. As Australian volunteers are more and more relied upon to provide needed services it is more important than ever to ensure that any legislation or policy affecting volunteers is firmly based on the Principles. Outcomes Sought • Governments and policy makers both commit and subscribe to the Principles

of Volunteering. • A guarantee from governments in all jurisdictions to the volunteers and

volunteering-involving organisations of Australia that legislation or policy will not be implemented that has the potential to weaken the community activity of volunteering. And this guarantee is ensured by consulting with the sector.

• Volunteer peak bodies provide a ‘Volunteer Impact Statement’ on any legislation or public policy likely to effect volunteers or volunteering.

• Volunteer- involving organisations work with the peak bodies to ensure that responses to government policy or proposed legislation is informed and captures diverse viewpoints.

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4. Acknowledge that the activity of volunteering is not without cost and develop means by which Australian volunteers and volunteer-involving organisations are supported and funded to provide valuable services. One of the greatest fallacies about volunteering is that as volunteers are unpaid their involvement has no negative resource implication for either the volunteer-involving organisation or volunteers themselves. Many organisations have, to their dismay, felt the effect of underestimating the cost of involving and supporting volunteers. And whilst it is proper to account for the considerable dollar value of volunteer contribution it is equally as important to calculate the financial overheads needed to support volunteers in their work. Many volunteers cover their own costs in addition to providing valuable services for which they are not paid; others simply are unable to afford the outlay required of them. The work of volunteers cannot be taken for granted by not-for-profit organisations, the community, business or governments and the cost of supporting them in their work should be considered as an investment in the future of Australia. Outcomes Sought • Access to affordable and adequate volunteer and public liability insurance for

volunteer-involving organisations. • Volunteer out of pocket expenses dealt with under the taxation system, any

anomalies identified and resolved and some equitable means of providing relief for those outside the tax system is found.

• Travel concessions for volunteers travelling to and from their volunteer workplace.

• Volunteer-involving organisations have adequate allocations for volunteer management in their annual budget.

• Government when funding service providers that rely on volunteers, explicitly require, and provide for, an adequate budget allocation for volunteer involvement, management, recognition and reivmbursement.

• Volunteer-involving organisations and funding providers, for example, governments, business and trusts, recognise volunteer management as a genuine and necessary expense item in funding submissions and funding allocations.

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5. Ensure excellence in all levels of volunteer involvement and volunteer management to encourage, protect and enhance the work of volunteers. Australia is a beautiful and vast country that has large expanses of uninhabited and dangerous terrain surrounded by ocean. Australia is prone to natural disasters, such as bush fires, landslide, storms and flood. The sheer size of our country alone, taken together with the numerous opportunities for recreational pursuit in isolated places, places a heavy responsibility on search and rescue volunteer crews both on land and sea. Our successful response to emergencies is heavily dependent on the professionalism of volunteers. Much of our natural heritage is protected and conserved through the dedicated work of volunteers. Volunteers also work in sport and recreation, arts and culture, health, welfare, education, religious, animal welfare, youth development and human rights arenas to build a strong cohesive society. Australia has a small culturally diverse population, a large percentage of which is nearing retirement age. This in itself will pose numerous challenges in the future delivery of volunteer services. Changing technology and the diversification of the volunteer role also has an influence on how volunteers are involved and managed. With almost 4.4 million Australians actively engaged as volunteers it is timely to ensure that standards for their involvement, management, and conditions of employment are met. Outcomes Sought • Volunteer-involving organisations comply with the National Standards for

Involving Volunteers and other industry standards that impact on volunteers and their work.

• Volunteer-involving organisations recognise that volunteers both require and deserve training.

• Standardised volunteer training by industry type. • Portable training to reduce unnecessary repetition and duplication for

volunteers. • A national skills register to ensure recognition of previous training and skills. • Government funding for volunteer training. • A uniform, affordable and effective national system for pre-employment

reference checking (police checks). • A positive image of volunteering portrayed through the media. • National youth strategies to ensure that young people are provided with the

types of volunteer activities they seek. • Volunteer-involving organisations respect the rights of volunteers. • Shared resources for recruitment e.g. on-line recruitment sites. • Standards of excellence in volunteer referral services. • Trained managers of volunteers. • Training packages for managers of volunteers. • Tertiary courses, for example, social work, sport, recreation and youth work

include ‘working with volunteers’ as an elective subject. • Competency standards for volunteer management training to ensure a level

of competence and a career path for managers of volunteers.

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6. Ensure that volunteering is a potent, dynamic and unifying social force for community benefit by acknowledging and accepting that it is a diverse and evolving activity. Volunteering was until recent years regarded as the province of the middle class, middle aged woman. So entrenched was this stereotype that it remains one of our greatest challenges to refashion the image, and build an awareness of the true scope and scale of volunteering. Of all the tasks that lie ahead of us, if we are to maintain the relevance of volunteering, the most important is to recognise and celebrate it as a changing, dynamic and inclusive movement for the common good.

Outcomes Sought • Volunteer-involving organisations have strategies in place to involve young

people including redesigned job roles, short-term projects and group volunteering. And the needs, aspirations and motivations of young volunteers are accepted as valid.

• The concept of corporate volunteering is widely accepted and encouraged as a legitimate way in which skills are transferred from the business sector to the voluntary sector for the benefit of the community.

• Volunteer-involving organisations have strategies in place to remove barriers to the involvement of people from culturally diverse backgrounds

• Organisations have strategies in place to address gender imbalance. • The community work and support networks of indigenous Australians are

recognised as valuable variations to the more formal activities typically accepted as volunteering.

• Innovative forms of on-line volunteering opportunities are available to volunteers isolated through disability or locality or restricted by paid employment to volunteering outside business hours.

• Innovative forms of volunteering opportunities to address complex social problems.

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Acknowledgements_____________________________ A National Agenda on Volunteering: Beyond the International Year of Volunteers is the result of a national consultation that Volunteering Australia and Australian Volunteers International conducted on behalf of the IYV National Community Council of Advice to identify the major issues affecting volunteers and volunteer-involving organisations. The IYV National Community Council of Advice would like to thank all those individuals and organisations who have contributed to the development of A National Agenda on Volunteering or assisted with organising forums or distributing questionnaires. All enquiries about this document should be directed to: Volunteering Australia Inc. Suite 2, 33 Queens Road, Melbourne Vic. 3004 P: (03) 9820 4100 F: (03) 9820 1206 volaus@infoxchange.net.au www.iyv2001.net www.volunteeringaustralia.org www.govolunteer.com.au Additional copies of this document can be downloaded from the Community IYV Web Site at www.iyv2001.net © Copyright 2001 Volunteering Australia Inc.

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Appendix 2: SA Model for estimating VAO dollar value

SA Ambulance Service Model for Calculating Monetary Value of VAO.

The SAAS model assumes that if you had to replace volunteers with career staff you would use the most economic roster model available, that being on-call. This would be appropriate because of the relatively low workload compared to existing career stations. In SA to provide an on call roster 24 hours a day 365 days a year for two officers on an ambulance it takes 5 paramedics. By multiplying the base level paramedic earnings by 5, and adding a 62% shift and on call allowance the total cost equals $294,840. This is the cost to put one ambulance on the road for a year 24 hours a day. The estimated cost to replace VAO in SA in this manner is $27 million(Lemmer, 2002).

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Appendix 3: Additional data

Industry employed in

Industry employed in

OtherEnvironment/farming

ReligiousHealth

Education/trainingBusiness/professiona

Community/welfare

Freq

uenc

y300

200

100

0

Figure 5: VAO rate between occupational groupings.

Participation in paid labour force

Participation in paid labour force

Not in the labour foUnemployed

Employed part-timeEmployed full-time

Freq

uenc

y

500

400

300

200

100

0

Figure 6: VAO labour force status.

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Highest education level attained

Highest education level attained

Post graduateDiploma/Degree

Trade certificateHSC

High SchoolPrimary School

Freq

uenc

y400

300

200

100

0

Figure 7: VAO highest education level attained.

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Appendix 4: Stand Up and Be Counted Survey Section 1 The aim of this section is to understand why you became a volunteer and why you continue to volunteer your services. Circle the appropriate number. If a point is not applicable, answer “not at all”. 1. Please indicate how important each point is in influencing your decision to be a

Volunteer / Honorary Ambulance Officer. Please circle the appropriate number. Level of importance to you

5______________________________1

Very Not at all

Learning new skills 5 4 3 2 1 Meeting new people 5 4 3 2 1 Improving employment prospects 5 4 3 2 1 A sense of achievement 5 4 3 2 1 Assisting the community/helping others 5 4 3 2 1 Excitement 5 4 3 2 1 Being part of a group/friendship 5 4 3 2 1 Gaining self-esteem 5 4 3 2 1

2. Please indicate why you joined a Volunteer Ambulance Unit. Please circle the appropriate number.

Level of importance to you 5______________________________1

Very Not at all

The local ambulance unit stood out in the community 5 4 3 2 1 I had seen the VAO in action and it prompted me to join 5 4 3 2 1 I had friends or family who were members 5 4 3 2 1 A representative of the organization asked me to join 5 4 3 2 1 The organization advertised for volunteers 5 4 3 2 1 The unit needed more volunteers to continue 5 4 3 2 1 I am interested in the medical/ first -aid field 5 4 3 2 1 3. List three ambulance volunteer activities you enjoy.

1. ________________________________ 2. _____________________________ 3. _________________________________

4. List three things that make involvement in Ambulance Volunteer activities difficult, if any.

1. ________________________________ 2. ______________________________ 3. ________________________________

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1. For how long have you been a Volunteer/Honorary Ambulance Officer? Years ___

2. Estimate how many hours in an average month you would spend doing volunteer:

Training_______ On call availability_______ Administrative work_______ Call-

outs________

Section 2 The aim of this section is to find out which forms of organisational support you

most value. Please circle the relevant number. 3. Please indicate the level of importance of these events to you (Whether or not they

occur) Level of importance to you

5______________________________1

Very Not at all

Receive Thank- you letter 5 4 3 2 1 Receive Training Certificate 5 4 3 2 1 Receive Letter of Commendation 5 4 3 2 1 Receive some other form of appreciation 5 4 3 2 1 Publicity in media regarding Ambulance Organisation 5 4 3 2 1 The opportunity to provide feedback to management 5 4 3 2 1 Management contact person is available and supportive 5 4 3 2 1 Social events organised by management/volunteer unit 5 4 3 2 1 Receive National or Ambulance Medal 5 4 3 2 1 Receive organisational information 5 4 3 2 1 Public relations work within local area 5 4 3 2 1 Management staff visit unit 5 4 3 2 1

4. Please indicate how important each service is to you as a Volunteer/Honorary Ambulance Officer (whether or not it is offered by your organization).

Level of importance to you 5______________________________1

Very Not at all

Critical Incident Stress Management 5 4 3 2 1 Counselling services 5 4 3 2 1 Clinical feedback on significant cases 5 4 3 2 1 Occupational Health and Safety 5 4 3 2 1 Branch Station Officer/ Paramedic assistance 5 4 3 2 1 Adequate Uniform 5 4 3 2 1 Adequate equipment 5 4 3 2 1 Reimbursement of phone / meals/ travel costs 5 4 3 2 1 Training 5 4 3 2 1

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Section 3 The aim of this section is to find out how well training fits your needs as a volunteers.

Please tick the box

Never Sometimes Often Always Training Sessions Involve: Formal training with a qualified trainer Volunteers training/assisting volunteers Equipment practice Skill checking/competency assessment Unit paperwork and business Socialising Training Sessions: Never Sometimes Often Always Are interesting Offer new information Allow me to upgrade my qualifications Have the necessary equipment (manikins, etc) My unit is able to offer Never Sometimes Often Always Training that is appropriate for my needs Assessment that proves my competency A training plan Internet access to training materials Videoconferencing or teleconferencing Induction training for new recruits within 4 months Skills maintenance training Adequate roster cover for the community Case debriefing Training at times and locations that suit me I would like Less Same Amount More Formal training with a qualified trainer Volunteers training volunteers Equipment practice Skills checking Skills maintenance training Socialising Case debriefing Internet access to training materials

Training sessions are usually held weekly ___ fortnightly ___ monthly__ irregularly___

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Section 4 The aim of this section is to establish basic information upon which other

information can be added. Please circle your answer 1. Age Gender Marital Status Dependents Which industry are

you employed in? 18-24 Male Single Yes Community/welfare 25-29 Female Married/Partner No Business/professiona 30-34 Education/training 35-39 Health 40-44 Religious 45-49 Environment/farmi 50-54 Other 55-59 Over 60 2. Circle more than one answer per section if appropriate. Usual Paid

Occupation Volunteer for which Organisation/s State/

Territory Education

Level Employed full-time Ambulance Servic NT Primary School

ime St John A ce hool Fire ervices Qld HSC

ES SA rade certificate ther WA loma/Degr

Post Grad

-------------------------------------------------------------- ------------ ----------------- -----------

-------------- ------------ ----------------- -----------

------------------------ ------------ ----------------- -----------

--------------------------------------------- ------------ ----------------- -----------

h to convey your thoughts on issue hat you f l need expan g on, or ar not e use the back page. This info ation m not be includ in the sta al

ered important information for further c sideration.THANK YOU FOR YOUR ASSISTANCE

urvey will assist us in developing a national profile for ambulance olunteers and allow ambulance organisations to work at a national level to improve support

for ambulance volunteers.

Please use the self-addressed envelope to return your survey.

l

ng

e Employed part-t mbulan Vic High Sc Unemployed S Not in the labour force S T O Dip 3. Do you have any other comments?

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If you wis s t ee din e covered, pleas rm ay ed tistic

analysis, but will be consid on

The information from this s

ee uate

v

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