The Bottom Line: Insights Into EMS Staffing [2024 EMS Trend Survey]

Editor's Note: In August 2024, EMS1 and Fitch & Associates released their annual EMS trend survey, What Paramedics Want, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. Today's entry is written by Jay Fitch, PhD, founding partner at Fitch & Associates. 

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After nearly a decade, consistent trends and patterns across various demographics and questions have been observed in the annual survey conducted by EMS1 and Fitch & Associates. The survey gathers insights about “What Paramedics Want.”

As compensation and benefits remain an overarching issue that impacts many aspects of the EMS profession, it is not surprising that staffing/retention is consistently ranked as a critical problem. Other significant issues include funding, recruitment, career advancement, stress/ provider mental wellness, and agency leadership. Let’s dive into the results of the 2024 EMS Trend Survey.

Survey Demographics 

The 2024 EMS Trend Survey was conducted in early 2024. The EMS1 and Fitch & Associates teams developed the questions and widely promoted the survey open to all members of the EMS community.

A total of 1,608 responses were received from EMS professionals representing a wide range of service models across the U.S., U.S. Territories, and Canada. Respondents represented suburban (35%), rural (32%), and urban (29%) service areas across fire-based (19%), public third service (20%), public utility (10%), private for-profit (16%), private non-profit (18%), hospital-based (15%) and federal/military (1%) service models.

The majority of respondents’ primary role is ALS 911 response (48%); and 51% are ground field providers, 11% field supervisors, 10% manager/directors and 11% chief/administrators.

Paid roles account for 87% of the respondents, with 3% volunteers and 10% serving in both paid and volunteer roles.

Seventy-one percent of respondents obtained a degree (up from 65% in 2023) – 30% associates, 27% bachelor’s, 12% master’s and 2% doctorate.

Eleven percent of respondents have 0-5 years of experience, 15% 6-10 years of experience, 24% 11-20 years of experience, 24% 21-30 years of experience and 26% more than 30 years of experience.

Staffing

Lack of staffing is creating increased dissatisfaction among EMS workers and other system stakeholders. Almost 60% of survey respondents (57.3%) indicate that they do not have enough personnel to respond to 911 calls in their primary service areas.

The number of negative press reports is also increasing. It is not uncommon to see headlines such as: “Waited more than an hour for an ambulance for a heart attack” and “A woman died after waiting 3 hours for an ambulance.”

Response expectations remain high. The caustic impact on caregivers and external stakeholders of staffing shortages and coverage limitations will likely expand until the staffing crisis is fully resolved.

Career pathways and development

Respondents identified lack of available personal time as their biggest barrier to career development. Nearly two-thirds of respondents (62%) report they are on 12- or 24-hour schedules. About three-quarters (76%) of the survey respondents report being satisfied with their schedule and hours.

Financial constraints were the second-most-frequently identified barrier to career development.

A majority (52.8%) said that they did not plan to change employers and, in the free text responses, a common theme was, “the grass isn’t always greener on the other side.”

Leadership

Agency leadership has been consistently named as problematic for caregivers. It has been among the top five issues in each of the last 3 years. Examining this year’s results a bit closer, of those who rated poor agency leadership among their top three issues, nearly half (48%) indicated it was the most stressful issue, while the caregiver’s direct supervisor was rated as the most significant stressor by almost a fourth (24%) of the respondents.

Operations

Operations-related questions also revealed some interesting responses. Several other scientific studies have questioned the value of “running hot” (lights and sirens) to all calls. An increasing number of caregivers recognize that “running hot” represents an increased risk.

Over a third of survey respondents report that the opioid epidemic is having a very high impact on their communities. To address that need, 57% report using leave-behind naloxone, with an additional 13% reporting they are planning to adopt this policy soon.

More than six in 10 respondents (61%) indicate that they frequently or occasionally utilize a special response team for patients experiencing a mental health crisis.

Digital transformation and artificial intelligence (AI) tools have been slow to be adopted in EMS.

Overall, 8 in 10 respondents (82%) indicate they have not adopted AI tools. Of those using AI tools, 60% indicated they are using or planning to use AI for operational analysis, while 50% are using or are planning to use AI tools for both human resource support and clinical care or documentation.

Another area of operations that has not seen large scale acceptance yet is the use of hybrid/electric ambulances. Only 5% report frequently using electric ambulances, while 23% of respondents indicate their agency is planning to adopt EVs at some point.

Caregiver wellness

When asked about how caregivers prioritize their health, 43% of the survey respondents indicate that they give it some attention but not enough. Adequate rest remains a significant concern in 2024 with only 4% of respondents getting the recommended amount of sleep daily.

When asked if department leaders recognize stressors for caregivers, nearly 60% agreed, while 23.5% strongly disagreed. Nearly 60% (57.21%) indicated that their department provided behavioral health support services, but with less than a third (31%) indicating that peer support teams are well trained, additional support resources should be considered.

In summary, the consistent trends observed in the survey from year to year underscore the reliability of the findings. The EMS Trend Survey provides valuable insights for individual service leaders and national policymakers alike. By understanding the responses and adapting to the trends, organizations can better meet the needs and expectations of their stakeholders in the years to come. The articles that follow will describe in more detail certain aspects of this year’s survey results. 

Download the full digital edition: What Paramedics Want 2024

About the Author

Jay Fitch, PhD, is a founding partner at Fitch & Associates. Now semi-retired, he serves as a core faculty member for Fitch EMS Foundation and as the senior advisor for mentoring and leadership development for the Fitch Education Foundation.

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