By The EMS Leadership Academy
The EMS system, a cornerstone of public health and safety, is facing an unprecedented crisis as underfunded departments struggle to provide essential care. Recent findings from the 2024 NYS EMS Workforce Report and the EMS1 and Fitch & Associates What Paramedics Want in 2024 national industry trend report reveal that systemic underfunding and lack of federal and state support have created unsustainable working conditions for paramedics and emergency care providers [1,2].
The alarming trend is compounded by a growing shortage of EMS professionals, leaving communities vulnerable to delayed emergency responses and inadequate care. The EMS workforce crisis is not only affecting patient outcomes, but is also taking a significant toll on those who dedicate their careers to saving lives.
A strained system reaching a breaking point
The number of active EMS responders in New York State declined by 17.5% between 2019 and 2022, according to the NYS EMS Workforce Report, 2024. This decline jeopardizes the ability of communities to respond to emergencies effectively, especially as the demand for emergency medical care continues to rise. Additionally, over the past decade, the number of ambulance services in New York State has decreased by 9%, from 1,078 to 982, exacerbating the strain on the existing system [1].
Nationwide, nearly 60% of EMS agencies report insufficient staffing to meet 911 call demands, leading to delayed response times and increased risks for patients in critical need, as revealed by the What Paramedics Want in 2024 report. These growing deficiencies underscore the urgent need for systemic reform to ensure that EMS professionals are adequately supported and that their vital services remain sustainable [2].
Underfunding creates unsustainable models
EMS systems across the country are heavily dependent on revenue from Medicare and Medicaid, both of which often reimburse below the actual cost of care. Private insurers, too, frequently deny emergency claims, further burdening EMS providers who are already operating on thin margins. Many local governments do not subsidize their EMS systems adequately and treat them more as a source of revenue than as an essential public service.
This underfunding results in a number of serious consequences, as identified in the reports:
- Low wages: 45% of EMTs report having an hourly base wage of $19 or less; and 76% of EMTs in New York earn $24/hour or less, comparable to wages in retail jobs despite the high-stakes nature of their work. Paramedics, too, earn far less than their counterparts in other healthcare, public safety and law enforcement roles, e.g., nurses, firefighters and police officers [1].
- Overworked professionals: Nearly half (49%) of paramedics report working more than 40 hours per week, with many holding multiple jobs to make ends meet. This increases stress levels and contributes to higher rates of burnout [2].
- Health concerns: Only 27% of EMS providers meet CDC recommended guidelines for sleep, and 61% cite lack of time as a significant barrier to maintaining physical health [2].
The combination of underfunding, low wages, and overwork has led to high rates of burnout. In fact, 73% of EMS providers nationwide report experiencing burnout or compassion fatigue, with 37% planning to leave the field within 5 years [2]. This high turnover rate further strains an already overwhelmed system and threatens to exacerbate the EMS workforce shortage.
Leadership and systemic change are key
To address the EMS workforce crisis, comprehensive reforms are needed, including increased public funding and strategic policy changes. The EMS Leadership Academy, a leading advocate for the EMS workforce, is calling for the following reforms:
- Sustainable funding models. Local governments must take responsibility for adequately funding EMS systems, ensuring agencies are well-resourced to meet community emergency demands. This includes providing fair wages and equitable retirement plans to enhance recruitment and retention in this challenging field.
- Career pathways and leadership. Creating clearer career pathways and offering better leadership opportunities will help retain talented EMS professionals and reduce turnover. By recognizing the value of experienced EMS providers, who not only deliver critical life-saving services but also connect patients with necessary healthcare resources, communities can improve overall public health outcomes.
- Mental health and wellness support. Expanding mental health services for EMS providers is essential, as currently, only 12-15% of EMS workers access behavioral health support. Prioritizing mental wellness will reduce burnout and help EMS professionals maintain their physical and emotional well-being.
Quote from leadership
In addition to direct advocacy efforts, the EMS Leadership Academy supports the documentary “Honorable but Broken: EMS in Crisis,” which highlights the challenges faced by EMS professionals [3]. American actress and producer Sarah Jessica Parker, recognized as one of “TIME’s” 100 most influential people in 2022, was announced as the narrator for the film, which was produced by Bryony Gilbey, a former producer for CBS News, and Rich Diefenbach, a former deputy bureau chief at CBS News.
| More: ‘Honorable but Broken’: Producer Bryony Gilbey shares the backstory of the Sarah Jessica Parker-narrated EMS documentary
Gilbey, inspired by the stories of EMS workers stretched to the brink by the COVID-19 pandemic, explained: “EMS professionals have been telling us for years that the system is unsustainable, and we haven’t been listening. While our film shines a spotlight on their irreplaceable value to society and their urgent need for an updated funding mechanism, Sarah Jessica Parker took that spotlight and increased the wattage 1,000%. We are beyond grateful that she supports our cause and wanted to narrate.”
Gilbey continued: “When the pandemic hit, EMS workers continued to show up at great risk to their own health, uncertain whether they would infect their families. These are healthcare professionals. We absolutely owe it to them and, frankly, to ourselves to pay them a livable wage so that they can continue to work in their chosen field and we can count on them showing up when we call 911.”
Notably, EMS services remain non-essential in most states, and in New York, a bill sponsored by Senator Shelley B. Mayer and Assemblyman Steve Otis earlier this year passed the state Senate but ultimately failed in the Assembly.
Legislative efforts
One significant legislative effort this year, spearheaded by New York State Senator Shelley B. Mayer and Assemblyman Steve Otis, aimed to address EMS funding issues. Although the bill passed unanimously in the state Senate, it ultimately failed in the Assembly. This highlights the ongoing challenge of securing the necessary legislative support to protect EMS providers and ensure they have the resources they need to perform their crucial work.
About the EMS Leadership Academy
The EMS Leadership Academy, founded by Robbie MacCue and Lisa Giruzzi, is committed to transforming the future of emergency medical services through innovative leadership training and comprehensive educational programming. The Academy’s year-round offerings and renowned EMS Leadership Summit empower EMS professionals to develop the resilience and leadership skills needed to navigate the complexities of the modern healthcare landscape.
For more information, visit the EMS Leadership Academy’s official website.
REFERENCES
- The NYS Emergency Medical Services Council. 2024 Update on the EMS Workforce Shortage: Where are the Emergency Medical Responders? Sept. 2024. Available at: https://nycremsco.org/2024-update-on-the-ems-workforce-shortage/
- EMS1, Fitch & Associates. “What Paramedics Want in 2024.” Aug. 08, 2024. Available at: https://www.ems1.com/ems-trend-report/digital-edition-what-paramedics-want-in-2024
- “Honorable But Broken: EMS In Crisis.” Produced by Bryony Gilbey and Richard Diefenbach. Available at https://www.honorablebutbroken.org/