A big difference between emergency medical services in the District and in the Maryland and Virginia suburbs is that suburban services rely heavily on volunteers, while DC hasn’t had volunteers for more than a century.

The combination of volunteers and career people has served Maryland and Virginia well, according to EMS experts in both states. “Our volunteers are trained just like our career people, and all are required to be qualified in fire suppression and EMS,” says Ned Sherburne, himself a volunteer and chief of the Bethesda–Chevy Chase Fire and Rescue Service.

DC’s Fire and Emergency Medical Services agency is funded by tax dollars; emergency services in the suburbs are funded by both tax money and donations. B-CC Fire and Rescue is almost completely supported by private donations and endowments.

EMTs in all the suburban jurisdictions are also trained in fire suppression, and there appears to be little of the friction between fire and emergency medical personnel so evident in DC.

“Some firefighters don’t like to do EMS, mainly because of all the paperwork, and some EMTs don’t like to do fires,” says Sherburne, “but the majority of our people like to do both.”

Volunteers work a certain number of hours each week and are given lots of responsibility. At both the B-CC and Glen Echo departments in Maryland, all-volunteer forces cover nights and weekends. Fire/EMS forces in St. Mary’s and Calvert counties are all-volunteer.

EMS departments in most outlying Virginia suburbs have more volunteer than career people. The closer you get to DC, the higher the percentage of career EMS officers, says Melinda Duncan of the Northern Virginia EMS Council. There are 1,400 volunteer and 500 career fire-and-rescue-service providers in Loudoun County; Prince William has about 1,300 volunteers and 500 career officers. Fairfax County has a career EMS staff of 1,400 and 250 volunteers. Arlington and Alexandria have relatively fewer volunteers.

Salaries and benefits for career EMTs in Maryland and Northern Virginia are generally better than they are for civilian EMTs in DC, and training-and-certification programs are more rigorous. The entry-level salary for civilian EMTs in the District is $41,218; for firefighter EMTs it’s $44,301. In Montgomery County, the beginning EMT salary is $43,278; firefighter EMTs in Arlington County start at $44,636, in Fairfax County at $48,278.

In Maryland, both volunteer and career EMTs must meet statewide training-and-certification standards. Maryland also has statewide standards for emergency medical protocols, which means patients with similar medical conditions will be treated the same way whether they’re in Baltimore or Bethesda. The state regularly updates its medical protocols.

Maryland’s integrated statewide EMS system—singled out for excellence in a 2007 Institute of Medicine study—is administered by the Baltimore-based Maryland Institute for Emergency Medical Services Systems (MIEMSS). Established in 1972 as a statewide trauma system that designated certain hospitals as trauma centers, MIEMSS is an independent agency governed by an 11-member board; it’s funded through a surcharge on vehicle registration. MIEMSS divides the state into five regions; Region V comprises Montgomery, Prince George’s, Calvert, Charles, and St. Mary’s counties.

A statewide communications system is headquartered at the Emergency Medical Resource Center (EMRC) in Baltimore. When a Beltway accident recently injured nine people, Sherburne says, he was put in contact through EMRC with three hospitals—Holy Cross, Suburban, and Shady Grove—to coordinate which patients should be taken where.

Virginia doesn’t have a statewide EMS system like Maryland’s, but Northern Virginia EMS departments are medically driven and regularly update their medical protocols. EMS departments in both states provide EMTs with all the drugs needed for emergency care, including Valium and morphine, neither of which District EMTs have.