When you call 911 for a medical emergency, you expect trained EMTs and paramedics to be dispatched to your aid. But what happens if there aren’t enough?

“I wouldn’t say we have a shortage, but the counties around us probably do,” said Brad Ellis, director of the Boyle County EMS, of a rumored “paramedic shortage” in the state. “I don’t know, that’s just what you hear.”

Some of the larger cities, he’s heard, are facing a shortage, too.

Boyle County is “fortunate,” Ellis said, and has been able to fill vacancies as they arise. Those replacements are likely people coming from neighboring counties, he said.

“If we take from the counties around us, we’re just hurting them,” he said.

Ellis said the problem Boyle County is currently facing is whether or not the county is going to be able to replace a group of paramedics nearly ready to leave — there are six on the cusp of retirement.

“It’s coming. The shortage is coming. I think in the next five years we’re going to have to probably look at different response models,” said Mike Rogers, education coordinator of Boyle County EMS.

He has also heard of a shortage in the area, but couldn’t comment specifically on any other agencies.

“We’re fortunate; we have a good agency. We consider it progressive; (it) doesn’t have a super high, crazy run volume. Agencies like Jessamine County … they’re hurting bad for paramedics,” Rogers said. “We haven’t seen the shortage yet, but it’s coming.”

The six pending retirees, Ellis said, are strictly paramedics. The department tries to maintain an equal number of paramedics and EMTs, and has some part-time staff. Ellis said he doesn’t think the agency’s part-time paramedics will be able to move into the vacancies — three work full-time for fire departments and two are retirees.

Rogers said Boyle County currently runs three trucks each shift, with a supervisor and generally one EMT and one paramedic each. Full-time paramedics earn $11.50 an hour; full-time EMTs earn $9.25 an hour; part-time paramedics earn $11 an hour; and part-time EMTs earn $8 an hour.

During the day, Rogers and Ellis run a fourth truck, if necessary.

Training EMTs to be paramedics

According to the Kentucky Board of Emergency Medical Services (KBEMS):

• EMTs (short for Emergency Medical Technicians) are required to attend a 119-hour training program, at minimum, to teach basic care. They must know CPR prior to starting their training.

• Paramedics are required to have more advanced skills than an EMT — they must graduate from a KBEMS-approved school and complete clinical and field experience.

“Several years ago, we had a paramedic class. We would pull from that class, and we kept a lot of people here in central Kentucky (supplied) with paramedics. Now, we don’t have that,” Ellis said. “That’s a biggie for me as an administrator. I would love to send people to class.”

Accreditation protocols for offering classes changed in the state, unintentionally contributing to the shortage, Rogers said. It became “too much money” for an agency like Boyle County to continue offering its class.

“We would have to hire more people, have more equipment and partner with a university. We could do it — we could do it with the hospital, but we would have to have a lot of money,” he said.

Ellis said the county would have to partner with agencies in other counties to make it potentially feasible.

While going through the college system is good, said Rogers, who called himself a proponent of education, it’s not set up to encourage working EMTs to become paramedics.

“The problem is, we’re not empowering the EMT to go from EMT to paramedic,” he said.

The expense for classes has more than doubled — it used to cost around $5,000 to send an EMT to paramedic class; now it costs more than $10,000.

College classes, Rogers pointed out, are also generally on Mondays, Wednesdays and Fridays, or on Tuesdays and Thursdays. EMTs and paramedics work a 24-hour on, 48-hour off schedule.

“Brad, as a director, he can’t afford to pay someone (overtime) to come in and cover a shift so an EMT can go to class,” Rogers said. 

“When we did the class, we did it on a 24/48 rotating schedule,” Rogers said.

That way, all of those attending school could be scheduled off on the days they have class — they still get paid for attending training, but no overtime pay has to be spent, as no one is covering an extra shift.

“It’s hard now to keep that EMT moving up. You have no place to send them,” he said.

Rogers said he’s talked to colleges around the region, trying to find someone to work within that schedule, but most say that’s incompatible within the “college system.”

There is a program in Somerset, through the Bluegrass Community and Technical College system, but it is on the regular college schedule.

Pension-related retirements and competition

Ellis said one of the biggest questions facing the department is whether or not those who have reached retirement will feel the need to retire earlier than originally planned, because of the proposed changes to the state’s pension plan.

“It does get everybody’s attention. Me, for example — I’m close to retirement,” he said. “I’m watching that really close — ‘Do I need to leave now?’ ‘Can I wait another year?’”

“It’s kind of been said, we all want to leave on our own terms,” said Rogers.

The agency has already lost one paramedic because of the proposed changes.

“He had said he was going to wait another year. Then all the talk started and he decided to go ahead and leave,” Ellis said.

The changes could also impact those retirees who work part-time for the agency, he said, although it’s too early to know exactly how.

“It’s just going to make the paramedic shortage worse,” Rogers said. “You have paramedics that have retired and can still work.”

But, if changes are made, he said, they fear the retirees won’t be able to work.

It might also make potential paramedics reconsider the field.

“The biggest reason most people become a paramedic — it doesn’t pay well, it’s very rewarding, it’s hard, it’s stressful, but you do get a retirement,” Rogers said. “That was a recruiting tool, ‘The pay’s not good. It’s stressful. You’re going to be away from your families. We’re going to ask you to do things that most other people won’t. But you get a retirement.’

“It’s going to only get worse.”

Rogers said a lot of people considering being a paramedic usually weigh it against being a nurse, which sometimes comes with a higher pay. He said the two are comparable fields competing for a similar pool of people, he thinks.

EMS agencies also face competition for the paramedics they hire from hospitals, which often hire them for more than EMS agencies can pay, Ellis said.

“We’ve lost one to Ephraim McDowell. I’ve heard other services have lost to UK,” Ellis said.

Rogers said besides Ephraim McDowell Regional Medical Center and the University of Kentucky Chandler Medical Center, Central Baptist Hospital is also hiring paramedics; agencies like AirEvac also take some of the more experienced paramedics.

“Right now, there’s probably more paramedics in the state than there was 10 years ago, but the options became more,” Rogers said. “If you call 911, there’s a lot of agencies that can’t guarantee you’re going to get a paramedic.”

Rogers said some say the solution is to pay paramedics more.

“It’s hard to tell a fiscal court, ‘We’re going to have to raise pay because there’s no paramedics,'” he said.

There are potential solutions on the horizon, such as allowing those who have been inactive for longer than five years to take a refresher course and become relicensed. Currently, after five years, to become relicensed requires taking an entire program again.

“It’s just talk right now,” Rogers said. “It would not be a big difference; it’s not going to solve the problem.”

The big difference would come if a college could work with agencies, to make scheduling easier for current EMTs, he said.

“We could empower that EMT to continue their education and have a pathway to paramedic. Then a pathway to their associate’s degree, if they want,” Rogers said. 

He recently graduated with an associate’s degree from EKU, and said he took “one class a semester for three years.”

“I agree that our industry needs degree paramedics,” Rogers said. “But we are going to have to find a way to get there without leaving a county without paramedics.”