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Collier County’s EMS request for increased workforce highlights a state and nation-wide issue

Collier EMS ambulance as seen on the Collier County Emergency Medical Services government website. Collier EMS asked for an increase of 12 FTEs in order to fill vacancies in hopes to avoid burnout and fatigue.
Collier County
Collier EMS ambulance as seen on the Collier County Emergency Medical Services government website. Collier EMS asked for an increase of 12 FTEs in order to fill vacancies in hopes to avoid burnout and fatigue.

The Collier Board of County Commissioners unanimously approved adding 12 Full Time Equivalent (FTE) positions to the county’s Emergency Medical Services (EMS) division.

The addition of 12 FTE’s is meant to ensure the county’s EMS operation has sufficient staffing to support ambulance services, reduce overtime for paramedics and emergency medical technicians (EMTs), and to provide plans for EMS expansion throughout the next two years. EMS handles a multitude of medical, traumatic, and psychological incidents and EMS providers are critical to public health and safety, according to the U.S. Centers for Disease Control and Prevention.

However, our nation’s EMS system is facing a crippling workforce shortage, a long-term problem that has been building for more than a decade and Collier County was not spared in this nation-wide issue. Collier EMS has experienced an increase in sick leave usage, FMLA and workers’ compensation usage over the last two years due to COVID leave, injuries and needed time off to address fatigue and mental health.

“When employees are absent from work for any type of leave, vacancies must be filled with employees from other shifts working overtime,” Chief of Collier County EMS Tabatha Butcher said. “Filling these vacancies is mandatory so we do not reduce the level of service that we provide to our community.”

Prior to 2007, when Collier EMS added a growth unit, seven employees were added to provide the additional personnel to account for vacancies without utilizing overtime. This practice was eliminated during the recession and through attrition there are currently no people to cover those vacancies.

“For years, EMS has covered these vacancies with employees on overtime and we've managed and continue to provide timely and efficient service to this community,” Butcher said.

Within the past year and a half, Collier County’s EMS has seen an increase in call volume of nearly 14%. Collier’s EMS existing employees also worked nearly 80,000 hours of overtime within the past year, which cost over $2.6 million.

Collier County’s population is continually increasing, meaning the demand for EMS services will likely increase with it. All these factors can lead to burnout and fatigue of first responders, according to Butcher. “These men and women are passionate about what they do, and they want to continue to provide high quality service to this community,” Butcher said. “But they also need rest to prepare for the next shift to give their best to our citizens and visitors.”

EMS vacancies are not unique to Collier County. The neighboring Lee County has also seen vacancies in their EMS division. “Our county and board took steps late last year to address this,” Lee County Communications Director Betsy Clayton said.

In November 2021 the Lee Board of County Commissioners authorized the hiring of 21 additional EMS workers. The county also developed a new apprentice program, which is a collaboration between County Administration, Public Safety, Economic Development, Human Resources and Hodges University. In addition to the usual hiring of certified applicants, this program allowed the rapid training and onboarding of non-certified applicants, according to Clayton. Training takes seven weeks, plus one to two weeks to achieve state certification as an EMT.

Charlotte County Fire and EMS also approached their board and created 9 additional positions. For Charlotte County, it wasn't a matter of finding people. It was a matter of being able to fill vacancies for several different reasons, according to Charlotte County Fire & EMS Deputy Chief Michael Davis.

“This career field is very different and unique in a lot of ways,” Davis said. He explained that in many professions, if an employee were to not show up to work due to a number of reasons, that office door is shut, and nobody has to come in and fill that office. In the EMS field, that is not an option.

“For us, they're operational positions,” Davis said. “So, if somebody is scheduled to be at work, they're filling a required position. We just can't shut that ambulance down, or that fire truck down or that rescue down for the day. We have to fill that vacancy.”

Charlotte County Fire & EMS is a full-service career department that provides fire suppression and rescue operations and pre-hospital emergency medical care and transport. The department in Charlotte has seen similar trends in population growth, resulting in higher demand for their EMS services.

“We're growing,” Davis said. “We have a lot of tourism just like Collier County does. We have a lot of visitors. We are definitely growing in population and that's a direct correlation with call increases.” He said the work EMS staff provides is essential to the community. “We're public employees and we have to be available and ready 24/7. So, it's very imperative that we make sure our staffing levels can support covering those vacancies.”

Ensuring staffing levels cover vacancies has proven to be critical with the population increases Southwest Florida has seen. Changes in service demand require changes and adjustments in the deployment of staff and resources to maintain acceptable levels of performance and to continue to provide exceptional pre-hospital care.

With increases in demand comes increases of stressors on top of being understaffed and overworked. Mental health and fatigue in first responders are growing issues throughout the country. It is estimated that 30% of first responders develop behavioral health conditions including, but not limited to, depression and post-traumatic stress disorder, as compared with 20% in the general population, according to the Substance Abuse and Mental Health Services Administration.

Collier’s EMS staffing consists of three shifts of employees who work 24 hours a day. They work 24 hours on and have 48 hours off. Each ambulance is staffed with 2 employees per shift for a total of 6 employees per ambulance.

Collier County resident of 42 years, Denise Weaver, said she wants health of the emergency medical workers to be a priority. “With the news that the EMTs are becoming burnt out because they're understaffed and overworked, I feel good about it,” Weaver said. “EMTs definitely need to be well rested in order to perform their job.”

The addition of 12 FTE’s will cost just over $1.1 million annually.

The last major adjustment to EMS services in Collier County was in 2014, with a mid-year expansion of resources to address response times throughout the county.

“Like other first responders in Collier County, EMS is important to this community,” Butcher said. “They take care of the people and witness tragic incidents every day. Without our employees, we would not have the outstanding service we have. We must take care of them so they can continue to take care of others.”