The Plight of Paramedics in the United States

Paramedics are suffering. They are dying. They are in pain; their relationships and personal lives in shambles. And yet, no one seems to care.

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Paramedics learn on their first day that they are entering a field in which the hours are long, the pay is abysmal, and the conditions are deplorable. In spite of this, many continue their training and enter the field. They call upon the prospect of something new and exciting to drive them. They yearn for a field that might allow them to save a life, make a difference, and offer excitement from time-to-time. But, are abysmal pay and long hours truly necessary for the delivery of emergency medical care? Should paramedics get paid more and be allowed to demand better working conditions?

Paramedics must be paid more. Paramedics do deserve basic labor rights and safe working conditions. It’s not selfish for someone who has entered a selfless profession to strive for a better life for themselves and their families. Anyone who tells you otherwise is either despicably self-serving, or is delusional.

The long hours that paramedics are subjected to are brushed aside by public and professional leadership alike with fragile justifications. One such justification is that paramedics are allowed to sleep during their long shifts. “What a gift!”, emergency medical services (EMS) leadership would tell you. How could paramedics ever complain about such a thing? When evaluated discerningly, however, sleep is never guaranteed while on shift and is rarely restful. Sleep deprivation is the root of many long-term detriments on paramedics, and its effects are prolific.

Paramedics work anywhere from 12–36 hours (and sometimes longer) without a single uninterrupted break. Indeed, this is not an occasional happening. Paramedics must consistently stay awake for 24 hours or longer, without promise of food, drink, or rest. During those 24 hours, the paramedic may be asked to do tasks as mundane as driving the ambulance, or as serious as placing a breathing tube in the trachea of a dying child.

Sleep that occurs during a paramedic’s shift is of a broken, ineffectual brand. Sleep is interrupted often by the sound of a radio or “tone”: a loud auditory signal designed to jolt paramedics awake. As the body and mind are yanked from sleep, the heart rate and blood pressure sky rocket. Dizziness, headaches, and nausea are common. The paramedic must go to the ambulance, stumbling under the weight of utter exhaustion, to care for someone in dire need.

The disruption of the paramedic’s sleep cycle persists during their days away from work. Excessive sleep during time-off may be necessary to pay the debt for lost or ineffective sleep during shifts. Paramedics never can truly get rejuvenating sleep, whether at work or at home. They must contend with a biological clock that does not know morning from night, and is never allowed to reset.

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Lack of sleep has been indicted in a variety of mental and physical damages, including (but certainly not limited to) shorter lifespan, higher incidence of heart attack, higher incidence of stroke, and high blood pressure. Also, increased rates of depression, suicide, and post-traumatic stress are linked to sleep deprivation. Plenty of literature exists on the negative effects of poor sleep, and plenty of literature exists on the poor mental and physical health of paramedics. It is easy to surmise that sleep deprivation is a significant contributor to the poor health of paramedics.

Paramedics must work at night and on weekends. This is an inevitability of working in a field that responds to other’s emergencies. But, they shouldn’t work 24 hours straight, 36 hours straight, or longer. Paramedics should not work 80 hours or more per week. To combat the negative effects of working night shifts, perhaps shorter (8–16 hour) shifts and shift regularity would be helpful. Currently, paramedics often switch erratically from night shift to day shift. Shift regularity would support a normal sleep cycle for paramedics, at least in relative terms.

Paramedics suffer because of the constant imbalance of their sleep cycle. These sleep cycle disturbances are caused by ludicrously long hours and erratic shift scheduling. Simultaneously, paramedics must endure long hours away from family, friends, and personal life. Birthdays are missed. Holidays pass by. Life itself slips away. And, in turn, they lose every opportunity to recover from their work.

Compounding the issue is deplorably low pay. The most often heard arguments against higher pay for paramedics tend to revolve around low insurance reimbursement rates, lack of public funding, and significant downtime on shifts. Employers often justify their low pay rates by telling employees that they can tap into a trove of money, as long as they are willing to work excessive amounts of overtime. The employer will pay a lot, on the condition that the paramedic works a lot. If they have the money to give out copious amounts of overtime pay, why is it that the same money cannot be redirected to a more reasonable base pay rate?

If a paramedic works 40 hours per week, they will be rewarded with a pay rate that can compared to that of retail workers, trash collectors, and restaurant workers. The singular way a paramedic can make a comfortable living is if they relinquish their personal life, family life, and social life… along with their mental and physical health. If a paramedic works 40 hours a week or less, they are resigning themselves to perpetual poverty.

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The median salary of a paramedic in the United States (as of 2017) is a measly $33,380. A police officer’s average salary as of 2017 was $61,050, massage therapists made an average of $39,990, and medical secretaries averaged $34,610 annually. How is it justifiable that paramedics are the lowest paid of these professions? An individual needs more formal education to be a paramedic than any of the other professions listed. These other professions can expect more reasonable working hours. Even police officers, who work nights, weekends, and holidays, are infrequently forced to work a full 24 hours or longer (as paramedics are forced to do constantly). Also, except for police officers, these other professions carry a great deal less personal responsibility in their work. If a massage therapist makes an error, a client is unhappy. Perhaps if they make an egregious error, the client suffers from pain or minor injury. If a paramedic makes an error, another human being dies.

Perhaps the most staggering comparison to make is that of paramedics to nurses and respiratory therapists. Paramedics, respiratory therapists, and nurses all offer a comparable level of care. They all must undergo extensive training to work in their profession, and all have a great deal of crossing over of roles and responsibilities.

Paramedics have more training, knowledge, and skill than is often assumed by those outside of the field. They can give medications, provide advanced airway management (such as intubation), interpret EKGs, start IVs, along with a variety of other skills. Paramedics command a broad scope of skills that nurses and respiratory therapists cannot independently bring to the table.

I do not make this comparison to disparage nurses or respiratory therapists. These individuals have a deep knowledge base in their given areas of expertise, and work hard to offer effective, collaborative care to the patients they serve. But, paramedics are asked to keep a massive, multidisciplinary breadth of knowledge and to use that knowledge with little oversight. In light of this, how does one justify that the top paid 25% of all paramedics make about $13,850 less than do the lowest paid 25% of all nurses? Similarly, how does one justify that the median salary of respiratory therapists in 2017 was $26,330 higher than the median salary of paramedics in the same year?

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Why does this massive pay gap exist? Some argue that you need more education to be a nurse or respiratory therapist, so they deserve much more money. This is marginally correct. Respiratory therapists need a two-year degree in most cases and many are now pursuing four-year degrees. Similarly, nursing requires a minimum of a two-year degree, and has made fantastic strides towards requiring a four-year degree to enter the profession. Paramedics, in contrast, can complete a certificate program that takes somewhere between a year and a year and a half to become licensed.

Although this is the case, two-year paramedic degrees are becoming increasingly popular and common. Four-year paramedic degrees are not common, but exist and are growing in popularity. This small difference in educational requirements does not justify the massive difference in pay.

To be worth more money, paramedics need to increase their education standards. Requiring a two-year degree is a good start. But, pay has to start to increase, and working conditions must improve before an increase in education requirements happens. Otherwise, no incentive exists for people to get a higher academic degree to enter the field.

How can we require that paramedics complete a collegiate education when they know that they will make an average of 50% less than nurses and respiratory therapists? Why would they choose a life of struggle and hardship when they could pursue a collegiate education to become a nurse or respiratory therapist, and live a comfortable, stable life? The reality is, if you want paramedics in your community to be educated and experienced, the pay must be higher.

The heinous conditions that paramedics exist in are a discredit to the health care system of the United States. Paramedics are treated as disposable assets that are easily replaced. Much like a fire extinguisher in a cabinet, paramedics (and their problems) are willfully cast out from the collective consciousness of society, so no one has to acknowledge that they may need a paramedic someday. Paramedics come to people on their worst day; exhausted and dejected… and still yet, willing to help.

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A career as a paramedic mandates one of two routes: either accept that working in EMS will render you mentally, physically, and financially desecrated — or accept that you want better for yourself and your family, and change careers.

What I am asking of you, the reader, is to push for a third route for the betterment of your community, the healthcare system, and those who would care for you on your worst day. I am asking you to push the leaders in your communities to mandate a fair wage and basic labor rights for paramedics. To mandate pay that allows paramedics to work reasonable hours, and to pressure ambulance companies to allow paramedics to work shorter, more regular, safer shifts.

We, as paramedics, have already tried to do this, and it hasn’t worked. EMS is a small community, something we are proud of. Yet, this point of pride is also our downfall. We do not have the sheer numbers to stand against the deplorable labor practices of our industry. This is why we need you.

You may ask: if the conditions are terrible, why not leave EMS? Why not stop being a paramedic? The answer is, a lot of us do, but wish we didn’t have to. We care about this job, we care about our community, and we care about you. We will always be there for you in your time of need, but will you be there for us?

Overview of nurses, respiratory therapists, and paramedics (including the salary data used for this article):

Resources discussing mental health and paramedics:

Articles on sleep and sleep deprivation:

Articles on pay in EMS:

I am a writer; for fun and for work. I am also a doctoral student in clinical psychology and paramedic.

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