Roundtable: Should EMS providers be given hazard pay during the COVID-19 pandemic?

U.S. Treasury Secretary Steven Mnuchin has said that hazard pay for first responders could be included in future legislation to address the COVID-19 pandemic as the department considers a fourth stimulus package.

We surveyed the EMS1 Editorial Advisory Board, asking: Should pandemic response be considered part of the job, or should EMS providers on the frontlines of COVID-19 response be compensated with hazard pay?

Here, they share their perspective on first responder hazard pay.

Hazard pay, maybe? Sustainable EMS funding, absolutely!

The harsh light of COVID-19 has exposed the crumbling fault lines in the foundation of EMS as agencies struggle to equip personnel with PPE, maintain minimum staffing and meet a surging demand for service. Undoubtedly, the EMS personnel on the frontlines are operating in a hot zone, made worse by the persistent failures of elected officials, regulators, policy makers and taxpayers to properly fund a modern EMS system.

I despair about the deaths, lasting medical illness and the permanent physical or mental disability that will result to members of our workforce from prolonged exposure to a highly hazardous environment. Perhaps hazard pay of a few extra dollars per hour or a one-time tax-free payment could make those who are suffering the most whole again or at least close the gap.

While the White House experts predict 100,000 to 240,000 COVID-19 fatalities, EMS has unprecedented attention of the media, elected officials and civilians. Now is the time to make sure every citizen knows that EMS was spiraling to catastrophe well before the declaration of a national emergency and that every response is an act of undeniable heroism in the face of staggering danger.

You likely know the reasons that EMS has struggled to thrive for decades. Inadequate reimbursement and increasing costs mean compensation for most EMS providers is low. The combination of poor pay and benefits, increasing call volume and limited opportunities drives too many good people out of the profession. The EMS providers left behind are increasingly pessimistic and burnt out, which further exacerbates recruitment and retention challenges. When EMS struggles to pay the majority of the workforce a living wage, it is nearly impossible to fund non-required training and ensure adequate inventory of PPE for slightly unusual incidents, let alone the worst case scenario of a pandemic that can increase call volume by 50% while forcing 10% or more of the workforce into isolation.

Instead of hazard pay, follow the lead of the NAEMT, American Ambulance Association, and many other advocacy organizations and demand Congress and the President support immediate funding relief to EMS along with long-term reimbursement increases for Medicare/Medicaid. Legislators must make permanent the reimbursement for transport to any appropriate receiving facility and ensure that EMS receives equal funding through grants for future training and equipment purchases.

Let’s not settle for the short-term satisfaction of hazard pay. Instead, make hazard pay something in addition to long-term funding for a sustainable EMS system so that rising out of the COVID-19 aftermath will be the modern, high-performance EMS system our providers and communities deserve.

— Greg Friese, MS, NRP, editorial director, EMS1

EMS professionals deserve more

Having served in the military, there were several reasons I received hazardous duty pay – from jump pay, to flight pay, to combat pay. Even though the extra money was nice, it still defined that we were in a hazardous job and that our life was on the line every day we put on the uniform.

Is EMS really that different? Every day, we put on the uniform and we are reminded of the hazardous conditions that our responsibilities as EMS professionals encompass. Sure, COVID-19 is putting EMS providers on the edge of the cliff with every patient breath we are exposed to, and one of those patient breaths could be the transfer of this deadly virus that eases our peers over that cliff.

So, is hazardous duty pay something that EMS providers should receive? Well yes, it is, but, just like the military, it is a stark reminder of the hazards of working in the EMS field.

Secretary Mnuchin, please do all you can to make certain this is something my peers can receive. Then, when this is all over, do your due diligence to uncover just how hazardous being a first responder is, and keep that money flowing to those who deserve it. It is nice you recognize the hazard of this disease; it is disappointing it takes a deadly virus to recognize EMS professionals deserve more. Much more.

— Chris Cebollero, president/CEO, Cebollero & Associates

Hazard pay is minimal and temporary

In response to discussions regarding hazard pay for EMS, I think that there are other issues that can be addressed by the industry that will have a more significant impact. Specifically, permanently increasing reimbursement and ensuring that all responders are receiving a living wage appropriate for the cost of living for their area. Any hazard pay increase will be minimal and temporary.

I think we also need to address and mitigate ongoing hazards such as lack of appropriate and necessary PPE, use of lights and sirens, and fatigue mitigation/lack of sleep. Increasing base pay so that all first responders are receiving a living wage and mitigating hazards will go much further towards improving quality-of-life during this pandemic than temporary hazard pay.

— Ann Marie Farina, executive director, The Code Green Campaign

Recognize the assumption of risk

Absolutely. EMS providers are often the first point of contact for patients harboring contagious diseases. It could be suggested that this is “just part of the job.” But the current pandemic is unprecedented in scope and magnitude. EMS is the tip of the healthcare response spear. We enter environments that have the potential for high viral load, and must take significant containment steps to reduce - not eliminate - transmitting the disease to ourselves or any other worker in the continuum of care. An increasing number of providers are now needing to sacrifice their home lives as they self-isolate, creating hardship on their family members.

As part of both the public safety and public health nets, EMS providers assume the risk of injury, illness and the potential for death that is significantly higher than the general population. Hazard pay is one tangible method to recognize the assumption of that risk.

— Art Hsieh, MA, NRP, program director, Santa Rosa Junior College

Sacrifice will never be sufficiently compensated

While EMS providers’ safety is one of our top concerns, the first response to any emergency or disaster (in this case, pandemic flu) is part of the job and is not contingent on hazard pay. Without intending to be cavalier with this statement, most first responders generally agree that emergency response is inherently riskier than other professions, as much as we mitigate and prepare.

If the government has issued a quarantine, as is the case in some states, healthcare providers have no choice but to report to work due to duty and sacrifice.

Comparing duty compensation of EMS providers versus other emergency healthcare workers is a topic of another discussion, especially now in an era of EMS workforce challenges, such as lack of volunteer retention.

Sacrifice will never be sufficiently compensated. Incentives should be intended to ensure continuous willingness to respond, as well as physical and mental readiness. Incentives may include a combination of hazard pay and other benefits, such as priority access to scarce resources.

Therefore, the federal government should allocate resources to incentivize EMS and other first responders to hold the line and continue to provide the best possible out-of-hospital medical care.

— Gustavo E. Flores MD, NRP, FP-C, director & chief instructor, Emergency & Critical Care Trainings LLC

Spend that money on PPE, preparing for next contagion

Knowing what we do (and considering what we still have yet to learn) about COVID-19, the thought of hazard pay seems a good idea at first glance.

However, isn’t dealing with infectious patients and potentially hazardous situations already part of our job description? Aren’t we all given extensive training in disease transmission, PPE, hygiene and vaccinations, and biannual refreshers on the subject? Part of working as an EMT, police officer or firefighter is the understanding that every morning when we leave the house in our uniform, there is a possibility, however small, that we will not return. We cannot entirely avoid personal risk in EMS, a fact driven home with the deaths of so many firefighters, cops and EMTs on Sept. 11, 2001. Hundreds of emergency responders lost their lives on that day because no scene is ever absolutely safe. Yet we respond anyway, trying at least to mitigate any risks we cannot entirely avoid.

And frankly, seeing the lack of faith displayed by our government in caring for responders who developed chronic illnesses from responding on 9/11 and the subsequent cleanup, I am skeptical to the extreme that the government will live up to any promises they make. Of what use is an additional stipend of hazard pay if I develop COVID-19 and am on a vent for two weeks in an ICU, and wind up discharged with 40% lung function? Will a few weeks of hazard pay cover hundreds of thousands of dollars in medical bills that my insurance won’t? What are the chances our employers and insurers try to dodge responsibility by setting an unreasonable standard of proof that our COVID-19 was an occupational exposure? Are they going to pay my girlfriend and daughter’s healthcare costs if I infect them?

I’d rather our elected officials and policymakers accept the responsibility they’ve shamelessly dodged, and spend the money on procuring greater PPE and ventilator stockpiles, and preparing for the inevitable next contagion. Our hospitals have to run at 90% or better census to remain solvent, and thus cannot handle any significant surge. Rural critical access hospitals have been closing for decades, and the entire EMS system operates on an antiquated reimbursement model and razor-thin operational margins. Small EMS systems can barely pay living wages, much less afford to purchase thousands of masks and face shields a week like we’re doing now – if we can find them in stock.

In short, I’d tell Secretary Mnuchin, “Keep your hazard pay. I’d rather your boss and Congress do their jobs, for a change.

— Kelly Grayson, NRP, CCEMT-P, critical care paramedic