Iowa ambulance services working to reverse decline of certified EMTs

Working in an ambulance is not an easy job. The hours are irregular, the job can be overwhelming, and it doesn’t always pay well. In some rural areas, where ambulances are staffed by volunteers, it doesn’t pay at all.

In Iowa, and across the country, ambulance services have been struggling to attract and retain staff. Data from the Iowa Department of Health and Human Services shows that the number of certified EMTs in the state has decreased every year since 2018. But ambulance service professionals have been working to reverse that trend, and changes made to state law in 2021 may have been the first step in the right direction.

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Data shows recruitment, retention strategies may be working

In the state’s most recent emergency medical services annual report, the Health and Human Services Department noted that although the number of EMTs has continued to decline, the change between Jan. 1, 2023 and Jan. 1, 2024 — from 6,191 to 6,131 — is the smallest decrease the state has seen since 2019.

The decrease in total emergency medical clinicians — meaning all EMTs, paramedics, and other emergency medical responders — was also small, dropping just 33 people, from 10,743 in 2023 to 10,710 in 2024.

There are four levels of emergency medical clinicians: EMR, or emergency medical responder; EMT, or emergency medical technician; AEMT, or advanced emergency medical technician; and paramedics. Part of the reason for the decrease in people with EMT certifications has been because some EMTs have advanced to AEMT or paramedic status, according to the report.

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The report also notes that between 2023 and 2024, the number of EMS clinicians between the ages of 17 and 40 increased, meaning that more young people are joining the profession.

“The data above indicates that the EMS industry may be improving recruitment and retention strategies,” the report states.

Higher paying medical fields lure some paramedics

While the decrease in certifications is slowing, that doesn’t necessarily translate to more available staff for ambulances. Many of those who progress to a paramedic level certification end up continuing their education to pursue careers in higher paying medical fields, like nursing.

Anna Demuth, service director for the North Benton Ambulance, said she has seen a lot of paramedics leave to field to go into nursing. The North Benton service recently increased salaries in order to compete, both with hospitals hiring nurses and with larger ambulance services who may lure clinicians away from the service.

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For ambulances that are staffed by volunteers, the struggle to stay fully staffed is even more difficult.

“Across the country, EMS providers are definitely declining, or they’re not replenishing the field as much as we need,” said Andy Ney, president of the Iowa Emergency Medical Services Association and director of operations for Paramount Ambulance in Dubuque. “I think in Iowa, we’re just feeling it a little bit more, because we depend so much on the volunteers in each of these communities where they’re not getting paid to do the job.”

According to the annual EMS report, 63 percent of ambulance services are staffed entirely by volunteers, and another 10 percent are staffed partially by volunteers. Ney said volunteer ambulance services across the state are finding it increasingly difficult to remain fully staffed as fewer people are taking time to volunteer. In coming years, it may be necessary for those rural ambulance services to find the funds to become paid, or hybrid services.

“What we really need is to make the career be more fulfilling for somebody that's coming in,” Ney said. “It’s one of the riskiest careers there is in this country, so I think we can make the compensation package look better.”

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Finding those funds won’t be easy with the current reimbursement system, though. Ney said many ambulance services — both volunteer and paid — have had a hard time keeping up with inflation over the past several years. He said reimbursement rates — the amount of money an ambulance service gets paid by Medicare or private insurance companies for each transport — have not kept up with the increasing prices of equipment and other costs, making it difficult to offer competitive wages that retain employees.

“We're really needing to figure out how we can work with these commercial insurers to make sure we're not being left behind on reimbursement,” Ney said. “I think that is something in the state we're really working on, and we might go legislatively as far as some protections for EMS, if we're not able to hear back from these private insurances to be able to increase our rates when we really need it.”

Essential service designation provides new revenue stream

New legislation in recent years in Iowa has aimed to help ambulances with their financial difficulties. In 2021, state lawmakers passed a law that gave counties the ability to declare emergency medical services an essential service, meaning that the county could levy taxes to support it, if voters give their permission.

Since then, 20 counties have passed public measures to levy taxes for their EMS programs. Seven of those counties — Appanoose, Butler, Cass, Hamilton, Jefferson, Sac and Tama — passed the public measure this year in the Nov. 5 election. Five other counties — Buchanan, Floyd, Guthrie, Page and Taylor — had similar measures on their ballots this year that did not pass.

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Jones County passed an EMS levy in 2022, and 2024 is the first full year the county’s ambulance services have been able to draw from the funds. They aren’t able to use the money to fund salaries, but the tax dollars can be used to pay for equipment and buildings.

“If this money can be used for equipment and buildings and some non-disposable supplies, then it will hopefully alleviate some of the current funds being used for that type of thing, and they can use their other funding sources for salaries and wages,” Jones County Auditor Whitney Hein said.

The funds also can be used for training, which Brenda Leonard, the Jones County emergency management coordinator, said has been helpful for recruitment for both volunteer and paid positions because the ambulance can offer to pay for the certification classes for recruits.

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“They aren’t going to have to take time out of their private life to go do fundraisers, or to pay to take the class out of their own pocket,” Leonard said. “We have a new class coming up and have had quite a bit of interest in it, knowing that it’s not coming out of their own pocket.”

The 2021 legislation also changed state law to allow ambulance services to host their own certification training classes. Previously, those programs could only be hosted by hospitals and colleges. This has helped increase opportunities for recruitment by ambulance services.

Demuth, with the North Benton Ambulance service, is currently teaching an EMT certification class as a way of recruiting more emergency medical technicians. She partnered with Mercy College of Health Sciences in Des Moines to host the class, which is held virtually with some students in Des Moines and some in Vinton. The students get together once each week at both locations for in-person reviews and skills training for the class.

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Three of Demuth’s students were already working for the ambulance service as drivers and had expressed interest in becoming EMTs, which was part of the reason Demuth decided to start the class.

“We're having to look at different options to get education to those that want it, and that's always a challenge. There's the time commitment and work on top of it, and family life, and all of the above,” Demuth said.

Comments: (319) 398-8328; emily.andersen@thegazette.com