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Study of underrepresented groups shows change will be slow to come in EMS diversity

Researchers suggest early recruitment efforts to improve the lack of diversity in EMS, which has cultural divide, communication implications


Emergency personnel carry a two-year-old boy to a waiting ambulance after he fell into White Oak Bayou in Houston on Thursday, Feb. 26, 2009.

AP Photo/Houston Chronicle, Steve Campbell

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A recent study found that language and communication barriers in the field could be reduced if a more diverse EMS workplace existed (read the full study below).

The study, which was performed retrospectively and includes an analysis of 10 years’ worth of data, was posted as a news article and received an overwhelming response from the EMS1 community.

Some readers agreed with the study’s findings, and the importance of encouraging and recruiting a diverse workforce. However, others stood on the opposite side of the argument – noting that agencies should focus on making the EMS profession an attractive career path for all potential employees.

“You can’t force people to choose EMS as a career,” paramedic and EMS1 Facebook fan Tom Meiser said. “We have to figure out ways to make EMS a more attractive career path across multicultural lines. We have a real PR problem these days. Our profession still demands these long hours for pay that doesn’t seem to match the commitment. It’s getting hard to create incentives to recruit anyone.”

The researchers’ goal, according to Dr. Remle Crowe, research scientist and performance improvement manager at ESO, and lead author of the study, was to serve as a baseline for future work to increase diversity in EMS.

Below, we’ll break down the study’s findings and their implications for the EMS profession as a whole.

Gathering gender and racial/ethnic data of certified EMTs and paramedics

Along with Dr. Crowe, colleagues affiliated with Ohio State University and the NREMT gathered gender and racial/ethnic data of EMTs and paramedics who received National EMS Certification from Jan. 2008 to Dec. 2017. Moreover, the study further examined the 2017 data by comparing the gender and racial/ethnic makeup of EMS providers to the overall U.S. population.

In total, the study’s population included nearly 600,000 EMTs and over 100,000 paramedics.

The data revealed that over the course of a decade:

  • Female EMTs rose from 28% to 35% percent of the workforce, while those earning paramedic certification rose from 21% to 23%
  • African-American EMTs accounted for a steady near 5% of the workforce, while those earning paramedic certification accounted for a steady 3%
  • The number of Hispanic EMTs rose from 10% to 13% of the workforce, while those earning paramedic certification rose from 6% to 10%
  • EMTs belonging to a minority racial/ethnic group rose from 22% to 27% of the workforce, while those earning paramedic certification rose from 13% to 19%

Furthermore, the study assessed the EMS profession’s workplace diversity by comparing the 2017 data of newly certified EMTs and paramedics against the U.S. Census Bureau’s population data by region for the same year.

The researchers concluded that African-American and Hispanic EMTs and paramedics were underrepresented in all regions.

“The underrepresentation of females and minority racial/ethnic groups observed during this 10-year investigation of EMTs and paramedics earning initial certification suggests that EMS workforce diversity is unlikely to undergo substantial change in the near future,” the study concluded.

Ultimately, the study determined a disconnect remains in regard to encouraging and recruiting diverse students to pursue a career in EMS.

How a diverse workforce reduces cultural, communication barriers

Prior research, according to Dr. Crowe, has shown that having a diverse workforce can assist in reducing language, cultural and communication barriers.

“This, of course, does not mean that EMS professionals whose race or gender does not match that of the patient will provide a reduced quality of care, but rather the research suggests that having fellow students and coworkers with diverse backgrounds gives us all greater ability to overcome communication barriers and provide culturally and linguistically competent care,” Dr. Crowe added.

According to Dr. Crowe, the underrepresentation of females and minority racial/ethnic groups among newly certified EMS professionals was not a surprising finding. “Previous research has reported underrepresentation of people of minority racial/ethnic groups and women in the EMS workforce,” she said.

The concerning finding, she said, is the continued underrepresentation among a large, national group of recent EMS graduates. “These underrepresented groups are less likely to enroll in EMS education programs and pursue careers in EMS. This suggests that the overall diversity in the EMS workforce is not likely to change right away.”

Making a change, Dr. Crowe added, requires a systems approach and won’t come easy.

Recruiting a younger generation to EMS

The documentation of the underrepresentation of women and people of minority racial/ethnic groups is an important finding, and one that is starting a discussion among EMS professionals regarding diversity in EMS.

In regard to initiating change, Dr. Crowe said there is no silver bullet. In fact, she said further research is needed to understand and address the barriers related to people of diverse backgrounds enrolling in EMS education programs and earning certification.

“Finding ways to encourage women and people of racial/ethnic minorities to consider and pursue careers in EMS by enrolling in EMS education programs is key,” she said.

One possibility, she said, is to increase efforts of making people aware of careers in EMS at a younger age.

“Some recruitment efforts are focused on reaching high school students through CPR, emergency responder or EMT classes,” she said. “But, speaking to students in middle school or even elementary school could have positive effects.”

On a larger scale, Dr. Crowe said organizations must learn from EMS programs that have successfully found ways to encourage diverse student populations.

“For example, St. Paul’s EMS Academy in Minnesota has leveraged partnerships to help diverse classes of students complete EMS education programs and earn initial certification,” she said. “The Bay Area Youth EMT program has set out to increase diversity in the EMS profession by encouraging inner-city youth to pursue education in EMS and fire.”

Learning from a variety of EMS programs around the country, Dr. Crowe said, is a good starting point for replication on a national scale.

A coordinated, national recruitment effort to improve diversity

Although the study’s purpose was not meant to provoke any parties, it has successfully created and spurred a discussion among EMS professionals at all levels in their career.

“As the saying goes, ‘if you can’t measure it, you can’t change it,’” Dr. Crowe said.

The study’s results found that there must be a coordinated, national recruitment effort to improve diversity in EMS.

And, whether that discussion and potential change in direction is spurred by workforce statistics, the need to resolve low EMS wages or the importance of early exposure to EMS, the outcomes all have one thing in common: change must occur to ensure a well-rounded and diverse EMS workforce.

Sarah Calams, who previously served as associate editor of and, is the senior editor of and In addition to her regular editing duties, Sarah delves deep into the people and issues that make up the public safety industry to bring insights and lessons learned to first responders everywhere.

Sarah graduated with a bachelor’s degree in news/editorial journalism at the University of North Texas in Denton, Texas. Have a story idea you’d like to discuss? Send Sarah an email or reach out on LinkedIn.