EMS warns of ‘crippling labor shortage’ undermining 911 system

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Nationwide pandemic-induced shortage of emergency medical technicians and paramedics is so severe that ambulance service providers warn of significant service cuts and longer waits for calls to 911, even when it is a matter of life and death.

Companies have had to shut down, consolidate, or come up with new strategies for answering calls, said American Ambulance Association president Shawn Baird, who added that there simply weren’t enough EMS staff to cover calls in many parts of the country, especially during the pandemic.

The loss of staff due to burnout and low wages linked to the pandemic created a vicious cycle, requiring greater dependence on the workers who remained. The situation has deteriorated to such a degree in recent months that ambulance services and industry leaders are begging Congress and state legislatures for help.

“The scale has really exploded over the past few months,” Baird said. “When you take a system that was already fragile and stretch it, because you didn’t have enough people entering the field, you start a public health emergency and all the extra burdens that place on our hand. – labor as well as labor shortages throughout the economy, and that has really put us in crisis mode. “

It’s a crisis that has made it difficult to hire and even more difficult to retain paramedics and paramedics, according to an AAA survey of 258 EMS organizations across the country.

In 2020, nearly a third of the workforce left their ambulance business after less than a year, according to the survey. Eleven percent left within the first three months.

“It’s almost unmanageable,” said Ken Cummings, who runs Tri-Hospital EMS in Port Huron, Michigan. “I don’t think an EMS provider wants to go out in public and say your service might be down, but the reality is that due to the extremely low labor situation right now, we will starting to see delays. We’re already seeing that across the country right now. “

Cummings said it currently has 10 vacant positions, or about 10 percent of its workforce. He is currently paying double the overtime to fill the void left by those vacancies, but that has increased the average workweek of his paramedics by at least eight hours.

The amount of money he pays in overtime also becomes untenable, and his workers lose interest in the extra money.

“We are spending money today which we hope to get tomorrow, to be very honest with you,” he said. “It’s not a long term solution.”

There are about 1,000 EMS positions open in Michigan alone, Cummings said.

The good news for Cummings is that he has a handful of students who will graduate from the paramedic program next year, but the churn rate is constant. The Republican-controlled Legislature and Gov. Gretchen Whitmer, a Democrat, also agreed to allocate $ 12.9 million from the state budget to increase reimbursement rates.

But that didn’t slow down the revolving door nature of work. Among full-time paramedics, 47% in 2020 said the reason for leaving was a career or trade change, according to the survey. That number is 45 percent among paramedics.

“In my experience running an EMS department, I have seen more than a few employees enter the industry and leave within six months,” said Judd Smith, program director for Texas EMS School at Abilene. “I’m going to see people work for three weeks and then take the next step.”

The decline in Texas has been particularly significant. As of mid-August, only 27% of licensed EMS professionals had submitted a patient care record, according to the Texas Department of State Health Services, meaning more than 70% of licensed paramedics in Texas had not worked. on an ambulance for the first eight months of the year. This is a significant drop from the 43% of paramedics who submitted reports in 2020 and the 45% who did so in 2019.

Circumstances prompted the American Ambulance Association and the National Association of Emergency Medical Technicians to send a letter to Congress last week requesting a hearing to address the shortfall and request more funding to increase wages.

The letter warned that “our country’s EMS system is facing a crippling labor shortage, a long-term problem that has been developing for more than a decade. It threatens to undermine our 9-1-1 emergency infrastructure and deserves urgent attention from Congress. . “

Houston Fire Department paramedics transported a woman with breathing difficulties to a hospital last month.John Moore File / Getty Images

“We are hemorrhaging”

The pandemic has exacerbated a serious work problem.

The spread of the virus, the frequency of calls, fear of a potential infection and the necessary safeguards emergency personnel must take to protect themselves have created additional stress that has caused many to leave the field, said Suppliers. Their departure then increased the need for those who remained to work overtime, pushing them even more to leave the field.

The nationwide health emergency has also resulted in the closure of many EMT and paramedic courses, meaning there is a shortage of students entering the industry.

“We don’t bleed anymore – we bleed,” said Gary Wadaga, who operates Bay Ambulance in Michigan’s Upper Peninsula.

Ambulance companies have faced years of manpower issues that have hampered their ability to respond quickly to calls, but the situation is getting worse.

Last year, due to the closure of an ambulance service south of his company’s service area, Wadaga had to occupy an additional 100 square miles of land. Now it covers 1,500 square miles and receives about 1,000 calls per year with six paramedic stations.

The problem is, he hasn’t been able to fill two positions and has two other employees on leave, leaving him and another person to answer every call. emergency that is coming.

“I haven’t seen him so badly in 41 years, and you can’t just put that aside,” Wadaga said, adding that the increasing demands of the job had caused him great anxiety. “You want to be there for your community, but the fact that one day we won’t have enough people absolutely bothers me.”

Ambulance companies once had the luxury of considering applicants, but that seems to be a concept of the past. Today, companies are actively recruiting and even attacking each other because the pool of eligible workers is so small.

“Overall it’s robbing Peter to pay Paul,” Baird said, “because every community needs these people.”

A death spiral?

Wadaga and other ambulance service operators said the pandemic had heightened the nastiness of a labor shortage and put the country’s emergency medical system at risk of a “death spiral.” Which might be difficult to get out of.

The wage demands of a shrinking workforce are increasing while wages are stagnant. The 2020 median salary for paramedics and paramedics was $ 36,650 per year or $ 17.62 per hour, according to the Bureau of Labor Statistics. This represents an increase of around 7.5% since 2011.

Lawyers said the wages no longer match the demands of the job.

“When you are a life threatening EMS provider and you enter a closed environment with infectious patients and you can make more money working in an Amazon warehouse, it becomes really difficult to hold back the people, ”said Robert Luckritz, who is chairman of the EMS workforce committee of the National Association of Emergency Medical Technicians.

But it’s not just retail and warehouse work that is calling. Luckritz said hospitals facing their own nursing and healthcare shortages sometimes actively recruit paramedics and paramedics, promising higher wages, better hours and increased benefits.

This is an issue that Luckritz and his colleagues are trying to work on, but it is a challenge. They need more money to hire more people, but the rates for ambulance companies are set by insurers and the government for Medicare and Medicaid, both of which contribute the vast majority of calls. said Luckritz.

A Houston Fire Department EMS nurse prepares to transport a 2-year-old Covid-19 positive girl to a hospital in Texas on August 25.John Moore File / Getty Images

“Unlike most other industries across the country… we are not able to raise our prices – our prices are set by the government,” he said. “So with the reimbursement not keeping up with our costs, it’s very difficult for us to compete for labor.”

The fear is that if the country does not face these problems now, they will not be resolved later.

Baird, the AAA chairman, said if things get too bad, “we can’t even get people into the field because it seems too intimidating.”

“We have to turn the tide,” he said.

One bright spot is that there is increased interest in online EMS programs, such as Smith’s Texas EMS School – even though nationally there is a decline in enrollment in traditional programs.

The number of applications for their EMT program, which can be completed in 10 to 18 weeks through a mix of online courses and clinical and field practice experience, has grown from 495 applicants in 2019 to 1,469 in 2021.

The jobs are definitely there to wait for them upon graduation.

“I don’t know of any of our students who haven’t been hired within the first week of getting licensed,” Smith said. “We’ve even had a lot of them hired before they even got their certification, so they start working as soon as they’re done.”

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