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7 important questions to answer before hiring your agency's first paid EMT

Once a volunteer EMS agency decides to hire paid EMTs, these questions must be answered before the positions are announced and interviews begin


Your volunteer rescue squad has decided to add paid EMTs to help cover the schedule. Getting to this decision point was likely fraught with conflict and issues within the department.

Bringing in the right staff, not just bodies to fill shifts, is essential in order to solve the current issues and avoid future problems. Reaching this point, though, may likely bring to light a whole new set of issues and possibly more drama.

Unfortunately, setting the budget for personnel costs is often some version of the governing body appropriating the money for paying the new staff by picking an arbitrary number to be allocated for staffing.

Often this number is based on what somebody heard is being paid to support a neighboring agency. Or the number is picked on baseless assumptions regarding billing revenue, local or regional grant funding, labor costs and operational expenses.

After the arbitrary allocation is set, the volunteer agency leaders look for the cheapest, easiest option to cover shifts.

This is a short-term work around of the current staffing problem. It is not an adequate solution to provide reliable, long-term coverage.

Before a job is posted, the following questions need to be asked and answered as objectively as possible.

1. Who will be the employer?

Any of these entities can employ EMTs.

  • Rescue squad
  • Village, town, city or county
  • Commercial EMS company that leases employees per diem
  • EMS staffing company

There are benefits and downsides to each option that need to be researched and evaluated.

Hiring EMTs per diem from a commercial service should only be used as a stop-gap or emergency measure. It is unlikely that you will have any control over the selection of the personnel, their clinical proficiency and perhaps most importantly, their attitude towards serving your community.

EMS staffing companies are becoming more common. The company owners are typically experienced EMS providers who also have had supervisory and business experience. Because their success depends on the success of the volunteer agencies, they are highly motivated to hire and provide their clients with seasoned and volunteer-friendly EMTs.

They often offer other services such as training, mentoring programs, quality assurance and operational consulting.

An EMS staffing company could be the fastest and simplest solution, but is likely to be more expensive than other options. Weigh the value of outsourcing personnel and the liabilities versus handling staffing as in-house responsibilities for a few dollars an hour less.

2. How will regulatory and legal compliance requirements be monitored and met?

Dealing with personnel issues, labor laws, tax laws, employee benefits, worker’s compensation insurance, scheduling, payroll, training and disciplinary actions requires a body of knowledge and a time commitment that often exceeds the capabilities and time constraints of most volunteer line officers. Unless you have members with actual HR training and experience who are willing to assume both the responsibility and the liability associated with that task, you should outsource the hiring of employees to a private firm or partner with your village, city or county HR department.

Outsourcing compliance employment and labor regulations is probably the best option. One way to do this, before you begin hiring EMTs or signing a contract with another organization for outsourcing, is to hire an attorney who is familiar with EMS to review your processes.

Remember, volunteer members cannot work as paid personnel in their own agency. It is an FLSA violation.

3. Who is the boss or supervisor?

How do you supervise, reward or discipline an employee if you are not the boss? Who will these employees answer to?  

EMTs who are municipal employees are often hired by people with no EMS background and can be subject to budget cuts and the whims of politicians, who would rather have them assisting the fire department or public works than mentoring volunteers. How EMT employees will use the time in between EMS calls is important to clarify before the first hire is made.

EMTs, hired as local government employees, may have specific labor protections or processes in place regarding discipline or employment termination.

4. How many EMTs are needed?

The number of potential hires and their function is a factor in deciding who should actually employ the new staff. Which model will serve your agency best?

  • Pool of part-time EMT’s available as needed
  • Full-time EMTs with regular schedules
  • A paid crew chief partnered with a volunteer
  • An operations director to run the agency

Instead of just looking at shift coverage consider what kind of help will bring the best bang for your organization's buck. A handful of full-time employees with the availability to work different days and shifts might make coverage easier, be easier to manage and be more invested in your agency.

5. Which positions are needed?

For some departments, a full-time employee functioning as an operations manager whose responsibilities include scheduling, training, recruitment, purchasing and covering a certain amount of shifts might make more sense than a cadre of part-time EMTs simply filling shifts.

A manager can be incentivized to decrease the need for hourly staffing by recruiting and retaining more volunteers. A manager can be accountable for ensuring the agency meets or exceeds agreed-upon performance measures and budget.

6. What level of pre-employment screening is required?

Focus on suitability, not an EMS pedigree. An experienced provider should be able to provide letters of recommendation from previous employers and their medical director. Clinical competency should be an expectation.

Criminal background checks, motor vehicle record checks, Medicare fraud checks, and medical clearance exams are necessities. Conducting these checks and ensuring fitness for duty are the responsibility of the hiring agency.

Remember, the right paid staff are people who will help you rebuild your organization. They are not just meat in the seat.  

Confidence, patience, congeniality, tolerance and a sincere desire to help others be successful is required. Positive experience as a volunteer or interacting with volunteers is important.

Seek out people who will be committed to the success of your organization. If outsourcing staff, have a clear, written understanding with regard to what influence your agency will have in ensuring that contracted EMTs meet employment and competency requirements. Your agency must be able to negotiate both qualifications and employee wages as part of the contract.

7. How well should we pay EMTs?

To attract the best people, your agency needs to be their primary employment. Overextended and fatigued providers attempting to "earn money sleeping" do little to contribute to the safety of your community or the success of the agency.

EMTs being paid below a living wage is a national disgrace. Volunteer, non-profit EMS agencies are in a unique position to raise the bar on EMS salaries. Currently most EMS wages are based on a flawed and unsustainable reimbursement model. The subsidy provided by your volunteer hours, which was $23.56 per hour in 2015, can allow an attractive salary and benefits package for your career staff while still providing the most economical solution for EMS provision in your community.

Much will be expected from your new staff: make it worth their while. When your budget is considered, be prepared to educate the public on the real value of having EMS provided locally.

Answering these questions the right way — gathering and discussing facts without emotion — is the path to finding the right people to ensure the future success of your volunteer EMS organization.

Learn more about EMS staffing:

These are three EMS staffing agencies that I am personally familiar with and provide staffing services to volunteer EMS agencies.

  1. Emergency Resource Management
  2. VINTECH Management Services
  3. E5 Support Services

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