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Why do Emergency Medical Services (EMS) professionals leave EMS?
Abstract
Objective
The objective was to determine why Emergency Medical Technician (EMT)-Basics and Paramedics leave the Emergency Medical Services (EMS) workforce.
Methods
Data were collected through annual surveys of nationally registered EMT-Basics and Paramedics from 1999 to 2008. Survey items dealing with satisfaction with the EMS profession, likelihood of leaving the profession, and likelihood of leaving their EMS job were assessed for both EMT-Basics and Paramedics, along with reasons for leaving the profession. Individuals whose responses indicated that they were not working in EMS were mailed a special exit survey to determine the reasons for leaving EMS.
Results
The likelihood of leaving the profession in the next year was low for both EMT-Basics and Paramedics. Although overall satisfaction levels with the profession were high, EMT-Basics were significantly more satisfied than Paramedics. The most important reasons for leaving the profession were choosing to pursue further education and moving to a new location. A desire for better pay and benefits was a significantly more important reason for EMT-Paramedics’ exit decisions than for EMT-Basics.
Conclusions
Given the anticipated increased demand for EMS professionals in the next decade, continued study of issues associated with retention is strongly recommended. Some specific recommendations and suggestions for promoting retention are provided.
BlauG , ChapmanSA . Why do Emergency Medical Services (EMS) professionals leave EMS?Prehosp Disaster Med . 2016 ; 31 (Suppl. 1 ): s105 – s111 .
... The health of healthcare professionals has been predominantly studied from the perspective of ill health. Existing research on paramedics' health primarily focuses on the negative aspects, associating their poor overall health perception, physical condition and particularly high levels of perceived stress with their intention to leave their profession (see Blau & Chapman, 2016;Mirzaei et al., 2021;Skrikanht et al., 2022). Nevertheless, emerging evidence suggests that a good quality of work life, employee participation in decision-making (Aminizadeh et al., 2022) and strong organizational support, such as managerial endorsement of a healthy work-life balance (Ma et al., 2022;Petrie et al., 2018;Sanner-Stiehr et al., 2022), can positively influence the intention to remain in demanding nursing roles. ...
... The high turnover rate of paramedics is a global challenge for EMS organizations (Blau & Chapman, 2016;Dopelt et al., 2019), and the situation further deteriorated during the COVID-19 pandemic (Mirzaei et al., 2021). This poses a significant risk to patient safety and quality of care (Blau & Chapman, 2016;Dopelt et al., 2019). ...
... The high turnover rate of paramedics is a global challenge for EMS organizations (Blau & Chapman, 2016;Dopelt et al., 2019), and the situation further deteriorated during the COVID-19 pandemic (Mirzaei et al., 2021). This poses a significant risk to patient safety and quality of care (Blau & Chapman, 2016;Dopelt et al., 2019). ...
Aim
To investigate the association between paramedics' salutogenic health and their intentions to stay in their profession.
Design
A cross‐sectional survey.
Methods
Paramedics from eight purposively selected organizations participated in this study ( n = 433). The data were collected in 2022 with the Salutogenic Health Indicator Scale and validated single questions that assessed work ability, recovery and self‐rated stress. Intention to stay was measured using two questions about the intention to leave prehospital emergency medical service work and leave the nursing sector completely during the next 2 years. Data were analysed using logistic regression and statistical significance tests.
Results
Men had higher mean salutogenic health scores than women. No significant differences in salutogenic health were observed across work experience or occupational groups. Paramedics intending to stay in their profession exhibited higher salutogenic health scores than those intending to leave. In the logistic regression models, increasing levels of salutogenic health and work ability were associated with intention to stay in the profession.
... IN THE UNITED STATES, there is significant concern in the prehospital community regarding the recruitment and retention of the emergency medical services (EMS) workforce. [1][2][3][4] Much of the discussion surrounds the need for adequate staffing of ambulances to respond to the increasing volume of emergencies in both urban and rural communities. 4,5 Adding to this challenge, in 2005 approximately 6% of EMS professionals reported an intention to leave within 12 months, 1 and an estimated 4% left EMS in 2013. ...
... The decision to leave can be influenced by many variables including stress and burnout, dissatisfaction with pay and benefits, and lack of fulfilment within the job. [1][2][3] It is likely that EMTs and paramedics may have different intrinsic and extrinsic motivations to leave EMS. 2,9 A major determinant may be the differences in duration of training, education, and certification requirements as well as the in-field experience of EMTs and paramedics. 10,11 While EMTs are required to complete a course of at least 150 hours and provide basic, non-invasive procedures, paramedics often attend accredited degree-granting programs and provide advanced life support. ...
... The decision to leave can be influenced by many variables including stress and burnout, dissatisfaction with pay and benefits, and lack of fulfilment within the job. [1][2][3] It is likely that EMTs and paramedics may have different intrinsic and extrinsic motivations to leave EMS. 2,9 A major determinant may be the differences in duration of training, education, and certification requirements as well as the in-field experience of EMTs and paramedics. 10,11 While EMTs are required to complete a course of at least 150 hours and provide basic, non-invasive procedures, paramedics often attend accredited degree-granting programs and provide advanced life support. ...
Background:
Retention in emergency medical services (EMS) is a concern. To evaluate workforce stability within EMS, it is critical to understand factors that may lead an emergency medical technician (EMT) or paramedic to leave the profession.
Objective:
We compared the most important factors influencing an EMT or paramedic's decision to leave EMS and determined whether these factors differed between the two certification levels.
Methods:
We performed a cross-sectional analysis of an electronic questionnaire deployed to EMTs and paramedics who did not renew National EMS Certification in 2017 and were no longer working in EMS. Chi-squared tests with Bonferroni adjustment were used to compare factors between the two groups.
Results:
Of the 5,093 responses, 53.1% (n=2,703) were no longer practicing in EMS and were included in the analyses. The most important factor for leaving EMS was pursuing education for EMTs (20.6%) and seeking better pay/benefits for paramedics (19.6%). Excluding those considering retirement, 32.4% of EMTs and 16.4% of paramedics (p<0.001) stated an intention to return to EMS.
Conclusion:
EMTs and paramedics leave EMS for different reasons, and fewer paramedics reported an intention to return. The need for better pay and benefits and lack of career advancement opportunity were common themes.
... The last two tools were compiled by the researchers and included items drawn from published studies on job satisfactions and reasons for leaving this profession (e.g. [27][28][29],). The two tools were validated at face value to be relevant to the work of paramedics in Israel by five experts: two experts in organizational behavior and three senior paramedics. The questionnaire parts are as follows: ...
... Our findings confirm those found by Wacht (2013) [6]. The most significant reasons for quitting the paramedic job cited by the interviewees in the present study are similar to those mentioned in previous studies in other countries [27,28]. Moreover, the reasons cited in the qualitative interviews were consistent with those listed in the online survey. ...
Background:
The rate of Israeli paramedics leaving the profession has been increasing in recent years: 50% leave the profession in three years, for the most part before retirement. While approximately 2500 paramedics have been trained, only about a third of them are still active. The number of paramedics per 100,000 in Israel is only 8, compared to around 66 in the US, and in light of the shortage of paramedics it is important to enhance retention rates. The purpose of the study was to examine the factors related to paramedics leaving the profession in Israel.
Methods:
1. An online survey was sent to 1000 paramedics via Email. 533 were recruited of whom 200 have left the profession. Questions included demographics, job satisfaction, and reasons for leaving or remaining in the profession. 2. In-depth interviews with 15 paramedics who left the profession.
Results:
Out of 1000 emails sent, 533 Paramedics responded, of which 200 paramedics who left the profession responded (73% left five years after completing training and 93% after 10 years). Among these former paramedics, choosing the paramedic profession was based mainly on an idealistic sense of mission and eagerness to help others, yet leaving the paramedic profession was related to extrinsic factors: lack of career options, extensive and strenuous physical demands accompanied by unrewarding salaries, unusually long work hours, and shift work that negatively affected family and personal life.
Conclusions:
It seems that work conditions, including the lack of opportunities for promotion, lack of professional prospects, and inappropriate compensation for hard work are crucial factors in the decision to leave.
Recommendations:
A joint committee of the Ministries of Health, Justice, and Finance and MDA (Magen David Adom, the national EMS in Israel) should be established for the purpose of improving the conditions and modalities of employment of paramedics and providing appropriate emotional support for paramedics who are exposed daily to work under extreme conditions of stress and human suffering. A joint effort could greatly reduce rates of leaving, training costs, and costs incidental to turnover, as well as increase job satisfaction. Moreover, regulating the profession and expanding the scope of practice to new fields like community paramedicine as part of the EMS service and expanding the scope of physician assistants as an academic profession can create opportunities for advancement and diversity at work that will help retain paramedics in the profession.
... Other studies in samples of nationally-certified EMS professionals have demonstrated similar findings to our study. 13,21 In a different sample, the desire for better pay/benefits and perceived lack of advancement opportunity were more important to partially compensated/non-compensated/volunteer EMS professionals than fully compensated EMS professionals. 13 Among a longitudinal cohort of EMS professionals, paramedics reported the desire for better pay and benefits was a more important reason for leaving the profession than EMTs. ...
... 13 Among a longitudinal cohort of EMS professionals, paramedics reported the desire for better pay and benefits was a more important reason for leaving the profession than EMTs. 21 Additionally, inadequate pay has been cited as a barrier for agencies in retaining EMS personnel regardless of urban or rural practice setting. 4 This is in contrast to an analysis conducted by Blau and Chapman where desire for better pay and benefits was found to be the least important factor. ...
Objective:
Inadequate staffing of agencies, increasing attrition rates, and frequent turnover of personnel make employee retention an ongoing concern for Emergency Medical Services (EMS). Faced with increasing demand for EMS, understanding the causes underlying turnover is critical. The objectives of this study were to describe the proportion of individuals that left EMS, likelihood of returning to the profession, and key factors contributing to the decision to leave EMS.
Methods:
This was a cross-sectional study of nationally-certified EMS professionals who left EMS. Respondents to a census survey who reported not practicing EMS were directed to a subsection of items regarding their choice to leave EMS. Demographic and employment characteristics, likelihood of returning to EMS, and factors influencing the decision to leave EMS were assessed. Descriptive and comparative statistics (Chi-square and nonparametric test of trend [p-trend]) and univariable odds ratios were calculated.
Results:
The overall response rate for the full survey was 10% (n = 32,114). A total of 1247 (4%) respondents reported leaving the profession and completed the exit survey. The majority (72%) reported that they will likely return to EMS. A stepwise decrease in the reported likelihood of returning was seen with increasing years of EMS experience (e.g., 2 or less years of experience: 83%; 16 or more years: 52%; p-trend < 0.001) and months away from EMS (e.g., 0-2 months: 89%; more than 12 months: 57%; p-trend < 0.001). The most common factors reported to influence the decision to leave EMS included desire for better pay/benefits (65%), decision to pursue further education (60%), dissatisfaction with organization's management (54.7%), and desire for career change (54.1%).
Conclusion:
This cross-sectional study found an attrition rate of approximately 4% among nationally certified EMS professionals; however, the majority reported that they intended to return to the EMS profession. Intention to return to EMS decreased as years of experience and months away from the profession increased. Important factors in the decision to leave EMS included a desire for better pay and benefits and the decision to pursue further education. Targeting the factors identified as important in this study should be a priority for key stakeholders in improving recruitment and retention of EMS professionals.
... Recently, there has been heightened concern regarding the stability of the EMS workforce with significant data describing the impact of EMS turnover on the available workforce. [2][3][4][5] However, the challenges associated with the entry of EMS clinicians into the workforce remain unclear. ...
Objective:
Recent concerns for the strength and stability of the emergency medical services (EMS) workforce have fueled interest in enhancing the entry of EMS clinicians into the workforce. However, the educational challenges associated with workforce entry remain unclear. Our objective was to evaluate the educational pathway of entry into the EMS workforce and to identify factors that lead to the loss of potential EMS clinicians.
Methods:
This is a cross-sectional evaluation of all US paramedic educational programs, with enrolled students, in the 2019 Committee on Accreditation of Educational Programs for the EMS Professions annual report survey. This data set includes detailed program characteristics and metrics including program attrition rate (leaving before completion), and certifying exam pass rates. Descriptive statistics were calculated, and multivariable logistic regression analysis was conducted to evaluate the association between high program attrition rates (>30%) and program specific characteristics.
Results:
In 2019, 640 accredited programs met inclusion with 17,457 students enrolled in paramedic educational programs. Of these, 13,884 students successfully graduated (lost to attrition, 3,573/17,457 [21%]) and 12,002 passed the certifying exam on the third attempt (lost to unable to certify, 1,882/17,457 [11%]). High program attrition rates were associated with longer programs (>12 months), small class sizes (<12 students), and regional locations.
Conclusions:
Nearly 1 in 3 paramedic students were lost from the potentially available workforce either owing to attrition during the educational program or failure to certify after course completion. Attrition represented the largest loss, providing an avenue for future targeted research and interventions to improve EMS workforce stability.
... Several studies continue to highlight funding, recruitment, and retention as some of the biggest challenges for rural EMS, now and into the future. (Blau and Chapman, 2016;Freeman, Slifkin, Patterson, 2009;Phillips, 2015). Recruitment and retention are EMS's most critical issues, especially for rural EMS (Freeman, Slifkin, Patterson, 2009). ...
This qualitative narrative analysis used interviews with rural senior emergency medical services (EMS) leaders in the Midwest to investigate how they developed their leadership skillset in the absence of formal development. The study culled the experiences of the EMS leaders from the beginning of their career to the present day because research shows that leadership is a lifelong endeavor (Liu et al., 2021). The experiential learning theory advanced by David Kolb (2015) was the theoretical framework used to guide this research. The main research questions that guided this study are: What are the experiences of senior rural EMS leaders that formed their current leadership abilities? and Based on their developmental experiences, what competencies do senior rural EMS leaders say that future EMS leaders need to learn? The findings indicate that experience-driven leadership was the primary means of development for these rural EMS chiefs. Additionally, the chiefs suggested that having strong clinical leadership, communication, and networking skills are competencies that the next generation of leaders should develop before taking on an organizational leadership position. The main implication of this study is that experiences are a more significant driving force in the development of leadership skills than leader development programs. This indicates that models like Kolb’s experiential learning theory are important for guiding the development experiences of the leader–learner.
... In prior work from the Committee on Accreditation of Educational Programs for the EMS Professions and the National Association of EMS Educators, surveys of EMS educators identified concerns early in the pandemic consistent with many of the top 8 research priorities identified by the panel. 11,12 Access to education and the ability to complete continuing education were recognized as challenges affecting recruitment and retention in EMS, even before the COVID-19pandemic.[23][24][25] Many EMS education programs reported varying levels of continued operation, 11-13 which potentially limits access to initial EMS education. ...
Objective
Our objective was to identify research priorities to understand the impact of COVID-19 on initial emergency medical services (EMS) education.
Methods
We used a modified Delphi method with an expert panel (n = 15) of EMS stakeholders to develop consensus on the research priorities that are most important and feasible to understand the impact of the COVID-19 pandemic on initial EMS education. Data were collected from August 2020 to February 2021 over 5 rounds (3 electronic surveys and 2 live virtual meetings). In Round 1, participants submitted research priorities over 9 specific areas. Responses were thematically analyzed to develop a list of research priorities reviewed in Round 2. In Round 3, participants rated the priorities by importance and feasibility, with a weighted score (2/3*importance+1/3*feasibility) used for preliminary prioritization. In Round 4, participants ranked the priorities. In Round 5, participants provided their agreement or disagreement with the group's consensus of the top 8 research priorities.
Results
During Rounds 1 and 2, 135 ideas were submitted by the panel, leading to a preliminary list of 27 research priorities after thematic analysis. The top 4 research priorities identified by the expert panel were prehospital internship access, impact of lack of field and clinical experience, student health and safety, and EMS education program availability and accessibility. Consensus was reached with 10/11 (91%) participants in Round 5 agreeing.
Conclusions
The identified research priorities are an important first step to begin evaluating the EMS educational infrastructure, processes, and outcomes that were affected or threatened through the pandemic.
... Consequently, they experience high levels of stress and suffer from chronic stress. Studies showed that 22% of EMS providers deal with stress-related complications [3,4] such as anxiety, irritability, social isolation, sleep disorder [5][6][7][8], job dissatisfaction, burnout [9][10][11], workplace incivility, leaving the profession, suicide [12][13][14] post-traumatic stress disorder, risk behaviors, psychological problems, and depression, and are more likely to commit medical errors [15][16][17]. ...
Introduction
Emergency medical services (EMS) providers are at continuous exposure to occupational stressors which negatively affect their health and professional practice. This study explored perceived occupational stressors among EMS providers.
Methods
This qualitative study was conducted from December 2019 to April 2020 using conventional content analysis. Sixteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. Semi-structured interviews (with length of 45–60 min) were held for data collection. Data were analyzed through Graneheim and Lundman’s conventional content analysis approach.
Findings
Data analysis resulted in the development of two themes, namely critical conditions of EMS provision, and personal and professional conflicts. The six categories of these two themes were complexity of patients’ clinical conditions, interruption of EMS provision, health hazards, interpersonal problems, interprofessional interactions, and legal conflicts.
Conclusion
Besides the stress associated with emergency patient care, EMS providers face many different occupational stressors. EMS managers can use the findings of the present study to develop strategies for reducing occupational stress among EMS providers and thereby, improve their health and care quality.
... Investing in building their capacity therefore is recommended. Blau et al. (2016) state that the main reason for EMS staff (EMTs and paramedics) to change jobs are related to pursuing higher education or changing location, followed by a wish for better pay. Note: due to low sample sizes, the differences between staff categories are not statistically significant. ...
Emergency medical services (EMS) systems and prehospital care are vital in saving lives and decreasing morbidities but are difficult to evaluate because they are interrelated. This survey aims to provide evidence-based recommendations to improve the overall quality of EMS in Ukraine, with a special focus on the oblasts (administrative regions) of Luhansk and Donetsk in eastern Ukraine. A newly adopted law has assigned administrative and financial responsibilities for prehospital emergency care to EMS centres at regional level, moving from fragmented district-based supervision to a more coordinated, regional approach. The following aspects of EMS were studied: demand and efficiency, operational attributes, financial attributes, quality attributes, end-user satisfaction and public information, human resource attributes and the legal framework. The survey outlines core approaches needed in EMS reform with key suggested interventions, and proposes strategic directions. Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest).
... Because paramedic certification requires more time to complete, the longer duration of service for this level was expected. These findings align with previous studies that have identified that turnover is a concern within the EMS community (12)(13)(14)(15). Even if EMS providers continue practicing patient care in the profession, turnover between EMS jobs or agencies could still have a negative impact on the workforce and provision of EMS care. ...
Background: The emergency medical services (EMS) workforce is a key component of healthcare in the U.S. Characteristics of active EMS professionals who are treating patients in the prehospital setting is unclear. The purpose of this study was to describe the roles and settings in which nationally certified EMS professionals are providing patient care and to evaluate similarities and differences of the demographics and practice settings of the three major certification levels.
Methods: We conducted a cross-sectional evaluation of all nationally certified EMS professionals in the U.S. that recertified between October 1, 2017 and March 31, 2018 and October 1, 2018 and March 31, 2019. Within the recertification application, EMS professionals completed an optional demographic profile. Those who were nationally certified, functioning as a patient care provider for at least one non-military EMS organization, aged 18 to 85 years, and recertified at the EMT level or higher were included. Demographic, agency and job characteristics were assessed and descriptive statistics were calculated.
Results: In 2017-2018, 101,363 EMS professionals recertified and 87,471 (86%) completed the profile; in 2018-2019, 106,893 EMS professionals recertified and 92,640 (87%) completed the profile. Of the 142,751 EMS professionals who met inclusion criteria, the population was primarily male (76%) and age increased by certification level. By race/ethnicity, 85% were white, 5% were Hispanic/Latino, 5% were Black/African American, 2% were American Indian/Alaskan Native, 2% were Asian and 1% were Native Hawaiian/Pacific Islander.
Paramedics had the highest proportion of associate degrees (EMT:16.0%; AEMT:16.6%; paramedic:28.5%); some college experience was common for all certification levels (EMT:34.7%; AEMT:37.2%; paramedic:31.6%). Most EMS professionals reported 3-7 years of experience, were working full-time (78%) and 28% were working for 2 or more agencies. Most were working for a fire department (48%) or private agency (21%) and providing 9-1-1 service (72%). No substantial differences were observed between the two recertification cycles.
Conclusion: This is the most comprehensive study evaluating the demographics of the national EMS workforce of active patient care providers. Understanding the characteristics of EMS professionals and the settings they practice in is important for educational and training initiatives, as well as protocols and policies.
... Results regarding recruitment and retention are generalized towards specific managerial practices, but still highlight a similar healthcare versus public service motivational dichotomy amongst respondents 6 . In addition, surveys on why providers leave the field noted themes of higher education, limited job growth, moving to new areas, or poorer pay and/or benefits than their public service counterparts 7 . Demographically, the LEADS study highlighted gender disparities between EMTs versus paramedics, where more men than women advance to the level of paramedic. ...
The modern concept of Emergency Medical Services (EMS) has grown from its humble volunteerism origins to a multidisciplinary enterprise, outstretched into the realms of both healthcare and public service. As the American EMS community continues to assume greater responsibilities and further develop its professional standards, the moral foundations of this field open themselves to more thorough scrutiny. Upon examination, the major deficit in the ethical structuring of EMS becomes glaringly obvious: it exists as a piecemeal collection of its medical and militaristic counterparts unified by theoretical generalizations that avoid its inherently unique structure. If EMS wishes to matriculate into complete professionalism, or even continue its assumption of critical responsibilities surrounding the health and safety of others, then it must also develop and maintain its own individual ethical framework from which it operates. In doing so, an urban bioethical approach rooted in context-driven analysis and pragmatic solutions may provide the best guidance and protections for all those who interact with the EMS system while respecting the values of this distinctively prideful service.
... The extent of this sense of injustice remains untested, but further research would allow us to ascertain how its impacts can be delimited to determine its influence on emergency personnel's longer-term work plans. [32][33][34] This article offers novel insights about what is driving many paramedics in the UK ambulance service to leave their profession well before retirement, and we wish to signpost the important financial consequences that may arise from making this decision. It provides evidence that concerns about health and also longevity caused by additional demands being placed upon them may be driving self-protective actions 35 such as the pension sacrificing behaviours. ...
Objectives
To explore and portray the perspectives of National Health Service Ambulance personnel related to the latest rise in the National Health Service occupational pension age.
Methods
Data gathering took the form of 35 in-depth interviews. A thematic analysis was used to characterise and articulate key concepts and meanings. The analysis applied interpretive techniques, as views expressed were from personal experiences, and allowed for an in-depth analysis of shared meanings.
Results
The themes reported captured the desire of many Ambulance personnel to exit their employment well in advance of their retirement age, despite satisfaction gained from patient care. This early exit is being driven by increased worry that the work demands of the job are unsustainable, especially for older workers, as clinical responsibilities increase and their social support diminishes. Also, Ambulance personnel feel betrayed by their employers, because their retirement is being delayed further by another change in their pensionable age.
Conclusion
There is an increased orientation for ‘living for today’ and indications of a willingness to sacrifice salary and pension income in order to protect their health in older age, which has implications for long-term financial and general well-being in retirement.
... Fear of the bus exploding, the provision of first-aid services for a considerable number of casualties, transporting several of the casualties by a single ambulance, the disrespectful behaviors of some physicians and nurses at the time of the victims' delivery to the hospitals as well as violence against the EMTs were observed as some of the factors that affected the EMTs' mental health. Psychological disorders among the EMS personnel were also reported as a result of having to provide medical care to multiple victims [22][23][24][25]. The over-commitment of several EMTs to the extrication of trapped victims endangered their own life. ...
Background:
In Iran, Road Traffic Injuries (RTIs) with mass casualties occur repeatedly. Since Road Traffic Accidents (RTAs) occur far from health facilities, EMSs play an important role in reducing the disability and mortality resulting from RTIs. Thus, the study aimed to report Iraqi pilgrims' bus which rolled over in the Malayer town.
Case presentation:
A mass casualty event occurred on 7 September 2017 when a bus full of Iraqi pilgrims rolled over on a road 4-km outside of Malayer, Iran. A large team of responders were dispatched including 5 ambulances with 10 EMTs along with 6 police officers serving in the area. The accident resulted in 35 injured patients (21 female and 14 male) as well as 11 deaths ranging in age from 2 to 65 years. Twenty-one of the injured were transported to the hospital and 14 patients refused transport and 12 patients sustained multiple trauma. The case has been described four phases of dispatch, on-scene, hospital and post-mission. Frequent calls made by laypeople were considered as the main challenge of dispatch phase. The response on scene was hampered by large numbers of lay bystanders. The over-crowding around the emergency units disrupted the medical care procedures in hospital phase.
Conclusion:
This case highlights over-crowding and laypeople interference at the scene disrupts the relief and rescue. To solve these challenges, the public education and police monitoring and control is recommended. Establishing a unified command post at the scene can facilitate effective coordination among relief and rescue organizations.
The purpose of this theoretical concept article is to spark a dialogue on the use of organisational behaviour theory to address emergency responder retention. In the United States, emergency medical services (EMS) appear to be burdened with continuing problems of retaining staff. Poor responder retention affects the ability of EMS to deliver high-quality services; without trained, educated and experienced first responders, the EMS system struggles, and what suffers is the ability to provide medical care. The authors set out to construct a pathway for addressing the underlying issues leading to the exodus of professionals using organisational behaviour theory. To develop the idea, an inductive logic approach was used to address underlying negative factors influencing poor retention and discuss the promise of organisational behaviour theory in improving the retention of responders.
Emergency medical service (EMS) professionals have a stressful vocation, inarguably worsened by the COVID-19 pandemic, which affects their mental health and makes them a vulnerable population warranting further study. However, to date, no published research has compared non-treatment and treatment-seeking EMS professionals in the same greater metropolitan area. In this study, we examined differences and similarities among the non-treatment-seeking EMS professionals ( n = 57) from a local EMS agency and treatment-seeking EMS personnel ( n = 53) from a non-profit community treatment center on six assessment instruments that measure attachment avoidance, attachment anxiety, resilience, depression, generalized anxiety, posttraumatic stress disorder (PTSD), and suicidality. The Mann-Whitney U test revealed attachment avoidance, attachment anxiety, depression, generalized anxiety, and posttraumatic stress disorder (PTSD) were significantly higher in the treatment-seeking sample compared to the non-treatment-seeking group. Resilience and suicide did not significantly differ. Correlational analyses revealed that the most consistent findings for both samples were PTSD, depression, and generalized anxiety. Findings suggest that negative affect may underlie these three constructs, regardless of whether the individual is treatment-seeking or not. These findings are conceptualized through three different theoretical frameworks: attachment, resilience, and negative affect. We also make recommendations for EMS agencies and suggest future scholarship based on these preliminary findings.
Objective: The aim of the study is to develop a valid and reliable measurement tool for the evaluation of 112 Emergency Health Services Stations in terms of satisfaction, efficiency, safety and performance with the opinions of the employees. Methods: In order to obtain candidate scale items, an item pool consisting of 44 items was obtained by applying open-ended questions from 50 ambulances personnel. In the first execution, explanatory factor analysis and reliability analysis were performed with the data obtained from 414 ambulance personnel. Confirmatory factor analysis was carried out with the data obtained from the second execution, which was made with a group of 230 ambulance workers different from the first group. SPSS 26.0 and AMOS statistical software were used in the analysis of the data. Results: Four independent scales were developed within the questionnaire form created in the first stage of the research. Satisfaction, productivity, performance and safety sub-dimensions reliability values were 0.878, respectively; 0.856; It was determined as 0.825 and 0.935. It was concluded that the four independent scales developed in the context of the participants in this study were valid and reliable. No significant difference was found between the gender, title and duration of duty of the emergency ambulance personnel and their scale scores (p>0.05). Conclusion: It is thought that the developed scale will contribute to the literature on this subject, to the development of emergency aid stations and to increase the general motivation of the staff.
Background:
High turnover among physicians in emergency department is a great challenge in China. However, the rate and the reasons why physicians intend to leave have not been extensively studied yet. Therefore, this study aimed to identify the risk factors of turnover intention among physicians in emergency department.
Methods:
A national cross-sectional survey was conducted from July to August 2018 in China. A total of 10 457 physicians in emergency department were investigated using a structured self-administered questionnaire, which included demographic characteristics, work-related factors, turnover intention, the Patient Health Questionnaire and Positive and Negative Affect Scale. The stepwise logistic regression analysis was applied to identify the risk factors of turnover intention among physicians.
Results:
A total of 55.18% of the physicians in emergency department reported turnover intention in China. Turnover intention were more likely to be reported among physicians who were male (odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.13-1.38); who perceived medical errors (OR = 1.35, 95% CI = 1.23-1.47); who had a lower average monthly income; who provided out-of-hospital resuscitation services; who experienced physical violence (OR = 1.39, 95% CI = 1.26-1.54) and who reported higher score on negative affect and depressive tendency (OR = 1.06, 95% CI = 1.05-1.08; OR = 1.10, 95% CI = 1.09-1.12). Conversely, physicians who perceived shortage of manpower (OR = 0.74, 95% CI = 0.66-0.81), or reported higher score on positive affect (OR = 0.96, 95% CI = 0.94-0.97) were inclined to stay in emergency department.
Conclusion:
This study shows that turnover intention among physicians in emergency department is high in China and was significantly associated with gender, average monthly income, perceived shortage of physicians, the times for provide out-of-hospital resuscitation services, exposure to workplace violence, depressive tendency, positive affect and negative affect. Targeted interventions are required to improve the retention rate among physicians in emergency department from the comprehensive aspects.
(1) Background: Shortage of skilled workers is a relevant global health care problem. To remain competitive with other professions, job satisfaction is a critical issue; however, to date, there are no data available on the German EMS. This study aims to perform a statistical analysis of job satisfaction and performance orientation and to identify risk factors for low job satisfaction of paramedics in the German EMS. (2) Methods: Data were collected from 2590 paramedics through a nationwide cross-sectional survey, using the job satisfaction questionnaire by Neuberger and Allerbeck and the performance orientation questionnaire by Hippler and Krüger. Descriptive and regression statistical analysis were performed. (3) Results: The participants scored significantly lower than the reference sample on job satisfaction, with “organization and management” and “payment” being the lowest rated subscales. Around 9% of employees feared losing their jobs. While work attitude toward performance and success enhancement was high, fear of failure was also common. (4) Conclusion: Job satisfaction of paramedics in the German EMS is below that of the reference sample. Discontent with payment and organizational issues is common. Performance orientation is high, but fear of failure is frequent. Current and future efforts that aim at an attractive working environment should reflect on these findings.
The purpose of this theoretical concept article is to spark a dialogue on the use of organisational behaviour theory to address emergency responder retention. In the United States, emergency medical services (EMS) appear to be burdened with continuing problems of retaining staff. Poor responder retention affects the ability of EMS to deliver high-quality services; without trained, educated and experienced first responders, the EMS system struggles, and what suffers is the ability to provide medical care. The authors set out to construct a pathway for addressing the underlying issues leading to the exodus of professionals using organisational behaviour theory. To develop the idea, an inductive logic approach was used to address underlying negative factors influencing poor retention and discuss the promise of organisational behaviour theory in improving the retention of responders.
Introduction:
The COVID pandemic has significantly impacted educational development and delivery, yet there is little quantitative research on this topic. The primary objective of this study was to compare the total number of Emergency Medical Service (EMS) Refresher (ER) course completions during 2020 versus prior years. Secondary outcomes examined in person versus on-line/distributive learning during the study period.
Methods:
The Commission on Accreditation for Prehospital Continuing Education (CAPCE) is the only national organization that accredits continuing education (CE) for paramedics and EMTs and currently has a database with over 14 million CE records. The total number of ER course completions each month in 2020 were compared to 2019 and 2018. We also compared the different educational format types: live in-person (LIP), asynchronous on-line distributive learning (DL), and virtual instructor lead training (VILT) synchronous DL courses. Data was analyzed using descriptive and two-way ANOVA statistics.
Results:
There were 1,922,783 ER course completions in 2020 versus 1,166,335 in 2019 and 1,074,636 in 2018, representing a 179% increase during the study period. Asynchronous DL course completions in 2020 were 1,830,513 EMS versus 1,078,580 in 2019 and 987,749 in 2018 a 185% increase over the three-year study period. Asynchronous DL monthly means by year was statistically significant, F(2, 99) = 95.632, p < .001. Mean monthly LIP and VLIT educational deliveries by year were not significantly different, p = .802, p = .754, respectively. Total LIP course completions in 2020 were 20,045 versus 51,552 in 2019 and 63,058 in 2018. In 2020 LIP courses made up only 1.0% (20,045/1,922,783) of all ER completions. This study was limited to only EMS professionals taking ER course completions in the CAPCE database. However EMS is not unique, since previous research has suggested that DL has flourished in other health care disciplines while LIP courses have continued to decrease.
Conclusion:
This large nationwide study of EMS profession has shown the trend towards DL education and a trend away from LIP courses. Future studies should examine the advantages and disadvantages of DL education.
Background and Purpose
Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale is a helpful tool to triage patients with stroke in the field. However, data on its reliability in the prehospital setting are lacking. We aim to test the reliability of FAST-ED scale when used by paramedics in a mobile stroke unit covering a metropolitan area.
Methods
As part of standard operating mobile stroke unit procedures, paramedics initially evaluated patients. If the event characterized a stroke alert, the FAST-ED score was determined by the paramedic upon patient contact (in-person) and then independently by a vascular neurologist (VN) immediately after paramedic evaluation (remotely/telemedicine). This allowed testing of the interrater agreement of the FAST-ED scoring performance between on-site prehospital providers and remotely located VN.
Results
Of a total of 238 patients transported in the first 15 months of the mobile stroke unit’s activity, 173 were included in this study. Median age was 63 (interquartile range, 55.5–75) years and 52.6% were females. A final diagnosis of ischemic stroke was made in 71 (41%), transient ischemic attack in 26 (15%), intracranial hemorrhage in 15 (9%), whereas 61 (35%) patients were stroke mimics. The FAST-ED scores matched perfectly among paramedics and VN in 97 (56%) instances, while there was 0 to 1-point difference in 158 (91.3%), 0 to 2-point difference in 171 (98.8%), and 3 or more point difference in 2 (1.1%) patients. The intraclass correlation between VN and paramedic FAST-ED scores showed excellent reliability, intraclass correlation coefficient 0.94 (95% CI, 0.92–0.96; P <0.001). When VN recorded FAST-ED score ≥3, paramedics also scored FAST-ED≥3 in majority of instances (63/71 patients; 87.5%). A large vessel occlusion was identified in 16 (9.2%) patients; 13 occlusions were identified with a FAST-ED≥3 while 3 were missed. All of the latter patients had National Institutes of Health Stroke Scale score ≤5.
Conclusions
We demonstrate excellent reliability of FAST-ED scale performed by paramedics when compared with VN, indicating that it can be accurately performed by paramedics in the prehospital setting.
Background: Emergency medical response is provided by volunteer emergency medical services (EMS) professionals in many parts of the United States. However, little is known about those who serve as volunteer EMS professionals, especially as their main EMS job. Our objective was to compare the characteristics of nationally-certified volunteer versus paid EMS professionals in the U.S.
Methods: We conducted a cross-sectional evaluation of EMS professionals who recertified their National EMS Certification between October 1, 2017–March 31, 2018 or October 1, 2018–March 31, 2019. Data were obtained from 2 cycles of the biennial National EMS Certification recertification application. We included currently-working, non-military EMS professionals aged 18-85 years at the emergency medical technician (EMT) or higher certification level. Volunteer was defined as receiving nominal or no compensation for the provision of EMS services at an agency as a main EMS job. Comparisons were made, accounting for the large sample size, to determine notable differences between volunteer and paid EMS professionals.
Results: Of the 154,229 EMS professionals that met inclusion criteria (response rate =86%), 13% volunteered at their main EMS job. More volunteer than paid EMS professionals were female (38% versus 22%). There was also a significant difference in certification level between volunteer and paid (EMT: 82% versus 46%). Three-quarters (74%) of volunteer EMS professionals reported working in rural communities compared to 30% of paid. The states with the largest proportion of volunteers to any currently-working EMS professionals who recertified were Vermont (47%) and North Dakota (45%).
Conclusion: Approximately 13% of the EMS workforce held a primary job in EMS as a volunteer, and these volunteer EMS professionals differed from their paid counterparts – e.g., volunteers were more likely to be women, have EMT certification, and work in rural areas. We encourage further research to understand motivations for volunteering in EMS.
Purpose: This paper's aim is to study a neglected relationship: testing the impact of emotional labor on the work exhaustion for samples of emergency medical service (EMS) professionals. Design/methodology/approach: Three distinct samples of EMS professionals, i.e. emergency medical technician (EMT) - basic, EMT - intermediate, and paramedic, were surveyed to test the impact of three variable sets, personal (e.g. gender, age, health), work-related (e.g. years of service, job satisfaction), and emotional labor (i.e. surface acting, deep acting) on work exhaustion. Findings: Results across the three samples consistently showed that surface acting had a significantly stronger positive impact than deep acting on work exhaustion. In addition it was found that surface acting had a significantly stronger negative relationship to job satisfaction than deep acting. Surface acting also had a significant negative relationship to perceived health. Years of service were positively related to work exhaustion across all samples, while job satisfaction was negatively related. Practical implications: Work exhaustion is an occupational risk for EMS professionals. Individuals considering EMS as a career must have realistic expectations and information about the rewards as well as challenges facing them. To help buffer the impact of emotional labor on work exhaustion and related outcomes, EMS stakeholders should consider facilitating mentor and/or peer support group programs to enhance the development of stronger camaraderie in different EMS-based organizations (e.g. hospitals, fire services). Originality/value: Prior research has not tested for the impact of emotional labor on work exhaustion for EMS professionals. Even after controlling for personal and work-related variables, surface acting maintained a stronger positive impact than deep acting on work exhaustion. Key demographics for each of the three samples (type of work, community size, gender) indicate representativeness to previous cohort samples of nationally certified EMS professionals.
Purpose
A very limited number of studies have explored factors related to emergency medical services (EMS) workers leaving their jobs and the profession. This paper aims to investigate the correlates of intent to leave EMS jobs and the profession and compared two types of workers: emergency medical technicians (EMTs) and paramedics.
Design/methodology/approach
A national sample of 308 EMTs and 625 paramedics responded to a cross‐sectional survey. Independent variables were personal, job related, and work attitudes (job satisfaction). Outcomes were intent to leave job and profession. Analytic methods included factor analysis, t ‐tests, correlation, and hierarchical regression.
Findings
Factor analysis identified a five‐item intrinsic job satisfaction measure and a four‐item extrinsic job satisfaction measure across both samples. Contrary to what hypothesis one predicted, paramedics had lower extrinsic job satisfaction than EMTs. There was no difference between these two groups on intrinsic job satisfaction. Consistent with the second hypothesis, after controlling for personal and job‐related perceptions, extrinsic job satisfaction was negatively related to intent to leave job and profession for both EMTs and paramedics. However, intrinsic job satisfaction was negatively related only to intent to leave the profession for paramedics.
Research limitations/implications
Future research efforts might utilize stronger measures and incorporate longitudinal methodologies to further explore the career intention of EMS workers and similar occupational groups.
Originality/value
This paper examines job satisfaction and job and career intentions in a rarely studied occupation that provides critical prehospital emergency care to the population.
Purpose
Little research has been done in studying the impact of sleep‐related impairments on the perceived health and retention intent of Emergency Medical Service (EMS) workers. This paper aims to fill some of the gaps.
Design/methodology/approach
This study used a time‐lagged research design to test the impact of three sleep impairments measured in 2005, i.e. sleepiness, relationship difficulty due to sleepiness, and general activity difficulty due to sleepiness, on perceived general health measured in 2006 and 2007, and 2007 intent to leave the EMS profession. Background and work‐related variables, also measured in 2005, were controlled for. A total of 288 complete data EMS repeat‐respondents constituted the study sample across the three years. Although this was only a very small percentage of the total number of respondents, this sample was found to be demographically representative of the incomplete data respondents.
Findings
The three‐sleep impairment variable set had a collective significant additional impact for explaining both years of subsequent perceived health and retention intent, beyond the controlled‐for background and work‐related variable sets. The perceived general health variable set explained a small but unique amount of additional variance in retention intent beyond the controlled for background, work‐related and sleep impairment variable sets.
Originality/value
People's lives can depend on the quick and efficient reactions of EMS workers. There has been little prior research studying the impact of sleep impairments on health and retention outcomes using an EMS sample. The results seem promising enough to suggest continued study of the impact of sleep‐related impairments on work outcomes for EMS personnel, and other samples sharing common work stresses.
The purpose of our study was to investigate the importance of different items as reasons for leaving the Emergency Medical Service (EMS) profession. An exit survey was returned by three distinct EMS samples: 127 full compensated, 45 partially compensated and 72 non-compensated/volunteer respondents, who rated the importance of 17 different items for affecting their decision to leave EMS. Unfortunately, there were a high percentage of "not applicable" responses for 10 items. We focused on those seven items that had a majority of useable responses across the three samples. Results showed that the desire for better pay and benefits was a more important reason for leaving EMS for the partially compensated versus fully compensated respondents. Perceived lack of advancement opportunity was a more important reason for leaving for the partially compensated and volunteer groups versus the fully compensated group. Study limitations are discussed and suggestions for future research offered.
An exit survey was returned by a sample of 127 respondents in fully compensated positions who left the EMS profession, most within 12 months prior to filling out the exit survey. A very high percentage continued to work after leaving EMS. Respondents were asked to rate the importance of each of 17 items in affecting their decision to leave EMS. A higher than anticipated response to a "not applicable" response choice affected the usability of 8 of these items. Nine of the 17 items had at least 65 useable responses and were used for further analysis. Within these 9, stress/burnout and lack of job challenges had the highest importance in affecting the decision to leave EMS, while desire for better pay and benefits had the lowest importance. Desire for career change was positively related to life satisfaction after leaving EMS and negatively related to likelihood of returning to EMS. Stress/burnout was positively related to life satisfaction after leaving EMS. Study limitations and future research issues are briefly discussed.
Few studies have examined employee turnover and associated costs in emergency medical services (EMS).
To quantify the mean annual rate of turnover, total median cost of turnover, and median cost per termination in a diverse sample of EMS agencies.
A convenience sample of 40 EMS agencies was followed over a six-month period. Internet, telephone, and on-site data-collection methods were used to document terminations, new hires, open positions, and costs associated with turnover. The cost associated with turnover was calculated based on a modified version of the Nursing Turnover Cost Calculation Methodology (NTCCM). The NTCCM identified direct and indirect costs through a series of questions that agency administrators answered monthly during the study period. A previously tested measure of turnover to calculate the mean annual rate of turnover was used. All calculations were weighted by the size of the EMS agency roster. The mean annual rate of turnover, total median cost of turnover, and median cost per termination were determined for three categories of agency staff mix: all-paid staff, mix of paid and volunteer (mixed) staff, and all-volunteer staff.
The overall weighted mean annual rate of turnover was 10.7%. This rate varied slightly across agency staffing mix (all-paid = 10.2%, mixed = 12.3%, all-volunteer = 12.4%). Among agencies that experienced turnover (n = 25), the weighted median cost of turnover was $71,613.75, which varied across agency staffing mix (all-paid = $86,452.05, mixed = $9,766.65, and all-volunteer = $0). The weighted median cost per termination was $6,871.51 and varied across agency staffing mix (all-paid = $7,161.38, mixed = $1,409.64, and all-volunteer = $0).
Annual rates of turnover and costs associated with turnover vary widely across types of EMS agencies. The study's mean annual rate of turnover was lower than expected based on information appearing in the news media and EMS trade magazines. Findings provide estimates of two key workforce measures--turnover rates and costs--where previously none have existed. Local EMS directors and policymakers at all levels of government may find the results and study methodology useful toward designing and evaluating programs targeting the EMS workforce.
Using a sample of 854 emergency medical service (EMS) respondents, this study supported a four-dimension model of occupational commitment, comprised of affective, normative, accumulated costs, and limited alternatives. When personal and job-related variables were controlled, general job satisfaction emerged as a negative correlate of intent to leave. Controlling for personal, job-related, and job satisfaction variables, affective and limited alternatives commitment were each significant negative correlates. There were small but significant interactive effects among the commitment dimensions in accounting for additional intent to leave variance, including a four-way interaction. "High" versus "low" cumulative commitment subgroups were created by selecting respondents who were equal to or above ("high") versus below ("low") the median on each of the four occupational commitment dimensions. A t-test indicated that low cumulative commitment EMS respondents were more likely to intend to leave than high cumulative commitment EMS respondents.
The present investigation involved a field study of cancer registrars (CRs), who collect data used by the National Cancer Institute and the Centers for Disease Control and Prevention to study trends in cancer incidence and outcomes. Because of the forecasted shortage of CRs due to the aging of the CR workforce, the professional organization of CRs needed to research the factors related to the recruitment and retention of this workforce. From a national database of 3,393 CRs, data regarding intent to leave one's job and occupation, along with occupational commitment, were obtained from a sample of 374 CRs to meet this research need. The focus of this field study was to assess patterns of association between the correlates of "intent to leave" variables, including measures of job satisfaction and occupational commitment. Results showed that satisfaction with job rewards, interpersonal relations, and fringe benefits had a stronger negative relationship to intent to leave one's job compared with intent to leave one's occupation. Affective and normative occupational commitment facets had a stronger negative relationship to intent to leave one's occupation compared with intent to leave one's job. Beyond demographic control and perceptual variables, these attitudinal job satisfaction and occupational commitment variables together explained the greatest amount of variance in both "intent to leave" measures.
The effects of increasingly prevalent job and profession changing and re-evaluation of work vs. family priorities have led to a growing interest in careers issues. However, aids to understanding and managing career transition phenomena have not yet been developed. Toward that end, varieties of career transitions are identified here, and commonalities across transitions are explored.
Career change research has suffered from the absence of a comprehensive theoretical framework. The proposed model of career change is based on career change research and previously tested turnover theory. Both the determinants and process of career change are explained by the model. Longitudinal panel studies are suggested for testing of the model.
The development and construct validation of a 12-item career entrenchment measure is reported. Taking a theory-driven approach, three dimensions comprising career entrenchment were defined: a career investments dimension reflecting accumulated investments in one's career success that would be lost or deemed worthless if one were to pursue a new career, an emotional costs dimension assessing the anticipated emotional costs associated with pursuing a new career, and a limitedness of career alternatives dimension gauging the perceived lack of available options for pursuing a new career. Using a combination of methodological procedures, these three dimensions were investigated in two pilot studies and a field test. Results support the intended measure's reliability and validity. Implications for individuals and their careers are discussed.
Using longitudinal data collected over a 4-year period from a sample of medical technologists, this study found that intent to leave one's organization, intent to leave one's profession, and intended retirement age were distinguishable interrole work transitions. Job context (i.e., job satisfaction) had a significant impact on subsequent organizational and professional withdrawal intent. Organizational context (i.e., work-force reduction, shift, schedule) had a significant impact on subsequent organizational withdrawal intent, while professional context (i.e., role orientation and professional commitment) had a significant impact on subsequent professional withdrawal intent. Copyright 2000 Academic Press.
Job resources have a protective role in minimising job strain and associated adverse outcomes. Although autonomy and support are recognised as valuable resources across nearly all occupations, relatively few occupation-specific resources have been identified within the literature. We studied global (general) emotional resources and an occupation-specific emotional resource (camaraderie) as potential buffers against the deleterious effects of emotional demands on emergency responders. A random sample of 547 volunteer fire-fighters completed an anonymous survey. Through path analysis we identified significant main and interaction effects of emotional demands and resources on psychological strain and burnout. Camaraderie, the specific resource, had the most consistent protective effects against poor psychological health; the effects of global emotional resources were not as consistent. These findings have important implications for theory (e.g. the specificity of resources most appropriate for theory testing and development) and for practice (e.g. for designing primary, secondary, and tertiary stress prevention and management initiatives).
This study proposed and tested corresponding sets of variables for explaining voluntary organizational versus occupational turnover for a sample of medical technologists. This study is believed to be the first test of the Rhodes and Doering (1983) occupational change model using occupational turnover data. Results showed that corresponding job (occupational) satisfaction and intent to leave organization (occupation) variables were each significant for explaining subsequent organization (occupation) turnover. Job insecurity was found to be a significant correlate for organizational turnover while work exhaustion was found to be a significant correlate for occupational turnover. Study limitations and directions for future research are discussed.
Using a more rigorous research design than previous studies, results generally supported the discriminant validity of professional withdrawal cognitions (PWC) versus organizational withdrawal cognitions (OWC). The sample consisted of 226 medical technologists tracked over a five year period, and the research design used pre- and post-measures of PWC and OWC. Attitudinal professional commitment had a stronger negative relationship to subsequent PWC versus OWC, while gender discrimination and organizational support had stronger relationships to subsequent OWC versus PWC.
Collected data from 3,148 respondents in 19 samples regarding evaluative feelings about their jobs and developed the Job Satisfaction Survey (JSS), a 9-subscale measure applicable specifically to human service, public, and nonprofit sector organizations. Included are a multitrait-multimethod analysis of the JSS and the Job Descriptive Index, factor analysis of the JSS, and scale intercorrelations. Correlations of JSS scores with criteria of employee perceptions and behaviors for multiple samples were consistent with other satisfaction scales and with findings from the private sector. (47 ref) (PsycINFO Database Record (c) 2007 APA, all rights reserved)
The contexts of human resource management -- Staffing -- Employee development -- Compensation -- Governance
Ensuring the health and productivity of emergency medical services (EMS) professionals is important. However, there has been no known national baseline assessment of the health and wellness of EMS professionals in the United States. According to Healthy People 2010, top indicators of personal health include physical activity, body mass index (BMI), and smoking prevalence.
The objectives of this study included quantifying existing health conditions and describing key health indicators among EMS professionals. It was hypothesized that work-life characteristics were associated with existing health conditions and key health indicators.
Data utilized for this analysis were obtained from a 2007 questionnaire included in biennial national recertification packets. This questionnaire utilized validated items from the Behavioral Risk Factor Surveillance System (BRFSS) and the Longitudinal EMT Attributes and Demographics Study (LEADS). Along with common demographic characteristics, items inquired about existing health conditions (diabetes, asthma, hypertension, myocardial infarction, angina, stroke, and/or high blood cholesterol level), general health, physical activity, and smoking status. Descriptive analyses were performed utilizing chi-square tests, and logistic regression was utilized to describe associations between existing health conditions and the key health indicators.
There were 58,435 individuals who became recertified in 2007, with 30,560 (52%) returning questionnaires. Individuals with missing data were removed, leaving 19,960 individual records. There were 4,681 (23.5%) individuals who reported at least one existing health condition. The mean BMI for the study participants was 27.69 kg/m(2). There were 5,742 (28.8%) individuals classified as having normal weight and 5,146 (25.8%) who were obese. The overwhelming majority of individuals did not meet the Centers for Disease Control and Prevention (CDC) recommendations for physical activity (15,022, 75.3%). There were 3,394 (17.0%) individuals classified as current smokers. Finally, logistic regression analysis indicated that when controlling for work-life characteristics and age, BMI and level of physical fitness were associated with preexisting health conditions.
This study was the first known baseline assessment of EMS professionals regarding the key health indicators identified by Healthy People 2010. Investigations regarding the impact of health and wellness in relation to workforce stability should be undertaken. Further research should also be conducted to identify strategies to improve the health of the EMS workforce.
The primary purpose of this study was to characterize job satisfaction with opportunities for advancement, job satisfaction with pay and benefits, and intent to leave the EMS profession among Nationally Registered EMT-Basics and EMT-Paramedics. A secondary data analysis was performed on the National Registry of EMTs Longitudinal Emergency Medical Technician Attributes and Demographic Study Project (LEADS) 2005 core survey. We used chi-square and multiple logistic regression analyses to test for differences in job satisfaction with opportunities for advancement, job satisfaction with pay and benefits, and intent to leave the EMS profession across years of experience and work location. Among 11 measures of job satisfaction, NREMT-Basics and NREMT-Paramedics were least satisfied with opportunities for advancement and pay and benefits (67.8 and 55.2%, respectively). Nearly 6% of respondents reported intentions of leaving the profession within 12 months. In univariate analyses, job satisfaction with advancement opportunities varied across years of experience and work location. Job satisfaction with pay and benefits varied across years of experience and work location. The proportion reporting intentions of leaving the profession did not vary across the two independent variables of interest. In multivariable logistic regression, statistical differences observed in univariate analyses were attenuated to non-significance across all outcome models. Income, personal health, level of EMS certification, and type of EMS work were significant in several outcome models. EMS workforce research is at its infancy, thus our study adds to a limited but growing body of knowledge. In future and replicated research, one will need to consider different person and organizational variables in predicting different measures of job satisfaction among EMS personnel.
To determine if stress levels of emergency medical services (EMS) personnel can be reduced by adjusting work schedules to personnel preferences.
A prospective, longitudinal, cohort study with a work-schedule modification intervention was performed. All EMS personnel employed by the City of Cleveland EMS were eligible for participation. EMS employees voluntarily completed an abbreviated medical personnel stress survey (MPSS-R), a 20- question validated stress-assessment tool, in September 1989, February 1991, and September 1991. A new scheduling pattern was introduced March 1991. At that time, 27 EMS employees volunteered to work the new schedule (12 hours/ shift: 3 days on/2 days off/2 days on/3 days off). The remaining 109 EMS employees remained on the old schedule (8 hours/shift: 6 days on/2 days off).
Mean MPSS-R stress scores increased significantly from September 1990 (61.9 +/- 7.87) to September 1991 (65.08 +/- 7.23) (p < 0.05). In September 1991, mean stress scores of EMS personnel working the new schedule (64.39 +/- 7.82) were not significantly lower than stress scores of EMS personnel working the old schedule (65.25 +/- 7.10).
Stress in EMS personnel increased despite a new schedule pattern designed to accommodate the preferences of EMS personnel.
Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics. Information was drawn from three focus groups of EMT-Basic, EMT-Intermediate, and EMT-Paramedic personnel recruited from participants at an annual conference. Thoughts and feelings of EMTs and paramedics were investigated using eight questions designed to explore entry into emergency medical services, what it is like to be an EMT or paramedic, and the EMT educational process. Data were analyzed at the group level for common themes using NVivo. For a majority of respondents, emergency medical services was not a primary career path. Most respondents entered the industry as an alternate or replacement for a nursing career or as a second career following military medic service. The majority of respondents believed the job was stressful yet rewarding, and although it negatively affected their personal lives, the occupation gave them a sense of accomplishment and belonging. Respondents expressed a preference for EMT education resulting in college credit or licensure versus professional certification. Job-related stress produced by numerous factors appears to be a likely contributor to low employee retention. Recruitment and retention efforts should address study findings, incorporating key findings into educational, evaluation, and job enhancement programs.
Why do Emergency Medical Services (EMS) professionals leave EMS?
- Sachapman Gblau
The longitudinal study of turnover and the cost of turnover in emergency medical services
- Pdpatterson
- Cbjones
- Mwhubble
Retrospectively exploring the importance of factors in the decision to leave the emergency medical services profession and their relationships to life satisfaction after leaving EMS and likelihood of returning to EMS
- Gblau
- Schapman
Managing Human Resources NJ: Pearson
- Lrgomez-Mejia
- Rlcardy Dbbalkin
Exploring the importance of different items as reasons for leaving emergency medical services between fully compensated, partially compensated, and non-compensated/volunteer samples
- Gblau
- Schapman
- Mbentley Ggibson
Career transitions: varieties and commonalities
- Mrlouis
Testing for correlates of intent to leave one’s job versus intent to leave one’s occupation among cancer registrars
- Schapman
- Gblau
- Rspred
- Vlindler
Characterizing job satisfaction and intent to leave among nationally registered emergency medical technicians: an analysis of the 2005 LEADS survey
- Pdpatterson
- Cgmoore
- Ndsanddal
- Gwingrove
- Blacroix
An integrated model of career change
- Mdoering Srhodes
Stress levels in EMS personnel: a study with work-schedule modification
- Rcydulka
- Cemerman
- Jkubincanek Bshade
Measurement of human service staff satisfaction: development of the job satisfaction survey
- Pspector