Another Look at EMS Staffing in Action

In South Africa, public employees have been striking recently, with the primary points of contention, according to credible news reports, being problems related to wages and housing allowances. Both sides acknowledge the need for increases not only to keep up with inflation but also to bring public employees’ wages closer to the national average. However, management and labor still disagree about exactly how much employees should receive over their cost-of-living increases. One unfortunate result of the strike has been that it has not only hurt the health care system in South Africa but has also been blamed for a number of deaths.

Disagreements between management and organized labor are not uncommon in any modern nation. A number of laws in the United States (and several other countries) prohibit “essential” public employees from using a “job action” such as a strike or “sickout” to pressure government officials. The reason for these laws is primarily the types of work paid for by taxpayers and performed by public employees. Almost all first responders, to cite perhaps the most obvious example, are either public employees or contracted to public agencies.

A job action for EMS (Emergency Medical Services) workers is almost always a losing proposition for labor. Beyond the threat of legal action – e.g., two days of pay lost for each day of job action – it is very easy for management to spin the usually erroneous concept that EMS staff care more about their own pay than they care about the patients who are (or are considered to be) their primary concern. In fact, that argument is exactly what is being put forth in South Africa.

Actions, Explanations & Sometimes Successful Strategies 
Nonetheless, a job action is also not beneficial to management itself because, regardless of how it ends, the loss of staff availability for even a short period of time will still have to be resolved – and explained to the public as well. One way of filling the resource gap during a strike or job action is to request additional staff from other agencies, in the same general geographic area, under mutual-aid agreements. However, that strategy can be successful only when the community providing the assistance is not subject to the same loss of personnel resources. Many political jurisdictions contract out their EMS responsibilities – but there are often only a few major contractors within a region, particularly in nations with relatively low population densities.

The sharing of common employee sources can be beneficial, therefore – but it can also be injurious, depending on local circumstances. When neighboring towns use the same contractor, they have the benefit of their EMS units (and other first-responder agencies) sharing dispatch, command, communications, and other personnel and equipment resources. However, in a job-action situation, communities that use common contractors almost always are staffed by common labor pools as well.

Blizzards, Warm Bodies & Budget Shortages In desperate times, as officials at all levels of government – and in the private sector – well know, desperate measures must sometimes be taken. When resources do not meet current needs, decision makers are often forced, particularly in the medical-care field, to meet those needs by using staff that are not typically trained for EMS work. For example, during severe blizzards in New York City, the New York National Guard has often been employed to assist EMS units in getting to the scene of a major incident both safely and rapidly. In similar fashion, many emergency management plans in communities throughout the United States call for the use of fire and/or police staff to augment the EMS ranks.

Here, a cautionary note is recommended: When planning to use non-EMS resources for EMS tasks, special care must be taken to ensure that the orders given are both effective and legal. Many states such as New York have statutes in place that specify the minimum staffing required for an ambulance. But with budgets shrinking almost everywhere, ambulances are often staffed at the minimum level allowable.

Substantively, this means that adding additional warm bodies does not necessarily add ambulances to the operational inventory at the same time. For example, in New York, a BLS (Basic Life Support) ambulance must by law have two emergency medical technicians (EMTs) assigned. During the blizzards earlier this year, when National Guard resources were added, they operated in addition to rather than as replacements for the two EMTs.

For legal as well as operational reasons, many emergency plans call for the use of fire-service personnel – largely because many fire departments require that their firefighters also be qualified as EMTs. However, even when that is the case, it is still possible that organized labor may be unwilling to cross the line during a job action.

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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