Introduction
EMS providers and leaders across all levels of care reported staffing to be one of the top challenges facing the industry. A recent study reported over 86% of providers experienced recruitment and retention challenges in the past three years.1
Fitch (2023) reported that many EMS providers have lowered educational requirements, lowered the minimum age, and eliminated certification before hiring (i.e., paid time for training) to overcome workforce shortages. Despite these efforts, maintaining an adequate workforce in EMS organizations and agencies across the country is a growing concern.
Providers continue to evaluate and adjust recruitment strategies to maintain their critical role in the public health and safety system in the United States; however, little is known about the efforts to recruit from underrepresented populations.
Recruitment and Retention
Rivard et al. (2020) reviewed over 142,000 EMS records and found that practitioners in EMS were primarily male (76%) and white (85%).2 This shows us that recruitment and retention efforts are working for one demographic, but not others.
JEMS: Increasing the African American Youth Representation in Emergency Management
There is a justifiable concern regarding the stability of the EMS workforce, and because of this, providers should look for innovative recruiting and retention practices that appeal to a larger audience, specifically underrepresented populations.
The underrepresented groups in the EMS workforce that we’re referring to in these articles are females as well as individuals who identify as Black, indigenous, and/or People of Color (BIPOC).
Investigating the Problem
The Savvik Foundation and Delaware State University, alongside Savvik Buying Group, began investigating this issue in October of 2022. More specifically, researchers pursued a rationale to explain why females and BIPOC are:
- Not entering the EMS workforce and/or
- Not being retained in the industry.
Savvik Buying Group, the Savvik Foundation, and Delaware State University researchers hope that findings from this study may aid in the recruitment and retention of a workforce that reflects the communities they serve.
Methodology
Researchers immediately got to work looking for ways to survey opinions of EMS professionals on the current workforce diversity and any contributing factors that may be blocking female and BIPOC members of the workforce.
To do this, researchers needed to make sure they were asking the right questions. They noticed recruitment and retention are often discussed in direct relation to the frequency that certified EMS professionals pass the National Registry exam.
There are well-documented concerns with standardized testing bias in other fields, and researchers were concerned individuals in the Black, Indigenous, People of Color (BIPOC) community would perceive an unfair disadvantage in completing the National Certification Exam due to their ethnicity.
As a first step, the research group met with the Chief Science Officer at the National Registry of Emergency Medical Technicians.
Examining Testing Bias
The (then) chief science officer informed researchers of the process to prevent testing bias. When he started with the National Registry in 2016, his primary responsibilities included managing the psychometric processes associated with national professional certification programs.
He also developed processes for improving and maintaining the quality of the exam program and trained the staff in industry standards for certification testing. Most notably, data gathered from the EMT Certification Exam was analyzed for potential bias.
The chief scientist explained if a particular question prompts a pattern of incorrect responses from a specific demographic (gender, racial, or ethnic) group, the question is pulled from the exam. The pulled question is then reviewed by a panel of experts.
This panel isn’t always the same group of people, however; the National Registry ensures that each panel represents the demographic that struggled with the question. The panel’s goal is to identify any possible reason that the question would produce an incorrect response from that demographic group.
If the panelists are confident that they have addressed the bias, the question is reentered into the practice test and re-analyzed before being placed back on the certification exam.
Establishing Focus Groups
The next step for researchers was to gain insight into the industry- which they chose to do by carefully building focus groups to help gain dynamic and useful information from practitioners.
Participant recruitment was conducted using an agency list provided by the NREMT’s chief science officer, the researchers personal networks and Google to identify state agencies across the country.
In two months, the research team sent recruitment emails that included 72 contacts across all 50 states. Approximately 38%, or 28 individuals, agreed to participate. A total of 8 individual interviews of EMS educators and three focus groups (with 10 additional participants) were completed.
Survey Creation
The focus groups introduced three assumptions to researchers that may explain a lack of diversity in the EMS workforce. The assumptions were:
- Discrepancies in the education and recruiting before the National Training Certification
- Specific items on the National Training Certification that are not culturally universal.
- Practices during the field training and/or the onboarding process that encourage turnover.
Researchers also documented participant statements that fit one of the three assumptions. These statements were shaped into a survey that was reviewed by subject matter experts for clarity, content, validity and face validity.
The final, validated survey included 10 demographic questions, four items relating to education and recruitment, four items relating to the National Training Certification, and nine items relating to events after passing the National Training Certification.
The researchers were incredibly confident that the survey they built asked the right questions.
Survey Distribution
The survey was launched at EMS World Expo in October 2022. Researchers found many participants were willing to complete the survey, provided their email addresses, and requested a link to send to their professional networks. During the next two months, 751 EMS professionals responded to the survey.
This survey provided perceptions of leadership opportunity, the opportunity to pass the written portion of the national exam, how organizations welcome diversity, and mentorship opportunities. In the second article of this three-part series, we dive into the data gathered in those surveys and how it can help us understand our current workforce challenges.
References
1. Fitch, J. (2023, November 21). What paramedics need to persevere. https://www.ems1.com/ems-advocacy/what-paramedics-need-to-persevere
2. Rivard, M. K., Cash, R. E., Mercer, C. B., Chrzan, K., & Panchal, A. R. (2020). Demography of the National Emergency Medical Services Workforce: A description of those providing patient care in the prehospital setting. Prehospital Emergency Care, 25(2), 213–220. https://doi.org/10.1080/10903127.2020.1737282
