Indiana Emergency Medical Services Needs Assessment: Workforce and Training Issues

A mail survey was conducted to assess issues related to the EMS workforce and EMS workforce training in Indiana. Responses were received from approximately 45% of individuals and EMS organization contacted. Major findings are: Evidence exists of a shortage of EMS personnel in Indiana due to high vacancy rates. This is particularly acute in volunteer organizations, which report the greatest difficulty in recruiting EMS personnel. Paid EMS personnel work on average significantly more than a standard 40 hour week, and high percentages of EMS personnel add a second job. Because excessive working hours have been linked to low quality healthcare, this may indicate potential problems with the quality of EMS care. Differences in training needs and training received in areas related to cardiac care indicate potential disparities in the quality of care for heart attacks between rural and urban areas. Contrary to the Indiana requirements for recertification, it appears that a significant proportion of Indiana EMS personnel and organizations are not using audits as a tool for ensuring quality and developing skills. A wide variety of training needs have been identified. While some clinical skill areas (basic and advanced life support) are needed, many of these areas are in important non-clinical areas, such as automobile extrication, foreign languages, safety, and incident management. The training environment, both in terms of initial and continuing training, is so varied that it cannot realistically be considered a “system.” In the abstract, EMS personnel prefer “hands-on” type training, but when presented with specific scenarios they indicate a greater affinity for locally-delivered mechanisms such as classroom courses at a local school or computer-based training. This probably reflects the tradeoff between time and utility, and is consistent with findings that time is the largest barrier to continuing education and the high percentage EMS personnel who hold second jobs. Self-assessment of preparedness levels by EMS personnel reveals that the EMS system in rural areas is likely to be less prepared and capable than in urban areas. Volunteer organizations rate themselves as less capable than paid organizations, although this is largely not reflected in self-assessments by volunteer EMS personnel