ABSTRACTS
A Statewide Evaluation of EMS Certification and Licensure Longevity Among Underrepresented GroupsAuthor: Sara Cox | | Associate Authors: Andrea Cantwell-Frank, William McClurg, Stephanie Merriam, Kim Lew, Judith Gomes, Remle P. Crowe
Introduction: Women and racial/ethnic minorities are underrepresented in EMS, yet limited data exist regarding workforce exit patterns. Our objective was to examine licensure or certification patterns across different gender and racial/ethnic minority groups as a proxy for whether underrepresented groups leave EMS differentially. Methods: This retrospective analysis leveraged demographic data from the California Emergency Medical Services Authority Central Registry as of May 1, 2024. We included all EMS clinicians certified (EMT) or licensed (paramedic) in California, which both have 2-year certification cycles. We compared certification/licensure patterns (transitioned or lapsed) using Chi-square tests. Results: We analyzed 204,071 certification/licensure records. Of EMTs (n=186,361), 56.5% (105,227) lapsed. More female EMTs lapsed compared to males (48.3% v 31.3%, p<0.001). More female EMTs lapsed after one certification cycle compared to males (68.6% v 63.5%, p<0.001). Compared to White EMTs, more Asian EMTs lapsed (15.2% v 20.5%, p<0.001). Among lapsed EMTs, 66.7% of White EMTs lapsed after one certification cycle, compared to 87.1% of Asian EMTs, 77.8% of Black EMTs, and 76.9% of Hispanic EMTs (p<0.001). 9.8% of EMTs transitioned to paramedic. Females were less likely to transition to paramedic compared to males (6.3% v 18.9%). Compared to White EMTs, Asian EMTs were less likely to transition to paramedic (24.3% v 8.4%). Of paramedics (n=41,535), 60.4% lapsed. More female paramedics lapsed compared to males (28.6% v 20.3%). More female paramedics lapsed after a single cycle compared to males (16.5% v 13.5%, p<0.001). 10.9% of White paramedics lapsed compared to 6.9% of Asian paramedics, 12.1% of Black paramedics, and 6.0% Hispanic paramedics (p<0.001). Less Asian paramedics lapsed compared to White paramedics (6.9% v 10.9%). Among lapsed paramedics, 15.4% of White paramedics lapsed after a single certification cycle, compared to 11.5% of Asian paramedics, 17.5% of Black paramedics, and 11.2% of Hispanic paramedics (p<0.001). Conclusion: In this statewide evaluation, female and ethnic and racial minority EMTs lapsed at a higher rate, maintained EMT certification for fewer cycles, and pursued paramedic licensure at a lower rate compared to their male and White counterparts. Limitations include the inability to evaluate clinical use of certification or licensure.
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