Overwhelmed

2
Overwhelmed

Not me, but EMS as a profession certainly seems to be.

Here are a few data points from here and there.

One private service is offering up to $40.00/hour for paramedics based on years of experience. They are still unable to fill empty slots.

Fire based services are also having trouble filling slots despite the generally better schedule, pay, benefits, and working conditions. In my state anyone who wants to be a fire fighter pretty much only has to become a paramedic, take the fire exam, and they will be offered a job, probably several.

Once hired, these brand new, ink still wet, paramedics are being placed on ambulances with little to no field mentoring. That’s good for me because I get to spend a lot of time teaching them what paramedics generally learn after they start treating patients under the guidance of an experienced medic.

These days, few departments have the time or money to do that, so the new hires are sent right to the ambulance. This is not particularly good for either the provider or the patient.

As I’ve said many times before, getting a paramedic license is just getting a ticket to actually learn how to treat patients. For you downhill skiers, it’s the Bunny Slope of EMS if you get my meaning.

At that, fewer people are taking the fire exam overall.

Some fire departments are hiring people who are basic EMTs and paying for them to go to paramedic school.

Traditionally, a person stayed with his fire department for an entire 30 or so year career. No more. As one chief officer described it, “It’s like musical chairs, only there are more chairs than players.”

A good number of experienced paramedics are transferring to other fire departments that do not have ambulances. They are getting an annual stipend because they are paramedics, but don’t actually do more than first responder duties.

At least one fire district has added ambulance availability to it’s morning radio/availability checks. Traditionally that only included engines and ladder trucks, but now some departments are reporting that they can not send an ambulance for mutual aid on medical calls. They are just too busy trying to cover their own cities or towns.

There is some talk of starting up regional non transporting “fly car” systems. Which used to be common in my state, but died out through the 1990s into the early 2000s as fire based services started to provide ALS care.

Everything goes in cycles, I guess.

Some areas of my state have reverted to the long discarded staffing system of one medically trained crew member and an first aid trained ambulance driver. That system started to die in the mid 1970s just before I became a full time EMS provider. Now, it’s coming back to help relieve staffing shortages.

As a result, there is more stress and work load on the single provider as what the driver can do in terms of care is strictly limited.

Some private services have taken advantage of the emergency regulation changes and are trying to convince the state regulatory agency that this should be a permanent change. Which will of course drive more people out of EMS as they get burned like an electric vehicle under salt water.

My former employer is now reporting zero available ambulances at various times during the day. The private services that used to provide back up 9-1-1 service are no longer doing so because they are too overwhelmed with their own emergency and Inter Facility Transfer (IFT) calls.

Patients are being held additional days in Emergency Departments because the hospital has no available beds and the private services that do their transfers are booked solid days in advance.

One large non profit teaching hospital has started it’s own ambulance service at two of it’s larger facilities.

Why did this happen? There are a few reasons.

  1. COVID. Since the pandemic started requests for ambulances have gone up. No one is quite sure of why since COVID transports aren’t a huge part of either emergency or IFT calls. Of course if providers test positive they are barred from working for some period of days. Early one, that was two weeks, but now it’s often less time. The additional work load has driven some providers to just leave the field entirely.
  2. No one seems to want to work. At least not in EMS. When fast food restaurants are paying as much to start as an EMT would make, why take the harder job.
  3. The population is aging. Baby Boomers are all approaching or at retirement age. Which means that a lot of providers are no longer working in EMS. Like me. I’m in good physical condition for my age, have minor ailments, and could theoretically work on an ambulance. But I don’t have to and do want to. I’ve done my service and now perform easier EMS related tasks.
  4. People are living much longer and using EMS more often. It’s now fairly routine to see patients over 100 years old. When I started in EMS I might see one or two a year. Now, services are seeing that number every week if not more often.
  5. Ironically electronic Patient Care ReportĀ  (ePCR) systems take longer than the old pen and paper reports to write. That often increases at hospital time. They are great data collection tools, but in addition to more time, they provide far less useful clinical data.

I’m pretty pessimistic right now as are people who work in the field and the managers who have to try to find and retain EMS providers.

I’d like to think that maybe this will get better, but I can’t see how or when.

Japan is starting to use robots to provide care in nursing homes. Is there a role for robotic EMS providers?

We may well find out.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.

2 COMMENTS

  1. Sadly, everything you’ve said is true for pretty much the entire US… One minor correction- ‘with little to know field mentoring’ should say- ‘with little to NO field mentoring’

    • Thanks for the comment. Yes, sometimes my fingers type words on their own. I’ll fix that.

      Yes, it appears to be nation wide. I fear it’s also not limited to EMS and the fire service.

      One thing I forgot to mention is that a large city police department just had 24 officers resign after getting hired by the city’s fire department. They were fed up with how the police are being treated and opted to move on.

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