February 2, 2022 | View as webpage | Too many emails? Update Subscription Preferences


The 2022 EMS Trend Report will provide expert analysis of 7 years of survey data measuring the trends shaping the future of the profession. This year's EMS Trend Survey seeks to explore issues directly tied to provider recruitment and retention, including physical and emotional safety factors and management support. 

The information you provide will help us identify the strategies successful agencies are employing and the action items for growing a qualified, satisfied workforce. 

Please take a few moments to fill out the survey and share it with your colleagues.  

Thank you, 

— Kerri Hatt 
Editor-in-Chief, EMS1 


Getting the top job
By Rob Lawrence 

In April 2021, nationally respected and longtime Austin Travis County EMS Chief, Ernie Rodriguez, retired. His departure set the wheels in motion for a nationwide search to find a replacement. It’s a big job. The city’s EMS department serves 2.2 million people across Austin and Travis County and covers more than 1,000 square miles. The chief is responsible for strategic planning, management and oversight of all operations in the EMS department.

In an open and inclusive process, the city engaged in a search that kept the public informed at every step of the way. The candidate search opened on Sept. 8, 2021, and initially yielded 37 applicants. After screening and review by leadership, the candidate pool was narrowed to five top candidates. The five were interviewed by two city panels, whereafter two candidates emerged: ATCEMS Interim Chief Jasper D. Brown and Robert Luckritz, chief operating officer of Transformative Healthcare, a multi-state EMS, medical transportation, and public health organization in New England.

During an online Community Input Meeting, candidates each answered a set of nine questions, after which viewers were invited to offer their feedback on the finalist by either entering comments into a website or by contacting the city’s 311 number before the city manager makes a final appointment decision. Austin Assistant City Manager Rey Arellano noted during the public meeting, “no doubt the recruitment process and the input the community is providing will bring us the best EMS chief.”

Can you answer the questions posed to ATCEMS top candidates?

The questions posed to Brown and Luckritz covered every aspect of EMS leadership and management, and are posted below.

An EMS chief, someone who aspires to be a future EMS chief, or an EMS provider interested in the present and future of EMS may do well to have a go at answering the questions (replacing Austin Travis with their own service area). How would you do with not only having to come up with a great answer but also sell yourself to the watching general public? Oh, and by the way, you have 15 minutes to answer all the questions posed. Set your timer, and go!

  1. Can you share with us your professional background and experience highlighting the points that will help you be successful as the next EMS chief and why you want to serve in this position?
  2. How would you engage your staff to make decisions about response and deployment models and what metrics would you use to ensure their effectiveness?
  3. While being budget-conscious, how can the agency continue to be a medical community leader in patient-centered emergency and public health?
  4. How will you increase employee morale in order to retain and recruit enough employees to keep the department functioning?
  5. How would you describe the difference between management and leadership – how would the organizations you have led describe your leadership style?
  6. Besides dispatching an ambulance to a 911 call, what other priorities do you believe EMS should be focused on in addition to prehospital emergency care?
  7. What do equity and inclusion mean to you and how do you incorporate them into your work at EMS?
  8. What alternative staffing models have you used in your experience that might be brought to the agency to reduce employee fatigue and mandatory overtime while keeping units staffed?
  9. In addition to topics already discussed, do you believe there are any other challenges that may be facing the agency – if so how do you intend to address them?

How did you get on? Many of these questions could be fodder for individual articles, webinars, or podcast subjects in their own right. How did Brown and Luckritz answer? All their responses are now a matter of public record and can be found here.

At the time of writing, a chief has yet to be appointed, but the clear winner has to be the process – the inclusive way a soon to be very public figure receives maximum public scrutiny but also has a chance to show, tell and demonstrate their qualities to everyone they hope to serve.

The greatest leadership challenge in EMS
By Randall W. Hanifen, PhD, CFO, FIFireE 

Being an EMS chief is supposed to be gratifying, allowing you to make your organization one of the premier ones in the country. What many forget to mention is that you are facing the largest-ever challenge that EMS has ever seen: the need to expand services with a disappearing workforce. Unlike other industries, EMS cannot supplement the workforce with computers or robots.

Expanding services

The current model of EMS in most areas is one where someone calls 911, and within a few minutes, an ambulance and/or fire truck shows up, begins treatment and assessment of the patient, and – unless the patient refuses transport – they are taken to the emergency room. Unless it is a true medical or trauma emergency, the emergency room discharges patients and tells them to follow up with their family doctor.

For an increasing portion of the population, this follow-up never occurs, and the process repeats daily. This repetitive model is a failure that is straining resources at the local government level, and in hospital systems. Recent news coverage shows that citizens in critical need could wait nearly an hour for an ambulance. This causes first responding fire apparatus to wait during lag time – and to be either unavailable, or in less optimal situations to respond to subsequent fire and EMS calls.

This crisis can only be fixed through a re-design of the EMS system and policy that involves a more collaborative effort among all aspects of healthcare. In the future, EMS must be equipped with the knowledge and legislative authority to make referrals to more definitive healthcare solutions. Whether this is to provide financial assistance for a diabetic patient who cannot afford medications, or for a dentist to deal with a toothache, EMS must be able to have resources that allow options beyond emergency department delivery and discharge.

Disappearing workforces

Several factors have contributed to creating a disappearing workforce that results in ambulances making 30-40 calls in a 24-hour shift – preventing crews from getting any rest.

No one will argue that as you ascend the management rungs, higher education is needed to succeed. However, some looking at EMS and Fire jobs at the entry level see a mostly dirty environment in which much daily physical exertion is needed. For the teenager used to clean and quiet environments, this type of work is likely not as appealing. This problem is perpetuated by high schools that focus on preparing students exclusively for four-year college, rather than showing any options of a trade. Arguably, some students are set on a four-year college even before they start high school.

Leadership actions needed

The first leadership action needed is for the many segments of EMS to come together at the table and have a common voice on policy – both nationally and at the state level. While the trend in many areas is to move from a fire-based EMS system to an efficiency of scale (i.e., not a lot of fires, but increasing EMS) created by combining the services at the local government level, there are many areas of the country that currently have a private or hospital-based service.

Much of the work related to the expanding service model will begin only after the legislation – both nationally and at the state level – is enacted. This work will not be done alone. We need to collaborate with the hospitals, public health and mental health professionals of the country so this model of change can occur and still meet the needs of each group. A large hurdle to overcome will be a need to protect EMS personnel from malpractice.

To combat the disappearing workforce, increased collaboration will be necessary. Working with the local school superintendents, the local vocational schools, and the local fire and EMS organizations will be necessary to determine the best way to present EMS services as a career option for high school graduates. Additionally, one key step will be inviting local technical colleges to see if a college/work option can be created within high schools, in order to allow recent graduates to attend college and work in the EMS field. Leaders of EMS, especially those in the fire-based EMS fields, must emphasize a schedule that allows for flexibility with many days off, as work-life balance is particularly important in today’s workplaces.

Leaders in the EMS field must begin to think beyond traditional roles and take the lead to move the next model of EMS forward, just as our predecessors did.

Additional resources:

spacer.gif 3 AND OUT ...
3. EMS Trend Survey 2022. Take 10 minutes to help us identify the strengths, challenges, opportunities and needs of the EMS workforce.

2. Communicating across 20 deployment areas. Cataldo Ambulance’s Ron Quaranto discusses leading through the pandemic, recruitment and retention, and vaccine mandates.

1. Webinar: Ambulances held hostage. Strategies to unilaterally reduce ED wait times and get back into service from Wolfberg, Wirth and Lawrence.
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