Not just COVID alone, but a lot of other factors as well.

As I’ve mentioned in the past my post EMS second career is doing Quality Improvement work with various EMS systems under contract. Most of our clients are fire based systems with dual roll providers.

I get to know not only the providers, but most of the their officers as well. In all but one agency I’m on a first name basis with everyone in the agency.

As a result, I hear a lot of things not directly related to my work. First, a lot of people are retiring and in some cases just quitting the profession. Which used to be unheard of in the fire service. Once on a a department just about everyone spent their entire career there. Now, people are just leaving because they are burned out from doing EMS.

It’s not so much responding to COVID calls per se, but responding to calls from people who want to go to the hospital, but think that their risk will be minimized by going via ambulance. Makes no sense, but there it is.

Other providers are transferring from agencies that provide EMS with transport to agencies that restrict their EMS  role to first response until the private contract service arrives to show up.

Every couple of months one of my clients loses an experienced provider to another department that doesn’t transport. Or they’ll lose a provider to a larger department where providers get respite from the constant flow of EMS calls.

There is what I call a “generational change in EMS and fire service EMS in particular. A lot of the providers who were hired in the early to mid 1990s have now reached retirement age. Many are leaving the minute that they hit the magic numbers for a full pension.

In order to replace those providers, fire departments and even private services are forced to hire new medics with little or even NO EMS experience. One of my clients as a brand new firefighter/paramedic who was hired because he is certified as a paramedic. Other than the ride time he had during his paramedic program he has never worked in an ambulance until he was hired.

The results are predictable and I’m frequently out to his department to review a call with him and provide education (that’s our approach to QI) on what errors he made and how to better treat patients in the future. This is an agency with a very good in house mentorship, but that can only go on so long because their is a slot to be filled on their roster and it becomes prohibitively expensive to keep paying overtime.

I don’t know how this will work out for him and his department, but I’m not optimistic.

Even at that, agencies are having trouble recruiting new providers. The state civil service fire exam used to draw 15,000 applicants. The last exam drew 2,500 with about 10% of them being paramedics. EVERY paramedic that passed the exam was offered a job, sometimes from multiple departments.

As I commented to a Deputy Chief I work with “It’s like musical chairs, only with more chairs than players.”

All of this has lead to a measurable decrease in the quality of patient care. We work with about a dozen agencies and it’s persistent among all of them. It’s also traceable for the most part to the new providers although there are a few more experienced “Valued Repeat Customers” in the mix as well. Some of them would have been removed from providing cares, but agencies can’t find replacements that they are confident would be an improvement.

It’s worse among out one big private service client. During the height of COVID the state EMS office issued a waiver to allow ambulance services to staff with one EMT or paramedic and one “first responder” driver. A first responder has to have taken a first aid course and be certified in CPR. They can’t be the primary care provider and there are limits to what they can do.

As I learned in my years working for a government agency, there is nothing more permanent than a temporary rule or procedure. I fear that the state will continue this waiver for the foreseeable future.

This private service has no mentorship program at all, so it’s not unusual to see a provider working as an EMT on Monday, have a day off on Tuesday, and then be working as a newly minted paramedic on Wednesday with no mentor or paramedic partner.

This is a formula for disaster as these providers know only what they were taught in paramedic school with bad practices that they observed over their ride time or when working with a paramedic partner when they were EMTs.

I’ve seen a lot of serious medical errors that definitely harmed the patients and had a high risk of a bad outcome for them. We do what we can to better educate these new providers and help them become better, but there are more calls than we can handle.

I jokingly refer to it as the “EMS Artifact Full Employment Act of 2022”, but it’s really not funny.

If EMS can’t fix this, we are plunging headlong back to the bad old days of “throw and go” when an ambulance was little more than a horizontal taxi.

In case anyone wonders why I don’t jump back into the fray, the answer is that I’m just too old for that.  Even with things like power stretchers and lift systems, stair chairs with track rollers to make moving patients down stairs, and even better ride quality for ambulances EMS is not a job for older people. At least not high volume emergency responses.