BENTONVILLE, Ark.— A mock-up of an ambulance filled one corner of the classroom and simulated hospital rooms took up the opposite wall, but Grant Wilson’s students one recent morning were focused on the 3-inch-thick books in front of them simply labeled “Paramedic Textbook.”
That day’s chapter was on toxicology, dealing with every variety of poison or toxin that could be in someone who called for an ambulance. It covered how to clean out a stomach — “like flushing a transmission,” someone joked — and how to deal with a chemical found in badly made moonshine, which got more chuckles from the group.
“This is the time of year, weather’s cooling off, CO (carbon monoxide) and cyanide are going to hit big time,” Wilson said, referring to potentially deadly compounds released into the air by many indoor fires.
His students were emergency medical technicians, most of whom work for area fire departments, according to the Northwest Arkansas Democrat-Gazette. They’re working to make the jump to fully fledged paramedics, who can provide more extensive and complex medical care than EMTs to an ambulance patient on the way to the hospital. Several said they relished the chance to be able to offer more help at what can be someone’s most dire moments.
“As an EMT, you’re set in a rhythm,” giving the same basic first aid in most calls, said Joey Spivey, who works for Bentonville Fire. “As a medic, it’s on my shoulders.”
Fire and ambulance services across Northwest Arkansas say they desperately need people such as Spivey because there are barely enough paramedics to go around. No health official could give a firm number for the region’s paramedic needs, but hints pop up throughout Benton and Washington counties.
Wilson’s yearlong course at Northwest Arkansas Community College could hold 26 students, but has 18. Central EMS, covering all of Washington County except Springdale, has had an open paramedic position for weeks. Departments complain of dipping into overtime to cover similar gaps and to make sure all ambulances have a paramedic on board.
The situation is so urgent many departments nonetheless cover the cost of training their EMTs into paramedics — often between $7,000 and $8,000 at NWACC — while also continuing to pay EMTs’ salaries while they’re taking the course and paying other EMTs to fill in for them in the meantime.
“The last few (paramedics) we’ve hired have either been from Missouri or Oklahoma,” said Chief Stephen Sims of the Bella Vista Fire Department, which, like most ambulance services in the area, employs people trained as both firefighters and EMTs or paramedics. “I mean, there’s just nobody out there to hire.”
No individual ambulance has been short-staffed, but several chiefs said the problem will only grow if nothing is done. It also wears on the paramedics who work an already challenging job.
In Gravette, where a fire department with eight positions provides ambulance service to Benton County’s northwest corner, paramedic and captain David Orr occasionally has worked shifts more than 80 hours long in the past two months to fill an empty paramedic position. A typical shift is 24 hours long, followed by 48 hours off.
“After you’ve been here two or three days it starts to wear on you pretty hard,” Orr said, adding his girlfriend’s youngest child, a toddler, forgot who he was after one long shift. Frivolous calls — Orr recalled one from someone with insomnia, another for a mild fever — wear him down the most, and he must go to every one while on duty. Even when the department’s fully staffed, it can still be stretched if more than one call comes in at once or someone can’t come in.
“Right now, if I call in sick, I have to schedule it,” he said.
Departments across the state have complained of the shortage, mostly in rural areas, said Greg Brown, chief of the Arkansas Health Department’s emergency medical services branch. Scattered reports around the country from The Associated Press and other news outlets have described localized shortages as well.
For many, the problem seems to come down to pay, Brown and other officials agreed.
Departments’ starting salary for paramedics range from about $35,000 to $40,000. At the low end, a week with three 24-hour shifts would translate to an hourly wage of less than $10 for high-stakes, high-pressure work at any hour of the day with varying amounts of sleep in between.
“I go back to school for another year and a half to nursing school and double that or triple that,” Brown said. A registered nurse in Arkansas made, on average, about $57,000 in 2015, according to the U.S. Bureau of Labor Statistics, compared to about $35,000 on average for all EMTs and paramedics.
Some paramedics go on to work at hospital emergency rooms instead of ambulances even without becoming nurses because of better pay or other reasons, Brown and other officials said. In rural areas especially, “the argument from folks is always, ‘Why do I want to move to Monticello for $11 an hour?’“
Ambulance services also compete with one another. Becky Stewart, chief for Central EMS, said many of her paramedics plan from the beginning to eventually move to the major fire departments, which can offer generous retirement benefits. Starting pay for paramedics at the public service is about $38,500.
“It’s important for people in this profession to have their time off, away from everyone else’s chaos and tragedy,” she said, adding seven of her EMTs are at NWACC or other paramedic training programs, and she expects to need them all to keep her paramedic numbers steady. “There’s not a lot of return of what you do except for knowing you’ve done the right thing and done a good job and helped somebody.”
About 2,200 people have worked as paramedics in Arkansas this year, according to Health Department data. That’s half the number of EMTs, but has increased about 13 percent since early 2013.
It’s not clear how many of them are working somewhere other than an ambulance service, Brown said. The last major survey of all of the state’s paramedics came about a decade ago, when virtually all worked on ambulances, he added. “Today that’s not the case.”
The department next spring will be renewing registrations for about half of the state’s emergency medical service providers and plans to ask all of them where they work, Brown said.
The temptation to become a nurse was clear at NWACC’s class Tuesday. Morgan Mauldin, an EMT in Kansas, Oklahoma, said her mother and grandmother were nurses, and moving from EMT to paramedic to nurse was her original plan. The plan changed after getting a taste of the EMT life.
“I did my first ride out as an EMT and I was like, ‘Forget that,’“ Mauldin said with a laugh, referring to becoming a nurse.
Adina Schumacher, an EMT with the Northeast Benton County fire and ambulance service, said she eventually hoped to become a nurse, but not for several years at least.
“That’s more for when my body can’t handle the stresses of being an EMT anymore,” she said.
Schumacher’s point brings up another factor that could be tamping down the number of paramedics: It’s “a young person’s occupation,” as Brown put it. Most in the NWACC class, for example, are in their 20s or 30s, with a couple in their 40s. Brown has been a paramedic for about 30 years but said he hasn’t been on an ambulance in more than a decade.
The state and local departments have taken some steps to attract more people to the paramedic field. The Health Department now allows 40 percent of the required coursework to be done online, for example, and continuing education requirements decreased from 72 hours every two years to 50 hours. Wilson, the NWACC instructor, said the course had been pared as much as possible while still giving enough training to do the job well.
There is occasional good news in the profession. NWACC’s paramedic class, though still not full, has grown from 12 students a couple of years ago to this year’s 18. Douthit said recently a Missouri paramedic passed Gravette’s application process and would likely take at least a part-time position there. Cody Keller, a Springdale Fire Department EMT in the NWACC class, said the culture among firefighters and paramedics alike has shifted, actively encouraging people to become paramedics.
