21 EMS staff retention ideas

This article was originally posted August 11, 2021. It has been updated.

PHOENIX — Retention of staff, a top concern of EMS leaders, was the focus of a 2021 Pinnacle EMS leadership forum session facilitated by Greg Thompson, MS, the director of Metropolitan EMS (MEMS) in Little Rock, Arkansas.

Thompson started the session by sharing with the attendees that call volume in his service area was up 25% and wall-time – the time personnel spend waiting to offload a patient at the hospital –had increased dramatically during the COVID-19 pandemic. It had become common for MEMS crews to wait 1-3 hours at the hospital before transferring patient care.

For Thompson, it was a top priority to keep and care for the MEMS staff throughout the stress and challenge of the COVID-19 pandemic. Thompson knew the organization had problems with staff feeling overworked and underrecognized. “We needed to start holding the problem a little differently,” Thompson said when describing his approach to coming up with novel solutions to make sure units were staffed.

Staffing ideas and lessons from the pandemic

Attendees, in a conversation facilitated by Thompson, shared the things they have tried to increase compensation, relieve the stress on field staff, take better care of providers’ health and wellness, and hear the concerns of personnel during call surges. Note, most attendees did not share their service affiliation or position and, unfortunately, most of these ideas are not attributed to the contributor.

Financial incentives

1. Call volume bonus. MEMS medics on a 12-hour truck receive an extra $40 for running a seventh call during the shift. The medics get an extra $10 if they run an eighth call.
2. Shift bonus paid on the off-week. MEMS medics are paid every two weeks. The call volume bonus is paid on the opposite weeks.
3. $300 bonus to accept an open shift. If an EMT at an unnamed service accepts an open shift outside of their normal schedule, they can receive up to $300 in addition to their shift pay. This still isn’t enough to fill open shifts.
4. Work with a buddy. A flex or buddy shift is made available as an extra work opportunity for two colleagues at an unnamed service to choose to work together to cover an open shift.
5. Workforce housing and no-interest loans. A Colorado fire-based EMS agency is acquiring and building housing for its staff because the cost of housing has exploded in their end-of-the-road resort community. Staff can also receive a $40,000 interest-free home loan from the department.

Novel staffing approaches

1. Getting out-of practice paramedics back on rigs. Many organizations have former field paramedics who have moved into administrative and support roles, who have maintained their licenses but not kept up their skills. Being able to run as an EMT, without the expectation of being a paramedic, and able to work as the second person on a crew has proved successful in expanding the pool of people to keep ambulances staffed.
2. Wall time patient monitoring and care. Medics on light duty get sent to the hospital to take over care of the patients waiting in the halls so the ambulance crews can get back on the streets.
3. Sister stations. Busy and less-busy stations are paired so crews can move from a busy station after two shifts to a less-busy station for a shift.
4. Power trucks during peak demand periods. A service has added power trucks in the afternoon during periods of high or peak demand. The shift length for the power truck crews is call dependent. An 8-hour power shift ends after running four calls or working eight hours, whichever comes first. If the crew goes home after four hours, they still get paid for 8-hours of work.
5. Impact cars. Similar to a power truck, impact car crews, scheduled for short daytime shifts, are used to relieve the workload from 24-hour trucks who are generally busier during the night. Impact cars also try to jump calls so the 24-hour truck crews can take a lunch break or get some rest during the day.
6. Ambulance decon staff. Personnel are hired just to clean, freeing up field staff to rest, refresh and catch up on paperwork while the ambulance is prepared for the next patient.

Health and wellness solutions

1. Snack fairy deliveries to field crews. Several attendees mentioned creating opportunities for office-based staff or special shifts for field providers to deliver snacks and water to field crews that are stuck at a hospital or running back-to-back calls non-stop. Some services include their competitors and neighbors in the special deliveries, an important and easy way to build relationships.
2. EMS comfort stations at hospitals. One agency has set up air-conditioned event tents and caterers at hospitals for field personnel, who can use the tent to cool off, eat and complete patient care reports.
3. Lunch coolers and cooling towels. Keeping crews fed, hydrated and cool is a top challenge for many EMS leaders. One organization purchased a lunch-sized cooler and cooling towel for every EMS provider.
4. No-cost psychological services. A county EMS department has contracted with an independent mental health professional, in addition to the EAP, to offer anonymous and free psychological services to all personnel. Another agency has partnered with a university hospital to provide 24/7 free-of-charge psychologist coverage that is funded through a Substance Abuse and Mental Health Services Administration grant. Yet another county has been able to create a $40,000 fund for any personnel experiencing a mental health crisis to use for specialized care.
5. Pet therapy. A small EMS agency was asked to help introduce service dogs in training to the ambulance, lights and sirens should a service dog’s future partner need EMS care. This has led to an open invitation to any on-duty crew to visit the service dog organization between calls. Personnel find the time with the dogs relaxing and like contributing to the dogs’ training.
6. Safety time out. A service that works 24-hour shifts lets any crew member call a safety time out to rest, begin to process a traumatic call, catch up on reports or for personal hygiene. The safety time out can last up to two hours and at the end of two hours, the crew evaluates their ability to return to duty with a supervisor.
7. Dinner on the chief. Several leaders mentioned either paying for staff meals out of their own pockets or inviting on-duty crews into their homes on Thanksgiving and Christmas for a home-cooked meal.

Hearing concerns and sharing information

1. Increase employee briefings and shift meetings. Thompson began a weekly web meeting during the pandemic to update staff on the organization and to take questions. He’s had more than 100 field providers attend some of these weekly web meetings and he is able to either address concerns or make commitments as to what he and the organization can do or not do, relative to a comment or question.
2. Morning meeting supervisor meeting. All staff are welcome to attend the daily 8 a.m. supervisors meeting at an unnamed service to review the day’s incident action plan. Though this started during COVID, crews asked that it continue because they appreciated receiving information and being kept up-to-date on policy changes.
3. Monthly town hall meeting at each station. An EMS chief holds a meeting at each station to better get to know the staff, the challenges they are facing at work and at home, and receive updates on spouses and children. The chief wants to more fully know the staff.

Thompson ended the session by encouraging attendees to embrace this unique moment in EMS history. By holding problems a little bit differently – changing perspective – and engaging with personnel, leaders can try new things, learn as they go and make improvements that will help retain staff throughout the pandemic and beyond.