Good Help Is Hard to Find: The EMS Workforce Agenda for the Future
Though provider shortages have plagued many EMS services in recent years, attempts at fixing them have been piecemeal. Some state offices have tried to help, and some departments have recruited successfully on their own, but there's been no comprehensive long-range national plan for developing and maintaining a viable, healthy, well-trained EMS workforce.
The Emergency Medical Services Workforce Agenda for the Future is precisely that plan. Assembled by experts at the University of California San Francisco with funding from NHTSA and the EMS for Children program, the document, published in May, imagines a future "in which all EMS systems have a sufficient number of well educated, adequately prepared, and appropriately credentialed EMS workers who are valued, well compensated, healthy, and safe." That's admittedly ambitious, but with employment of EMS providers expected to rise 9% between 2008 and 2018 (per the Bureau of Labor Statistics [BLS]), tackling workforce issues is a fast-growing imperative.
"We've pulled together all of what we know about where we are and what our key workforce issues are, as well as laying some groundwork for addressing those issues in the future," says lead author Susan Chapman, PhD, RN, director of allied health workforce studies at UCSF's Center for the Health Professions. "It's a document that's truly meant to be an agenda and give us some guidelines for moving forward."
The Agenda breaks down EMS workforce issues into four components: health, safety and wellness; education and certification; data and research; and workforce planning and development. For each, it evaluates where we stand today, where we want to be in 2020, and how to get there. It also proposes an EMS Workforce Technical Assistance Center to assist with workforce development at all levels.
Health, Safety and Wellness
EMS providers are susceptible to a lot of risks--lifting injuries, vehicle crashes, infectious diseases and assaults, to name a few. But Chapman's team found a general lack of workplace safety measures, inconsistent reporting of accidents and close calls, and a lack of driver training and standards. Importantly, there's no national-level EMS illness and injury surveillance program, which prevents us from documenting exactly what's hurting providers and where the greatest risks lie. But knowing and remedying that is essential to creating the kind of safe and healthy workplace that can draw and retain good people.
NHTSA looked at the possibility of a surveillance system in a 2007 report, Feasibility for an EMS Workforce Safety and Health Surveillance System. It concluded that existing systems such as the Census of Fatal Occupational Injuries, Fatal Analysis Reporting System and National Electronic Injury Surveillance System were insufficient to capture all the data needed for an EMS workforce illness and injury profile, and instead conceived a national EMS Workforce Injury and Illness Surveillance Program (EMS-WIISP).
That's a key element in the Workforce Agenda's plan. It proposes an integrated program of EMS occupational health and safety surveillance, which will produce data epidemiologists can use to evaluate risks and ultimately help guide strategies to reduce them. An effective surveillance program, authors say, should track types and prevalence of illness, vehicle crash morbidity and mortality, incidence of death and disability, etiology of illness and injury, and "near miss" incidents.
The Agenda also emphasizes development of the workplace culture of safety, with measures borrowed from analogous industries like trucking and wellness programs tailored to EMS. It supports the five goals set for EMS in the National Occupational Research Agenda's agenda for safety and health research in American public safety: reducing injuries and fatalities from vehicle crashes; reducing injuries from patient movement; reducing hazardous exposures; implementing workplace illness- and injury-reduction policies; and creating a health and safety surveillance system for EMS.
Whether a safer EMS workplace can lure and keep providers a less-safe one wouldn't remains to be seen, but at the least it should reduce time lost by current workers to injury and illness. After all, part of maintaining a workforce is keeping workers at work.
"We know EMS is among the most challenging jobs from a safety perspective," says Chapman. "This is really to promote safety as both a workplace responsibility and a personal responsibility of the worker. It involves education as well as organizations taking action."
Education and Certification
Despite national standard curricula and a body like the National Registry, EMS educational requirements and quality vary a lot across the U.S. Lack of easy reciprocity can hamper providers from moving across state lines for jobs and may discourage people from entering EMS. The EMS Education Agenda is an attempt to develop a more standardized national system of EMS education.
Implementing the Education Agenda is essential to the workforce plan. Chapman's team supports national paramedic program accreditation required by states; skills verification through national certification as a basis for licensure; national recertification with common requirements across states; and common scopes of practice, titling and licensure categories. It also calls for educational programs' enrollment and graduation data to be reported to the National Center for Education Statistics (NCES).
The Workforce Agenda also promotes the NIMS National Emergency Responder Credentialing System to facilitate response in cross-jurisdictional emergencies.
Data and Research
Workforce research is necessary to guide workforce development, but in this area as many others, EMS lacks a good body of it. We don't even know the size of the EMS workforce or how many students we're grooming for it at any given time. That, the authors acknowledge, could make other parts of the Workforce Agenda hard to address.
The Workforce Agenda urges the EMS community to keep working with entities like BLS and NCES to improve data collection, workforce size estimates and future supply/demand projections. How hard could it be, for instance, for BLS to separate EMTs from paramedics in its data, or to identify cross-trained EMS providers working in fire departments? (It currently does neither.) Elsewhere, EMS systems across America must participate in data collection, using common terms and definitions and accounting for volunteers, the cross-trained and EMS workers in allied health fields.
While designed to gather patient and system data, the National EMS Information System (NEMSIS), Chapman's team notes, could advance workforce research by helping us analyze factors like ambulance staffing configurations vs. patient outcomes. They also call for developing researchers with EMS backgrounds, reliable funding sources and a searchable index of EMS workforce research.
Workforce Planning and Development
Workforce planning basically boils down to measuring current supply vs. future demand, with an eye toward any new skills to be needed down the line. As it adds up currently, that equation worries a lot of EMS leaders. Worker shortfalls were EMS employers' most consistently identified concern in interviews by Chapman's team. Agenda investigators found we know little about why workers leave EMS, and don't have much to offer departments in the way of workforce planning resources or guidance, particularly in the volunteer arena. We need to know more about what motivates people to volunteer and remain as EMTs. Typically, workforce planning considers factors like current supply (number of workers, students in pipeline) and demand (vacancy and turnover rates); compensation; environmental factors (e.g., population demographics, regulations, other providers in the region); and cost/budget considerations.
State offices have to take the lead in doing this better. The Workforce Agenda urges them to provide workforce planning resources and education to local systems, help identify best practices, help collect data to inform planning, and project trends and future demands.
Some good news is that healthcare workforce development was one focus of the Patient Protection and Affordable Care Act, so attention and resources, including grants, are now being directed to that area.
"Many states now are doing more workforce planning as part of healthcare reform," says Chapman. "The message to EMS is to get involved with the larger healthcare workforce planning efforts in their states, and make sure their issues are on the table. For example, in California, the EMS Authority is working with the Office of Statewide Health Planning and Development and California Health Workforce Alliance to make sure they're all on the same page and understand each other's workforce planning issues moving forward. EMS can't be segmented away."
Technical Assistance Center
The National EMS Workforce Technical Assistance Center proposed by Agenda authors would facilitate data collection and research, including working to improve illness/injury surveillance, and help guide progress in the above four areas.
The Future
The passage of PPACA in 2010 was a late-game curveball in considering EMS workforce issues. The Workforce Agenda doesn't analyze its impact, but as the legislation remolds how healthcare is delivered in the U.S., it will surely have implications for our field.
"There's a huge workforce issue within healthcare reform," notes Chapman. "What is the impact of these changing programs, and of many more people having insurance or potentially taking advantage of healthcare? There's a lot of opportunity to reconsider who does what in the healthcare workforce. We have to look at whether we have the numbers of workers needed to address what's happening. In almost every case, it's a matter of having more folks."
Related Links
- Emergency Medical Services Workforce Agenda for the Future
- Emergency Medical Services Education Agenda for the Future
- Feasibility for an EMS Workforce Safety and Health Surveillance System
- National Occupational Research Agenda: National Public Safety Agenda for Occupational Safety and Health Research and Practice in the U.S. Public Safety Sub Sector
