How to Successfully Find New Employees: An EMS World Roundtable

Recruitment is a major concern for the North American EMS industry, as a combination of low pay, long hours, and the challenges of working with an increasingly hostile and violent client base convince many EMS employees to quit and work in other fields.

So what can be done to find and sign new recruits? To find out, EMS World spoke to two people who deal with this problem every day.

Susan Bailey is President of the National Association of Emergency Medical Technicians (NAEMT). With more than 92,000 members, NAEMT represents the professional interests of paramedics, EMTs, and other professionals in this field.

Shane Muir is Chief of Superior North Emergency Medical Service, an EMS agency that serves the District of Thunder Bay in northwestern Ontario, Canada. They employ approximately 240 individuals, cover 14 municipalities, and operate 15 EMS stations including a district headquarters located in the City of Thunder Bay.

Here’s what they had to tell us:

EMS World: To begin, what are the challenges facing EMS in terms of employee retention? Why are people leaving? 

Susan Bailey: The turnover rate among EMS personnel was high before the COVID-19 pandemic, and the pandemic further exacerbated the EMS exodus. The pandemic also expanded the opportunities for EMS practitioners to areas such as emergency departments, clinics, remote (travel) employment, and physicians’ offices. This resulted in paramedics and EMTs leaving EMS agencies to work in areas with more controlled working conditions, equal or better pay, and equal or better working hours.

Reimbursement reform for EMS agencies must take place to become competitive in the areas where EMS practitioners are seeking to work. An NAEMT report finds that improving retention and reducing the numbers of paramedics and EMTs who are leaving the EMS workforce, is essential to addressing workforce shortages.

Chief Shane Muir: Superior North EMS (SNEMS) is currently facing a staffing crisis. We have a challenge in finding paramedics to work in rural EMS stations and find it difficult to recruit to more isolated areas of Northwestern Ontario.

We have lost a number of paramedics from staffing front-line ambulances to an ever-increasing number of mental health-related claims as well as physical injuries. Paramedics may not be able to return to work as front-line professionals after experiencing negative health-related outcomes. We have also lost small numbers of staff to allied agencies including Police and Fire services which can offer higher wages.

EMS World: Where can new EMS people be found, both through schools for paying jobs and communities for volunteers? And how difficult is the recruitment process?  

Susan Bailey: EMS agencies have created innovative solutions to attract new recruits, such as signing bonuses, free EMT training, and other strategies. For example, conducting EMT courses in high schools has been very successful in many areas, introducing high school juniors and seniors to the EMS profession. Meanwhile, the SIREN Act created a grant program for public and non-profit EMS agencies and fire departments in rural areas to support the recruitment, retention, education, and equipping of EMS personnel.

Unfortunately, volunteerism is in decline. Attracting volunteers is especially challenging because free time is less available, views of civic duty have changed, and there is no succession plan for volunteers within families and communities.

Chief Shane Muir: We often promote the profession in schools, township meetings, and media, but still require individuals to be trained at the college level prior to considering employment.  

Because of Ontario legislation found in the Ambulance Act Regulation 257/00, paramedics working in ambulances must have graduated from a Paramedic College program, be pending or hold a valid A-EMCA (Advanced Emergency Medical Care Assistant) qualification, and meet all other conditions of employment such as a class F driver's license.

This adds significant barriers to hiring from outside of the college graduate system. At the same time, colleges in Ontario are currently unable to keep up with the demand for paramedic graduates in the north of the province.

EMS World: What are the most effective ways of attracting new people, including social media?  

Susan Bailey: To aid the recruitment process, EMS agencies are offering career days and partnering with high schools to depict the life of a Paramedic or EMT, and incentivize students to consider a career in EMS.

One agency in South Carolina launched an EMT Boot Camp where recruits are paid while they take a 12-week EMT course. We can also attract new hires by retelling our rewards — from giving hearts a second chance to giving births in austere environments to giving comfort to families after a tragic loss — are what inspire the right people to enter our profession and should be communicated loudly!

This being said, promoting the positive aspects of our EMS profession is important for boosting recruitment, across all communications channels. The news media must represent the EMS profession with equality by highlighting the positive and often heroic response events that happen every day proportional to infrequent negative incidents.

EMS agencies and practitioners alike must promote the good that is being done by them and in our communities at every opportunity. Public engagement and social media are great vehicles for publicizing our community paramedicine services, and our training provided to communities on disaster response, CPR, bleeding control, and Narcan administration.

Chief Shane Muir: SNEMS utilizes a broad social media strategy in collaboration with a local Communications Agency and The City of Thunder Bay Human Resources department. Social media platforms provide a robust means of communication and public engagement. SNEMS also participates in many community-level events including, charity and non-profit fundraising, school visits, and education programs, as well as mainstream media interviews. These methods allow us to reach a broad audience and engage with potential recruits.

EMS World: Would offering more money and better working conditions aid EMS recruitment?

Susan Bailey: Offering signing bonuses, pay increases, improved benefits, outlets for support, and working conditions are all considerations for driving recruitment.

In NAEMT’s 2022 National Survey on EMS Workforce Satisfaction and Engagement, many survey respondents indicated that pay was a top concern – 63% of respondents said they felt their pay and benefits were inadequate for the work performed. “Asked for advice on how agencies could improve retention, the vast majority of respondents said boosting pay and benefits could improve retention. However, a second major source of concern was work-life balance.”

Chief Shane Muir: SNEMS has offered recruitment incentives including the Educational Cost Recovery Program that allows for new graduates to recover up to $4,000 after working 2080 hours of regular on-duty time. This is stackable after 4,160 hours for up to $8,000 in incentives.

SNEMS also offers multiple psychological supports with rapid access and dedicated retained clinical psychology appointments. This is in conjunction with an internal Wellness and Peer Support Coordinator and Employee and Family Assistance Program with 24/7 access to support and care. SNEMS has a strong focus on employee support and workplace retention.

EMS World: What assistance exists to help EMS agencies recruit more people?

Susan Bailey: National and state EMS organizations have rallied behind EMS practitioners by providing recruitment and retention resources, tool kits, and federal funding sources for recruitment and training grants, especially in severely weakened rural areas. The NAEMT Foundation works to strengthen and build the future of EMS through funding EMS education (scholarships) and research. EMS career-focused websites, scholarships, and flexible training programs are now offered to a greater extent than ever before.

Chief Shane Muir: SNEMS has a Recruitment Committee that provides ideas on paramedic recruitment and hiring. This committee has selected members who travel to colleges throughout Ontario to speak with Paramedic Program students to provide information and discuss the benefits of working with our service.

This in-person presentation in conjunction with a Social Media Strategy allows for information to be readily available. It fosters a platform for two-way communication with the service and potential candidates in hopes of gaining interest in working for our paramedic service.

EMS World: How well are these new approaches working to date?

Susan Bailey: Steady progress has been made in states across the country, such as Minnesota, South Carolina, and Texas.

Chief Shane Muir: Although the techniques used above allow SNEMS to reach a broad audience and engage with many prospective recruits, we are still in need of paramedics to join the service. We are currently experiencing vacancies in full-time and part-time positions across the district of Thunder Bay.

EMS World: What else can be done to alleviate EMS’ labor shortage?

Susan Bailey: When it comes down to money, some of the most dire funding shortages are in rural areas. To help, spread the word about the Rural EMS Training, Equipment, and Assistance Grant program, also known as the SIREN grants.

Thanks to SIREN, one EMS agency in Minnesota has been able to train new EMTs, supply first responder units with naloxone, and launch a community paramedicine and EMS telehealth program with an area hospital.

To sustain all of EMS, we need across-the-board reimbursement reform — namely, payment for treatment in place (TIP) and transport to alternate destinations (TAD). NAEMT, in collaboration with other national EMS organizations, is strongly advocating for legislation that would direct Medicare to reimburse EMS for the care we provide, as opposed to just the transport that we supply. To advance these efforts, send an email to your Senator and Representatives asking for their support.