James Campbell, chief of emergency medical services for the Montgomery County Hospital District, said paramedics and emergency medical technicians in Texas are being adversely affected by a shortage of workers.

A study by the American Ambulance Association in 2022 found the national employee turnover rate for emergency medical services is at an all-time high, reaching a range of 20-36%.

Campbell said MCHD’s turnover rate has been below the national average for the past three years, but numbers still remain high. In 2020, the turnover rate in Montgomery County for EMTs and paramedics was approximately 8%, doubling in 2021 to 16% before increasing in 2022 to 19%. As of May 2023, the turnover rate for this year is at 15%. Campbell said the goal is to be at or below 15%.

“One of the biggest contributing factors that is leading to the paramedic shortage is burnout—we’re busier now than we’ve ever been,” he said. “If you look at having more calls but fewer paramedics and fewer trucks on the road, it’s causing people to leave the industry.”

In order to address the high turnover rate, Campbell said his first step was to focus on employee retention. In January, MCHD implemented a schedule change to allow paramedics and EMTs five consecutive days off to help restore work-life balance.

Meanwhile, The Woodlands Fire Chief Palmer Buck said his department implemented a similar schedule change. Firefighters now work 48-hour shifts before taking four consecutive days off.

Buck said The Woodlands Fire Department has not been greatly affected by the EMS shortage and remains fully staffed. However, he said some services have been adjusted to help out with the regional paramedic shortage.

The fire department can now respond to medical alarms and write refusals for patients that do not want to go to the hospital without waiting for the signature of a paramedic, he said.

“All the fire departments have helped pitch in to keep ambulances available,” he said. “We work together to maximize that because that’s the goal—to always make sure someone is available to answer when there is an emergency.”

Sarah Cuccia, captain of professional development at MCHD, said hiring is another high priority for the hospital district.

The Texas Workforce Commission projects that the EMS occupation in the Gulf Coast, which includes Harris and Montgomery County, is expected to grow 22% in 10 years. Despite seeing a shortage of workers, Campbell said MCHD is 99% staffed as of late May. There are currently six open EMT positions and 14 paramedic positions.

To fill the remaining vacancies, Cuccia said the district is offering to pay tuition for EMTs to attend paramedic school. In exchange, new graduates commit to working at MCHD for at least three years.

“It’s a good opportunity if you’re an EMT and you want to be a paramedic,” she said. “You can go to school full-time and get paid to work full-time.”

Texas EMS Alliance, which serves as the state's public policy voice for EMS providers, listed pay as another major contributing factor to the shortage.

According to the U.S. Bureau of Labor Statistics, the annual median wage for paramedics as of May 2021 is $46,770. The average salary for EMTs is $35,470.

The average median salary for a paramedic at MCHD, according to Campbell, is $67,505 while an EMT’s median salary is $48,100.

Michael Furrh, a board member of Texas EMS Alliance, said the salary for first responders is paid through a city or county budget, causing challenges in upping pay.

“All of us want to pay our employees more,” he said. “Most of us can’t, but somebody will always be there to answer the call, it just depends on where you are in the state on how the shortage is being addressed.”