Not enough EMTs, ambulance services understaffed and struggling across the North Country
National ambulance and EMT shortages
The US is experiencing a crisis in emergency services. The American Ambulance Association wrote a letter to the US House and Senate last October warning of impending collapse and a 'crippling workforce shortage.' It’s particularly bad in rural places like the North Country. Some communities have lost ambulance service, many are experiencing staff shortages.
Terry Hill, the Executive Director of the National Rural Health Resource Center, says declining volunteerism and a shortage of paid EMTs have put rural emergency services on the brink.
"A lot of America we’re seeing resignations. We’re having some of the same issues with nurses and various other types of healthcare personnel. This extends to ambulances. I think it’s actually a worse problem than a lot of the other healthcare worker resignations."
He says because so many EMTs are volunteers, and those that are paid are paid so little, they are particularly difficult to replace. But they play a critical role.
EMTs: frontline responders, but underpaid
EMTs play a critical role in our healthcare system. How quickly EMTs respond, and the kind of care they give, is often the difference between someone arriving at the hospital alive or dead.
So you’d think they’d make good money. But Terry Hill says it's the exact opposite: EMTs sit at the absolute bottom when it comes to pay. They commonly make between $14 and $20 dollars an hour. Salaried EMTs make around $33,000 a year.
And EMS services are run very differently, depending on where you are. In most of the North Country, and a lot of rural America, you have this patchwork of service, sort of determined community by community.
There are town-run services that pay local EMTs an hourly wage. Some communities will contract with a private service to run an ambulance. But the majority of North Country communities rely on 100% volunteer, unpaid departments. Across the nation, 35% of rural communities rely on volunteer services.
COVID-19 breaks down an already disjointed and declining system
A report from 2019, conducted by the NYS Emergency Medical Services Council, found that the number of certified EMS providers in New York has declined 9% in the last decade, according to the New York State Department of Health Bureau of EMS. The coronavirus pandemic made things a lot worse.
Firstly, because of COVID-19, a lot of older EMTs, or those with underlying health conditions, have stepped away, especially in volunteer situations. COVID-19 surges have overtaxed ambulance services. And the nationwide worker shortage has hit EMS agencies hard, with the work increasing in difficulty, and wages staying low.
Tim Napper is the town supervisor of Saranac, in Clinton County. They use local taxes to pay for the Lyon Mountain ambulance service. He says it is a really tight budget.
"We don’t have enough funding to pay people say, like $22 a hour to do it. We’re trying to hire them at $14, and they could make better money at Walmart. The other thing is that everybody is a per diem employee. In other words, the only benefit you get is social security. There’s no benefits, no paid time off, because all those things would just make the service more expensive."
He says $14 just isn't a livable wage. He understands why people would take a retail job over something as stressful and difficult as being an EMT.
Contract and volunteer services also in danger
Communities that rely on contracted private services are struggling, too. The St. Regis Mohawk Tribe had a contract with a service in Massena, and that company canceled the contract because of staff shortages.
Michael Cook is the Saint Regis Mohawk Tribe Health Director. He says they’ll have to rely on the local police and on mutual aid, or nearby ambulance services repsonding to their calls. He worries about that.
“Every minute of waiting time can impact a person’s life given the nature of the emergency, so this is not a situation we’re taking lightly.”
But if more and more communties can’t staff and run services, that next 'nearby ambulance service' could get further and further away.
Volunteer departments have seen a massive loss in volunteers, with many older or health-compromised volunteers stepping away. In Sackets Harbor, in Jefferson County, teenagers took over the volunteer service when that happened. The EMS Captain there is twenty-year-old Grayden Brunet. He knows they're walking a thin line, and dedicates all his free time to the ambulance service.
“We have to coordinate our schedules because one of us has to be in the village at all times. I dread taking vacations and leaving the village, because who’s gonna help grandma when she falls?"
A bigger issue, which needs long-term fixes
EMS services have long been disjointed and underfunded, but the pandemic has pushed them to a "near breaking point," says Terry Hill. But that also means reform may be on the way.
NY State passed a bill late last year, Senate Bill S3503C, authorizing the creation of a ‘Rural Ambulance Services Task Force’. That group will be re-evaluating how EMS services are run and can be improved in rural areas of New York, like the North Country.
Locally, NY Senator Dan Stec has introduced a bill that would let Adirondack municipalities join together and form multi-town EMS districts. The hope there is to help address some of the staffing and service shortages communities have been facing.
More immediately, on January 17, Governor Hochul deployed 30 FEMA ambulance teams to upstate NY for a month. This won’t solve the larger worker shortage problem, but it will help get North Country communities through the omicron surge.
And local, grassroots efforts are also underway. Jefferson County EMS is running a free, five week certification course to onboard at least two dozen new EMTs. Paul Barter, director of the Jefferson County Office of Emergency Medical Services, told the Watertown Daily Times that "It [the program] is designed to try to decrease the current burden on the EMS system and the health care industry in general.”