Many who have worked within the emergency medical service, or EMS, for any period of time would agree that EMS is imperfect. As a former emergency medical technician, or EMT, who worked for over five years servicing rural and suburban areas of Massachusetts, I can personally testify the dire state of our country’s 911 call force. As stated in the Institute of Medicine’s report on the future of emergency care in the United States, while EMS has made strides over the past few decades, “underneath the surface, a national crisis in emergency care has been brewing and is now beginning to come into full view.”

Just over a year ago, our nation’s emergency services joined hands with the greater medical community to address the COVID-19 pandemic. From New York City to Lake George, Louisiana, to Santa Clara County, California, tens of thousands of EMS providers worked tirelessly to provide lifesaving interventions and transportation services for the critically ill.

While we thank these providers with salutes during parades, discounts at shopping centers and accolades during conversation, society fails to support them with a living wage. The average EMT wage is less than $40,000 a year, which is comparable to the wage of an Amazon delivery driver. While both services are certainly important and necessary, one would think that the added risk of caring for the health needs of a community would award a higher salary.

Comparatively, other civil service workers such as firefighters and police officers not only earn substantially more — with starting wages of $50,000-60,000 — but have the added benefit of competitive retirement packages and pensions offered by the municipality. In order to receive these same benefits, many of my coworkers in the private industry regularly worked over 90 hours a week to meet their financial, retirement and personal needs. 

The result was burnout. The American Ambulance Association conducted a survey in partnership with Avesta that was managed by the Center for Organizational Research at the University of Akron. In this study, published in 2019, the center found that there is a 30 percent turnover rate for full-time EMTs and a 24 percent turnover rate for paramedics. This translates to about 100 percent turnover within a four-year time period. 

Why might this be the case? Aren’t emergency medical services and medical companies deserving of the same wage and same benefits? Aren’t the educational requirements similar?

The answer to this question is multifaceted. While a high school diploma and certificate training are the minimums for all civil services, they are not federally considered equal. EMS is not considered an essential service by the federal government, and therefore, it does not receive the same financial support that police and fire services do. EMS is not prioritized, and the evidence is in the money. In New York City, for example, approximately $321.1 million was designated to emergency medical services in 2019, whereas four times that number — $1.4 billion — was designated for “Fire Extinguishment/Emergency Response.”

Consequently, communities have been forced to adapt. When one surveys the country for EMS and ambulance services, you will find structures that range from private for-profit, private nonprofit, volunteer, municipality, fire department-operated and arrangements of these options.

The simple explanation for this is that the industry at large is less developed. EMS is relatively young, starting in the 1960s and 1970s, whereas some of the other civil services have been around for hundreds of years. The political bodies that fought for fire and police salaries and pensions had more uniformity than those that exist in EMS — EMS is relatively decentralized.

However, the infancy of EMS awards malleability. EMS as it stands today is very different than it was 20 years ago — ask any senior paramedic at your local 911 service; they will attest to this reality. 

One area of growth that municipalities could benefit from while increasing funds to EMS workers would be a shift from focusing on acute disease and injury prevention to a broader public health focus. Best said in “The Formation of the Emergency Medical Services System” by Manish N. Shah, associate professor of pediatric neurosurgery at the University of Texas:

“EMS has the unique characteristic of caring for patients in their homes at unscheduled times. As a result, EMS providers can provide public health interventions, such as screening for diseases and injuries and evaluating home environments, notifying physicians and public health officials of identified deficiencies, and educating patients and family members on disease prevention during emergency responses.”

As the United States continues to battle COVID-19, with upwards of 100,000 hospitalized and over 1,300 deaths on August 31 alone, building the infrastructure for a field public health workforce has never been more necessary. Boston, one of the leaders in the direction of our nation’s EMS, has done just this with their Boston EMS Community Initiative.

The community must stand strong in supporting our EMS providers. Our state and federal governing bodies should recognize that EMS workers and the industry have the capacity to service our community with vital, lifesaving public health initiatives and therefore need greater funding allocation.

Joseph Williams is a first-year MPH candidate in the Yale School of Public Health. His column 'Contemplating health' runs on alternate Thursdays.