ABSTRACTS
A Statewide Analysis of EMS Workforce TrendsAuthor: Jackson Déziel PhD, MPA, NRP | Professor | Santa Rosa Junior College Associate Authors: Braithwaite, Susan, EdD, NRP
Introduction As of June 2025, nearly 25% of paramedics and 35% of EMTs in North Carolina hold a valid certification but do not work in that capacity. This inactive dearth begs the question of why anecdotal evidence continually points towards EMS staffing challenges. While many answers are apparent, there may be opportunity for administrative intervention in procedural arenas. Methods A cross-sectional survey was distributed to assess staffing levels among North Carolina EMS agencies. The survey was distributed to top-level EMS administrators in North Carolina. Survey responses were collected from February 1, 2025, through February 28, 2025. Elasticity and semi-elasticity functions were derived with average marginal effects. Due to potential endogeneity, statistical modeling was further validated using a general method of moments (GMM) instrumental variable. Results Survey responses represented 54% of North Carolina’s EMS systems. A majority (90%) of EMS agencies reported constant or improving staffing trends but indicated difficulties in hiring, with only 14% reporting no difficulties in hiring. A median of nine weeks were needed to hire paramedic positions and four weeks for EMT positions. A 10% increase in onboarding time for new paramedic employees increased subsequent paramedic hiring time by 3.8% (p=0.001; 95% CI: 0.168 – 0.581). And a 10% increase in onboarding time for new EMT employees increased subsequent EMT hiring time by 5.2% (p<0.0001; 95% CI: 0.299 – 0.735). Average marginal effects estimated a one-week increase in onboarding time for new paramedic employees increased subsequent paramedic hiring time by 0.46 weeks (p=0.001; 95% CI: 0.206 – 0.714). A one-week increase in onboarding time for new EMT employees increased subsequent EMT hiring time by 0.42 weeks, 2.94 days (p=0.001; 95% CI: 0.171 – 0.664). The GMM function validated these findings. Conclusion With a significant number of inactive EMS providers in North Carolina and open positions available, there remain many questions as to why EMS agencies struggle with recruitment. There are a myriad of answers, and one overlooked factor may be one of onboarding time. Administrators should evaluate their onboarding practices to aid in the speed of hiring subsequent open positions, as extended onboarding practices appear to significantly increase hiring times.
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