The first thing I wrote that was published was a guest editorial in my hometown newspaper, where I lamented the poor pay and working conditions of EMS personnel. The article was therapeutic to write, and it did bring about some improvements in EMS in my hometown of Fort Worth, TX. However, nearly 30 years later, EMS is still plagued by many of the same problems: low pay, dangerous working conditions, poor employee benefits and declining morale. These all result in a standard of living for EMS personnel that is less than ideal. In fact, in the November 13, 2003 episode of CBS MarketWatch, EMS was listed as one of 10 most underpaid jobs in the U.S. The report, which was based upon information from the U.S. Bureau of Labor Statistics, reported an average annual EMS salary of $25,450. The only professions in the survey that had lower salaries were restaurant dishwashers, consumer loan collection agents, preschool teachers, slaughterers and meatpackers.
A recent study in Annals of Emergency Medicine detailed how dangerous the EMS profession can be. The authors looked at various data and found that there was an estimated rate of 12.7 fatalities per 100,000 EMS workers annually, compared to 14.2 for police officers and 16.5 for firefighters. They concluded that the occupational fatality rate for EMS workers exceeds that of the general population and is comparable with that of other emergency public service workers.
Why has pay in a relatively dangerous profession remained so low in much of the country? What keeps people loyal to the profession when the pay and benefits can potentially put them and their families in financial peril? When will the situation improve?
EMS on the Texas Frontier
Presidio County, TX, is one of the largest and most rural counties in the United States. Located in the Texas frontier on the border with Mexico, it covers 3,856 square miles of rugged west Texas desert and is home to 7,466 hearty souls. The population density is 1.9 persons per square mile, compared with a Texas statewide average of 79.6 persons per square mile. Presidio County is served by two EMS services operated by the two largest cities in the county (Marfa and Presidio). Presidio County, like much of west Texas, is so remote that medical helicopters do not service the area. All patients must be transported by ground ambulance to community hospitals or to slightly larger hospitals in communities an hour or more away.
Marfa, TX, is a small town with a population of 2,424 that lies in northern Presidio County. Marfa is best known for its mysterious "Marfa Lights"-located nine miles outside of town off Highway 90. The lights were first identified in 1883, and their cause remains a mystery. These lights continue to draw tourists and UFO buffs from across the country to this rural area near Big Bend National Park.
The City of Marfa operates Marfa EMS. With eight employees and two volunteers, the service provides EMS care to the citizens of Marfa and the residents of northern Presidio County. Jeremy Thomasson, EMT-I, is director of Marfa EMS. He and the service's two paramedics and assortment of EMTs and EMT-Intermediates provide 24-hour-a-day service. Last year, they responded to nearly 400 calls.
Despite the tough work, pay in west Texas remains very low. Marfa EMS personnel work approximately 86 hours per two-week pay period. Paramedics earn $6.65 per hour (approximately $16,013 annually), EMT-Intermediates earn $6.35 per hour (approximately $15,290 annually), and EMTs earn $6.15 per hour (approximately $14,809 annually). Minimum wage in Texas is $5.15 per hour. The city provides health insurance and retirement through the Texas Municipal League.
EMS education on the Texas frontier is hard to obtain. The local community hospital conducts sporadic EMS training. Jeremy is completing his paramedic education (a 1,100-hour course). He pays all costs, including travel, tuition and textbooks. As EMS director, Jeremy draws a salary of $20,300 annually; however, because of the shortage of paramedics, Jeremy must often staff the ambulances himself and was able to convince the city manager to reimburse him for his shift-work.