EMS workforce issues have been around since the birth of the profession, but current economic pressures, worker shortages, pending retirements, retention issues and declining volunteerism, coupled with perennial challenges regarding employee health and safety, have brought the topic to the forefront.
In the past, the job of identifying and understanding workforce issues has been left to individual agencies or states. Drew Dawson, director of the National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services, says the recently released EMS Workforce Agenda for the Future, prepared by the University of California San Francisco with funding from NHTSA and the Emergency Medical Services for Children program at the Health Resources and Services Administration (HRSA), is an attempt to assess the issue of developing and retaining a professional, well-trained EMS workforce and provide a comprehensive, long-range strategy for developing and retaining a qualified, well-educated workforce.
“The overall purpose is to provide a vision of where we as an EMS community want to go and [identify] the four components for EMS managers at local and state levels, as well as others, to focus on,” Dawson says.
The first attempt to define and address the workforce issue came in 2008 with the publication of the EMS Workforce for the 21st Century: A National Assessment. That document was also funded by NHTSA and HRSA and produced in cooperation with UCSF and the University of Washington. Many of the same individuals participated in the development of both documents.
“It was intended to be a first step, applying the best science available [to the] issue,” says EMS Specialist Gamunu Wijetunge, MPM, NREMT-P. The next step was to develop an agenda for the future— a vision statement for the direction and challenges facing the EMS workforce of the future. According to the EMS Workforce Agenda for the Future, that vision is for all EMS systems to have “a sufficient number of well educated, adequately prepared and appropriately credentialed EMS workers who are valued, well compensated, healthy, and safe.”(1)
The process uncovered the challenges in collecting even the most basic information, such as the size of the EMS workforce. The Bureau of Labor Statistics (BLS) currently collects data on EMS workers, but does not include volunteers or cross-trained firefighters. Because EMTs are not distinguished from paramedics, median wage information is skewed. Essential information, such as the number of EMS students in the educational pipeline, is not being collected consistently. Attempts to accurately predict future demand for EMS workers is impossible without this data.
“Right now, the data and tools are not as available as they should be, and we don’t have the data we would like,” Dawson says. He also says that setting standard terms and definitions will go a long way toward predicting future workforce needs.
Dawson and Wijetunge acknowledge that implementing the recommendations of the Agenda won’t be easy or quick. “We are not under any illusions about that,” Wijetunge says. “It will take time. But understanding the issues, including the need for good data, is a very important part of good decision making.”
Both say the economic downturn does not change the essential message of the Agenda. “The vision of the Workforce Agenda still rings true,” Wijetunge says. “Whether it’s a good or bad economy, managers still need good reliable data.” Establishing a system that looks at the research and data is independent of the economy.
4 key components
Guided by research, steering committee direction and input from a group of national stakeholders composed of EMS industry leaders, experts from professional organizations, educational and credentialing organizations, public and private EMS providers, state and federal EMS agencies and other stakeholder groups, the Agenda authors identified four key components that are critical to developing a thriving EMS workforce, including:
• Health, safety and wellness;
• Education and certification;
• Data and research; and
• Workforce planning and development.
The Agenda also recommends that a National EMS Workforce Technical Assistance Center (TAC) be established to assist national, state, territorial, tribal, local and private EMS stakeholders with workforce development.
Health, safety & wellness
The Agenda recognizes that by its nature EMS work is dangerous, even fatal. Workers are vulnerable to vehicle crashes, infectious diseases, assaults and musculoskeletal injuries. But before efforts can be made to improve the health, safety and wellness of EMS workers, national data on the exact nature of the issue must be collected. Those working on the Agenda found that current data is unavailable, inconsistent or unusable, making meaningful evaluation impossible.
To provide a foundation for evidence-based safety standards, operational practice and prevention strategies, the Agenda recommends the establishment of a national EMS Workforce Injury and Illness Surveillance Program (EMS-WIISP).
“The emphasis is not on adding a new system, but on coordinating the current systems that exist,” Wijetunge says.
The hope is that the data provided will allow such efforts as the NTSHA- and HRSA-supported Culture of Safety Project to guide and direct intervention strategies that will ultimately improve the health and safety of EMS workers at the local, state and national levels. Wijetunge says this is an example of how the Agenda can inform a national project.
Additionally, the Agenda recommends that the EMS industry “commit to implementing the strategic goals set forth from the National Public Safety Sub-Sector Agenda for Occupational Safety and Health Research and Practice in the U.S.”(2)
Education & certification
The Agenda recognizes a need to develop a national EMS education process and, thus, establish a high standard of quality that can be maintained throughout the country. Currently, challenges, such as variations in EMS certification and licensing, create difficulties for EMTs and paramedics who wish to take jobs across state lines. Lack of reciprocity has already been seen as a deterrent to EMS workers trying to respond to large-scale disasters outside their state.
To address these issues, the Agenda recommends the adoption of education and certification components based on the EMS Education Agenda for the Future: A Systems Approach, published by NHTSA in 2000.
The major objective of the EMS Education Agenda is to establish a national system of EMS education similar to that of other healthcare professionals. To accomplish this goal, five components have been set; of those three have already been completed. They include the National EMS Core Content, The National EMS Scope of Practice Model and the National EMS Education Standards.
The final two, the National EMS Education Program Accreditation and National EMS Certification, are currently being implemented across the country.
To address the issue of response to large-scale, out-of-jurisdiction emergencies, the Workforce Agenda recommends adopting the National Emergency Responder Credentialing System under the National Incident Management System (NIMS).
Data & research
The foundation of workforce planning is data and research. As the National EMS Research Agenda notes, there is currently a variety of EMS data, from academic and administrative databases to market surveys. However, much of the necessary research to adequately evaluate workforce issues is flawed or unavailable.
Without adequate research on the current state of the workforce, EMS will continue to be a blind person wandering in the dark. According to the authors of the Workforce Agenda, “until we have more fundamental knowledge about the EMS workforce, most of the other components of this workforce agenda will be difficult to address.”(3)
The two primary barriers to developing a strong EMS research program are the lack of specifically trained EMS researchers and reliable funding to support EMS research. The Agenda recommends that serious efforts be made to ensure cadres of well-trained researchers who specialize in EMS workforce studies are developed in the future. The goal would be a searchable index that would provide EMS workforce research on a local, state and national level.
Improved data collection is essential to laying a solid foundation for the future sustainability of the EMS workforce in the U.S. As a first step in improving the quality of EMS workforce data nationally, NHTSA has funded an effort by the American Institutes for Research (AIR) to develop uniform national EMS workforce data definitions. Pending publication of the national EMS workforce data definitions, the recommendation of the Agenda authors is that the EMS community continue to coordinate with the Bureau of Labor Statistics, the National Center for Education Statistics and others to improve data collection.
They also suggest that EMS agencies participate in the National Emergency Medical Services Information Systems (NEMSIS) and its effort to establish a nationwide network for collection of EMS patient and system data. Although the data set does not specifically address overall workforce issues, it does provide important information regarding such factors as ambulance staffing configuration on patient outcomes.
Planning & development
Meeting the demands of each practice level and predicting future demands is a critical issue for EMS managers regardless of agency size. For far too long individual agencies have had little or no guidance on workforce planning. The Agenda authors found that the big picture concept of workforce supply and demand is largely absent from the EMS field.(4)
The importance of developing a workforce planning model was outlined in the 2000 white paper, Building Successful Organizations: A Guide to Strategic Workforce Planning, published by the National Academy of Public Administration. To create planning models, critical information must be gathered. This includes current data on workforce supply and demand; worker compensation; environmental factors, such as regulations and population demographics that impact the need for EMS services; economics and cost analysis; and evaluation of the workforce planning model to determine that organizational objectives are being met are required.
The recommendation is to make this information available to local providers through state offices. These offices would also offer workforce planning guides, tools and expertise. A National EMS Workforce Technical Assistance Center would facilitate the collection of data and research and supply state offices with the necessary information and guidance.
The work of the Agenda authors has uncovered what EMS managers have intuitively known: There is a sobering lack of critical information when it comes to EMS workforce issues. By systematically addressing the complex components and the needs of the various EMS delivery models, the EMS Workforce Agenda for the Future has distilled the issues, recognized the shortfalls and made specific, practical recommendations for moving forward. Building on the work of the EMS Workforce Agenda for the 21st Century, the Workforce Agenda for the Future calls for a renewed emphasis on health and safety and recognizes the need for an evidence-based approach to planning. If followed, this long-range, national plan will help EMS ensure there is a well-trained workforce for many years to come.
The EMS Workforce Agenda is available online at www.ems.gov under the workforce tab.
1. Chapman SA, Lindler V, Kaiser JA. The Emergency Medical Services Workforce Agenda for the Future. May 2011; page 3. U.S. Department of Transportation, National Highway Traffic Safety Administration. www.ems.gov/pdf/2011/EMS_Workforce_Agenda_052011.pdf.
2. Chapman, page 16.
3. Chapman, page 22.
4. Chapman, page 26.