Wanted: Warm and Willing Bodies to Fill Vacant Seats

There's nothing too unusual about North Branford, CT. It's your typical small New England town, storied and picturesque, with a history reaching back more than a century before the American Revolution.

With a population of 14,000, North Branford lies somewhere between urban and rural. Big cities don't encroach--the state capital, Hartford, is 30 miles to the north; Boston and New York City are drives of several hours--but New Haven, with almost 125,000, is some 8--10 miles to the west, and the scenic Thimble Islands, a popular tourist destination, lie off the beaches of the Long Island Sound, five miles to the south.

With a median household income of $64,438, North Branford is fairly well-heeled compared to many small towns across America, but like so many others, the town has historically relied on volunteers for its essential public-safety services. Since the 1940s, fire and EMS responses have come via the North Branford Fire Department (NBFD), which fields four companies' worth of protection that has been, traditionally, all-volunteer.

Until recently, that worked fine. But at some point, it began to appear that the volunteer arrangement was no longer sufficient for getting the job done. The ranks of those willing to ride calls thinned. It became harder and harder to field timely responses.

"A lot of our members left to go to commercial services," says NBFD District Chief Anthony Esposito, Jr. "It seemed the ambulance company became a stepping stone for people to gather experience and then proceed on to services where they could be paid for doing the same things they were doing as volunteers. It deteriorated over time to the point where a significant percentage of initial calls for service were being missed."

For any service in any town, that's going to be a problem.

Getting People in the Ranks

North Branford's dilemma will seem familiar to EMS providers elsewhere. The issues faced in that small Connecticut town are far from uncommon. Nationally, almost everyone involved in the emergency medical services will tell you they need more people. The need is especially acute in small towns and among volunteer agencies, but even in the big cities, it seems, there often aren't enough warm and willing bodies to fill all the vacant ambulance seats. It's a problem that transcends the traditional EMS boundaries of paid vs. volunteer, public vs. private, fire-based vs. third service, ALS vs. BLS.

"The most pressing EMS work force issue," concluded attendees at the EMS Issues Summit, convened last May by the American College of Emergency Physicians (ACEP) to identify the issues and problems facing EMS and discuss ways to address them, "is ensuring that enough qualified and experienced EMTs and paramedics are available to meet current and future EMS work force needs."

In their final report, Summit participants--including such major national organizations as the National Association of EMTs, the American Ambulance Association, the National Association of State EMS Directors (NASEMSD), the U.S. Fire Administration, NHTSA and more--cited work force recruitment and retention as one of the top seven EMS problem areas. They acknowledged that many states are seeing declines in the numbers of students completing paramedic training programs; that some organizations routinely require their personnel to work overtime to compensate for shortages; that some have to search beyond their areas to find the people they need; and that many report increasing call volumes and training requirements (think WMD and disaster preparedness) impacting their work force needs. "Some of the direst

staffing shortages," they determined, "are reported to be in rural, frontier and tribal areas, where volunteerism seems to be declining."

From state to state, and within states, situations can of course vary greatly. But an overarching trend seems clear.