EMS Workforce Planning & Development
EMS WorkforcePlanning & DevelopmentGUIDELINES FOR STATE ADOPTION
October 2014Preparation of this publication was funded through a Cooperative Agreement between the NationalAssociation of State Emergency Medical Services Officials and the National Highway Traffic SafetyAdministration [DTNH22-11-H-00338/0003]. Supplemental funding was provided by the EMS for ChildrenProgram of the Maternal and Child Health Bureau, Health Resources and Services Administration. Theopinions, findings, and conclusions expressed in this publication are those of the author(s) and notnecessarily those of the Department of Transportation or the National Highway Traffic SafetyAdministration. The United States Government assumes no liability for its contents or use thereof. If tradeor manufacturers’ name or products are mentioned, it is because they are considered essential to theobject of the publication and should not be construed as an endorsement. The United States Governmentdoes not endorse products or manufacturers.
Core TenEMS Workforce GuidelinesTable of ContentsAcronym List .3Foreword .5Executive Summary.6Purpose Statement . 8Overview of Guidelines. 8Conclusion .10Background, Rationale and Needs Assessment . 11Summary of EMS Workforce for the 21st Century: A National Assessment . 11Workforce Supply.12Workforce Demand .12Workforce Shortages.14Critical Policy Issues .14Summary of the EMS Workforce Agenda for the Future . 15Health, Safety and Wellness of the EMS workforce .16Education and Certification .17Data and Research .18Workforce Planning and Development.19State EMS Office Overview. 20Brief History. 20Regulatory Practices of State EMS Offices . 20EMS Data Collection Issues . 22State Workforce Agencies . 24Local One-Stop Career Centers . 25Levels of Service Provided .26Youth Programs .27Workforce Data Collection, Planning & Development Resources . 27California’s Health Workforce Clearinghouse .29Health Workforce Information Center.29Bridging the Gap. 30Guidelines for State EMS Office Implementation . 31Guideline 1 Acquire Essential Workforce Data . 33Guideline 2 Engage Local EMS Agencies . 40Guideline 3 Engage State Workforce Agencies . 43Guideline 4 Credential EMS Educators . 45Guideline 5 Obtain Educational and Institutional Data . 46Guideline 6 Understand the EMS Education Pipeline . 49Guideline 7 Quantify Population Actively Functioning in a Paid or Volunteer Capacity . 54Guideline 8 Understand EMS Workforce Demand. 57Guideline 9 Support Military & Spouses Transitioning to the EMS Workforce . 61Guideline 10 Maintain a Healthy EMS Workforce . 64Appendix – Workforce Research and Literature Review . Error! Bookmark not defined.Page 2 of 66
Core TenEMS Workforce GuidelinesAcronym WCNHTSANIOSHNTCCMAccountable Care OrganizationsAmerican College of Emergency PhysiciansAdvanced Emergency Medical TechnicianAdvanced Life SupportAmerican Medical AssociationBasic Life SupportCurrent Employment StatisticsCenters for Medicare & Medicaid ServicesCurrent Population SurveyCommission on Accreditation of Allied Health Education ProgramsCommittee on Accreditation of Educational Programs for the EMSProfessionsDepartment of Health & Human Services (federal)Department of LaborEmergency Medical ResponderEmergency Medical TechnicianEmergency Medical Technician – IntermediateEmergency Medical ServicesEmergency Medical Services for ChildrenFull-Time EquivalentHealth Resources and Services AdministrationHealth Workforce Information CenterHealth Workforce Research CentersIndividual Training AccountsLongitudinal EMT Attributes and Demographics StudyLicensed Practical NurseLicensed Vocational NurseLocal Workforce Investment BoardsNational Academy of Public AdministrationNational Association of State Emergency Medical Services OfficialsNational Association of State Workforce AgenciesNational Council of State Emergency Medical Services TrainingCoordinatorsNational Center for Education StatisticsNational EMS Advisory CouncilNational EMS Information SystemNon-Governmental OrganizationNational Health Care Workforce CommissionNational Highway Traffic Safety AdministrationNational Institute for Occupational Safety and HealthNursing Turnover Cost Calculation MethodologyPage 3 of 66
Core TenEMS Workforce GuidelinesNREMTOESOSHPDPPACAUITACWIAWMDNational Registry of Emergency Medical TechniciansOccupational Employment StatisticsOffice of Statewide Health Planning and DevelopmentPatient Protection and Affordable Care ActUnemployment InsuranceTechnical Assistance CenterWorkforce Investment ActWeapons of Mass DestructionNote: This is the first generation of workforce related guidelines; futurework may evolve. These guidelines are developed as a tool and they do notaddress issues related to staffing, ambulance distribution and access orpopulation-based supply, demand and needs assessments.Page 4 of 66
Core TenEMS Workforce GuidelinesForewordIn the United States, emergency medical care is available to individuals suffering frommedical emergencies and traumatic injuries. The core components of this systemtypically consist of 9-1-1 centers and operators, first responders, Emergency MedicalServices (EMS) personnel, air medical services and hospital emergency departments.The term “EMS “ is sometimes used to reference this entire continuum, but in thisdocument the term EMS is used to specifically refer to the segment that providesservices associated with ground ambulances and air medical services used for responseand transport. Emergency Medical Responders (EMRs), Emergency Medical Technicians(EMTs), Advanced EMTs (AEMTs) and paramedics are the frontline providers of this EMSsystem. According to the 2011 EMS Workforce Agenda for the Future, “[a] principlecomponent of any EMS system is its workforce. The ability of an EMS system to deliverhigh quality prehospital emergency care depends upon a qualified and capableworkforce.”In light of our rapidly changing healthcare landscape it may be difficult to predict allaspects of supply, demand and need for the EMS workforce. However, growth rates ofmore than double the average workforce are anticipated for EMTsThe purpose of thisand paramedics. 1 Even though considerable time and attention hasdocument is to providebeen spent over the past decade on EMS workforce, there are stillrecommendations andsignificant gaps in data and understanding and very limited activitystrategies in the form ofto address these issues as a cohesive effort.guidelines to the StateThe purpose of this document is to provide recommendations andEMS Offices in order tostrategies in the form of guidelines to the State EMS Offices in order encourage and guideto encourage and guide them in a collective, national effort tothem in a collective effortaddress core workforce issues. It is critical for State EMS Offices toto address core workforcetake definitive action in order to contain and address the currentissues.and future challenges of the EMS workforce. Kansas serves as anexample state that has already worked to understand the input andoutput variables of their educational system and they know the percentage ofindividuals who complete education and become certified and licensed. Without thiscritical information about the education pipeline no state can adequately plan and fundtheir state’s EMS workforce needs.The most successful State EMS Offices will not attempt to do this work alone.Engagement of their local EMS agencies, educational institutions and State WorkforceAgencies will determine the level of success the State EMS Office achieves. The ultimateoutcome is for all states to accomplish the desired outcomes of these Core Ten EMSWorkforce Guidelines, thereby achieving a significant step to improve the readiness ofthe EMS workforce for the future.1Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, EMTs andParamedics, on the Internet at ics.htm (accessed March 25,2013)Page 5 of 66
Core TenEMS Workforce GuidelinesExecutive SummaryMore than 826,000 women and men, in both paid and volunteer roles, provide responseto more than 36.5 million calls and treatment and transport to more than 28 millionpatients each year. 2 Calls for help are answered in both rural and urban settings,regardless of weather, location or time of day. Emergency medical care is provided topatients of every age, regardless of complaint, environment or cause. While there is anincreasing amount of clinical and operational data available to leaders in the field ofEMS, there is little known about the workforce and how to plan for the future of thesevital services. State EMS Offices are called to initiate these 10 guidelines and provide afoundation for ongoing efforts to, “recruit and maintain a sufficient number of welleducated, adequately prepared, and appropriately credentialed EMS workers who arevalued, well compensated, healthy, and safe.” 3This document, the “Emergency Medical Services Workforce Planning & DevelopmentGuidelines for State Adoption” (EMS Workforce Guidelines) does not attempt to addressall aspects of the current and potential needs and demands on the EMS workforce butinstead recommends 10 core practices that are recommended to begin the process in adata driven and cohesive way. The vision of this work is that these “Core TenGuidelines” will become the foundation for State EMSThe vision of this work is thatOffices to work among themselves to advance theirthese “Core Ten Guidelines”collective knowledge and understanding of the EMSwill become the foundationworkforce. State EMS Offices are asked to work withfor State EMS Offices to worktheir local EMS agencies, EMS educational institutionsamong themselves toand their State Workforce Agencies to take these 10fundamental steps toward achieving a long-standing goal advance their collectiveknowledge andset forth in the Emergency Medical Services Workforceunderstanding of the EMSAgenda for the Future (EMS Workforce Agenda)(2011),workforce.to successfully “recruit and maintain a sufficient numberof well educated, adequately prepared, andappropriately credentialed EMS workers who are valued, well compensated, healthy,and safe.” 4In addition to the EMS Workforce Agenda, considerable time and attention has beenspent over the past decade to attempt to better understand and anticipate the supply,demand and needs of the EMS workforce. This work also includes but is not limited tothe National Emergency Medical Services Research Agenda (EMS Research Agenda) 5, the2Federal Interagency Committee on Emergency Medical Services (FICEMS), 2011 National EMS Assessment, U.S.Department of Transportation, National Highway Traffic Safety Administration, 2012, on the Internet athttp://www.ems.gov/pdf/2011/National EMS Assessment Final Draft 12202011.pdf (Accessed February 12, 2013)3United States. National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services,Emergency Medical Services Workforce Agenda for the Future, 2011, on the Internet athttp://www.ems.gov/pdf/2011/EMS Workforce Agenda 052011.pdf (Accessed January 10, 2013)4Ibid, NHTSA, Emergency Medical Services Workforce Agenda for the Future5United States. National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services,Page 6 of 66
Core TenEMS Workforce GuidelinesEmergency Medical Services Workforce for the 21st Century: A National Assessment (EMSWorkforce Assessment)6, and the 2011 National Emergency Medical ServicesAssessment (2011 EMS Assessment). 7 These and other efforts have dramaticallyimproved our understanding of EMS workforce issues, but more work is neededThe EMS Workforce Guidelines document foundation is in both the EMS WorkforceAssessment and the EMS Workforce Agenda. The primary objective of the EMSWorkforce Assessment was to, “address issues relevant to the process of workforceplanning.” 8 The EMS Workforce Assessment provides a listing of 12 critical policy issuesnecessary to understand the supply, demand and need of the distinctive EMSworkforce. While EMS personnel are known for their high level of devotion to the field,they receive comparatively low pay and meager benefits. The majority of the criticalpolicy issues highlighted also points out the lack of available and reliable data-relatedworkforce issues and the underdeveloped infrastructure necessary to collect thisinformation. The fundamental hope outlined in the EMS Workforce Assessment is thatthere is a distinct need to develop this infrastructure and a real opportunity to improveour understanding of EMS workforce needs now and into the future.The EMS Workforce Agenda outlines four focus areas that are the basis for movingforward: Health, Safety and Wellness Education and Certification Data and Research Workforce Planning and DevelopmentThe Core Ten Guidelines are all categorized based on these areas to help ensurecontinuity of efforts but also because all four areas remain relevant and elusive. EMSpersonnel are in one of our nation's highest risk professions with risk of mortality almosttriple that of the average worker. 9 The Bureau of Labor Statistics is home to a wealth ofinformation including its forecasted 33% growth in demand for EMTs and paramedicsbetween 2010 and 2020 while the average for all occupations is only 14% (see graphbelow). 10 This demand must be met with adequate supply of qualified, certified andlicensed EMS personnel. Workforce supply is a function of understanding education,National EMS Research Agenda, 2001, on the Internet at sed January 10, 2013)6United States. National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services, EMSstWorkforce for the 21 Century: A National Assessment, 2008, (No. DOT HS 810 943), on the Internet athttp://www.ems.gov/pdf/EMSWorkforceReport June2008.pdf (Accessed January 10, 2013)7Ibid, FICEMS, 2011 National EMS Assessment8stIbid, NHTSA, EMS Workforce for the 21 Century: A National Assessment9Maguire BJ, Hunting KL, Smith GS, Levick NR, Occupational Fatalities in EMS: A Hidden Crisis, Annals of EmergencyMedicine. 2002; 40(6): 625‐63210Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, EMTs andParamedics, on the Internet at ics.htm (accessed March 25,2013)Page 7 of 66
Core TenEMS Workforce Guidelinescertification, and licensure processes. Fortunately there is a tremendous resource inevery state for workforce planning and development but they are rarely in activepartnerships with the State EMS Offices. State Workforce Agencies have the expertiseand responsibility for this work. Most critically, the lack of useful, consistent andavailable workforce data is the fundamental hindrance to all workforce planning anddevelopment.Purpose StatementThe purpose of the EMS Workforce Guidelines is to provide recommendations andstrategies in the form of guidelines. These guidelines are intended to help show states,under the leadership of the State EMS Offices, how to begin to systematically addressthe current and future EMS workforce needs.Overview of GuidelinesThere are 10 core guidelines in this document. All guidelines fall into one of the fourcategories outlined in the EMS Workforce Agenda (Health, Safety and Wellness,Education and Certification, Data and Research, Workforce Planning and Development).Each guideline is presented with a: recommended activity, background information, astatement of rationale explaining its importance, fundamental considerations forimplementation of the guideline, any data required, and a desired outcome. Thoseguidelines that utilize data also provide the suggested methodology as to how to use thedata according to common workforce practices.Page 8 of 66
Core TenEMS Workforce GuidelinesThe following is a basic listing of the guidelines intended to be used by State EMS Officesas recommendations and strategies:Guideline 1: Data & Research - Acquire Essential Workforce DataCollect a core set of workforce data elements to address workforce assessment,planning and policy issues.Guideline 2: Workforce Planning & Development - Engage Local EMS AgenciesLocal EMS agencies need support and guidance to be able to recruit and maintain asufficient number of well educated, adequately prepared, and appropriatelycredentialed EMS workers who are valued, well compensated, healthy, and safe.Guideline 3: Workforce Planning & Development - Engage State Workforce AgenciesThe State Workforce Agency develops and maintains a statewide comprehensive systemof services that prepares, supports, and enhances the economic health of theworkforce.Guideline 4: Education & Certification - Credential EMS EducatorsStates should credential EMS educators based upon their ability to successfully preparestudents for competency based testing.Guideline 5: Education & Certification - Obtain Educational and Institutional Data(Workforce Supply)States should be able to track the number of individuals at each interval of theeducation, certification, and licensure process for each personnel level.Guideline 6: Education & Certification - Understand the EMS Education Pipeline(Workforce Supply)Utilize available information to analyze and address needs in and performance of thestate EMS education system.Guideline 7: Workforce Planning & Development - Quantify Population ActivelyFunctioning in a Paid or Volunteer Capacity (Workforce Supply)States should use data collected to quantify the population entering and continuing tofunction in the EMS workforce.Guideline 8: Workforce Planning & Development - Understand EMS Workforce DemandUtilize available information to analyze and understand the number of EMS jobsavailable for various types of personnel.Page 9 of 66
Core TenEMS Workforce GuidelinesGuideline 9: Workforce Planning & Development - Support Military & SpousesTransitioning to the EMS Workforce After Military ServiceStates should support separating service members, veterans and their spouses who seekto obtain EMS certification and/or licensure through necessary policy, education andlegislation.Guideline 10: Health, Safety & Wellness – Maintain a Healthy EMS WorkforceThe State EMS Office is encouraged to collect data relating to EMS worker illness andinjuries.ConclusionThe EMS workforce of today and the future is a fundamental element of our nation’shealthcare delivery system but one where many opportunities lie to help individualpatients and communities have better health and improved care at a decreased cost.This document, the EMS Workforce Guidelines, will be the foundation for practical,effective and replicable efforts to improve the availability, quality and safety of the EMSworkforce. The success of this effort will be determined by the level of leadership fromState EMS Offices and their ability to engage with their local EMS agencies, educationalinstitutions and State Workforce Agencies. This work is challenging and will take afocused and concerted effort by all parties to complete. Without these practical andcritical steps the stability and sustainability of the EMS workforce cannot be assured.Page 10 of 66
Core TenEMS Workforce GuidelinesBackground, Rationale and Needs AssessmentThe National Highway Traffic Safety Administration (NHTSA) Office of EmergencyMedical Services and the Health Resources and Services Administration’s (HRSA)Emergency Medical Services for Children (EMSC) Program have funded two significantdocuments related to issues concerning the current and future EMS workforce. The EMSWorkforce for the 21st Century: A National Assessment, (EMS Workforce Assessment)11was published in May 2008 and the Emergency Medical Services Workforce Agenda forthe Future (EMS Workforce Agenda) 12 was completed in May 2011. The overall goal ofthese projects was to establish “a national agenda for the future that helps ensure aviable EMS workforce.” It is important to understand the background and work withinthese documents in order to understand the recommendations provided in theseguidelines.Summary of EMS Workforce for the 21st Century: A National AssessmentThe EMS Workforce Assessment concludes that the EMS workforce is comprised ofvolunteer and paid employees and uniquely bridges healthcare and public safety. Thisdistinctive workforce is known for its high level of devotion to the field of EMS despitecomparatively low pay and meager benefits. This assessment also points out thepaucity of data available on workforce issues and the underdeveloped infrastructurenecessary to collect this information. The fundamental hope outlined in the EMSWorkforce Assessment is that there is a distinct need to develop this infrastructure anda real opportunity to improve our understanding of EMS workforce needs now and intothe future.The primary objective of the assessment was to, “address issues relevant to the processof workforce planning.” 13 Four research questions were outlined:1.2.3.4.Will the EMS workforce be of adequate size and composition to meet theneeds of the U.S. population in the future?How can potential workers be attracted to and encouraged to stay in thefield of EMS?How can adequate EMS workforce resources be available across allpopulations and geographic areas?Do we have the data and information needed to address the future demandfor and supply of EMTs and paramedics in the United States? Whatinformation is lacking and how might it be obtained?Between 2004 and 2006 the EMS Workforce Assessment utilized a variety of methods toanswer these four questions. This research included a literature review dating back to11Ibid, NHTSA, EMS Workforce for the 21st Century: A National AssessmentIbid, NHTSA, Emergency Medical Services Workforce Agenda for the Future13Ibid, NHTSA, EMS Workforce for the 21st Century: A National Assessment, p. 712Page 11 of 66
Core TenEMS Workforce Guidelines1973, ample numbers of interviews, surveys and field observations as well as extensiveInternet searches and utilization of an online blog for direct interaction and feedback.Data were also reviewed from the Longitudinal EMT Attributes and Demographics Study(LEADS) and the National Registry of Emergency Medical Technicians’ (NREMT) reregistration processes.In order to be relevant and congruent with other workforce planning documents andresearch, the EMS Workforce Assessment utilized previously accepted terms ofWorkforce Supply, Workforce Demand, and Workforce Shortage. These terms arecommonly used in disciplines of organizational and human resources management andhave been adopted by models developed by HRSA. 14 It is essential to understand thebasic definitions of these terms in order to properly utilize the guidelines.Workforce SupplyThe EMS Workforce Assessment cites the American MedicalAssociation’s (AMA’s) Annual Program Survey in 2004 whichreports 2,991 graduates from 178 programs. A 2005 surveyby the National Council of State Emergency Medical ServicesTraining Coordinators (NCSEMSTC) found 639 accredited orotherwise state-approved programs among the 42 statesresponding to the survey. The AMA recognizes thateducational programs are accredited by the Commission onAccreditation of Allied Health Education Programs’(CAAHEP’s) Committee on Accreditation of EducationalPrograms for the EMS Professions (CoAEMSP). 15 CAAHEPcurrently lists 353 accredited “Emergency MedicalTechnician-Paramedic” programs on its website and does not differentiate other levelsof education.16Note: The data listedhere is valuable butoutdated as it is themost recentcomprehensive dataavailable. The Core 10Guidelines will be asource for this andother valuable EMSworkforce data.Workforce DemandWorkforce demand was defined as the number of jobs available for various types ofpersonnel, filled and unfilled, and the number of projected jobs available in the future.Workforce demand factors include retention, worker satisfaction with wages and otherworking conditions.14Health Resources and Services Administration, Bureau of Health Professions, & National Center for HealthWorkforce Information and Analysis. (2004). HRSA State Health Workforce Data Resource Guide. Rockville, MD: U.S.Department of Health and Human Services. Page 1315American Medical Association (AMA), Allied Health, Emergency Medical Technician-Paramedic, on the Internet pdf(accessed June 7, 2013)16Commission on Accreditation of Allied Health Education Programs (CAAHEP), CAAHEP Accredited Program Search,tab, on the Internet at http://www.caahep.org/Find-An-Accredited-Program/ (accessed June 10, 2013)Page 12 of 66
Core TenEMS Workforce GuidelinesThe Bureau of Labor Statistics projected that an additional 75,400 EMTs and paramedicswould be needed, and an additional 45,400 would be needed to replace those leavingthe profession between 2010 and 2020.17 This represented 120,800 new andreplacement positions needed. The Bureau of Labor Statistics data provides a limitedperspective of actual demand although it was reported to be the most robust source ofdata.The Bureau of Labor Statistics projection was calculated from three data sources, theOccupational Employment Statistics (OES), the Current Employment Statistics (CES)surveys and the Current Population Survey (CPS). Both the OES and CES surveys drewtheir samples from the state unemployment insurance (UI). These UI files are usedbecause they are the most comprehensive and up-to-date source of informationregarding employment figures capturing roughly 97% of total employment figures. TheCPS survey
The EMS Workforce Guidelines document foundation is in both the EMS Workforce Assessment and the EMS Workforce Agenda. The primary objective of the EMS Workforce Assessment was to, “address issues relevant to the process of workforce planning.” 8 The EMS Workforce Assessment provides a listing of 12 critical policy issues
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Outline Earlier History of American EMS – “Back in the day” before formal EMS Systems Transformative years into the modern era Deep involvement of early medical directors: Science of Trauma and Cardiac Care Autonomous EMS Systems in the 80s-90s New EMS: Systems, Oversight, Quality Future trends in EMS and interface with EM
- 5 - continuing through NHTSA’s Uniform Prehospital EMS Dataset (1994), the EMS Agenda for the Future (1996), the EMS Education Agenda for the Future: A Systems Approach (2000), the National EMS Research Agenda (2001), the National EMS Information System (2001), the Rural and Frontier EMS Agenda for the Future (2004), the Trauma S
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