By Daniel Patterson
The News & Observer (Raleigh, North Carolina)
Copyright 2006 The News and Observer
CHAPEL HILL, N.C. — Recent news reporting has highlighted poor pay and working conditions as significant factors in low retention rates for local emergency medical technicians (EMTs) and paramedics. These issues are not limited to the Triangle or to North Carolina. High turnover of EMS personnel is a national problem.
The National Association of State EMS Officials and the National Rural Health Association have identified recruitment and retention as the most salient issues EMS systems face today. Reports of too few volunteers or not enough paramedics appear frequently in the news.
This trend should not be ignored. EMS and legislative leaders in North Carolina should address the work-force problems head on and relatively soon. Failure to act could lead to cases like a highly publicized tragedy in Philadelphia.
There, inadequate staffing of EMS systems contributed to the death of an otherwise healthy man, Ricky Badway, in November 2005. When it was obvious that Badway was experiencing a medical emergency, his girlfriend called 9-1-1 and immediately started CPR.
Twenty-two minutes later, emergency crews arrived to find Badway already dead. The lack of enough EMS professionals available for response prevented help from arriving on scene within the nationally recognized 8-minute time-frame.
Reaction to this tragedy has been significant. The Pennsylvania EMS office issued a call to all EMS systems to join forces and implement a statewide recruitment campaign. A rap video was produced to aid in recruitment. The legislature passed a bill targeting gaps in emergency services training and equipment.
Systems like those in Philadelphia, Raleigh, Durham and in other areas are under tremendous stress. Use of hospital emergency rooms and EMS services has increased dramatically over the past 10 years. In 2003, more than 114 million visits were made to emergency rooms nationwide. An estimated 16 million of those visits involved EMS transportation. Millions more Americans used EMS for transfers to and from one hospital to another.
Not all such transports are reimbursed by patients or insurers. The EMS medical director for North Carolina, Greg Mears, has said that on average only 25 percent of all EMS transports are reimbursed. This means the EMS system must absorb the cost, or shift it to those with insurance by charging more. The former is probably the more likely scenario.
In addition to growing utilization and financial stresses, the work-force is experiencing growing pains. EMS is not a lucrative occupation and never has been. Many people become an EMT or paramedic for altruistic reasons, and within a few years leave for work that offers better pay, benefits and flexibility. And some research suggests that a large proportion of individuals enter EMS only to bridge to another health profession, making EMS somewhat of an occupational stepping stone rather than a real career.
These are not trivial issues. In emergencies, whether medical or traumatic, EMS is often our first point of contact with the health care system. For rural North Carolina residents it is often the only health care service for miles. The accessibility and availability of EMS is very much a life or death issue.
Something can be done. The follow-up to the tragedy in Philadelphia serves as an example of the importance of state initiatives and legislation. Recruitment campaigns and grant programs designed to decrease turnover of EMS personnel and to invest in infrastructure and training are examples of the types of programs that can make real impacts.
There is no single federal source of EMS funding or technical assistance, so we cannot rely on Washington to identify and fix the problems in the Triangle and North Carolina. Since the early 1980s, EMS has been a local and state responsibility. Assessing the problem and discussing ways to improve conditions are important steps forward. Doing nothing leaves open the possibility for a Philadelphia-like tragedy for no reason other than a stressed EMS system.
(Daniel Patterson, Ph.D., is a post-doctoral research fellow at UNC-Chapel Hill’s Sheps Center for Health Services Research. He is also an EMT-B (Cadet) with the South Orange County Rescue Squad.)