About the Data
The JEMS Web-based salary survey consisted of approximately 125 questions (less than previous years), allowing participants to voluntarily “skip” sections considered “not applicable.” There were 2,863 successfully delivered email invitations to the survey. Of those, 46.3% opened the email and 367 organizations initiated the survey, up by 150% from last year’s respondents, when the response rate was 13%. Survey participation was open for a six-week period during May and June 2014.
Table 1 below shows the breakdown of provider types and their call volumes. The median of respondents fell between populations of 50,001–100,000 to 100,000–250,000 and responds to 5,000+ calls annually. Greater than 60% of respondents represent public providers (city, county or fire). Total respondents are noted as “N =” for each dataset where possible. In some instances, data was limited, not available or not applicable for all respondents. For example, respondents may answer call volume but not provider type, which means that “n” can change from dataset to dataset.
A representative sample of participation from provider organizations in each region of the U.S. and across all system model designs was achieved. (See Figure 1 below.) All 10 federal regions are represented in this year’s data; however, several job classes and regions didn’t reach required participation for reporting by region.
Salary reporting follows Department of Justice and Federal Trade Commission-issued Statements of Antitrust Enforcement Policy in Health Care.1 The complete text of the guidelines as they relate to salary surveys can be accessed online, but the most relevant extracts are presented in Antitrust Safe Harbor below.
Participating EMS organizations were given the option to complete the survey anonymously. With this selection the author and research staff are “blinded” to the email or IP address of the respondents. Regardless of how information is submitted, raw data is only available to the research staff and author, and only aggregate data is published.
Data accuracy is a primary objective. Survey results may be limited by the accuracy of the submitted data, organizational selective participation and an inconsistent pool of respondents year-to-year. Ambiguous, unclear or incomplete answers were unilaterally excluded from the dataset, rather than interpreted by the author, thus creating a potential additional bias.
The “JEMS Salary & Workplace Survey” is a joint research project in collaboration with Fitch & Associates LLC (www.fitchassoc.com). For 29 years, Fitch & Associates is the leading international emergency services consulting firm and serves a diverse range of clients.
- Nearly one third of respondents (N = 109) represented an organization’s human resources or compensation department.
- The survey represents all federal regions, but individual states New Hampshire, Rhode Island, Delaware, Maryland, Kentucky, Mississippi, Hawaii, North Dakota, South Dakota and Wyoming didn’t respond.
- Of 280 respondents, 88% selected the description, “Generally, agency employees can afford housing or property and live within the same area where service is provided,” and 12% noted that, “Generally, agency employees can’t afford housing or property and live outside the area where service is provided.”
- Median annual transport volume is up from 5,000 in 2013 to 9,000.
- Multi-role fire services represent the highest percentage of survey participants (27%).
- Salaries grew an average 6% across all job categories, exceeding the annual inflation rate for the 12 months ending in May 2014 of 2.1%).2
- Logistics/supply managers’ salaries were reported 21% higher than those reported in 2013, while fleet managers’ salaries came in 5% lower than 2013 data.
- Single-digit reduction or elimination of employee benefits was reported in this year’s survey, with healthcare and education leading the benefits loss.
- Agencies in the survey experienced an average decrease in operating budgets of 5.75% in the past 12 months.
- Employers report paying less for “existing benefits” compared with 2013. The average of benefits “paid in full by the employer” fell from 24% in 2013 to 19%, and “partially paid by employer” from 23% to 16%.
- The top five budget cuts reported in the survey were overtime, travel, professional development and delays in cost of living and performance merit increases.
- Benefits eliminated by organizations this year were liability insurance (1%), EMS tuition reimbursement (2%), college tuition reimbursement (2%), scholarship fund for employee’s children (1%) and stock purchase program (1%).
- The accident rate among agencies calculates to be 1.10 collisions per 100,000 miles, significantly down from 2013 (1.97) and well below the last published Coalition of Advanced EMS median rate of 1.46.3
Figure 1: Participants by region
Stepping out of the Adams City Fire Rescue ambulance, Daniel Matt shook his head in disbelief at the good experiences he was having on his ride-along. He’d already observed an ultrasound prehospital focused assessment with sonography for trauma (PFAST) exam and was now on his fourth trauma call for the shift—a vehicle rollover.
Upon arrival at the ED with the rollover patient, the field training officer tells Daniel about a new smartphone app that notifies the hospital of a trauma call. But he’s interrupted as the ambulance crew and hospital personnel head into the trauma room—the ED tech is looking quizzically at the vital sign monitor and a handheld computer.
“The Bluetooth on this monitor must be paired with another device, that’s why we can’t transfer the patient data. But the patient has been hypotensive,” explains fire medic Jonah Bullmann. “We’ll just print the data when we get back to the station and fax it over.”
“The fax machine is gone,” quips the attending ED physician. “Old technology.”
“You need to print the data to a PDF and email it to us,” comments the trauma nurse. “But only if the IT department has cleared your system for encrypted attachments. HIPAA, you know.”
“Stop,” commands Bullmann at the head of the backboard. “Let’s remove the pulse ox before we move the patient to the gurney. The last cable got kinked and we had to replace it. But be careful; there’s bone showing from that femur, and his pelvis is wrapped because it was unstable on scene and our PFAST exam shows fluid in the pelvis.”
Watching the patient, Daniel notices a tear rolling from the corner of the seemingly stoic, black leather-appareled, 54-year-old man’s eye. After the patient was transferred to the ED cot, he begins to appear agitated. The trauma and ED staff attach the monitor and pulse ox and change over the patient’s oxygen as he becomes more resistant and upset, attempting to remove the monitoring devices.
Oblivious to the change in the patient’s demeanor, Bullmann begins his handoff report. “Our patient was driving a late-model pickup, Harley in the truck bed, involved in a rollover when he was apparently distracted and drove off the shoulder at approximately 55 miles per hour … wait, you should see these photos of the truck I got on my cell.”
As the caregivers huddle around the medic’s cell phone, the patient yanks off his oxygen mask and begins to yell, “Let me up, I’ve got to get up!”
Daniel places his gloved hand gently but firmly on the patient’s arm and asks, “Are you in pain?”
“Pain I can take, but Buck was in the truck with me,” responds the unshaven and tattooed patient, quickly wiping a tear away. “I hope he’s just run away and isn’t hurt.”
The trauma room falls silent as everyone looks up from iPads, laptops and other portable devices to listen.
“Was there someone else in the truck with you?” Daniel asks.
“My dog,” answers the man in a frustrated tone. “He’s my only family and the cops didn’t find him before you guys got there.”
As eyes return to LCD screens and the ED physician begins to list orders to a scribe keying into a laptop, Daniel squeezes the patient’s forearm. “I’m done with my clinical ride-along after this call. I’ll go back out to the accident site and see if I can find him.”
“You find him and I’ll owe you my life,” responds the patient, his vice-like grip now on Daniel’s arm in return.
“I’ll do my best, but let these good folks help you.”
“Have at it, but find my dog.”
Technology & PPE
In 1988, Peter Pons, MD, attending physician at Denver Health’s ED and professor at the Department of Surgery at University of Colorado Health Sciences Center, reviewed technology and its relationship to prehospital care in an article published in Medical Instrumentation.4 He discussed current technology that included portable defibrillators, pneumatic antishock garments, 9-1-1 systems with computer-aided dispatch and aeromedical transport.
Much has changed since that report. The past 25 years have brought a wave of high technology to EMS. From prehospital emergency ultrasound to field telemedicine and smartphones and tablets, EMS is awash in new equipment to assist in the dispatch, diagnosis, treatment and documentation of patient care.5–7 Current technology is as amazing as it is addictive, and presumably as indispensable as it is potentially distracting and dehumanizing to our patients. Like texting instead of talking, technology can create a barrier to human interaction. When a provider is also wearing personal protective equipment (PPE), the human touch is easy to overlook.
One might have been present in the day of prehospital care when exam gloves were optional, and best practices in PPE were a good pair of nonslip, steel-toed work boots. Today, the range of PPE extends beyond exam gloves, facemasks and footwear to fully contained respiratory apparatus and protective garments. An EMS professional today can look an awful lot like an astronaut.
PPE is defined by the Occupational Safety and Health Administration (OSHA) as “specialized clothing or equipment, worn by an employee for protection against infectious materials.” But it’s not just infectious material that EMS personnel risk exposure to—there are chemical, environmental and physical hazards present in the EMS workplace. OSHA has developed and published a Best Practices for Protecting EMS Responders guide that defines four PPE levels of protection.8 (See Table 2 below.)
According to respondents in this year’s survey (N = 113), the majority of agencies (48%) offer at least level D protection, while 19% offer full level A protection. Level B and level C protection are provided by 8% and 25% respectively. Table 3 below provides a more detail look into PPE offered by EMS agencies across the U.S.
Technology and PPE create a real and often necessary barrier between the caregiver and patient. Yet as the fictitious opening to this article reminds us, the essence of emergency care is touch. The challenge then becomes: How do we as frontline EMS professionals work within safe practices and employ new technology, but not lose touch with our patients?
“Geez, for a biker guy, that patient was a real emo,” comments Bullmann as he and Daniel load the cot into the rig.
“‘Emo’ meaning emotional?” replies the student. “I guess, but he sure didn’t complain about the pain or his injuries. Most patients would’ve been shouting in agony, that guy was genuinely worried about his dog.”
“Yeah, I’ll give you that,” says Bullmann. “But when you put your hand on his arm—brilliant! He calmed right down, no sedation needed. But, how’re you going to find his dog?”
“Well, that’s the question … good thing I have a day off between work and school.”
On route to the earlier accident scene, Daniel makes a quick stop by his service’s administrative office to pick up his paycheck. “To what do we owe this visit on your day off, patient whisperer?” asks Deb Blanchet, the front office receptionist.
“Huh?” remarks Daniel tilting his head. “A what?”
“A patient whisperer. Like a horse whisperer. You develop rapport, offer reassurance, and take a kinder, gentler approach to care.”
“Are you messing with me?”
“The ED charge nurse called,” Deb says. “Something about how you handled a patient from a car accident just a while ago. Supervisors have been using the term ever since, like you’ve got some magic touch,” she jokes.
“All I did was look the guy in the eye, touch his arm and show a little empathy. Now I’m the ‘whisperer’?”
“Are you here for your check?” she asks, reaching into the drawer. “I’d not hang around unless you have time to take a bit of ribbing from the supervisors.”
Daniel opens the envelope containing the check, looks in and smiles, then spins on his heels heading for the door. “That’s a roll-back turn to you non-horse types,” cracks Dan, “I’m gonna giddyup and get outta here.”
Our character, like the real-life EMS staff represented in the 2014 survey, has reason to smile when opening his paycheck, as salary increases, in general, have outpaced inflation at 6% nationally for all job categories. (See Table 5 below.) EMT-intermediates have experienced an average 5% increase in wages, paramedics a 3% increase, and emergency medical dispatchers a 7% increase when compared to 2013 salaries. EMT-basics don’t fare as well, showing only a 1% increase this year against a 2.1% inflation rate. Only two job categories—fleet mechanics and administrative director/EMS administrative chief—demonstrated a decline in reported wages.
Despite paycheck in pocket, Daniel frowns as he drives toward the crash scene. All the training, experience and technology in his EMS toolbox, and a simple squeeze of the arm is what gets him recognition, notoriety and a new reputation? As he reflects on his recent clinical training, a thought begins to take hold. “Nah, that’s silly,” he says out loud to an empty car. “There’s nothing special about me—that could’ve been anyone.”
As he slows his car approaching the scene, he notices a large quad cab, diesel pickup truck parked where, hours earlier, a pickup truck rolled and the dog named Buck ran off. Stepping out of the car, Daniel is approached by a petite blond woman. Thrusting her hand out to shake his, she says, “Hi, I’m Kathy Jones with the humane society, but you can call me Kat.”
Hiding a grimace at the firmness of the handshake, Daniel replies, “Hello, I’m Dan.”
“Judging by that uniform, I’d say you’re in the ambulance business. Maybe you know something about the dog I’m looking for.”
“Not much,” replies Daniel. “His name is Buck—wait, don’t I know you? You work at the hospital right? OR? I did a clinical with you.”
“The hospital is one of my jobs, but today, the Sheriff called and wants me to find this dog. Wanna help?”
Daniel smiles. “That’s why I’m here. I made a promise to a patient.”
A second job remains mainstay to frontline EMS professionals, as organizations in this year’s survey estimate 43% of full-time staff have a second job, and 22% of part-time staff work full time at another agency. Fatigue remains a risk to EMS professionals’ health and safety. When asked, “By policy, what is the maximum number of consecutive hours your agency allows an employee to work before they are considered no longer eligible to continue working? (e.g., 24 hours),” 10 agencies reported an astounding 72 hours. Fortunately, the average hours worked, as reported in the survey, is limited to approximately 36.
Editor’s note—The following job titles were cut from the original version of this article for space: communications manager, billing manager, fleet mechanic, IT, FTO, EM dispatch, supply, billing clerk & communications supervisor. To view data on these job titles by region, click here. To view data on these job titles by call volume, click here. Links will open a downloadable PDF in a new window.
After several hours of futile searching, Dan makes the difficult decision to quit for the night and get some rest before his 24-hour shift the next morning. After saying goodbye to Kat, he drives down the highway toward home. His mind wanders from the road and he remembers a nurse in the ED cradling a sleeping baby at the nurse’s station, while the mother—a patient—slept on a nearby gurney. He remembers also seeing a young hospital volunteer holding the hand of an elderly patient and listening to stories of the Great Depression. The memories lead him to wonder what makes the difference between a good caregiver and a great one? Is it book smarts, procedural skills, technical know-how, or is it something basic like a kind word, empathetic ear or warm touch?
A shrill ring from his phone brings Dan back to the present. He pulls to the side of the road as he answers.
“Dan, it’s Kat. Good news! I discovered Buck had a GPS pet tracking collar. After the monitoring service gave me his code, I tracked him circling the location with my smartphone, so I just sat down with some food and he came to me.”
“That’s great news Kat, and it answers a question I’ve been kicking around in my head all day.”
“Really, what’s that?” she asks.
“I’ll explain it to you later. Right now I’ve got a patient to visit.”Acknowledgment: The author acknowledges the great support of the Fitch project team members and their contributions to the article and the continuing support, encouragement and love from his own “unsung support team.”
1. Pons PT. Advances in pre-hospital care: The technology of emergency medical services. Med Instrum. 1988;22(3):143–145.
2. Heegaard W, Hildebrandt D, Spear D, et al. Prehospital ultrasound by paramedics: Results of field trial. Acad Emerg Med. 2010;17(6):624–630.
3. Convertino VA, Ryan KL, Rickards CA, et al. Physiological and medical monitoring for en route care of combat casualties. J Trauma. 2008;64(4):S342–S353.
4. Pavlopoulos S, Kyriacou E, Berler A, et al. A novel emergency telemedicine system based on wireless communication technology—AMBULANCE. IEEE Trans Inf Technol Biomed. 1998;2(4):261–267.
5. United States Department of Labor. (2009.) OSHA best practices for protecting EMS pesponders during treatment and transport of victims of hazardous substance releases. Occupational Safety and Health Administration. Retrieved July 24, 2014, from www.osha.gov/Publications/OSHA3370-protecting-EMS-respondersSM.pdf.
6. Federal Trade Commission & Department of Justice. (August 1996.) Department of Justice and Federal Trade Commission statements of antitrust enforcement policy in health care statement 6: Enforcement policy on provider participation in exchanges of price and cost information. Federal Trade Commission. Retrieved July 24, 2014, at www.ftc.gov/bc/healthcare/industryguide/policy/statement6.pdf.
7. Bureau of Labor Statistics. (n.d.) Consumer price index inflation calculator. United States Department of Labor. Retrieved July 24, 2014, from www.bls.gov/data/inflation_calculator.htm.
8. Overton J, Andresen D. High performance and EMS market study 2009 [white paper]. Coalition of Advanced Emergency Medical Systems.
Antitrust Safe Harbor
Provider participation in exchanges of price and cost information
The agencies won’t challenge, absent extraordinary circumstances, provider participation in written surveys of (a) prices for health care services, or (b) wages, salaries or benefits of healthcare personnel, if the following conditions are satisfied:
- The survey is managed by a third party (e.g., a purchaser, government agency, healthcare consultant, academic institution or trade association);
- Information provided by survey participants is based on data more than three months old; and
- There are at least five providers reporting data upon which each disseminated statistic is based, no individual provider’s data represents more than 25% on a weighted basis of that statistic, and any information disseminated is sufficiently aggregated such that it would not allow recipients to identify the prices charged or compensation paid by any particular provider.
Job Descriptions for Salary Data
Emergency Medical Technician (EMT-B): Full-time emergency medical technicians with basic EMS skill levels that may include additional skills such as defibrillation, assisting patients with medications, and first-aid based on the current Department of Transportation’s National Standard Curriculum (NSC).
Emergency Medical Technician-Intermediate (EMT-I): Full-time emergency medical technicians–intermediate based on the current NSC.
Emergency Medical Technician-Paramedic (EMT-P): Full-time emergency medical technician at the paramedic level, based on the current NSC.
Emergency Medical Dispatcher (EMD): Full-time emergency medical dispatcher and other frontline communications positions. Duties include call taking, dispatch or both. May also be certified as an EMT or paramedic.
Communications/Dispatch Supervisor: First-line supervisor of emergency medical dispatcher(s). Duties may include shift supervision, scheduling, performance evaluation, call taking and dispatch. May also be certified as an EMT or paramedic.
Communications Manager: Senior management position of the EMS communication center. May oversee all operations, budgeting, hiring, quality and strategic planning.
Field Training Officer: Duties include field training of new employees or EMT students at all levels. May be a full-time position or performed as part of regular shift work.
Education Coordinator: Entry-level management position. May be charged with providing or coordinating continuing medical education, overseeing field training and supporting recertification of staff. In some organizations, duties may be blended with the quality management functions.
Quality Coordinator/Manager: Traditionally, an entry-level management position. May be charged with coordinating and managing key clinical performance indicators (e.g., cardiac arrest survival) and quality assurance (e.g., run form review and complaint investigation).
Chief Financial Officer/Manager: Full-time management position focused on budget and finance. May also have blended duties related to the oversight of billing operations.
Billing/Reimbursement Clerk: Frontline position responsible for processing patient care records, billing payers and collecting reimbursement for services.
Billing/Reimbursement Manager: Middle management position responsible for supervising the processing of patient care records, billing payers and collecting reimbursement for services.
Fleet Mechanic: Frontline mechanic in fleet services. Duties may include preventive maintenance, maintenance, vehicle remounting/replacement and purchase specifications.
Fleet Manager: Middle management position charged with leading fleet services. Duties may include supervising mechanics, coordinating preventive maintenance, vehicle remounting/replacement and purchase specifications.
Information Technology/Systems Manager: May be a management position. Responsible for maintaining technological infrastructure (e.g., email, servers and networks) of the organization.
Logistics/Supply Manager: May be management position. Responsibilities may include supply purchasing, storage, distribution and tracking. May also manage restocking of stations or ambulances.
EMS Operations Manager/EMS Chief: Middle- to upper-management position responsible for managing day-to-day operations. May have field supervisors and other frontline leadership positions reporting directly to them.
Administrative Director/EMS Administrative Chief: Senior-level management position. Traditionally includes oversight of all non-operations functions and may include finance, billing/reimbursement and human resources.
Executive Director/Highest Ranking EMS Chief: Senior leader of all EMS functions. Duties include strategic planning, constituent relations and leading senior management team.