EMS has long struggled with poor retention rates due to low wages, long hours and taxing working conditions characterized by traumatic calls and interrupted meals and sleep. During the COVID-19 pandemic, agencies in hard-hit areas like New York City had shrunken workforces as increasing numbers of providers were forced to self-quarantine for 14 days after exposure to COVID-positive patients. The NREMT even permitted EMT and paramedic students who had finished their courses but not yet passed the cognitive and psychomotor skills exams to practice in the field. While this pandemic isn’t going to leave EMS in these dire straits forever, the inherent stressful components of the job will continue pushing people out of the field and into better-paying positions in medicine.
I believe this problem could be alleviated through community-funded EMT programs for youths, particularly at-risk youths or those living in low-income neighborhoods. Freedom House Ambulance Service is the original model (and success story) of such a program. In 1967, 26 young black men, many of whom were unemployed or had criminal records, others Vietnam War veterans, were recruited from the poorest neighborhood of Pittsburgh to be trained as some of the first paramedics in the nation. Their scope of practice became the standard of prehospital care and shaped EMS into what it is today. Once considered aimless, these young men moved on to prosperous careers because they were offered an opportunity not previously available to them.
Last year in Philadelphia, Pa., the Community EMT Program was born through a partnership between the Philadelphia Fire Department (PFD) and a number of local workforce development agencies. In the fall of 2019, 20 students partook in a full-time, five-month EMT course led by PFD instructors. Thanks to funding from the West Philadelphia Skills Initiative, the course was free to students. Amazingly, PFD received 600 applications for the program, demonstrating people are hungry for advancement but may not have the resources available to them to pursue their goals.1
The high cost of EMT and paramedic schools deters many who consider applying, knowing they’re either going to be entering a volunteer service or paid position with low hourly wages that don’t begin to compensate for the cost of the education. If that factor was removed, we might have more EMTs and medics on the streets. Even if they’re only there for one year or five years, they’d likely be replaced by a continuous influx of students. Some agencies might be resistant to this concept out of fear that new recruits would use EMT and paramedic jobs as steppingstones to bigger career pursuits. If they want to move on to become an RN, PA or MD, so what? Let’s allow them the opportunity to advance themselves and ultimately patient care—with backgrounds in EMS, they are invaluable assets to other healthcare settings. If there were security in the numbers of well-trained students continuously rotating through paid programs, their duration in the field would become less of a concern and efforts could be focused more on providing higher quality EMS training and education rather than on building retention rates.
A career in EMS can open doors for young people who previously had none to open. EMS training can build their self-confidence and provide them the chance to give back to the community that supported them along the way once they become providers. It’s a win-win, and organizations like Freedom House and PFD's Community EMT program are testaments to that.
1. Matheson K. EMT Program Teaches Lifesaving Skills, Opens Doors to New Careers. www.phila.gov.