Kentucky's EMS workers are burned out and it's hurting patients

Supriya Sridhar | Courier Journal

Show Caption Hide Caption Louisville paramedic and EMT shortage is stressing resources Paramedic and EMT shortages are stressing resources in Louisville and across Kentucky.

Stress, long hours, low pay and an increase in ambulance calls are causing EMS workers to burn out

EMS workers fear the shortage could endanger patients' lives through increased response times

The trauma EMS workers witness can take a toll, causing severe PTSD, depression or suicide attempts

It was Christmas Eve 1994. An elderly woman was sitting at her kitchen table, struggling to breathe. Paramedic David Wilson kneeled in front of her and began taking vital signs.

Two feet away, her husband reached into the kitchen drawer, pulled out a .45-caliber handgun and pointed it at the back of Wilson's head.

Taken aback, Wilson tried to explain why he was there.

“Your son called us," he remembers telling the man, his own life now possibly hanging in the balance. "We’re here to help your wife.”

The man had dementia. Wilson's partner intervened and physically disarmed him. But two hours later, Wilson still couldn't stop shaking. He didn't sleep for days.

He's still haunted by the memory.

While Wilson's love of the job has caused him to continue working as a paramedic, he said he has seen many of his colleagues leave because of similar traumatic incidents.

Such on-the-job stress is not unusual, EMS workers said, and combined with long hours, low pay and an increase in ambulance calls, it is causing their ranks to thin as co-workers burn out and quit. The worker shortage, seen in Louisville and nationwide, could endanger patients' lives through increased response times, they said.

The trauma is also taking a psychological toll on the workers, causing severe PTSD and depression and driving some to suicide, mental health professionals said.

“The job changes you after a while," said Wilson, who works for an ambulance service in the Louisville area. "It changes you mentally. It changes you physically. It changes you emotionally.”

Vincent Robbins, president of the National EMS Management Association, said cities across the country are dealing with a shortage of EMS workers, particularly paramedics.

"We're seeing this across the country," he said. "It's worse in some places than others. But generally that's the trend we're seeing."

Since 2013, Louisville Metro EMS has lost 21 paramedics, reducing the number of people on its staff who have that level of advanced training to 55 from 76. Ideally, Louisville Metro would have 277 positions filled. Out of that about 80 would be filled by paramedics

Meanwhile, Louisville Metro EMS has 132 EMTs, who have less training than paramedics. Fully staffed, Louisville Metro would have about 190 EMTs.

Louisville Metro EMS pays EMTs $15.61 an hour, and paramedics start at $18.73. As time goes by, they receive raises based on their contracts.

The shortage in the city isn't just being felt by Metro EMS. Joseph Meyer, operations manager for private ambulance service AMR Louisville, said that the shortage is a problem for other EMS services, which help supplement Louisville Metro when they run out of ambulances.

“It is definitely happening," Meyer said. "We feel the effects just like everybody else does.”

Paramedics must go through more education than EMTs, making them harder to find, said Mitchell Burmeister, Louisville Metro EMS public safety officer. They have more advanced skills, making them better equipped to help certain patients, such as those who need advanced cardiac life support.

And while the Kentucky Board of Emergency Medical Services says there are more paramedics than ever in the state, EMS workers say they aren't all working in the field. As of this year, there are 3,632 paramedics in Kentucky.

Robbins said that's the case nationally as well. He said that people who are certified or licensed as paramedics aren't necessarily working in the field, and as workers retire or just leave, they are not being replaced by enough new workers.

Maj. Dustin Morganett, Louisville Metro EMS operations officer, said that fewer EMS workers can delay ambulance response times.

The result? Help can arrive too late.

The national average for ambulance response times is 8 minutes. In Louisville, it is 10 minutes and 19 seconds, according to a report released by the Pegasus Institute, a libertarian-leaning think tank that says it wants to improve Kentuckians' lives. Louisville's response time is greater than those in surrounding cities like Nashville (7 minutes, 12 seconds) and Indianapolis (5 minutes, 44 seconds).

To help make up for the shortages, many EMS workers like Wilson are pulling 60-hour shifts. This leaves them exhausted, groggy and stressed.

Too many calls, too little time

Bernice Fennessee sits in a chair on her front porch, head down, hands clutching a cane.

Louisville Metro EMS workers stand over the woman, asking her if she is diabetic, if she has eaten that day. Keeping her gaze down, Fennessee shakes her head no.

This will be Fennessee’s fifth trip to the emergency room by ambulance in the past three months for nausea and stomach pain.

“I can see it coming,” said Carol Fennessee, Bernice’s sister-in-law.

Bernice's diet consists of cigarettes and soda — and no matter how hard Carol tries, she said, it won’t change.

“I don’t know what else to do,” Carol said.

Carol stands in her doorway, hand on hip, frustrated, as Maj. Morganett says Bernice Fennessee needs to be treated by a primary care doctor. Her symptoms are non-emergency, ongoing and probably due to dehydration. Repeatedly going to the ER won’t help.

Exasperated, her sister-in-law explains her efforts. She’s talked to Fennessee about going into an assisted living facility, but she refuses.

In the midst of a staffing shortage, non-emergency runs like this deplete resources, Morganett said after the run.

“The call volume is going up, not down,” Morganett said.

Louisville Metro experienced a 16 percent increase in call volume between 2014 and 2017.

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While the increase follows the growth in the city's population, Louisville-area paramedic Angela Brown said that non-emergency runs contribute to the problem.

When EMS workers are occupied by non-emergency calls, sometimes there is nobody available to help a person in dire need, she said.

“There’s nothing you can do,” Brown said. “It’s frustrating and it is a very helpless feeling of we could have gotten to that person and saved them, but nobody was available.”

Brown said that many people think that if they go to the ER by ambulance, they will be seen faster.

But that is not the case. Patients are seen in order of the severity of their medical condition. Brown said that half of all people who call for an ambulance could be taken to the hospital by car.

Meanwhile, as the EMS workers' shifts grow longer because of worker shortages, rest time becomes shorter.

Sgt. Chris Kene knows this firsthand. The 35-year-old Louisville Metro paramedic said EMS workers typically are supposed to be scheduled to work 36 hours one week and 48 hours the next. But due to the shortage of workers, they are scheduled 48 hours one week and 62 the next.

The increased run and call volumes create exhaustion that can impact their lives outside the job.

“That stress wears on people and wears people down,” Kene said.

With long hours, exhaustion and stress, EMS workers are working to compensate for a lack of staffing, causing burnout and perpetuating an endless cycle.

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Overloaded by overdose runs

“I am fine.”

“I’m not doing anything bad here.”

Running his hands across his tattooed head, a man paces back and forth, repeating the words to a group of police officers and EMS workers that has surrounded him.

A Courier Journal reporter overheard EMS workers say that the man is on spice, a form of synthetic marijuana. A 911 call was made by a passer-by, who reported the man was on the ground, unconscious.

Agitated, he stops moving around, body pressing against a white fence. The man refuses to receive help.

“Has he thrown up yet?” an EMS worker asks a police officer, attempting to assess the situation.

The workers plead with the man to allow them to make sure he is OK. But mumbling through his missing front teeth and furiously shaking his head, the man refuses.

“I don’t need to go to the hospital,” the man said. “I don’t need this.”

His words grow more and more agitated as he begins to grit his teeth.

He won't accept help, and he won’t sign papers stating he was offered help.

Stuck in a standoff, workers look at each other with frustration, watching valuable minutes waste away.

The incident was one of the large quantity of drug-related calls EMS workers have had to answer as a drug crisis has swept the country.

Last year, Louisville Metro EMS received 7,651 overdose calls, and from January to June of this year it received 3,361.

Wilson said he saw only two heroin overdoses between 1988 and 2013. Then the epidemic hit.

“In 2015 it was like the flood gates opened, and we’re making four, five and six a day. It was just incredible,” he said. “It was like a wave coming through.”

Wilson said that while drug-related runs are not difficult medically, dealing with patient reactions is. If a patient has overdosed on heroin or another opioid, the workers can inject the person with a shot of Naloxone, an antidote that can revive them. But once the patient wakes up, they often refuse to go to the hospital.

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EMS workers cannot force them to go, but if they are left and the Naloxone wears off with heroin in their system — they could go unconscious and stop breathing.

Sometimes, crews will take a patient that overdosed to the hospital and leave, only to pick that person up again 45 minutes later, Wilson said.

“One person can only take it so much and it starts to exhaust you,” Brown said.

Time spent arguing with patients in drug-related situations wastes time that could be spent helping patients in life or death situations, she said.

But as the epidemic continues, EMS workers are forced to help those who are often too sick to want it.

Toughing out trauma

Losing a child, healing a gunshot victim, working with victims of abuse — the human brain is wired to keep these traumatic events in long-term memory.

The stress of these runs combined with sleep deprivation can cause major mental health issues for EMS workers.

“Our brains were never built to deal with complex trauma,” said Dr. Robert Mattson, who works with first responder communities.

Longtime retired paramedic John Hultgreen has some resulting mental scars. Due to a traumatic run, he can no longer use a garbage disposal. Smiling, he says he leaves the task to his wife.

As an air paramedic, he would return from a bad flight and try to get some sleep. But 45 minutes later, he would be called to strap on his boots again and help another critical patient.

Brown, the paramedic frustrated by unnecessary calls, said that many workers get only a couple of hours of sleep after working 16-hour shifts, then have to begin the next one.

“You really need people who are alert and well-rested for the job," Hultgreen said. "And this job does not promote that.”

Because of the frenetic pace of the job, EMS workers face higher rates of post-traumatic stress disorder, depression and substance abuse, Mattson said.

Hultgreen said he has seen EMS lose workers due to mental health issues, which in some cases has led to suicide.

“The stress just got to them because it’s a bad job,” he said.

Elizabeth Barton, first-responder outreach coordinator for American Addiction Centers, located in Brentwood, Tennessee, knows the impact this can place on loved ones first-hand. Her grandfather was a first-responder and took his own life due to the trauma he experienced, she said.

The lack of sleep experienced by EMS workers only exacerbates issues of anxiety and depression, Barton said.

This causes EMS workers to develop coping skills, and often those skills can be negative. Barton said that the center sees EMS workers with addiction issues, whether that be substance abuse, adrenaline or gambling.

These issues can bleed into life outside work and cause people to leave the job.

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Hultgreen said that when he started in EMS, older workers would encourage others to ignore traumatic experiences, seeing it as a weakness in doing the job.

While mental health concerns are still present within EMS, over the years, the stigma related to trauma is beginning to decline.

“We all look back and we can identify things that we have experienced or saw, we can identify how they have affected us,” Hultgreen said.

EMS companies in the Louisville area offer crisis intervention after a particularly difficult run, if the worker requests it. At Louisville Metro after a difficult run, employees are brought in and their mental state is gauged. But ongoing treatment is not offered.

Brown noticed the need for mental health care due to mental health problems within the EMS community. She created a Facebook group called Code EMS.

The group, which was created in February, already has 1,200 members.

Workers talk about trauma and difficult runs, supporting one another. Mattson offers biweekly sessions for three to four weeks, helping workers process events.

Mattson said that while the job has negative health impacts, those who seek help tend to stay in EMS.

They are working to be healthy enough to continue the job that’s mental health strain has already caused many to leave.

Relief could be on the way

There are 44 people in Louisville Metro EMS’s new EMT class. They will graduate on Aug. 28.

If they make it through, that is 44 people who could offer relief and go through more training to become paramedics.

Currently there are 19 EMTs training to be paramedics in Louisville Metro EMS. They will graduate in November.

In the EMT class is 20-year-old Revel Lewis IV, who has been in the Army national guard since 2016. He said he wants to become a paramedic as soon as possible.

“People need us out there to help them,” he said.

The Kentucky Board of Emergency Medical Services has hired a new full-time marketing and public relations person to improve recruitment and retainment across the state.

Lewis said members of his EMT class and instructors have discussed mental health — how to take care of themselves and spot others having a hard time.

While he is aware of the low pay, long hours and health risks, Lewis said he still wants to pursue the job.

“It’s a sacrifice to be in public service,” Lewis said.

Wilson knows this sacrifice.

Over his career, he has broken his hand, had three surgeries, walked into a robbery and had had a gun pulled on him multiple times.

But he loves his job.

“I love what I do," he said. "I love helping people.”