“Rescue EMS”: An Ironic but Dark Reality

Authored by: Janghee Lee

Art by: Amy Em

In January of 2024 Andrea Feeley desperately called for help as her daughter Yuna stopped breathing [1]. The adequate help never came. Fire crews responded within minutes but the town’s two ambulances were preoccupied with other calls. Instead of receiving care inside of an ambulance from a paramedic, Yuna was rushed to the hospital in the back of a fire chief’s SUV and she did not survive. 

Unfortunately, Yuna’s case underscores a troubling trend across the nation. In Ulster County in New York State, it is estimated that nearly 10% of emergency calls for medical attention go unanswered [2]. This workforce crisis is similar in states like Wisconsin, where the state’s EMS workforce has shrunk around 25 to 30% while calls have increased 21% leading to many calls going unanswered [3].

As emergency medical services struggle across the U.S., it's more important than ever to understand why. A large part of that answer is the financial strain affecting EMS systems nationwide. While fire protection, law enforcement, and even garbage collection are mandatory services funded in every state, emergency medical services are not [4]. Even in the thirteen states that recognize EMS as an essential service, the funding is far from adequate.

The lack of funding for EMS has pushed the burden of such a crucial service onto the hands of overworked workers who receive little compensation. In fact, many areas of the United States rely solely on volunteer EMTs to provide life-saving coverage, which has resulted in inconsistent response times [4]. Despite their invaluable work, EMS workers are often forced to work overtime hours to make ends meet and struggle with housing insecurity, food security, substance abuse, and healthcare affordability concerns [5]. Compounded with a job that frequently encounters traumatic incidents, financial stressors are especially burdensome for EMS providers mentally and physically. A study shows that the lack of financial stability in EMS is responsible for nearly 90% of EMS providers screening positive for burnout [5]. As a result, many EMS professionals are leaving, leading to even greater staffing shortages and pressure on remaining workers. Further, among the workers that remain, burnout negatively affects response times and quality of care in a profession that deals with life or death scenarios.

The stakes are higher than ever, for both the lives of EMS workers and the American population. Increased awareness and advocacy for changes to the current EMS model are desperately needed with a primary goal of bolstering resources and capacity for EMS agencies. To combat the pressing issues facing EMS, advocates are pushing for a couple of promising policies. 

In New York, advocates are pushing for a “Rescue EMS” project that includes a package of legislation that would fund county wide coverage and help cut costs for EMS agencies state-wide [6]. There are more innovative solutions on the table as well. Advocates are suggesting the implementation of a telemedicine program that allows EMS agencies to efficiently respond to individuals that do not need an emergency room visit. Another proposed idea is the introduction of a graduate-prepared paramedic license that would provide a more robust clinical pathway for individuals to pursue a career in [7]. There are also considerations of lowering the age requirement for obtaining an EMT license. 

Each of these solutions pose a variety of potential benefits and harms. For example, utilizing telemedicine could greatly help reduce the financial and time burden that EMS agencies suffer from responding to non-emergency calls. At the same time, patient evaluations can be flawed in a virtual setting and create difficult decisions that non-medical professionals should not be expected to make. A primary portion of EMS patient evaluations involve taking vitals which would not be possible through the screen. With the policy to lower the age requirement, introducing EMS services to younger teens could help foster interest and create a larger workforce but could also threaten both patients and the teens themselves. While there is no right answer to what policies should be implemented, one thing is certain, change is needed and change is needed now. 

References

1. Curran, K. (2024, August 13). “Is the ambulance coming?” What happens when EMS crews can’t respond. NECN. https://www.necn.com/investigations/ems-ambulance-level-zero-massachusetts/3308403/

2. Most, R. (2022, September 14). “Very scary”: Why 10% of 911 dispatcher calls to EMS services go unanswered in Ulster County. Hudson Valley One. https://hudsonvalleyone.com/2022/09/13/a-comprehensive-study-of-emergency-services-in-ulster-county-is-long-overdue/

3. Jahnke, P. (2023, June 11). Emergency calls going unanswered. The Mid-West Farm Report. https://www.midwestfarmreport.com/2023/06/11/emergency-calls-going-unanswered/

4. Rogin, A., & Young, K. (2023, July 15). Rural shortages lead to worsened ambulance deserts and delayed medical care. PBS NewsHour. https://www.pbs.org/newshour/show/rural-shortages-lead-to-worsened-ambulance-deserts-and-delayed-medical-care

5. Basting, J., Salerno, J., & Bradshaw, C. (2023, October 23). Prevalence of social needs & social risks among EMS providers. JEMS Exclusives. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10702479/#:~:text=Background,%2C%20low%20wages%2C%20and%20burnout

6. Arpey, J. (2024, February 2). Advocates push bills to help New York’s EMS crisis. Spectrum Local News. https://spectrumlocalnews.com/nys/central-ny/politics/2024/02/02/advocates-rally-for-ems-bills-

7. Cramer, T. (2024, January 29). EMS and the fight to be recognized as an essential service. Michigan Journal of Economics. https://sites.lsa.umich.edu/mje/2024/01/29/ems-and-the-fight-to-be-recognized-as-an-essential-service/