EMS departments across North Carolina are understaffed and over burdened

EMS departments across North Carolina are understaffed and over burdened


By Rachel Crumpler and Clarissa Donnelly-DeRoven

About 10:30 a.m. on April 20, an 84-year-old Forsyth County resident tripped and fell to the floor in her kitchen. She laid there, unable to get up. Her husband quickly called 911. 

The dispatcher on the other end asked about the woman’s breathing. “Fine,” her husband said. 

And her pain? “An eight,” said the woman.

The dispatcher told the couple, who did not want their names to be used by NC Health News because of privacy concerns, that an ambulance would arrive as soon as possible but it might take a while. 

Confused, the husband asked if there had been a big accident, or something else, that was causing delays? 

The answer: “No, this is just normal traffic.” 

A half hour later, the woman was still stuck on the floor — with a broken hip, she’d later learn. Her husband called for an update.

Unfortunately, the dispatcher said, they’d need to wait a while longer. 

“They could not have been nicer or more concerned but they didn’t have anybody to send,” he said.

Time dragged on and the two grew more anxious. During the wait, the dispatcher did call back to check on her status.

But it took over two hours before the ambulance finally arrived.

“If I had told him that she wasn’t breathing or answered any of his triage questions negatively, I guess it would have gotten somebody there sooner,” the husband said. “But you can’t complain when that’s everybody that they have got.”

Staffing shortages

The post-pandemic labor shortage has hit nearly every position of every industry, and emergency services is no exception. To get a scope of how the labor shortage is hitting EMS offices in North Carolina, NC Health News sent inquiries to 22 county EMS offices, a mix of rural, suburban and urban areas. We asked about the current number of filled and vacant positions, any monthly reports or analyses the office had compiled about shortages since the start of the pandemic, and data on the county’s 911 call volume and response time. 

About half of the counties responded and provided the data. Nearly all of them were experiencing a shortage or had been in the recent past.

“[Staffing] is the number one issue that we have been working on for the past, really, year and a half as an association,” William Kehler said in June. He’s the chairman of the North Carolina Association of EMS Administrators and the director of emergency services in rural McDowell County.

For months, his local office struggled with high vacancy rates —  between 10 percent and 20 percent at any given time. The same has been true a couple of hours east in Mecklenburg County, one of North Carolina’s most populated regions. Jonathan Studnek, the deputy director of that county’s EMS agency, Medic, said the pandemic brought on the worst vacancy rates he’d seen in his 15 years there. 

Medic is budgeted for a mix of 374 EMT and paramedic positions. In June, 71 of those positions were unfilled — a vacancy rate of about 19 percent. Studnek said that’s about as high as the vacancy rate has ever been over the past two and a half years.

Studnek said the staffing crisis began for his county about six months into the pandemic. 

“People were getting tired of working in health care just in general and we started to see a little bit higher turnover, and with that higher turnover, we saw lower numbers in new hire classes,” he said. “One of the precipitating factors early on was that a lot of the education institutions had to take a pause, and so new EMTs and new paramedics weren’t necessarily right in the pipeline.”

Across the state, EMS staffing was so strained that the North Carolina Department of Public Safety requested the support of 50 ambulances and crews from the Federal Emergency Management Agency, or FEMA. Twenty-five ambulances, each with a two-person crew, arrived in September 2021 to temporarily help nine counties. In early 2022, with the labor shortage persisting and cases surging due to widespread infection with the coronavirus Omicron variant, the federal agency dispatched more ambulances around the state. 

“That really provided relief to our team,” said Studnek, whose EMS agency benefitted from the assistance of FEMA ambulances.

“It lowered their daily demand just a little bit and allowed us to maintain some protection on responding quickly to our sickest patients.” 

Increased call volumes

Alongside the historic vacancy rates, emergency services officials say they’ve also been busier than ever.

Daren Ziglar, the director of Forsyth County EMS, told NC Health News in July that the first months of the pandemic in 2020 caused an “extreme drop-off in calls,” since people were afraid to leave home and possibly be exposed to the coronavirus.

“Once it opened back up, it came back with a vengeance,” Ziglar said. “We still run COVID calls but we’re running more shootings, we’re running more heart attacks, we’re running more of everything.”

From 2020 to 2021, Ziglar said his department saw an 11 percent increase in call volume, amounting to about 52,000 calls last year, a number the department seems on pace to meet again this year. Historically, he said they’ve seen a rise of about 3 percent each year.

Two Buncombe County EMS workers. Credit: Courtesy of Buncombe County EMS

In Buncombe County, EMS Division Manager Jamie Judd said each ambulance in the department would ideally respond to about 2,400 calls per year. Now, ambulances are running an average of 3,000 calls, which can lead to longer wait times. 

Durham also saw a large increase in its call volume last year at 14 percent. The county’s chief paramedic, Mark Lockhart, said August 2021 was the department’s busiest month since the organization began in 1975.

“When we get really busy, and that happens now almost on a daily basis, we’ll hold the Alpha and Omega calls,” Lockhart said, referring to lower acuity emergencies. Those calls get put into a queue so the agency can save its resources for any potentially life threatening calls that might come in. 

But we’ve had a number of days where we’ve just flat out run out of units and so we rely on mutual aid from our surrounding counties — mostly Orange, Wake and Person county.”

Prior to the staff shortages, Lockhart said an ambulance ran about six to eight calls per shift. Now, they may run 10 or 11. Sometimes, he said, the emergency responders will be out continuously responding to calls for the entirety of their 12-hour shift. 


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