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7 reasons why EMS providers flee, and how to combat them

Everyone has a breaking point; it’s important to understand the reasons why some EMS providers may decide to leave, and how to turn a potential problem into a solution


The voluntary turnover rate in EMS is higher than in most other professions. It’s important to understand the reasons why some EMS providers flee the profession in order to put a situation into perspective.


There are many reasons why providers leave, from safety concerns, to the physical and mental toll EMS can take, to outdated technology and policies, disconnected management, and low pay. In our Special Coverage package, “Defying the EMS retention crisis,” learn how to combat these and other retention challenges.


If you’ve been in EMS long enough, then you’ve likely had a thought or two about quitting.

The days are long, the shifts are rough and, sometimes, it just might not seem worth it. But, then a call comes along that turns that perspective upside down. Whether it’s a great save, a simple “thank you” from a grateful family member or even – dare I say it – a quiet shift, where providers are able to connect with those they encounter; for better or worse, things turn around. These moments help EMS providers remember why they joined this profession in the first place – to help people.

And yet, the voluntary turnover rate in EMS is higher than in most other professions. It’s important to understand the reasons why some EMS providers flee the profession in order to put a situation into perspective.

Here are seven reasons why EMS providers may decide to leave, and how agencies can turn a potential problem into a solution.

1. Career advancement

Career growth is a universal reason to move on from a position. But what if you create opportunities for providers to advance their education and their careers while remaining at your agency?

Last year, the Nebraska Legislature set aside money for partial tuition reimbursement for EMS providers. To be eligible, providers must hold an active Nebraska EMS license and be a member of a Nebraska licensed EMS service that’s located within the state. The reimbursement payment amounts are tiered, but any amount of money goes a long way to helping a provider pay their way through college.

Another example is American Medical Response’s “Earn While You Learn” program. Thirty students recently graduated from the “Earn While You Learn” inaugural EMT Academy class. The students, who were hired before beginning their training, earned income while undergoing the New York State EMT program and the AMR new hire orientation program. Providing stable financial security, as well as a job waiting goes a long way to finding and keeping recruits.

2. Mental health, stress and anxiety

A career in EMS is not for everyone. It takes a certain kind of person to be able to do the job – day in and day out. An average person cannot imagine seeing what most EMS providers experience throughout their careers.

Providing emotional support is key. Many agencies offer an Employee Assistance Program (EAP) for their providers. EAPs are aimed at helping an employee in need of assistance. Specially trained and licensed counselors help with issues ranging from job-related problems, financial strains, mental health or behavioral difficulties, family concerns and more.

The “suck it up” mentality should not, and cannot, exist at any agency.

3. Sleep deprivation

Poor sleep and work-related fatigue go hand-in-hand. In December, a Burlington, North Carolina, EMS provider fell asleep at the wheel while driving an ambulance. The EMS provider hit a curb before traveling 70 feet and crashing into a concrete wall. The crash injured the other EMS provider in the rig.

To combat fatigue, Austin-Travis County EMS in Austin, Texas, implemented a “Safe Sleep Room.” The rooms include blackout shades, disabled tones, a fan, bedding and a sign on the door letting others know if the room is in use or not. EMS providers are given essential well-deserved and uninterrupted rest after a shift.

4. Juggling a paid career

Volunteer providers not only have calls to respond to, but also have another paying job to help put food on the table and keep the lights on. This juggling act is not for the faint of heart.

As a result, many volunteer EMS agencies are struggling to keep their heads above water. In Erie County, Pennsylvania, the dwindling number of volunteer responders has become a critical issue.

Many departments have started to offer incentives. In Middlesex County, New Jersey, the Middlesex County Regional Chamber of Commerce partnered with the Middlesex County College and Middlesex County Board of Freeholders to create a rewards card, as well as provide tuition credits at the county college.

The reward cards, which are given to volunteer firefighters and EMS providers, offer discounts at local businesses. Something as simple as a discounted meal goes a long way in thanking a volunteer for their time and dedication.

Moreover, in 2017, the JEB Stuart Volunteer Rescue Squad in Stuart, Virginia, started offering stipends to pay their volunteers per call. They now provide stipends to cover up to 16 calls every two weeks, or 32 calls a month. Again, a little help goes a long way.

5. A target of violence

The emerging threats facing today’s responders can be seen in news headline after news headline. EMS providers are part of an integrated response to mass casualty incidents perpetuated by violent offenders, and first responders are often targets of violence themselves.

It’s unfortunate that many EMS agencies are now dealing with responding to scenes that are in no way, shape or form safe. To protect their personnel, agencies are buying body armor.

There are many types of ballistic vests, and it’s important to understand and become familiar with not only the levels of protection but the limitations of the vests as well.

6. The physical toll

A job in EMS is physically demanding. It’s no secret that lifting and moving patients are the top causes of injury for EMS providers.

Thankfully, EMS providers now have what past providers didn’t – ergonomic stretchers. These hi-tech stretchers completely eliminate the need to manually lift a patient. Save your EMS providers’ backs and knees by using powered patient transport equipment. Implementing fitness programs and encouraging providers to exercise and stretch can also keep them fit and healthy.

7. Documentation woes

Documentation is a common target of water cooler grumblings in EMS, but it’s undoubtedly an important part of patient care.

Make your providers’ lives a little easier with advanced documentation software. They may no longer have to literally dot their Is and cross their Ts, but they still need to do it right to avoid any potential disasters.

Jeffrey Ho, MD, chief medical director for Hennepin EMS, who also doubles as a deputy sheriff, has been a longtime advocate for body-worn cameras in order to help improve EMS documentation.

A simulation study was conducted by Hennepin EMS to evaluate the accuracy of documentation. As a result of the study, 10 participating paramedics made a hefty 71 documentation changes.

To eliminate inaccurate reports, body-worn camera videos can help providers not only recall – but relive – an event during the documentation process.

Support is the key to retention

At the end of the day, no one said a career in EMS would be easy. Nevertheless, most would agree that it’s worth it.

So, when the days are long, and the shifts are rough, knowing that their agency has their back, and is doing their best to support their patient care mission can keep these providers on the job for years to come.

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.