What Stressors Stand in the Way of a Long and Full EMS Career?

Jordan Malone, age 23, followed a clear path along a path to an EMS career, from a Boy Scout Explorer program ambulance ride-along experience with Austin-Travis County, Texas, EMS when he was 14 to a one-semester EMT course at his local community college after high school. Hired as an EMT by Austin-Travis in 2020, he pursued its in-house paramedic school, obtaining his license in May of this year. He’s now in its ALS (Advanced Life Support) Academy, hoping to get further dialed into EMS medicine.

Malone gets together regularly with other Austin medics for physical activities—running, swimming, weight-lifting. “I try to be very intentional about taking care of my health. I think you can never start that stuff young enough,” he says. “I know plenty of medics and I’m constantly watching people that are further along in their careers, seeing what I like about their paths and what I don’t like.” Along with exercise and nutrition, that includes mindfulness meditation, “which has become increasingly popular. I have found some real benefits in that, using online apps like Calm and Insight Timer.”

Physically, ambulance work can be demanding, Malone says. “You have to lift and move the patients and carry a lot of gear while hiking up and down stairs. Emotionally, it can certainly be taxing when you’re constantly seeing people on the worst day of their lives.” But it’s exciting to respond to emergencies and feel like you’re making a difference.

He believes that EMS work has become more manageable in recent years—at least where he works. “We’ve been given a lot more tools to deal with the job stressors, and it’s being talked about more. We have an excellent peer support team. We have access to free mental health counseling, so I can go talk to psychologists or psychiatrists. I feel very supported in that way. It feels like the culture shift in EMS is that it’s okay to not be okay, to reach out for help.”

What Are the Biggest Hurdles?

Malone is starting his paramedic career with a lot of enthusiasm. Why have so many experienced paramedics lost that enthusiasm and left the field prematurely? Although a few have managed to piece together careers of 40 or more years (See “How Long Can a Paramedic Stay on the Job,” EMS World, November 6, 2023), the average career as a paramedic in this country is only 6.5 years.

Paramedics are well-trained, highly skilled health professionals in a demanding job who acutely feel the lack of respect from the public, their agencies, and other health professionals—respect that their skills and the rigors of the job should entitle them to.

Paramedic, preceptor, and peer counselor Jacob Allen Espy, age 34, who works for Falck Northern California, an ambulance company, says he loves his job—except for the pay, which he feels is not commensurate with the work he performs. “I like helping people, having the autonomy to treat my patients within our protocols,” he says.

"There might come a day when I have to leave this career because it does not provide enough for my long-term goals.” Those goals could include marriage, children, and home ownership. “I can make this lifestyle work as a single guy. Other paramedics have to work overtime just to feed their families with 60-to-70-hour weeks, and that’s unacceptable.” Plus, they face mandatory overtime on their precious days off.

"Most of us who live in the Bay Area will rent all of our lives if we choose to stay in this career,” Espy says. Or they could commute 70 miles from Stockton in California’s Central Valley, where real estate costs are lower, as some of his colleagues do. Espy shared his views with EMS World on a routine Friday evening ambulance ride-along in Southern Alameda County, which demonstrates the multiple decisions, tasks, procedures, equipment use, checklists, and teamwork that a skilled paramedic routinely juggles on the job—along with lots of miles on the road.

“I really like taking critical calls. It’s fun to be doing a lot of different stuff to help people. I’d rather that I take that difficult call, with the confidence I can help this person.” But Espy acknowledges that stress and burnout can accumulate from the slow grind of the job. “We see the gory, the sad, the gross—things that most people shouldn’t see,” he says.

“We’ll have spikes of stress that for me tend to come from accidents on the freeway or a pediatric emergency," he says. "I’ve had eight successful live births on this job. For me, bringing life into this world is a very rewarding experience. But a lot of paramedics are terrified of labor and delivery emergencies."

Stress ‘Junkies’

There is a common image of paramedics as stress “junkies,” Espy acknowledges. “There’s definitely a group of people who thrive in high-octane, stress-filled environments. Some people get into this field to see the crazy things.” Others do it to help people. Some eventually opt for lower-stress roles like transporting patients to psychiatric hospitals or between health facilities.

Cardiac arrests, in contrast, seem less stressful to him because the EMS crew’s job is straightforward, and clear-cut, following the protocols. “We’re working under our medical director’s license and orders. But we still have to interpret and make decisions based on our assessment skills.”

For ten-year EMT Claudia Cadena, also with Austin-Travis County EMS, the physical demands of the job and its negative impact on her own health, combined with the challenges of raising two kids and commuting 100 miles to Austin following her family’s recent move to San Antonio, make a long EMS career look less and less likely.

When a big snowstorm hit Austin in February 2020, she was carrying an EMS stair chair on a frozen road and ended up slipping and falling—tearing a ligament and damaging cartilage in her ankle. After two surgeries, with plans for a third to try to remove some Stage 3 osteoarthritis in her ankle, she is on unpaid leave from her job. She has been told it’s too late to apply for coverage of the disability that gradually emerged after her on-the-job spill on the ice.

Today Cadena feels cast aside by the career she loved. “No one has really reached out to me about other options. They said I could do dispatch. But only on 12-hour shifts, which would keep me in Austin, away from my kids, four days a week,” she says.

“I’m only 33. I loved that job and I had done it since I was 23. Before I had kids, I gave all my attention and empathy to my job—110 percent.” A runner, strength trainer, and kids soccer coach, she says, “Now I’m never going to do the things I loved to do.”

Other variables in paramedics’ ability to stay in their jobs include:

• Variation in the type and structure of the EMS agency—fire department, hospital-based, third service (governmental), private company;
• Whether the agency’s leadership—even with management also stretched thin—has shown that it has their backs;
• Hours, workload, and the volume of mandatory overtime shifts;
• The long-term negative effects of sleep deprivation and fatigue;
• The moral hazard of answering calls for psychiatric or drug-using patients who may not actually need emergency response;
• High injury rates on the job; and
• Dealing with personal threats or acts of violence in a job that has gotten ever more dangerous.

“People’s bodies give out,” said Selena Xie, an EMS paramedic, captain, and president of the Austin EMS Employees’ Association. “We are asking more and more of our paramedics, while pay continues to be an issue and it doesn’t feel like there are enough opportunities for job growth.”

For Henry Lewis, executive director of the South Carolina EMS Association, scheduling remains a big concern. Even though many medics say they prefer 24-hour shifts, they are paying a price. “More traditional business schedules, as opposed to working 24-to-48-hour shifts, will be critical for longevity in this career path."

SCEMSA, which represents 270 licensed providers in the state, has been studying the workforce, trying to get a better handle on career opportunities, educational needs, recruitment, and retention.

Medical School Calls?

Jacob Espy says he and his girlfriend have started exploring better work-life balance alternatives, such as moving to an area with a lower cost of living and a third-service EMS agency. He's also interested in upward mobility within the field, perhaps becoming a field supervisor or trainer, although his lack of a college degree closes off other options for advancement. "I have education as a paramedic in the pathophysiology of illness and etiology of disease, but it's not a college education," he says.

Cassi Lydon, an 18-year veteran paramedic with Austin-Travis EMS, says she feels lucky working for a third-service organization with a strong union, good contract protections, and stipends for additional education. "With our most recent contract, we're allowed to request a break after being out of station for a certain number of hours." A number of the stations offer kitchens, recliners, televisions, washing machines, and even the opportunity to catch an hour's sleep.

Because of contractual provisions when she started working, Lydon is eligible for a pension after 23 years of service—in just five more years. "So I'm actually going to be able to retire from this job when I'm 48. Then my plan is to get training as a death doula, which is something I'm really passionate about."

Jordan Malone at 23 is already a union representative and serves on the local's Board of Directors. All in all, he's just the kind of candidate one would want to have a long and satisfying career as a paramedic—not a career curtailed because of physical injury, emotional strain, stress, and burnout, like so many others in this field.

But because he came on board under different city contract provisions than Lydon, he has to reach both 30 years on the job and age 62 in order to qualify for a full EMS pension—which at this point seems unattainable, 39 years in the future. He is already thinking about what might come after his next three to five years as a paramedic. That likely includes applying for medical school. Becoming a doctor may not be an easier ride than the ambulance crew, Malone says, "but I've always enjoyed a good challenge—and I'm always looking for what comes next."