National EMS Week celebration revives workforce concerns
As Covenant Health hosted events honoring emergency medical service professionals as part of National EMS Week, a widespread shortage of qualified technicians and paramedics loomed large over its festivities.
Spirits were high on Wednesday as EMTs and paramedics from around the Lubbock region were treated to complimentary sausage wraps and refreshments outside of Covenant Children's. Fire engines and ambulances sat momentarily unattended as the workers ate and visited with one another.
Ray Garcia, a Covenant EMT with more than 20 years of professional experience, said he enjoys his job despite its constant strain. After spending some time away from the profession during COVID, he said it has taught him patience over the years and to “think through everything.”
“I can't see myself sitting in the office doing office work,” Garcia said. “But as long as I can stay healthy— physically healthy, mentally healthy — I’ll continue to do this job.”
Garcia said he and his fellow EMTs felt appreciated for all their hard work during the event. Still, all in attendance were keenly aware of its demands.
Garcia and his crew were there before undertaking 10-hour shifts and he said that burnout is “definitely a thing” they contend with. There are around 1,400 first responders - paramedics, EMTs, firefighters - who serve Lubbock and its 22 closest surrounding counties, according to the National Association of State EMS Officials
Dia Gainor, executive director for NASEMSO, said there are about 11,500 ambulance services nationwide that respond to 911 calls. In rural areas, those services tend to be comprised mostly of volunteers.
“It's increasingly difficult to get individuals qualified to be licensed as an EMT, or higher level, let alone to do it for no pay,” she said. “That's a straightforward reality and a problem that predates the pandemic.”
Moreover, this critical volunteer workforce is an aging one. Gainor said the average age of a volunteer EMT in Texas lands somewhere in the 50s.
To address this, the Texas Legislature appropriated $21.7 million in 2021 for the Department of State Health Services to fund education programs for new EMTs and paramedics. As of May 2023, over $9 million has been awarded to DSHS for the Texas EMS Scholarship program and funded the training of 424 EMT-basic students, 79 advanced EMT students and 988 paramedic students.
Garcia said this program is an encouraging sign that state leaders recognize their plight, but it does little to address the low wages that have already pushed many in the field to other lines of work. EMTs and paramedics are some of the lowest-paid healthcare workers nationally, according to employment data from the Bureau of Labor Statistics.
A 2022 survey of 119 EMS organizations by the American Ambulance Association showed the primary reasons for workforce turnover were low pay and benefits. That survey also found overall turnover increased by 6% in 2022 over the previous year.
Further, a report published last year by the Health Resources and Services Administration indicated that the country would need to train and employ roughly an additional 40,000 full-time equivalent EMS workers by 2030 to satisfy healthcare demands. Gainor said there are not enough “resources at the state level to solve the problem.”
“At the end of the day, it comes down to the local political jurisdiction — whether that's a city, or a county or a town — making a decision about what they want to be sure is available to their citizens and visitors,” Gainor said. “And the economic dilemma is that rural locations tend to have very low call volumes. They may get less than one call a day. So, it could be a pretty expensive prospect to fully staff an ambulance 24/7, 365 for so few calls.”
Despite a lower call volume, Gainor said the problem of fatigue is still just as much of an issue for rural ambulance services because of call intensity. Often, they must answer calls in their community and help people they personally know— further amplifying the situational trauma they experience regularly.
If few resources are at the disposal of local jurisdictions to address pay and burnout, even fewer exist to provide mental health support for EMS workers. Gainor said these issues have persisted since the beginnings of modern EMS, dating back to the 1950s and 1960s, but were made worse by the COVID-19 pandemic.
Fewer workers in ambulances is resulting in prolonged response times for 911 calls in situations where time is a critical resource. Some support exists in the form of 24/7 telephone service known as the “Heroes Helpline,” a free and confidential mental health support for first responders and healthcare workers.
DSHS said in a written statement it also offers programs for behavioral health training education and advocacy for first responders as well, which provides support for mental health issues like “depression, anxiety, PTSD and compassion fatigue” in addition to substance use issues.
Despite the critical care EMS provides, DSHS said it is not considered an “essential” service in Texas. State law allows counties to guarantee EMS services if they wish but none are required.
Only 11 states nationwide explicitly deem EMS services as essential, meaning it is required to be provided to citizens. Michael Furrh, EMS director for Lavaca County in Southeast Texas, said his department has only been fully funded by the county for about three years.
“What we're really concentrating on in our region is recruiting these EMTs, getting them to and through school and being able to put them through paramedic school so [that] we have more paramedics,” Furrh said. “If you've seen one EMS system in Texas, you've seen one EMS system in Texas. We're all different [with] how we operate and function.”
It is crucial in rural areas like Hallettsville, the seat of Lavaca County, to ensure an “advanced level of care” is available in nearly every ambulance call received, he said. This is because EMTs are specifically trained to handle “basic life support” duties — like providing CPR, oxygen and initial wound and injury care — while paramedics are further qualified to administer intravenous medications, intubate patients and diagnose heart attacks in the field, among other duties.
Although they face an uphill battle with retainment, Furrh said Lavaca County EMS has made some headway with recruitment and training thanks to the legislative allocations for EMT scholarships. While the program is a relatively new one, it has already garnered some positive results for EMS systems like the one in Lavaca County.
One EMT already on payroll was able to utilize state funding to train to become a paramedic at no cost, granting Furrh’s department one more advanced-care level medical technician under contract for at least the next two years.
“It's kind of hard to explain it to somebody that works at a bank nine to five, Monday through Friday, [that] we're on shift 24/7, 365,” Furrh said. “The majority of the time... my departments work two days on, four days off. So, they're literally at work a third of their life, and it takes a strong person to do that. … It takes a good organization to keep that person on the right path and give good treatment in the field.”
Healthcare workers and first responders in need of mental health or substance use support can call the Heroes Helpline at any time at (833) 367-4689 or online at heroeshelpline.org.