Emergency Service Staffing Shortages:

Developing Policy Solutions to Boost Hiring, Retention, and Volunteerism in EMS, Law Enforcement and Firefighting

Key Speakers

Overview

Across the United States, emergency services, a sector comprising law enforcement, emergency medical (EMS) are struggling to hire and retain enough staff. According to a survey conducted by the American Ambulance Association for example, nearly one third of EMS workers left the job within eleven months of signing on. This is on par with the annual industry turnover rate of 20-30% per year and results in a 100% turnover rate every four years. Firefighting faces similar challenges. Per the National Fire Protection Association about 70% of firefighters are volunteers and their numbers are dwindling. In Los Angeles county for example, the population has grown 12% in the last 40 years yet there are fewer firefighters than there were in 1989. The National Forest Service meanwhile reports that while wildland firefighting posts are 90% staffed on average, that number drops to 50% in some fire prone regions like California and Oregon. Finally in a 2021 survey of law enforcement agencies, the Police Executive Research Foundation found that on average, departments around the country were filling 93% of budgeted positions. They also found a 45% increase in resignations and an 18% increase in retirements over the year prior.

These staffing shortages are compounded by and in part a result of both funding difficulties as well as increases in demand. The Government Accountability Office for example found that for-profit EMS services barely break even even after factoring in reimbursements from Medicare and Medicaid. This has left more than 60% of non-volunteer EMS agencies struggling to field calls and many more volunteer-only services, often in rural areas, struggling to remain operational, putting nearly 60 million people at risk of being stranded in case of a medical emergency. This shortage is compounded by the fact that over 40% of EMS services are run out of Fire Departments, departments that per the National Volunteer Fire Council, are fielding 300% more calls than they were 30 years ago. At the Federal level the firefighter shortage left nearly 2000 crew mobilization orders unfilled in 2021. Shortages in police departments meanwhile are illustrated in a study of 9-1-1 response times commissioned by the city of New Orleans. Wait times for assistance have doubled across the country, stretching over two hours in some municipalities. 

The Covid-19 pandemic exacerbated many of these staffing problems, but according to fire and EMS industry professionals, the decline is a decades-long trend. On the emergency medical front, long hours, a median salary below the national average, the high up-front cost of certification, and the need for continuing education often as an out-of-pocket expense, weeds out all but the most dedicated. Many training centers also closed during the pandemic, cutting off a supply of new workers just as demand was peaking and burnout was pushing record numbers of EMTs and paramedics out of the profession. A similar issue has been plaguing volunteer firefighting, particularly in rural areas where the combination of higher living costs and fewer job opportunities has people commuting far out of their communities to work, sometimes multiple jobs, leaving them little time to volunteer or money to afford training and equipment. The challenges facing policing are slightly more complex, resulting as they do from increased public scrutiny following a series of high-profile shootings that have communities reevaluating their relationship with law enforcement. Anectdotally these incidents have reduced the appeal of police work, increased training requirements, and in some, but not all municipalities, led to decreased funding for law enforcement. Across the board, first responder organizations are being asked to do the same amount of work or more with fewer people and fewer resources. 

Policy responses to the shortage have come from all levels of government. Many counties across the country have taken steps to increase funding for ambulance and fire services while others have offered to cover the costs of training for new EMTs. Some state governments, like Michigan, meanwhile have allocated funds to boost medicaid reimbursements. At the Federal level, the recently passed bipartisan infrastructure law allocated a 50% salary bonus for two years for Federal firefighters, and two separate bills introduced to the senate would increase funding and support for local EMS and Firefighter operations respectively. On the law enforcement side, city and state governments across the country are responding to rising violent crime rates by reversing course on funding cuts and hiring freezes. Even the White House has stepped in, proposing a $37b Safer America Plan that would include $13b for hiring and training 100,000 new police officers. 

Criticism of such efforts is nuanced. In emergency medicine there are numerous local conversations happening over the degree to which the service is publicly or privately administered. In firefighting, some critics argue that with the overwhelming majority of calls to fire departments being medical and not firefighting in nature, many FDs function as expensive ambulance services and should be re-designed to more appropriately reflect the nature of the calls they take. The strongest pushback has been against efforts to increase police funding. Critics of President Biden’s plan see it as a repeat of the 1994 Crime Bill which accelerated racial disparities in mass incarceration, and they argue it won’t go far enough to ensure police officers are held accountable by their communities.

This symposium will bring stakeholders from across the public and private sectors together to discuss the shortage of emergency workers. Participants will explore the challenges facing EMS, fire, and police at all levels, identify obstacles to hiring and retention, and co-create strategies for addressing them in order to ensure they remain ready to assist in times of crisis.

Program

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