Many United States (U.S.) communities face challenges with Emergency Medical Services (EMS) workforce turnover. The demands created by the pandemic have worsened the stressors EMS clinicians face, possibly changing the drivers of workforce turnover. Our study aims to understand the factors associated with Emergency Medical Technicians (EMTs) and paramedics' likelihood of leaving EMS. We conducted a cross-sectional analysis of nationally registered civilian EMTs and paramedics ages 18-85 from October 2021 to April 2022. After recertifying their National EMS certification, respondents were invited to complete a survey regarding their primary role, additional jobs, and the likelihood of leaving EMS in the next 12 months. If likely to leave, reasons for leaving were collected and evaluated for the top reasons. Multivariable logistic regression modeling (OR, 95% CI) was used to describe the odds of being likely to leave in 12 months, adjusted for age, agency type, education level, primary role, and job satisfaction. A total of 29,671 (response rate-25.9%) EMTs and paramedics were included in the analysis, with 7.1% and 7.9%, respectively, reporting they were likely to leave EMS in 12 months. The EMTs likely to leave were younger (median age 32 vs. 37) and had fewer years with main EMS job (median 3 vs. 4) than paramedics. A lower proportion of EMTs were male (68.8% vs. 78.6%) and non-Hispanic White (79.8% vs. 87.6%). The EMTs were less likely full-time (65.6% vs. 87.5%) and held fewer EMS jobs (23.4% vs. 32.3%). The EMTs and paramedics reported stress as the most significant reason for leaving (27.9% and 38.8%, respectively), followed by COVID-19 (12.9% and 19.3%) and education (18.3% and 6.4%). Those dissatisfied had significantly higher odds of leaving (11.91 and 13.46, respectively). The EMTs and paramedics in hospitals (OR = 2.32, OR = 2.37), private (OR = 2.72, OR = 2.38), and government non-fire (OR = 2.22, OR = 1.98) agencies were likelier to leave than fire agencies. Although increased stress and pandemic-related factors are most common reasons reported for being likely to leave EMS, job dissatisfaction was the most impactful factor. A better understanding of factors that drive job satisfaction needs evaluation to develop strategies to enhance retention.

Detailed job satisfaction evaluations are often used to build strategies for employee retention. Despite recognizing that emergency medical services (EMS) dissatisfaction drives turnover, validated tools rigorously evaluating satisfaction have not been employed. We aim to assess the association between EMS clinician satisfaction and their likelihood of leaving the profession using the validated Spector Job Satisfaction Survey (JSS). We conducted a cross-sectional survey of nationally certified EMS clinicians in the United States recertifying between October 2022 and April 2023. Our primary outcome was the self-reported likelihood of leaving EMS within 12 months (likely or not likely to leave). The primary exposure was job satisfaction, assessed using the 36-item JSS, scored from 36-216, and analyzed in two models: total satisfaction (dissatisfied [scores 36-108], ambivalent [108-144], satisfied [144-216]), and satisfaction subscales (e.g., pay, promotion, supervision). We applied Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify key predictors of intent to leave EMS, adjusting for demographic and agency characteristics. Post-LASSO Bayesian logistic regression estimated odds ratios (OR) and 95% credible intervals (CrI). Among 33,414 EMS clinicians (response rate: 26.3%), the median age was 36 years (IQR: 29,46), 74.2% were male, and 83.0% were White, non-Hispanic. Most respondents worked full-time (77.6%), primarily as EMTs (48.5%), in urban settings (89.9%). Mean satisfaction scores were higher among those not likely to leave EMS (146.7 [standard deviation: 29.0]) than those likely to leave (121.2 [28.4]). Odds of leaving decreased for more satisfied clinicians: ambivalent clinicians [0.35 (0.32-0.38)]; satisfied clinicians [0.11 (0.10-0.13)]; referent dissatisfied. Additionally, specific satisfaction subscales were associated with lower odds of leaving for those satisfied compared to those dissatisfied, including nature of work [0.32 (0.28-0.37)], pay [0.46 (0.40-0.52)], promotion opportunities [0.53 (0.47-0.61)], supervision [0.65 (0.57-0.73)] and contingent rewards [0.77 (0.67-0.88)]. The EMS clinicians with higher satisfaction with their nature of work, pay, and promotion opportunities were less likely to report intent to leave. These findings highlight key factors that may inform workforce retention efforts.

Introduction: Recently, there have been annual increases in emergency medical service (EMS) demand with concurrent clinician shortages. Understanding the diverse number of EMS clinicians available for emergent roles is vital for planning and resource management. Our study aims to understand the roles and environments of US EMS clinicians. Methods: This cross-sectional study analyzed nationally certified civilian US EMS clinicians recertifying from October 2021 to April 2022, ages 18-85, with at least one EMS job. Respondents answered questions regarding their primary and secondary EMS roles, including emergent response (with/without 9-1-1), medical transport (non-emergent), clinical services, mobile integrated health (MIH), or none of the above. Next, respondents were asked about the number of jobs needed to make ends meet. All responses were combined with self-reported National Registry profile data (e.g., age, sex). Descriptive statistics were performed. Results: The study included 33,335 EMS clinicians (response rate: 34.0%). The primary role reported was emergent response with 25,086 (75.3%), including ground ambulance and non-ambulance response. Clinical service roles were reported by 2,427 (7.3%), including settings such as the emergency department and outpatient clinics. Medical transport roles accounted for 2,346 (7.0%), including ground interfacility and critical ground care. Educators and administrators made up 1,453 (4.4%). Overall, roles varied by sex, and 48.8% of respondents reported needing more than one job to make ends meet. Conclusions: Our evaluation highlights various US EMS clinician roles. These findings suggest the need for continued focus and attention on EMS roles, compensation structures, and sex distributions to ensure a resilient, diverse, and adequately supported EMS workforce.

The organizational culture significantly impacts employee behavior, satisfaction, and retention. Historically associated with hierarchical, fire-service-based structures, EMS cultures vary considerably, and their influence remains unclear. We aimed to identify organizational cultures within EMS agencies and examine their association with clinicians’ intent to leave within 12 months. We performed a cross-sectional survey of nationally certified civilian EMS clinicians aged 18–85 in the United States who recertified with the National Registry of Emergency Medical Technicians between October 2022 and April 2023. Respondents completed the validated Organizational Culture Assessment Instrument (OCAI), categorizing organizational cultures into adhocracy, clan, hierarchy, market, or mixed. Multivariable logistic regression evaluated the organizational culture and clinicians’ intention to leave, adjusting for personal demographics, workplace characteristics, and job satisfaction. In total, 30,762 survey respondents were included. Mixed and hierarchy cultures predominated, followed by clan, market, and adhocracy. Clinicians in adhocracy and hierarchy cultures had significantly higher adjusted odds of intending to leave EMS compared to clan and mixed. The organizational culture in EMS significantly influences clinicians’ intentions to leave. Adhocracy, hierarchy, and market cultures are associated with an increased likelihood of turnover, but clan-oriented environments do not increase risks. These findings suggest that optimizing EMS agency cultures towards collaboration and supportive environments may enhance clinician retention.

Emergency medical services (EMS) post-overdose outreach programs expand beyond traditional 9-1-1 response to offer overdose survivors linkage to substance use treatment and other related harm-reducing interventions. Although intuitive and increasingly popular, evidence to define expected outcomes is exceedingly limited. We evaluated process and patient outcomes of one large Midwestern post-overdose outreach program to describe outreach characteristics and linkage to substance use treatment. This retrospective cohort study used clinical program records of individuals referred to a multidisciplinary post-overdose outreach program following a non-fatal presumed opioid overdose with emergency response. Measures included (i) number of outreach attempts, (ii) modalities of outreach attempts (in-person visit, text message, letter, phone call, or electronic mail), (iii) outcome of outreach (i.e., if the individual was contacted), (iv) interventions provided including linkage to substance use treatment with coordinated admission and transportation. We used descriptive statistics to report patient characteristics, outreach frequency, outreach modality, successful contact, and treatment linkage through the program. From 2020-2022, the program attempted outreach to 3,437 individuals. The median age was 37 years (interquartile range, IQR, 30-47). Most individuals were white/non-Hispanic (n = 2,077, 63.1%) and male (n = 2,084, 61.2%). Few were unhoused at the time of outreach (n = 246, 7.2%). The program made a total of 7,935 outreach attempts with a median of 2 outreach attempts (IQR 1-3) per individual. The most common outreach modalities were in-person visit (n = 3,300, 41.6%) and text message (n = 2,776, 35.0%), though phone calls and in-person visits most often resulted in successful contact (52.6% and 23.7%, respectively). Outreach attempts resulted in 743 (21.6%) successful contacts and the program linked 304 individuals (40.9% of all contacted individuals, 8.8% of all attempted outreach) to treatment. Notably, 160 (52.6%) of the 304 individuals linked to treatment required 3 or more outreach attempts before treatment linkage occurred. Post-overdose outreach initiated by EMS can successfully find and link individuals to substance use treatment following a non-fatal opioid overdose. However, this intervention may be resource intensive, often requiring multiple attempts at outreach and several modalities of interaction to facilitate treatment linkage.