Demographics of the country also may be working against EMS by possibly creating a shortage of these staffers. “We're going to face increased challenges in the future because of all of the baby boomers growing older,” says Gary Ludwig, deputy fire chief for the city of Memphis, Tenn. Memphis is putting a greater amount of emphasis on EMS care and is increasing its workforce and funding for it, Ludwig says.
Some influential groups are taking a look at these core problems with how emergency medical services are provided and paid for, and changes could occur given healthcare's shifting of more focus on a patient's entire continuum of care and rewarding providers for improved quality.
Dia Gainor, executive director of the NASEMSO, says there are a number of issues that industry stakeholders are working to solve, including a workforce count; creating national definitions for what constitutes an EMS worker—paid or volunteer; and the industry's approach to reimbursement, which generally is below the cost of providing the service.
Work to review the EMS model is under way at organizations such as the U.S. Department of Transportation's National Highway Traffic Safety Administration, the National EMS Advisory Council and the Medicare Payment Advisory Commission as well as the NASEMSO.
The NHTSA, which has primary oversight of EMS as a result of its history as a transporter of patients, commissioned a series of major reports on the EMS workforce. The most recent of which, released last year, aims to highlight the issues facing the industry. Called The Emergency Medical Services Workforce Agenda for the Future, the report outlines goals regarding EMS workforce: health and safety; education and certification; planning and development; and data and research.
The dearth of data on the EMS workforce was previously addressed in a 2008 NHTSA report, and was summarized in the more recent report. “The most basic workforce statistics, such as workforce size, cannot be accurately estimated using available data,” the report authors wrote. The BLS doesn't distinguish between EMTs and paramedics, does not identify EMTs cross-trained as firefighters, and does not capture volunteer EMS workers, according to the report. Others note that many EMS workers have more than one job, which also complicates the calculation of an industry workforce total.
“It's very hard to count this workforce,” Susan Chapman, one of the authors of both reports, says in an interview. There have been different attempts to calculate workforce totals, but the studies' results produce divergent numbers, says Chapman, director of allied health workforce studies at the University of California at San Francisco's Center for the Health Professions and an assistant adjunct professor at the UCSF School of Nursing.