As demand increases, Eastern Iowa ambulance services struggle with workforce challenges

CEDAR RAPIDS — Eastern Iowa ambulance services — like other businesses — are facing pandemic-induced shortages of staff.

The challenge to hire workers — particularly paramedics — comes as the services are busier then ever, with more 911 calls and non-emergency transports over the past two years.

The busiest service — Area Ambulance Service, which provides 911 emergency response in Cedar Rapids, Marion and surrounding communities — never lacked job applicants before 2020 when the pandemic hit, Executive Director Keith Rippy said.

“We used to have folks come through the door with great regularity looking for a job,” he said. “We haven't seen that for the past year.”

Paramedics, in particular, are hard to come by, with Area Ambulance Service currently short two or three full-time paramedics, Rippy said.

It’s the same story elsewhere.

Johnson County Ambulance Service Director Fiona Johnson said she has more difficulty filling paramedic vacancies today than in previous years.

The challenge, she said, is not because fewer individuals are interested in the profession but because of the same workforce challenges faced across the health care industry.

Qualified emergency medical staffers have their pick of open positions at ambulance services and also at hospitals and clinics, she said.

“They’re being utilized in other medical facilities, when before they were hired by just ambulance services,” Johnson said.

As a result, the county-run emergency medical service provider has had to hire more emergency medical technicians (EMTs) to serve as a stopgap.

Johnson County typically staffs two paramedics in each ambulance per shift. But in an effort to reduce strain on full-time staff, the organization created “safety net” EMTs positions to fill in for a paramedic when needed, Johnson said.

“In those emergency situations, they help fill the gaps,” she said. “It’s certainly a resource for the service, and it’s great experience for the EMTs.”

EMTs — who earn $17 an hour at Area Ambulance — can handle basic health procedures like CPR and giving oxygen to a patient. A paramedic — paid $20.50 per hour at Area Ambulance — performs more advanced procedures like inserting IV lines and administering drugs.

Nationwide shortage

The shortage of emergency medical service staff is a long-standing challenge nationwide, but a recent survey suggests the pandemic has exacerbated the problem.

In 2020, nearly one-third of emergency medical workers left their jobs after less than a year of employment, according to the survey, which was conducted by the American Ambulance Association. That includes 11 percent who left within the first three months.

In a letter to congressional leaders, the American Ambulance Association and the National Association of Emergency Medical Technicians warned the nation’s EMS system is facing a crippling workforce shortage that “threatens to undermine our emergency 911 infrastructure.”

(By way of disclosure: The Gazette’s parent company, Folience, owns the ambulance manufacturer Life Line Emergency Vehicles in Sumner.)

Calls increasing

The shortage in emergency medical professionals comes as Eastern Iowa ambulance service providers are seeing more 911 calls and in nonemergency patient transports.

The 911 dispatch calls to Area Ambulance Service in the past three years have totaled:

Non-emergency transports — which include an ambulance transporting a patient to a nursing home or a hospital — also saw similar increases. At Area Ambulance, the totals were:

The main driver for the increased trips is likely the growing population of older people, Rippy said.

He also noted Americans have a high prevalence of heart disease, diabetes and other chronic medical conditions.

Also, Rippy said, “we're seeing an uptick in seriously ill folks,” including individuals who delayed doctor visits during the pandemic and are now seriously ill and others who are experiencing symptoms but had put off calling 911 or going to the emergency room.

Johnson County Ambulance Service reports a more moderate increase in call volumes in the past three fiscal years:

So far in fiscal year 2022 — from July 1, 2021 to Feb. 15, 2022 — the ambulance service has received 8,899 calls for service, Johnson said.

Solutions?

In response to more calls and workforce challenges, Area Ambulance Service has adjusted its operations for nonemergency transfers.

It launched a life-support ambulance staffed by two EMTs specifically to handle those transports on Mondays and Fridays — the busiest days of the week for those requests — and is considering adding that service on Wednesdays, too.

The change, Rippy said, alleviated stress on its 911 response capabilities and also helps keep its short supply of paramedics focused on emergencies.

The ambulance service managers also are adjusting their approach to recruitment and retention.

“In the past, we’ve had so many applicants, it's not a step we had to do,” Johnson said of the Johnson County effort. “Then we realized we needed to take matters into own hands and actively recruit.”

Officials have been speaking with EMS students at the University of Iowa and Kirkwood Community College, encouraging them to apply once they graduate.

In the past year, 10 staffers have been hired as a direct result of the recruiting efforts.

Rippy said Area Ambulance is in the midst of building a new recruitment plan, which he aims to put in place in the next six weeks.

“We're just trying to figure out and identify what else we might be able to do to attract these folks,” he said. ”It's very competitive out there.“

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