Good Help Is Hard to Find: The EMS Workforce Agenda for the Future

Though provider shortages have plagued many EMS services in recent years, attempts at fixing them have been piecemeal. Some state offices have tried to help, and some departments have recruited successfully on their own, but there's been no comprehensive long-range national plan for developing and maintaining a viable, healthy, well-trained EMS workforce.

The Emergency Medical Services Workforce Agenda for the Future is precisely that plan. Assembled by experts at the University of California San Francisco with funding from NHTSA and the EMS for Children program, the document, published in May, imagines a future "in which all EMS systems have a sufficient number of well educated, adequately prepared, and appropriately credentialed EMS workers who are valued, well compensated, healthy, and safe." That's admittedly ambitious, but with employment of EMS providers expected to rise 9% between 2008 and 2018 (per the Bureau of Labor Statistics [BLS]), tackling workforce issues is a fast-growing imperative.

"We've pulled together all of what we know about where we are and what our key workforce issues are, as well as laying some groundwork for addressing those issues in the future," says lead author Susan Chapman, PhD, RN, director of allied health workforce studies at UCSF's Center for the Health Professions. "It's a document that's truly meant to be an agenda and give us some guidelines for moving forward."

The Agenda breaks down EMS workforce issues into four components: health, safety and wellness; education and certification; data and research; and workforce planning and development. For each, it evaluates where we stand today, where we want to be in 2020, and how to get there. It also proposes an EMS Workforce Technical Assistance Center to assist with workforce development at all levels.

Health, Safety and Wellness

EMS providers are susceptible to a lot of risks--lifting injuries, vehicle crashes, infectious diseases and assaults, to name a few. But Chapman's team found a general lack of workplace safety measures, inconsistent reporting of accidents and close calls, and a lack of driver training and standards. Importantly, there's no national-level EMS illness and injury surveillance program, which prevents us from documenting exactly what's hurting providers and where the greatest risks lie. But knowing and remedying that is essential to creating the kind of safe and healthy workplace that can draw and retain good people.

NHTSA looked at the possibility of a surveillance system in a 2007 report, Feasibility for an EMS Workforce Safety and Health Surveillance System. It concluded that existing systems such as the Census of Fatal Occupational Injuries, Fatal Analysis Reporting System and National Electronic Injury Surveillance System were insufficient to capture all the data needed for an EMS workforce illness and injury profile, and instead conceived a national EMS Workforce Injury and Illness Surveillance Program (EMS-WIISP).

That's a key element in the Workforce Agenda's plan. It proposes an integrated program of EMS occupational health and safety surveillance, which will produce data epidemiologists can use to evaluate risks and ultimately help guide strategies to reduce them. An effective surveillance program, authors say, should track types and prevalence of illness, vehicle crash morbidity and mortality, incidence of death and disability, etiology of illness and injury, and "near miss" incidents.

The Agenda also emphasizes development of the workplace culture of safety, with measures borrowed from analogous industries like trucking and wellness programs tailored to EMS. It supports the five goals set for EMS in the National Occupational Research Agenda's agenda for safety and health research in American public safety: reducing injuries and fatalities from vehicle crashes; reducing injuries from patient movement; reducing hazardous exposures; implementing workplace illness- and injury-reduction policies; and creating a health and safety surveillance system for EMS.