The executive director of Louisville Metro Emergency Services told a Metro Council budget committee on Monday that the department is having trouble retaining the emergency medical technicians (EMTs) and paramedics who work in ambulances, but is ramping up aggressive recruitment efforts to fill these growing vacancies.
“We are short-staffed, and we’re doing our best to get to the staff that we need to continue providing that service to the community,” said Jody Meiman, the executive director of Emergency Services.
While employment figures from Mayor Greg Fischer’s proposed city budget for the coming fiscal year show that the department’s MetroSafe staff fielding 911 calls has remained relatively stable since the 2016 fiscal year, staffing for Louisville Emergency Medical Services (EMS) that makes ambulance runs has taken a steep decline as of April 1 of this year.
The average number of EMTs in the department was 138 in the 2016 fiscal year and rose to 141 in 2017, but as of this April, that number had declined to 127.
The number of paramedics — providing advanced life support instead of basic life support provided by EMTs — who ride in ambulances has fallen even further by 32 percent in that same time frame, decreasing from an average 75 in 2016 to just 51 in April.
The number holding the higher position of Paramedic II increased from 12 to 14 at the beginning of this year, with those individuals serving as supervisors and having SUVs that can respond to scenes as need, according to an Emergency Services spokesman, Mitchell Burmeister.
Meiman told council members in the budget hearing on Monday that while EMS has hired 80 people since last summer, they’ve lost nearly that amount of employees in the same time. While 12 of those were retirements and some were terminated, “the majority have left due to the circumstances of the job,” which includes “burnout.”
“They’re leaving for other EMS agencies, they’re leaving to completely get out of the field and do something different,” Meiman said. “There are other agencies offering more money. This is a steppingstone sometimes to get into different medical fields, and things like that.”
Part of the problem is the long hours worked by EMS staff due to staff shortages, the department says, as they are often forced to take mandatory overtime on top of their typical 12-hour shifts.
And these shifts have become increasingly demanding as Louisville’s opioid crisis has worsened, as the 124,883 EMS calls for service in 2017 was a 31 increase from 2011 and 15.7 percent increase from 2014.
However, Meiman says that the department’s new aggressive push to recruit, train and retain a new wave of EMTs and paramedics will help alleviate this problem.
“We’re making a big push, and we feel like when we get closer to full staff, that our retention of employees is going to be much better, because they’re not going to get mandatory (overtime), they’re going to be able to go home on time when they want to go home,” Meiman said.
EMS recently began a four-month training academy with 44 EMT recruits who will graduate in August and then be able to hit the streets in ambulances. Additionally, 19 current EMTs in the department are training to be ambulance paramedics and are set to graduate in November, with Burmeister stating that they “should help bring our numbers back similar to what they were in previous years.”
Citing a national shortage of EMTs and paramedics, Meiman said their push for EMT recruits has expanded to those with no previous experience or training in the field, which helped land a record 1,400 applicants this year. He told the council that the department is now “looking for young adults that may not know what they want to do,” or are “trying to get into something instead of college.”
Meiman said that the department has been able to save money by internally training such candidates instead of contracting out such training, and that those who receive this training must pay for it themselves if they don’t remain with the department for a certain amount of time. He also told the council that he feels confident that EMS will be fully staffed in a reasonable amount of time.
While the city’s opioid epidemic has significantly increased the number and intensity of EMS runs, Meiman did share a somewhat hopeful trend from the current year, as their overdose runs have gone down 24 percent from what they were at this point last year.
According to figures provided to Insider Louisville by the department, there were 2,108 overdose runs in the first four months of this year, which is a 30 percent decrease from the 3,023 during this period in 2017. The 483 overdose runs that occurred in April tied November of last year as the lowest monthly total over the past 27 months.
However, this dramatic decrease is partly due to the abnormal and record spike in overdoses that occurred in February of 2017, as this year’s total of overdose runs for the first four months is still slightly higher that what occurred in 2016 and is 68 percent higher than 2015.
As suburban fire districts have recently begun new ambulance services, this has not only challenged Metro EMS by pilfering their EMT and paramedic staff, but the revenue generated by the department.
City budget director Daniel Frockt told the council that these new ambulance services have “taken a disproportionate share of Medicare and privately insured patients, so our mix is tilted a little more towards self-pay and towards Medicaid,” which are “more difficult to collect.”
Frockt said this was partly reflected in the projected decrease in revenue for EMS over the current fiscal year and next fiscal year, which is expected to decline roughly $4 million from the $16.3 million collected in the 2017 fiscal year.
Meiman added that working with these new suburban ambulance services has been a “unique” challenge, operationally, as is there is sometimes a “confusing atmosphere” when it comes to which department should go on runs in those areas.
Fischer’s proposed budget calls for $42.1 million in general funds for Emergency Services in the next fiscal year, which is a nearly 1 percent decrease from what it received in the current year. Metro Council is expected to approve a final city budget at their meeting on June 26.
This story has been updated to correct the spelling of Meiman’s name.