Essential workers, but not a recognized essential service? 

I began my career in EMS over twenty years ago. Back then, there were many discussions highlighting the future of EMS as a federally defined essential service. 

In the late ‘90s there was a lot of disconnect among EMS agencies with regards to consistent training and pay. Additionally, much of rural America depended on volunteers to provide emergency medical treatment to communities, as it still does today. 

The goal was to unify EMS nation-wide to provide a more consistent level of service and training for all states. The National Registry of Emergency Medical Services implemented standardized testing which almost every state has since adopted. The expectation was that as EMS training became more standardized across the nation, EMS would gain more recognition as an essential service that could receive funding on a federal level. 

State and local funding 

I find it shocking that 20+ years later only 11 states deem EMS an “essential service,” unlike fire and police. Those states are Nevada, Oregon, Nebraska, Louisiana, Indiana, Virginia, West Virginia, Pennsylvania, Hawaii, Delaware, and Connecticut. In these states, the state government provides funding for EMS, whereas the remaining states rely on local funding for EMS services. Because the federal government does not recognize EMS as an essential service, it does not receive federal funding. This is concerning, as lower income or rural areas within the other states have to exhaust all avenues, including local fundraisers, just to be able to provide EMS services. 

Unfortunately, training and pay suffer the most in the areas where funding is scarce as well.  

When these two things are lacking, so may the skills to perform the job effectively and the ambition to do it when there is little monetary security. Moreover, in rural communities where funding is just not available, volunteers are becoming more difficult to find as well. Asking folks to work their full-time jobs that are often tiring in themselves, and then jump on an ambulance to go “save a life” for no compensation is a lot to ask. Hats off to the volunteer emergency workers who selflessly continue to provide these services. Without their dedication and commitment, many rural communities would have no EMS services at all. 

The hazards EMS face as a case for essential service status 

With the COVID-19 pandemic, the public has gotten a glimpse of the risk first responders face. While risk has always been there in the sense that a first responder never knows what they will face, the odds have definitely increased within that matrix. Without federal funding, EMS services must rely on local funding or financial support within the organization itself (in the instance of private service). How does this effect the safety of crew members with regards to adequate PPE and training for a pandemic? Furthermore, would it be logical that hazard pay be a nationwide consideration due to the increased risk? 

In an article on EMS1, Laura French discusses hazard pay for EMS. She relays that several states have implemented their own legislation that would provide such pay; however, federal funding has yet to be provided for hazard pay. For example, in Atlanta, GA, Mayor Keisha Lance Bottoms has issued an order which will remain in effect during the COVID-19 pandemic. 

It will provide “$500 a month in hazard for public safety, sanitation, and other front-line workers.” 

Where wages are already low, this may prove an adequate consolation for the risk involved. 

What happens after we finally have the COVID-19 pandemic under control? Is it fair to say that we should re-evaluate pay for EMS workers and make it more consistent nationally? The current pay scale varies significantly by location and role as an EMS provider. And, again, in some areas the services are volunteer only. An EMT in New York state makes an average of $39,420 annually, while a paramedic in New York averages $46,698. For the same roles in areas of North Carolina, EMTs make an average of $24,072 while paramedics make around $35,000. To put this in context, the average cost of living is $40,592 for New York state and $35,754 for North Carolina, according to 

National standardization and essential services 

Critical Care ground and flight paramedics typically bring in higher salaries. This is due in part to the additional training requirements and critical nature of the patients. But, these services also provide increased revenues. 

In New York, the median salary for a flight paramedic comes in around $78,000 per year, compared to $57,600 for flight paramedics in North Carolina. Again, these are just median ranges, but clearly very different pay based on location. 

If EMS gained federal recognition as an essential service, would a more even pay scale and consistent training emerge? The training curriculum for EMTs and paramedics has become fairly standardized across the country as many adhere to the National EMS Core Content. Testing has also achieved a fair amount of standardization, since most states now utilize the National Registry. Ongoing training within specific organizations and areas across the country vary, however. 

Plus, patients aren’t any less sick in rural America than they are in urban cities. In fact, due to limited resources and hospitals spread out over large geographies, rural EMS have greater challenges in that regard. They often have longer transport times with sometimes critical patients. 

So, why doesn’t EMS receive federal funding? Why isn’t it recognized alongside Fire and Police as an essential service by more than 11 states? When the first structured EMS was established in the 1970s, support was strong at both the state and federal level; however, in the 1980s comprehensive federal support was withdrawn leaving funding to the state and local government. This led to inconsistency across the nation, and an overwhelmingly low pay for EMS. It has yet to be fully addressed despite years of efforts by multiple organizations. 

Looking ahead 

There has been some light at the end of the tunnel though. In December 2019, Congress passed the SIREN ACT which provided $5 million to support public and non-profit rural EMS agencies. Through grants, rural agencies will have more access to training and more resources to recruit staff. While this is a positive step, under staffing and lack of unified training will continue to plague many rural organizations until EMS gains federal recognition and funding. 

Furthermore, the COVID-19 crisis is exhausting many of those resources with the expenses of added personal protective equipment, additional decontamination efforts, and additional training for staff – not to mention the EMS workers infected by COVID-19 who missed work resulting in over-time pay to replace them. If phase 4 of the COVID-19 legislation would include EMS, then it could help to fund those things temporarily.  

We have a long way to go to unify EMS across our nation. We continue to creep closer to federal funding as more states recognize EMS as an essential service. Many citizens are unaware that EMS is not considered essential in their area, so hopefully through community awareness and government urging, we can accomplish this goal once and for all in the near future. It would certainly be ideal for EMS to be a career that people can receive sufficient training and pay while providing such life saving measures to the community. 

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