Volunteer systems work, maybe, in communities where folks work in the community, rather than commute, and work at jobs with the flexibility to respond to the batlight. Not many communities like that anymore. We live in a service economy that requires employees to stand the watch, and not leave to save lives. Price of economic change.

Add to that the steady attrition of rural community hospitals in favor of larger centralized medical centers, and you have nowhere to go and no way to get there. Loss of community hospital ER's concentrates the work at the remainder, as does the increasing number of uninsured, un-doctored patients for whom the ER is the only available source of primary care. The ER's are burdened beyond the capabilities of personnel and physical plant, so they go on 'bypass'-they stop accepting ambulance patients. Excess capacity in in-patient hospitals has been systematically eliminated, resulting in hospitals that reach max capacity and stop accepting admissions and stop doing elective surgeries. This becomes a crisis in most hospitals during the flu season. Add any sort of mass casualty incident and the whole system will stop working.