Salaries, strong recruitment ease D.C paramedic shortage

By Raymond McCaffrey
Washington Post
Copyright 2008 Washington Post

WASHINGTON — To curb a critical shortage, fire departments across the Washington region have pursued paramedics like star athletes in recent years, enticing them with signing bonuses, handsome salaries and the promise of fast-track career paths.

Montgomery County hired a marketing expert and launched a national recruiting drive, reaching out in particular to women and minorities. Fairfax County offered top starting salaries, now totaling about $57,000 -- as much as 50 percent higher than some other local jurisdictions, though Fairfax paramedics generally work longer hours.

The increasingly sophisticated recruiting tactics have worked, fire officials say, turning around a shortage that gripped the region after the 1990s. During that decade, the number of medical-related 911 calls increased as the area's population grew by 16 percent and aged overall.

As a result of the efforts, response times to the most serious medical emergencies have improved significantly in many jurisdictions, according to data from the departments.

"We were getting worried," said Lt. Col. Karl L. Granzow of the Prince George's County Fire and Emergency Medical Services Department. "We were experiencing lot of attrition, and we were struggling with our capability for service as the community grew."

The department began offering new firefighters free paramedic training through a program at a community college, an effort that has helped to nearly double the number of paramedics and cut average response times in medical emergencies requiring advanced life support, or ALS, by more than a minute and a half. The initiative was successful enough that the county abandoned its aggressive recruitment efforts.

"We got into bidding wars with neighboring jurisdictions," Granzow said. "And that's not healthy."

Other departments targeted Pennsylvania and New York, areas with large pools of volunteer firefighters looking to switch to paying jobs. Loudoun County looked south and west after hearing that the Roanoke area had more people training to be paramedics at a community college than it had jobs.

In the past five years, the Fairfax County fire department has increased the number of paramedics by about 85 percent, improving response times slightly as its call volume has increased.

In roughly the same period, the D.C. fire department boosted its number of paramedics by almost 19 percent, lowering the average response time for ALS emergencies by 3 minutes, 21 seconds.

Montgomery nearly doubled its paramedic ranks during the past decade and improved emergency care in growing rural areas, such as Laytonsville, where the addition of a single paramedic cut the response times for ALS emergencies by about three minutes.

Experts say those minutes can mean life or death for the most critical patients: victims of heart attacks, car crashes and assaults.

Firefighters are typically certified emergency medical technicians, capable of performing CPR, setting broken bones and stopping bleeding. But paramedics -- EMTs who are certified after receiving intermediate or advanced training -- can perform as field doctors, providing more extensive treatment and diagnostic services, experts say.

The swelling number of local paramedics is due in part to the success that fire departments have had in attracting diverse candidates to a profession that historically had been the province of sons, grandsons, and great-grandsons of European immigrants. Now, recruiters are dispatched to ethnic festivals, county fairs and even a family reunion.

In recent years, Fairfax has run television ads featuring women and minorities. In one, a woman reading to her children suddenly looks up and says: "I'm a firefighter."

"You're not going to see a recruiting poster with five white males on it," said Fairfax Deputy Fire Chief Kevin Kincaid.

Adam Jones, a battalion chief in Montgomery, said he made sure to enlist the department's women and minorities in the recruitment push. He said, for example, that he might tell a firefighter: "You're a 22-year-old black female. You love this job. Tell your friends about this."

Leslie Maxam, a marketing expert with the department, said she has found herself bridging another cultural divide: the one that has separated firefighters and paramedics. One of her first moves was to redesign the department's recruiting flier, removing what she described as a "big ball of fire on the front."

"I don't know if every paramedic wants to run into a burning building," she said.

Historically, firefighters rode on engines, and paramedics rode in ambulances. Paramedics, their career paths limited, were often the objects of playful scorn because they so rarely went to a fire.

"I kidded them that their fire days were annual events. . . . They never got to ride the firetruck," said Montgomery County Assistant Fire Chief Mike McAdams.

Now, in Montgomery and elsewhere, paramedics are an integral part of the rescue service, often deployed on firetrucks and drawing larger salaries than firefighters.

The District created an entry-level paramedic/firefighter position that pays $48,731, plus a $7,000 hiring bonus, compared with the $44,301 standard starting salary for a firefighter/EMT. Other jurisdictions are offering bonuses that bring paramedics' salaries close to that level.

Some have cleared the promotion path for paramedics, but Prince George's has gone one step further. Firefighter recruits who are not certified as paramedics now face "limited" career prospects, said Granzow, the fire department's deputy director: "You can't advance any further. You can't be promoted."

This represents a major change from the 1990s, when the department required that newly hired firefighters obtain paramedic certification within 48 months. Four years later, the department realized that only 25 of the 250 firefighters hired since that requirement took effect had actually become paramedics.

"It wasn't realistic that the government was going to fire 225 employees," Granzow said. "We used to offer the stick; now we offer the carrot."

In 2005, the county developed a paramedic training program at Prince George's Community College, where recruits get free tuition and, once certified, a bonus. The county is on track to increase the number of paramedics so that about 40 percent of the department will be certified, Granzow said.

The demand for paramedics is expected to grow everywhere as the population ages, the number of medical calls increases and local jurisdictions continue to encounter recruiting barriers, including a lack of affordable housing.

"I think we can keep our head above water some days," said Loudoun County Battalion Chief Corey Parker. "On other days, we struggle."

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