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EMS in the News

First responders say years of low pay and chronic turnover have put coronavirus patients' lives at additional risk during the pandemic: 'We're screaming for help'

Dave Mosher and                                   BUSINESS INSIDER

A first responder takes a break outside Wyckoff Heights Medical Center during the coronavirus outbreak in New York City, April 5, 2020. Jeenah Moon/Reuters

In the past four years, Vincent Variale, a lieutenant EMT and 30-year veteran of Fire Department of New York's (FDNY) EMS, has seen two out of every three of his colleagues quit. "We lost 1,200 members in one year. We only have 4,000 EMTs. ... That's more than 25%. How do you explain losing that many people in one year?" Variale told Business Insider. "The only numbers that compare with that is a fast food restaurant like McDonald's." Now, during New York City's most deadly crisis in a century, Variale and other first responders say the group's chronic high turnover could be causing more people to die from COVID-19 than otherwise might have. "Studies have shown that the survival rate increases and positive patient outcomes increase when you have somebody with six or seven years experience or more as an EMT or paramedic. They have failed to retain that person," he said.

Variale, who is also the president of FDNY local 3621 union in Manhattan, added that the average FDNY EMS employee has been on the job just three years. About 75% have less than five years' experience. He and other union leaders blame the lack of compensation parity with firefighters, police officers, and other public service workers who put their lives at risk. Chronic understaffing is also a problem, Variale said, adding that requests for significant increases in pay, benefits, and staffing have fallen on deaf ears. New York's continuous loss of experienced workers is not isolated, national EMS representatives say: Staffing shortages and relatively low pay are common across the US and drive less experienced first responders to take on exhausting schedules to make a living. "I just spoke to somebody in Florida that did 48 hours straight between two different jobs," Philip Petit, director of the National Association of Government Employees' EMS labor union, told Business Insider. "They're not just working one 12-hour shift. They might work a 24-hour shift at one job, work a 24-hour shift at another job, take a day off, and then do it all over again."

 Sick and overworked

An EMT adjusts his personal protective equipment as he gets back in an FDNY ambulance after responding to a call amid the coronavirus outbreak in Brooklyn, New York, on April 14, 2020. Lucas Jackson/Reuters

The typical volume of 9-1-1 emergency calls in New York City is about 4,000 per day. In early April, as confirmed cases of COVID-19 peaked, that count exceeded 7,000 per day. The calls didn't dip below 6,000 per day for weeks prior to that.

"This is like 9/11 every single day. I've never seen this call volume in my entire life," Variale said in early April. "This is like a slow-moving train crash that hasn't stopped."

Faisel Abed, a paramedic with the FDNY EMS, was among thousands of first responders who rushed to the World Trade Center in the minutes after the terror attacks, but agreed that even that experience doesn't compare. "I saw the second building get hit. I witnessed people jumping out of buildings. I saw the towers on their way down," Abed told Business Insider. "This, to me, is worse." On top of the unprecedented call volume, more ambulance workers were out sick than ever before due to COVID-19 symptoms. In early April, about 20-25% of the 4,500-person staff was out sick, Variale said. Typically, 5-8% are out sick. Such staffing hits lengthen emergency response time and responders' ability to whisk critical cases to hospitals. EMS workers began taking two 8-hour shifts back to back — 16 hours per day — for up to five days a week.

"It's hurting the workforce, it's straining them, it's not giving them time to recover," Variale said.

But staffing was a problem before the coronavirus arrived. A November 2018 report by the New York City's Citizens Budget Commission found that more than 83% of emergency calls were medical in nature and only 2% fire-related. However, it also found firefighters outnumber EMS workers by about two-to-one, so the former have been taking an increasing number of medical calls each year despite being less equipped to handle them. "The unions have said we should have a staff of at least 7,000 to 8,000 to handle regular 9-1-1 properly so that you don't wait more than five minutes for an ambulance," Anthony Almojera, a lieutenant paramedic in Brooklyn and vice president of local union 3621, told Business Insider.

 'They don't stay because it doesn't pay well'

A member of the FDNY EMS team carries disposable medical supplies to an ambulance at the emergency room of the Elmhurst Hospital Center Robert Nickelsberg/Getty Images

EMS workers miss out on the pay and benefits given to experienced firefighters and police officers. The latter group receives unlimited sick leave; EMS workers get 12 sick days per year. If a firefighter or police officer dies in the line of duty, their spouses and kids get last year's salary and medical benefits for the rest of their lives; meanwhile, an NYFD EMS worker's direct family members get 80% of last year's salary for three years. EMS base salaries are about $35,000 to $40,000 less than those of firefighters, police officers, or sanitation workers. "The man who comes to pick up your trash is earning $40,000 a year more than the EMT coming to save your life," Variale said. "That's why they're leaving. The support and funding for EMS is not there from the city of New York, and it seems that the mayor has no intentions of fixing it." He added that EMS workers are mostly people of color (59%) and that there's a substantial portion of women in the service (27%). Fire ranks, however, are less than 1% female and largely white.

Almojera said some EMS workers see the work as a backdoor way to become a firefighter. "They come on the EMS, they don't stay because it doesn't pay well — most of us have second or third jobs — and they leave for other agencies," he said. The city told Business Insider that its EMS pay is fair and, factoring in typical overtime, on par with that of the private industry, which employs the majority of EMS workers in the US. It also said paramedics earn more than entry-level police officers, firefighters, and sanitation workers. "The salaries that we pay to EMTs and paramedics are competitive with private-sector salaries in New York City," Laura Feyer, a spokesperson for Mayor Bill de Blasio's office, told Business Insider in a statement. "In many other fields (e.g. engineers, IT personnel, lawyers, architects, and press reps), public sector pay lags behind the corresponding private industry. Here, salaries and benefits are both better overall for FDNY EMTs and paramedics when compared to their private-sector counterparts."

An ambulance drives across a nearly empty East 42nd Street in heavy rain and high winds in Manhattan during the outbreak of the coronavirus disease (COVID-19) in New York City, April 13, 2020. Mike Segar/Reuters

​But Variale said salary comparisons to the private sector are flawed, since many private workers are offered free education, childcare, and other benefits not afforded to EMS workers. Plus, he said, FEMA EMS workers summoned to NYC make about five times the salary doing the same work. And in some cities, such as Austin, Texas, and Oakland, California, experienced EMS workers bring in salaries on par with NYC firefighters or police officers. The New York Times editorial board pointed out in September that city officials had said paying paramedics and EMTs a salary comparable to firefighters would cost $450 million annually. "Cutting down on overtime pay at the Fire Department — which amounted to more than $340 million in fiscal year 2019, which ended in June — may help," the board wrote. In the context of the pandemic, Variale and others believe the lack of pay parity and the high turnover is costing lives.

Flatlining experience

Before the pandemic, New York City recorded about 50 to 70 calls for cardiac arrests each day. But in the second week of April, the FDNY said it received more than 300 per day, sometimes nearly 400. Cardiac arrests are frequent among critical COVID-19 patients; with less oxygen in the blood, hearts must work harder to move it around the body. The city estimates that about 200 people died from cardiac arrests as the pandemic peaked. Many of those perished in the care of EMS teams at their homes, and sometimes in front of family members.

In general, research suggests that an EMS team's experience level with cardiac arrest impacts the survival rate of patients with such an emergency.

An elderly person is admitted to NYU Langone Health Center on March 23, 2020 as New York City grapples with a coronavirus outbreak. Angela Weiss/AFP via Getty Images

A study from 2016 examined more than 21,000 out-of-hospital resuscitations attempted by thousands of paramedics in Victoria, Australia, over 10 years. Researchers concluded that the more revivals a paramedic had attempted in recent years, the more likely a patient was to survive long enough to leave a hospital. A 2018 case study (titled "Does Experience Matter?") looked at more than 340 paramedics and their out-of-hospital cardiac-arrest outcomes in urban San Antonio, Texas. For every 15 cardiac-arrest emergencies, the report found, a medic with 10 or more resuscitations under their belt revives one more person than someone with less experience.

"The more experience you have as a medic, the better you are. You wouldn't go to a hospital if everybody there had less than four years experience. But for some reason that's okay when we bring the hospital to you? No, that doesn't make sense," Almojera said. Variale said that for New York City residents at risk during the pandemic, the loss of experienced paramedics is "endangering their lives unnecessarily." "We were warning people about this stuff. We were telling people that staffing is inadequate. We were telling people this is gonna endanger people's lives. And nobody was listening," Variale said.

Joe McWilliams, a lieutenant EMT in Brooklyn, told Business Insider that it's well understood internally that "experience is paramount on this job." "The city and the department don't value it at all," McWilliams said. "We see experience walk out the door every day, and the public loses out there because we hire 18-year-olds to do this job. But the responsibilities that we put on their shoulders, in my opinion, far exceed the maturity of your average 18-year-old."

Frank Dwyer, a spokesperson for FDNY, emphasized that the deadly nature of New York's coronavirus outbreak isn't the fault of current EMS staff, however. "Anyone criticizing EMS members for survival rate during this pandemic is off-base. They are performing at the highest level possible," Dwyer told Business Insider.

 'The time is now to fix the problem'

Nationwide, a typical EMS worker makes about $17 an hour, according to federal data, whereas firefighters typically make 40% more and police officers almost double. Intercity bus drivers also earn more per hour than a typical ambulance-unit employee. National EMS worker representatives say the incongruent wages is a longstanding issue that's reducing ambulance workers' experience across the country. They worry we are now seeing a "calm before the storm" since other states and metropolitan areas are still approaching their peak in cases. "Folks don't understand where the industry was to begin with before this started. There was a paramedic shortage and has been for the last two years. And before the pandemic started, we were starting to see an EMT shortage," said Petit, who's also national director of the International Association of EMTs and Paramedics. "We're screaming for help."

President Donald Trump plays a clip of New York Gov. Andrew Cuomo praising the federal government's coronavirus response, with a portion edited out in which he was critical of the president. Tasos Katopodis/Getty

Nate Smith, an EMT in Michigan and national representative at the International Association of EMTs and Paramedics, said many people choose not to pursue the job "because it's not a well-paying career." "The time is now to fix the problem. The shortage of EMS professionals dates way back before this pandemic," Smith told Business Insider. New York Gov. Andrew Cuomo, who is often at-odds with Mayor de Blasio, has proposed a 50% hazard-pay bonus to all frontline workers during the pandemic, ranging from grocery clerks to healthcare staff. Variale said he and his colleagues feel compelled to speak up during the pandemic until city leaders make systemic changes for emergency responders. "We're not shutting up," Variale said. "We're gonna continue talking."

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