States with the highest number of paid EMTs and paramedics are California, New York, Pennsylvania, Texas and Illinois, according to BLS. The states with the highest concentration of paid emergency workers compared with the national average are Maine, Tennessee, Delaware, South Carolina and Kentucky. BLS economists said smaller states depend more heavily on paid EMS workers because they have smaller pools of volunteers.
“For a long time, EMS has been on the short end of the straw,” said Lundy of the EMTs association. He’s director of Charleston County EMS in South Carolina and has been an EMT for 38 years. “A lot of communities don’t understand the true value the emergency medical service brings to the community.”
Until there’s a problem or crisis. Lundy cited Washington, DC, which has been plagued with complaints about poor service and long wait times for ambulances. The city’s fire chief recently told the city council only 58 of 111 ambulances were in service, the city had only 245 paramedics (well short of its goal of 300), and some paramedics have responsibilities other than field work or responding to calls.
A key problem, Lundy and others say, is the lack of dedicated federal EMS funding.
“As we stand here today, there’s no federal funding for EMTs, no grants for the local level. There are grants for fire services, and about 2 percent of that money may go for non-fire EMS grants,” he said.
“There are a lot of very dedicated volunteers who are funding their organizations through barbecue chicken dinners on Saturday nights,” Lundy said. “That’s very sad because they are on the front lines of the health care people get every day. If you opened a hospital and made the staff throw chicken dinners every week to pay the bills, people would think you were crazy.”
A dozen states don’t fund EMS at all, the National Conference of State Legislatures reported in a study last year. Federal grants are available for state trauma systems through the U.S. Department of Health and Human Services, the NHTSA and the Department of Homeland Security. Some of that money can be used for EMS.
In addition, charitable foundations and corporations have become a source of revenue. For example, the Duke Endowment poured $5.5 million into emergency medical services in the Carolinas between 2004 and 2007.
“It’s an amalgamation of sources,” said Hollie Hendrikson of NCSL, who wrote the report on state trauma services. “Every state does it a little differently.”
Since the 1970s, when deaths from car crashes were a major concern, the Department of Transportation has housed an EMS office in NHTSA. Emergency services advocates are pushing for a lead federal agency for EMS, a need endorsed by the Institute of Medicine in 2006.
U.S. Rep. Larry Bucshon, R-Ind., a physician, introduced a bill in February that would set up an EMS office in HHS and provide EMS education and training grants. So far, the bill has just six co-sponsors.
Lundy hopes high-profile events like the Boston Marathon bombings will wake people to EMS needs. BLS estimates the need for paid paramedics and EMTs will rise 33 percent from 2010 to 2020, much faster than other occupations.
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