2017 EMS PRESENTATION

ATCEMS Employee Association

TOPICS:

• Experience and Retention

• Attrition

• Maintaining Performance Metrics

• Pay Comparisons

• Call Volume and Workload

• Hazards and Risk/Public Safety Pay

Parity

Training/Education

Experiential Learning

+Employee Retention

Experience

Excellence

PATH TO EXCELLENCE

0-1 years = Training & Education:academy, field training, clearance to independent duty.

1-5 years = Experiential Learning in the field:

high volume patient contact, interaction with peers,exposure to a wide range of events and conditions.

5 years = Attain Proficiency and Experience

Retention, Learning by Doing, and Performance in Emergency Medical Services

Guy David, Tanguy Brachet; Health Serv Res. 2009 Jun; 44(3): 902–925.

EXPERIENCE MATTERS

“Experience is associated with

better patient outcomes across a

variety of medical conditions.”

BACKED UP BY NUMEROUS PEER REVIEWED STUDIES:

Luft, Hunt, and Maerki 1987; Tu, Austin, and Chan 2001; Birkmeyer et al. 2002, 2003; Halm, Lee, and Chassin 2002; Elixhauser,

Steiner, and Fraser 2003; Gandjour, Bannenberg, and Lauterbach 2003; Huckman and Pisano 2006; Marcin et al. 2007

Photo: SXSW 2014

47.2% 50.0%64.7%

77.2% 74.1%

95.2%

0.0%

25.0%

50.0%

75.0%

100.0%

2012 2013 2014 2015 2016 2017

CURRENTLY 45% OF ALL FIELD MEDICS HAVE 5 YEARS TENURE OR LESS.

EXPERIENCE GAP GETS WIDER

Year Average Tenure of Medics Leaving

2013 6.26

2017 1.67

95% OF MEDICS LEAVING THE DEPARTMENT IN 2017 HAVE 5 YEARS TENURE OR LESS

% of medics leaving the department with 5 years tenure or less

RETENTION

DEPARTMENT 3 YEARS 10 YEARS

ATCEMS 10.2% 35%

APD 23.9% 41.8%

AFD 28.7% 41.9%

TOTAL % RAISE IN

SALARY DURING FIRST

3 AND 10 YEARS

EMS ATTRITION IS EXPENSIVE

Total Cost of Attrition 2008-2011 = $6,023,268.92

Total Cost of Attrition 2012-2015 = $15,477,892.03

Source: The Longitudinal Study of Turnover and the Cost of Turnover in Emergency Medical Services (2010).

Prehosp Emerg Care. 2010 Apr 6; 14(2): 209–221. (Note: adjusting for inflation and differences in MFI)

Costs are related to: Advertising and recruitment, Vacancy, Hiring, Orientation and training, New-hire productivity, Pre-turnover productivity,

Termination Vacancy costs (e.g., labor and expenses linked to overtime due to understaffed conditions) and new-hire productivity costs (e.g., time

required of new new-hire productivity costs (e.g. time required of new hires to reach cut-loose status) contributed the most to overall cost.

This is what it costs the City of Austin for every medic ATCEMS loses

$106,394.16(2017)

“Strategic Objective: Be an employer that

quality EMS professionals want to join;

where they can grow into recognized

industry leaders.”

ATCEMS Strategic Plan 2012

THERE IS MUCH TALK OF EXCELLENCE

“The vision of the Austin-Travis County

EMS Department is to be recognized

as a national leader.”

ATCEMS 2012-13 Annual Report

“Our innovations are world recognized…

and are models in the EMS industry.”

ATCEMS Annual Report 2014 *

* Note: 2014 is the last annual report published

“We need to embrace recruiting and educating clinicians who can be

decision-makers with a medical education that goes beyond the current

pattern recognition-based approach and diverges from the assumption that

most patients will be transported…

while we increase pay, increase autonomy and hopefully

increase job satisfaction so that we can stem the hemorrhage

of the EMS workforce.”

Mark Escott, MD; ATCEMS Medical Director

Managing the Personnel Crisis in EMS

Journal of Emergency Medical Services, July 6, 2017

BUT CAN WE MAINTAIN IT?

SOURCES: JEMS Salary Survey 2015; ATCEMS Pay Scale; King County Medic One Pay Scale.

PAY AND RETENTION

ATCEMS 2015-16 pay scale

EMT/Paramedic average

Hourly wage

$16.98

HIGHEST PAYING HOURLY

1. Nevada $35.85

2. Washington $35.40

3. Maryland $29.89

4. Alaska $29.33

5. Delaware $26.53

6. New York $25.49

7. Hawaii $24.70

8. Colorado $24.70

9. Missouri $24.23

10. New Jersey $23.79

LOWEST PAYING

1. Oklahoma $14.77

2. Montana $15.89

3. West Virginia $16.40

4. South Dakota $16.74

5. Kentucky $17.23

6. Kansas $17.32

7. Mississippi $17.48

8. Nebraska $17.53

9. Wyoming $17.91

10. Alabama $17.98

Monster.com (2016)

EMT/PARAMEDIC WAGES

HOURLY WAGE COMPARISON

IS UNRELIABLE

• TOO MANY VARIABLES

HIGHEST PAYING STATES ANNUAL

1. Washington $65,320.00

2. District of Columbia $57,900.00

3. Alaska $54,290.00

4. Hawaii $49,680.00

5. Connecticut $46,320.00

HIGHEST PAYING METRO AREAS

Kennewick-Richland, WA $75,740.00

Seattle-Bellevue-Everett, WA $74,030.00

Tacoma-Lakewood, WA $71,820.00

Olympia-Tumwater, WA $70,240.00

Anchorage, AK $61,800.00

Bellingham, WA $60,490.00

Santa Cruz-Watsonville, CA $59,160.00

Elgin, IL $58,500.00

Bremerton-Silverdale, WA $57,980.00

Redding, CA $57,730.00

ANNUAL SALARY A BETTER COMPARISON MEASURE

ATCEMS 2015-16 pay scale

EMT/Paramedic average

annual wage

$42,382.71

US Bureau of Labor Statistics 2016

TOP PAYING FOR EMT & PARAMEDIC

METRO AND MICRO AREAS NATIONWIDE WERE

EVALUATED BY AN INDUSTRY ANALYST FOR:

Average EMT/paramedic salaries

Housing affordability(percent of income spent on rent)

Area amenities(including arts, entertainment and recreation)

Employment attractiveness(a metric that combines job availability, density and competition)

#51 Austin-Round Rock, TX #3 Amarillo, TX -- #4 Baton Rouge, LA -- #13 Abilene, TX

#37 New Orleans-Metairie, LA -- #42 Dallas-Fort Worth-Arlington, TX

AND THE BEST 100 WERE RANKED

POPULATION GROWTH AND WORKLOAD

• POPULATION

• WORKLOAD IMPORTANT WHEN COMPARING SYSTEMS

• ONE OF OUR BUSIEST AMBULANCES RAN 7166 CALLS in 2014

• AMBULANCE RESOURCES vs. STAFF VACANCIES

Department (2014 data) Average Calls per

apparatus / ambulance

ATCEMS 3401

Austin Fire Department 1124

Williamson County EMS 1506

Montgomery County 1818

Fort Worth / Medstar 2298

BY 2016 AVERAGE CALL

VOLUME HAD

INCREASED 18% TO

4000 per AMBULANCE

Largest departmental contributor the the General Fund.

“EMS revenue is about 30% of total “other” revenue and the largest single contributor.”

Financial Forecast & Economic Outlook Fiscal Years 2018-2022; p.45

Returns revenue greater than half their total budget.

“EMS Annual Budget -- $83,786,011.00”

“EMS Annual Revenue -- $43,533,731.00”

2016-17 Approved Budget Volume 1; p.387

ATCEMS REVENUE GENERATION

DEPT GENERAL FUND % NET COST FTEs

EMS 4.2% $40,252,280.00 548.50

FIRE 18.8% $182,435,580.00 1256.00

POLICE 39.4% $382,255,464.00 2640.25

HEALTH 6.2% $60,058,729.00 260.75

HUMAN SERVICES

EMS NET COST

Financial Forecast & Economic Outlook Fiscal Years 2018-2022; p.46

COA Budget 2016-17 Approved Volume 1 p.387-495

ONLY 4.2% OF CITY

GENERAL FUND

Financial Forecast & Economic Outlook Fiscal Years 2018-2022; p.46

COA Budget 2016-17 Approved Volume 1 p.387-495

SMALL SLICE OF THE PIE

COST OF LIVING:

HOW AFFORDABLE IS AUSTIN

ON AN EMS SALARY?

1 in 5 ATCEMS employees work a

second job.

Austin-American Statesman, investigative report; July 25, 2017

COST OF LIVING vs ATCEMS SALARY

* Represents 80% MFI which is considered "low income" by HUD and COA

EMS Data Source: EMS 42 hour pay scale.

MFI Data Source: HUD; effective date as of February of each year.

RANK 2014 2015 2016 2017

Medic I (entry level) $38,313.60 $38,688.00 $39,062.40 $39,836.16

Medic I (4 years) $42,240.74 $42,653.52 $43,066.30 $43,919.37

Low Income for a family of 1* $42,250.00 $43,050.00 $43,600.00 $45,600.00

Medic II (entry level) $47,068.26 $47,528.21 $47,988.16 $48,938.70

Captain (entry level) $55,352.27 $55,893.17 $56,434.07 $57,551.94

Captain (6 years) $59,226.93 $59,805.69 $60,384.40 $61,580.57

Low Income for a family of 4* $60,300.00 $61,400.00 $62,200.00 $65,100.00

Medic I (17 years) $63,391.97 $64,011.43 $64,630.90 $65,911.13

Medic II (11 years) $64,781.73 $65,414.77 $66,047.82 $67,356.12

Commander (entry level) $66,334.16 $66,982.38 $67,630.59 $68,970.24

Medic I (25 years) $67,829.40 $68,492.23 $69,155.06 $70,524.91

Captain (13 years) $72,555.54 $73,264.55 $73,973.56 $75,438.85

100 % MFI for family of 4 $75,400.00 $76,800.00 $77,800.00 $81,400.00

Captain (14 years) $77,634.42 $78,393.07 $79,151.71 $80,719.57

Medic II (20 years) $79,360.40 $80,135.91 $80,911.42 $82,514.14

Commander 11 years) $81,262.20 $82,056.29 $82,850.39 $84,491.51

Active Single

Family Homes

Under $500k

HIGHEST INJURY RATE WITHIN CITY OF AUSTIN

A 2013 internal audit by COA found that ATCEMS

medics suffered on the job injuries at a higher rate than

other city employees AND the industry average.

Fatal and nonfatal injuries among emergency medical

technicians & paramedics.

Reichard A, Marsh S, Moore P.; Prehosp Emerg Care 2011;

15(4):511–517.

Also see:

Injuries and fatalities among emergency medical technicians

and paramedics in the United States.

Prehosp Disaster Med. 2013 Aug;

28(4):376-82. doi: 10.1017/S1049023X13003555.

Industry Fatality per 100,000 FTEs

EMS 7.0

Firefighter 6.1

All Workers 4.0

HIGHER FATALITY RATE THAN FIREFIGHTERS

In 2016 Austin-Travis County EMS had

108

on the job injuries to medics

That’s 21% (1 in 5) of its workforce

ATCEMS PROVIDES ON-SITE MEDICAL CARE AT SPECIAL EVENTS ACROSS AUSTIN

2011 = 150 events 2016 = 600+ events

EVENTS SUCH AS F-1, SXSW and ACL HAVE TENS OF THOUSANDS OF ATTENDEES

The EMS workplace is inherently dangerous.