EMS has always been a field with a lot of turn over. Unless a provider worked for a fire based or other government run service pay, benefits, working conditions were all far worse than other fields that paid more. Even some of the government based systems treated their EMS providers as second class citizens.

Starting in early 2020, the situation got dramatically worse. During what I call the “panicdemic” the stress and demand on all levels of medicine increased to never before seen levels.

Hospitals and providers were overwhelmed with unprecedented new procedures.

I won’t get into the current debate over whether any of that was necessary, some of it, or none it.

Questions about the origin of the virus, treatments, preventative measures, treatments such as intubation, and whether the vaccines work, didn’t work, or were even dangerous will rage on for years. We may never know the truth about what happened or why. So, I’ll ignore that.

At first my former medical director, with whom I maintain some contact felt that the whole thing would be over in a few weeks. Actually, so did I. In fact if you look back I predicted that. Both of us underestimated the hysteria that would grip much of the world. Or, at least most of the world with the internet, cable TV news, and politicians eager to grab control of large sections of the economy.

In EMS drastic changes took place. Among my fire based clients sleeping accommodations had to be completely revamped. The view that had double bunk rooms had to reconfigure offices and training spaces as sleeping quarters. Department members were essentially confined to quarters between runs. No dinner as a group, no training for almost a year, no other group activities.

Providers at all services had to follow the hospital procedures of wearing masks and gowns at all times when on duty. A two person ambulance crew sitting in the same cab had to mask up, wear gloves, and in many cases face shields both during and between calls.

And of course everyone who coughed once called 9-1-1 for an ambulance convinced that they were going to die from COVID. My state instituted two new protocols which allowed EMS providers to refuse service to people who had tested positive but were not acutely ill. I read more than one report where a provider had not only refused transport, but refused to even exam a patient before telling them to “suck it up” and only call if they were too sick to move. That’s a direct quote from a PCR I audited.

Procedures were also changed so that only one provider would make initial contact and were not required to bring more than a bare minimum of equipment. If they brought anything.

In my state staffing requirements were “temporarily” changed so that only one state certified provider was required, along with one driver. How retro.

Some of the private companies are still working under those waivers. Remember there is nothing more permanent in government than a “temporary emergency.”

Crews were doing twice the normal call load and it wore them down. Add to that the fact that if a provider tested positive, even if they were asymptomatic, they were sent home for two weeks (with pay) until they tested negative. That meant that other providers had to work forced overtime to fill slots on ambulances.

How bad was it? One fire fighter/paramedic I knew quit her fire job. IN THE MIDDLE OF HER SHIFT!

She just had one call too many, went back to the station, hand wrote her resignation, and then tossed that along with her turn out gear, uniform, and other equipment on the shift commanders desk.

While this was going on a good number of providers reached their agencies retirement requirements and did just that. Retired, leaving yet another hole to be filled. I will be frank here. If I were still working when this started and was able to retire I would have done the same.

Another straw on the camel’s back. Agencies were required to give unlimited and compensated time off to their employees who “Didn’t fee safe” working during the pandemic. Gee, I wonder if anyone anywhere might have stretched that definition like Lizzo in Yoga Pants?

Some hospitals added to the problem. They would require EMS crews to stay in the ambulance with the patient for up to an hour while the prepared a “COVID room” for the patient.

Not only did this put added strain on the EMS crew, it was very, very likely to be violation of the Emergency Medical Treatment and Active Labor Act (EMTALA). This is a federal law passed back in the 1980s that sets strict requirements for when a patient must be seen in an Emergency Department.

If only I had listened to my mother and gone to law school. Sigh.

All of that lead to shortages of EMS providers throughout public and private systems.

Private systems finally had to increase pay rates and improve benefits to retain and attract new EMTs and paramedics. Some started to run their own EMT classes and allowed people to enroll for free. Some even paid people to take the courses.

The fire service started to hire EMTs and encourage them to go to paramedic school with the promise of instant advancement to paramedic upon receiving the certification card. Imagine being a brand new EMT, going to school for some period of time, and then suddenly being the paramedic in charge of an ambulance? For that matter, imagine being the patient of that paramedic?

Keep in mind that this is good for me as it increases my work hours since there are so many new providers with next to new experience, no orientation to their new role, and no supervision.

Think of it as the “EMS Artifact Full Employment Act.” I kid you not, 2021 and 2022 were good years for me and the IRS.

Fire departments were so desperate for paramedics that they had to “adjust” some of their hiring requirements. Paramedics with marginal scores on the fire exam were offered jobs ahead of non paramedics who scored much higher on those exams.

A good number of those people were hired, went to the fire academy, and after a year or so decided that “The fire service isn’t for me.” They left or were encouraged to leave and a year of time and a significant amount of money were expended with no benefit to the taxpayers.

One department I’m familiar with has started to hire EMTs and then paying to send them to paramedic school. After that, they still have to go to the fire academy to be firefighter certified. So, they get paid for about a year to be trained before they can work as paramedics.

The net effect here is that there are fewer experienced EMS providers working now than four short years ago. That can’t be good for patient care, not good at all.

Will EMS ever recover? Maybe, but it will be years before we know. In the mean time, just hope that you get a paramedic with dry ink on his or her certification card.