CLEVELAND — A national paramedic shortage is being felt right here at home as the Cleveland Division of EMS is fighting an uphill battle to recruit and retain paramedics and EMTs. The staffing crunch comes as the division’s call volume and emergency response data have begun bouncing back after pandemic-related dips.
Whether it be the traumatizing and high intensity nature of the job or base pay, paramedics and EMTs across the country have left the industry since the start of the pandemic. According to a AAA survey of 258 EMS organizations across the country, nearly a third of the workforce left the ambulance service in 2020 after less than a year. Another national survey found nearly half of those those that left their full-time paramedic or EMT positions did so to find employment outside of the industry.
While the Cleveland Division of EMS has certainly witnessed a growing number of vacancies in its ranks, the issue has been compounded by a marked decline in the number of applications, according to Cleveland Director of Public Safety Karrie Howard and Nicole Carlton, the commissioner of the Division of EMS.
“We have suffered from a lack of applications for a number of reasons and this is something that is common across the country,” Howard said. “We have seen a decrease in the number of applications for EMTs and paramedics, as we have also seen with police.”
Carlton said the city’s recruitment and retention efforts have been playing ‘catch up’ since the early days of the pandemic.
“Unfortunately when COVID hit, we encountered the same problems as everybody else,” Carlton said. “It’s hard to recruit and retain during a pandemic. COVID really put a dent on our recruitment efforts where now we have the small number of classes that we did have and the number of candidates that apply. We took everybody that was qualified and now we’re trying to have larger classes to account for attrition and the staff decrease that we saw during COVID.”
The city and the EMS union, CARE Local 1975 (Cleveland Association of Rescue Employees) are negotiating a new labor agreement. Howard said Mayor Justin Bibb’s administration is supportive of making further investments into emergency services, both in terms of equipment and personnel.
“We will see a turnaround, we believe, at the end of our contract negotiations,” Howard said.
Mark Barrett, the president of CARE, said city leaders need to change how new paramedics and EMTs are recruited in order to compete for a dwindling number of applicants.
“Whatever they say they are doing isn’t working,” Barrett said.
Barrett said recruitment has been hampered by stagnant wages and growing workload. In addition to having to compete against surrounding municipalities, the division has also had to ward against more lucrative pay scales offered by private ambulance services.
“We’ve had nothing but stagnant wages and these private ambulance companies are now paying more, which is so surprising because the city used to pay almost double over what private ambulances paid,” Barrett said. “These private ambulance companies that we got people from are now our competitor.”
The staffing challenges have been greatly compounded by the increasing call volume and, in turn, have led to increases in the average response time, according to the 2021 annual report from the Division of EMS.
The division reported 124,842 incoming 911 calls in 2021 compared to 119,272 in 2020 and 123,364 calls in 2019. Additionally, the division responded to nearly as many emergencies in 2021 (109,370) as it did in 2019 (109,663). The pandemic-challenged year that was 2020 had the lowest number of responses to emergencies (104,937) in the past five years.
According to an analysis provided by CARE that was compiled via public records, the overall response time averaged out to be 11:55 in 2021, nearly two minutes longer than the average overall response time in 2019 (10:03).
“You just have to take it in stride. We can only do one call at a time and the calls that are waiting, they wait,” Barrett said.
Carlton and Howard pushed back against concerns about the average response time, pointing to the historical practice by the division to deploy "call prioritization." Under the practice, low priority calls are placed in a queue in order to have resources available for high-priority calls for immediate service. Carlton said dispatchers check in with the callers of low-priority runs every 20 minutes to ensure the situation hasn’t grown in severity.
Carlton and Howard also warned of potential unforeseen consequences from a continued focus on average response time.
“Individuals that have critical emergencies, it deters them from calling 911,” Carlton said. "Some of our most vulnerable citizens receive information about EMS call times and staffing levels and it may deter them to call EMS. We need our most vulnerable people to know that they can call EMS and they can rely on EMS services and it can be the difference between life and death. We want them to understand that we care about this community. We provide a very essential service and that service is timely. We prioritize to make sure that we get to the most critical, life-threatening emergencies.”