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TECHNICAL REPORT UCED 2003/04-03

Nevada Emergency Medical Services Survey Results

UNIVERSITY OF NEVADA, RENO

7/14/2003 ii

Nevada Emergency Medical Services Survey Results

Rural EMS Outreach Project Recruitment and Retention Committee

and University Center for Economic Development

Study Conducted by Rural Emergency Medical Services Outreach Project

Great Basin College

Report Prepared By:

Elizabeth Fadali John Nolan

Thomas R. Harris

Thomas R. Harris is a Professor in the Department of Applied Economics and Statistics and Director of the University Center for Economic Development at the University of Nevada, Reno. John Nolan is the Project Director of the Rural EMS Outreach Project at Great Basin College, Elko, NV.

Elizabeth Fadali is a Research Associate in the Department of Applied Economics and Statistics at the University of Nevada, Reno.

July 2003 UNIVERSITY OF NEVADA

RENO

The University of Nevada, Reno is an Equal Opportunity/Affirmative Action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability, and in accordance with university policy, sexual orientation, in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in the United States.

7/14/2003 iii

This publication, Nevada Emergency Medical Services Survey Results, was published by the University Center for Economic Development. Funds for the publication were provided by the United States Department of Commerce Economic Development Administration under University Centers Program contract #07-06-05359. This publication's statements, findings, conclusions, recommendations, and/or data represent solely the findings and views of the authors and do not necessarily represent the views of the United States Department of Commerce, University of Nevada, Great Basin College or any reference sources used or quoted by this study. Reference to research projects, programs, books, magazines, or newspaper articles does not imply an endorsement or recommendation by the authors unless otherwise stated. Correspondence regarding this document should be sent to:

Thomas R. Harris, Director University Center for Economic Development

University of Nevada, Reno Department of Applied Economics and Statistics

Mail Stop 204 Reno, Nevada 89557-0105

UCED University of Nevada, Reno

Nevada Cooperative Extension Department of Applied Economics and Statistics

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Table of Contents Executive Summary......................................................................................................... iv Introduction....................................................................................................................... 1 Section Reports.................................................................................................................. 1 1. Demographics................................................................................................................ 3

Survey Population ........................................................................................................... 3 Education ........................................................................................................................ 5 Length of Time in Community......................................................................................... 8 Household Income .......................................................................................................... 8 Race................................................................................................................................. 9 Write-in Comments ....................................................................................................... 10

2. EMS Affiliation ........................................................................................................... 11 NEMA Membership....................................................................................................... 11 Current Certification Levels ......................................................................................... 11 Permission to Respond to Emergencies ........................................................................ 12 Continuing Education ................................................................................................... 13

3. EMS Duties and Service Information ....................................................................... 14 Type of Service .............................................................................................................. 14 Highest EMS Certification and Additional Training .................................................... 15 Length of Time Involved in EMS and at Current Certification Level........................... 17 EMS Primary Occupation and Compensation for EMS Work...................................... 18 EMS Social Events ........................................................................................................ 21 Hours, Runs and On-call Status per Month.................................................................. 21 Reasons EMS Personnel Were Attracted to the Work .................................................. 22 How Long EMS Workers Plan to Stay on the Job and Why ......................................... 23 Recruiting and Retaining EMS Personnel .................................................................... 25

4. A Look at Volunteers.................................................................................................. 27 Some Demographics of Volunteers ............................................................................... 27 Affiliation, Certification and Work Characteristics of Volunteers ............................... 27 Volunteers Reasons for Leaving ................................................................................... 29

5. A Profile of the EMS Worker Who Will Leave in Less Than 5 Years .................. 30 6. EMS Job Satisfaction.................................................................................................. 33

Negative Aspects ........................................................................................................... 33 Positive Aspects ............................................................................................................ 34 Rural Urban Comparison ............................................................................................. 34

7. Community Satisfaction ............................................................................................. 39 Summary.......................................................................................................................... 44 Appendix 1 - Demographics Results…………………………………………………..46 Appendix 2 – EMS Affiliation Results………………………………………………...57 Appendix 3 – Duties and Service Results .....................................................................63 Appendix 4 – Job Satisfaction Results.........................................................................105 Appendix 5 – Community Satisfaction Results……………………………………...114 Appendix 6 – Survey Questionnaire………………………………………………….118

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List of Tables and Figures Figure 1.4 Education of Survey Respondents..................................................................... 7 Figure 1.5 Census 2000 NV Educational Attainment......................................................... 7 Figure 1.6 Histogram of Length of Time in Community.................................................... 8 Figure 2.1 Current Level of Certification ......................................................................... 12 Figure 2.2 Continuing Education...................................................................................... 14 Figure 3.1 EMS Services in Which You Participate......................................................... 15 Figure 3.2 Rural and Urban Comparison Total of Services Participated In ..................... 16 Table 3.1 Loss of Certification by Certification Level ..................................................... 17 Figure 3.3 Other Training for Rural and Urban Respondents .......................................... 18 Table 3.2 Years in EMS and Time at Certification Level by Certification Level ............ 19 Table 3.3 Hours, Runs, Times per Month on Call for Urban and Rural Respondents ..... 21 Table 4.1 Compensated and Non-compensated EMS Worker Averages ......................... 28 Figure 4.1 Certification Levels of Volunteers .................................................................. 28 Figure 4.2 Reasons for Leaving EMS for Compensated and Uncompensated................. 29 Table 5.1 Comparison of EMS Workers Leaving in Less than 5 Years and Staying More

than 5 Years, Averages ............................................................................................. 32 Figure 5.1 Those Who Will Leave EMS by Certification Level ...................................... 32 Figure 5.2 Factors Attracting Those Who Will Leave EMS Compared with Those Who

Will Stay ................................................................................................................... 33 Figure 6.1 Job Dissatisfaction - Highest Percentage to Lowest........................................ 36 Figure 6.2 Job Satisfaction Factors from Highest Percentage to Lowest ......................... 37 Figure 6.3 Satisfaction with Quality of Care Provided by Local EMS Workers for Rural

and Urban Groups ..................................................................................................... 38 Figure 6.4 Satisfaction with Time for Coworker Interaction for Rural and Urban Groups

................................................................................................................................... 38 Figure 6.5 Dissatisfaction with Local Dollars for EMS, Rural and Urban Groups .......... 39 Figure 7.1 Satisfaction with Social/Recreational Opportunities of Community for Rural

and Urban Groups ..................................................................................................... 41 Figure 7.2 Satisfaction with Degree of Safety for Urban and Rural Groups.................... 42 Figure 7.3 Rural and Urban Comparison of Community Satisfaction Factors................. 43

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Executive Summary

The Rural Emergency Medical Services Outreach Project, a partnership of all the Nevada community colleges, University of Nevada School of Medicine, the Nevada State Health Division’s EMS Office and Nevada Emergency Medical Association (NEMA), conducted a statewide mail survey of all certified Emergency Medical Services (EMS) personnel in Nevada in December 2002. The ultimate goal of the survey is to use the knowledge gained to help ensure an adequate supply of EMS personnel in Nevada, particularly in rural areas of the state. By learning more about the characteristics of the EMS workforce policymakers may be able to better devise methods of recruiting and retaining EMS workers.

The survey questionnaire asked EMS personnel over 40 questions concerning their demographic characteristics, work affiliation and duties, job and community satisfaction levels, whether, why and how long they would stay in the job and what they perceive to be the most likely barriers to recruitment and retention. 491 questionnaires were returned out of 9600. Around 1000 were returned with wrong addresses. Using zip code information the respondents were divided into rural and urban groups with about 56% of the surveys with location data being from rural areas. About 28% of the survey respondents were from the Las Vegas area with 16% from the Reno metropolitan area. A brief summary of results follows below. Demographic characteristics of respondents:

• 64% were male • 42% of the rural group was female, 32% of the urban group was female • average age was 41 years • rural respondents were more than twice as likely to be over 50 years old • 40% had high school degrees, 31% Associate, 19% Bachelor’s • the average number of years respondents had lived in their community was 18 • median household income category was $60,000 to $70,000 per year • 16% of the respondents had household incomes greater than $100,000 – the

majority of these respondents belonged to fire companies • 90% of respondents were white • 76% of the rural and 66% of the urban group were married

Work and affiliation characteristics of respondents are listed below:

• Only 19% of respondents belonged to NEMA • 9% held First Responder, 41% EMT Basic, 35% EMT Intermediate and 13%

EMT Paramedic as their current certification level • 83% belonged to an organization that can respond to emergencies • 52% belonged to a fire company, 27% to an ambulance service and 5% to a

rescue agency. • 62% of rural respondents belonged to at least 2 services and 17% to 4 or more

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• 72% used annual refresher courses, 36% attended EMS conferences and 24% used compressed video to renew certification1

• 86% of respondents had taken automatic defibrillation, 75% auto extrication and 69% basic trauma life support training

• only 12% reported being reimbursed for continuing education • average time involved in EMS was 11 years • time certified at current level was 8 yrs • only 24% said their primary occupation was their EMS position • 58% received at least some compensation for their EMS work • on average compensation was $31,000/yr if in the urban group and $14,000/yr for

the rural group for those reporting any compensation for EMS work • women received an average of $13,200/yr, while men reported $29,100/yr in

compensation for their EMS job • Those who said they would leave in less than 5 years averaged $17,000/yr

compared to $28,000/yr for those who said they would stay. • 90% of urban workers and 46% of rural workers were paid with salary or an

hourly rate • 33% of rural and 2% of urban workers were paid by the run • 79% of the total group reported having a job other than EMS-related duties • 23% reported difficulty getting time off for EMS. 56% said the difficulty was

because of schedule or shift work, 24% said loss of income made it difficult and 22% said a lack of support from the boss was a problem.

• 32% said no EMS social events were sponsored by their agency. 66% attended between 1 and 10 annual EMS agency social events.

• 50% of rural EMS personnel responding to the survey worked less than 18 hours per month whereas the 50th percentile was 120 hours for urban respondents

• The average number of times per month rural EMS personnel reported being on call or on duty was much higher on average (19) than their urban counterparts (10).

Summary statistics on what attracts EMS personnel to the job, whether EMS personnel are likely to leave in 5 years and why, recruitment and retention barriers, factors influencing job and community satisfaction are listed below: • Major factors attracting respondents to EMS work were the satisfaction in helping

others with 90% ranking it 4 or 5 (5= major factor), interest in emergency medical care (82%) and interest in trauma care (67%). These factors were very similar to those that respondents said make them likely to stay 5 or more years.

• 73% of respondents said they would stay 5 or more years in their EMS-related job • 75% of volunteers said they would stay 5 or more years • Major factors for leaving were low or no pay (30% ranked it 4 or 5), time

commitment (26%) and “I’ve done my time” (22%). • 43% said recruitment of individuals to their job title was difficult (ranked a 4 or 5

out of 5, with 5=great difficulty)

1 Total does not add to 100% because respondents could choose more than one category.

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• 59% of rural respondents versus 21% or urban respondents said recruitment for their job title was a 4 or 5 in difficulty

• Time commitment (57%), training requirements (51%) and poor recruitment efforts (39%) were ranked a 4 or 5 by the largest number of respondents with 5 = major barrier. Time and training were a larger concern for the rural group.

• 48% of rural respondents and 28% of urban respondents found retention of individuals in their job to be difficult.

• Time commitment, inadequate pay and poor retention efforts were marked most often as major reasons for EMS personnel to quit.

• On average respondents were by far least satisfied with the amount of local dollars available for EMS. Additional problem areas were professional respect (or lack thereof) from nurses and physicians.

• Respondents were most satisfied with the professional respect they received from local citizens, close relationships with peers and quality of care provided by local EMS workers.

• 58% were very satisfied (marked 4 or 5) overall with their community. For the rural group lack of social and recreational opportunities was the greatest cause of community dissatisfaction. For the urban group, not feeling safe was an issue causing dissatisfaction. Both groups were most dissatisfied with the health care system locally with 34% marking 1 or 2 (1=not satisfied).

The results of the survey analysis revealed some major themes, some new and some reinforcing what is already known:

Respondents in rural counties were older on average than their urban counterparts, while Census figures show an older than average general population in many rural counties. These two factors add to the challenges of making EMS work in rural counties. On the other hand, retirees might also be considered as a possible resource.

The survey results indicate that the number of minorities as well as women in EMS workforce is low when compared with census data for the state. This might represent another segment of the population to target for recruitment efforts in some counties.

Respondents who were certified at the EMT basic level were the most likely to say they would leave EMS in the next 5 years and most likely to report that recruitment for their title was difficult.

The most dramatic differences between rural and urban respondents emerged when examining patterns of work and compensation. Rural workers worked far fewer hours and runs, but were on call more often and tended to work for more different services than urban respondents did. Rural respondents received, on average, about half the compensation that urban respondents received.

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Low or no pay and inadequate pay emerged frequently as top reasons for recruitment and retention problems. Another top reason, time commitment and training requirements, seems to be related to the compensation issue.

Amongst respondents who were compensated EMS personnel, the single most striking difference between those who would leave in less than 5 years and those who would stay was that they received, on average, much less in compensation. Respondents who were volunteers, however, were no more likely to say they would leave their EMS work than were compensated workers.

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Introduction

The EMS personnel in the state of Nevada face many challenges in providing quality

emergency medical care through-out the state. About 13% of the population is spread out over

95,848 square miles with an average density of 1.7 persons per square mile. Long distances

separate these rural areas from the two major urban areas in Nevada and from each other.

Nevada is also the fastest growing state in the nation with some of the fastest growth occurring in

the rural counties. Most of rural Nevada is classified as a federal Health Professions Shortage

Area (HPSA) or a Medically Underserved Area (MUA). EMS personnel in rural areas are

struggling to increase their numbers, retain existing workers and to provide training and better

leadership.

The Rural Emergency Medical Services Outreach Project, a partnership of Nevada

community colleges, University of Nevada School of Medicine, Nevada State EMS Health

Division and NEMA led by Great Basin College, is working to improve recruitment and

retention of EMS personnel statewide in order to ensure an adequate supply of EMS personnel.

In December 2002 a statewide mail survey of all certified EMS personnel in Nevada was carried

out. The survey was funded by a Health Resources and Services Administration network grant.

The results of this survey are presented below. It is hoped that the information from the survey

will help in creating new strategies to meet these goals.

Section Reports

The questionnaire sent out to Nevada EMS personnel was divided into five sections:

demographics, EMS affiliation, EMS duties and service information, EMS job satisfaction and

community satisfaction. Basic results are grouped into these five sections but in some cases it

was desirable to look at cross tabulations of variables from more than one section. Sections 1 to

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3 discuss results of the demographic, affiliation, duties and service portions of the questionnaire.

Section 4 below profiles volunteers. Section 5 profiles respondents who said they were likely to

leave EMS in the next five years. Sections 6 and 7 discuss results of the job satisfaction and

community satisfaction portions of the questionnaire. To make figures more readable, missing

and non-applicable records are not reported. Frequencies are reported in full detail, including

numbers of missing and non-applicables, in Appendices 1 to 5. Also included in the appendices

are charts of percentages, cross tabulation counts and comparison charts for rural and urban

subgroups for each variable. Appendix 6 contains the questionnaire.

7/14/2003 3

Results Section

1. Demographics

Survey Population

The State of Nevada provided a mailing list of all certified EMS personnel. Surveys were

sent to about 9600 addresses. About 1000 questionnaires were returned with bad addresses. 491

EMS providers returned a questionnaire. Because the project was carried out by the Rural EMS

Outreach Project as stated on the opening page of the survey, it is not surprising that rural

response rate was much stronger than urban resulting in about 56% of the questionnaires with

location data being from rural areas. About 28% of the survey respondents were from the Las

Vegas area with 16% from the Reno metropolitan area. Around 3% of the rural respondents lived

in other states bordering Nevada.

Age and Gender and Household Size

Respondents ranged from age 18 to 78 with an average age of 41 years. Ages were

somewhat higher for the rural respondents with an average age of about 43 compared to 37 for

urban respondents. Rural respondents over 50 made up a quarter of the rural respondents and

were more than twice as likely to be over 50 when compared to the urban respondents (see

Figure 1.1 below). If survey respondents reflect the general EMS population this may be a

matter of some concern since rural areas may contain both an aging population more in need of

EMS services and an aging EMS workforce. The aging workforce is a nationwide phenomenon

but it may be that rural areas will feel the pain of these demographic changes earlier and more

acutely. Census data shows that the proportion of Nevada’s rural residents age 65 and over, at

about 13.1%, is higher than in the two urban counties, Washoe at 10.5% and Clark at 10.7%. The

7/14/2003 4

individual counties range widely in percentage of residents 65 and older, from 5.9% in Elko to

19.8% in Mineral County as seen in Table 1.1 below.

Table 1.1 Population Over 65, Figure 1.1 Rural and Urban Respondent Age Categories

County

Percentage Population 65 and over

Carson 14.9% Churchill 11.9% Clark 10.7% Douglas 15.2% Elko 5.9% Esmeralda 17.2% Eureka 12.4% Humboldt 7.5% Lander 7% Lincoln 16.2% Lyon 13.7% Mineral 19.8% Nye 18.4% Pershing 7.8% Storey 13.1% Washoe 10.5% White Pine 13.5%

http://quickfacts.census.gov/qfd/states/32000.html U.S. Census Bureau State and County Quickfacts, Census 2000

Age Categories for Respondents

65 a

nd u

p

51 to

65

yrs

41 to

50

31 to

40

18 to

30

yrs.

Perc

ent Urban

Rural3

22

3129

14

10

26

3430

65% of the respondents were male and 35% were female. Females made up a larger

percentage of the rural group with 32% of urban respondents being female in contrast to 42% of

the rural respondents. The average annual compensation for male respondents reporting

compensation (volunteers are not included in the calculation) was about $29,100. Women

reporting compensation received an average of about $13,200 a year. The difference between

male and female compensation was even more striking when comparing median compensation

which was about $18,600 for males and $3,100 for females. Approximately the same percentage

7/14/2003 5

of men and women reported being certified at the first responder, EMT basic and intermediate

levels. 16% of males reported certification at the paramedic level versus 7% of females (see

Figure 1.2 below). Clearly one explanation for the large gender gap in compensation was that

women worked fewer hours on average (about 62 hours per month) than did men (98 hours per

month). The large difference in average compensation may also occur in part because of the

lower number of women reporting membership in a fire company: 34% of female respondents

reported fire company membership whereas 60% of male respondents did so. Women were

more likely to be affiliated with an ambulance service (50%) when compared to male

respondents (17%, see Figure 1.3).

Average household size was high at around 3 compared to the Nevada average of 2.6 per

household.

Education

Education levels are shown in Figure 1.4 below. Census 2000 categories for the state are

not directly comparable but are shown below in Figure 1.5. On average it would appear our

respondents are better educated than the general population and, not surprisingly, it would appear

that a much larger percentage of the EMS personnel have associate degrees than does the general

population.2 A somewhat larger percentage of urban respondents had obtained associate degrees

(35% urban versus 27%) and rural respondents were more likely to report a high school degree

as their highest level of educational attainment (46% rural versus 34% urban). The percentage of

rural and urban respondents with college degrees was roughly the same, about a quarter of

respondents.

2 Mail survey respondents in some cases may have different characteristics than the general population and could have higher levels of education. It is possible that the EMS survey respondents show higher levels than the general population of EMS workers because of these self selection biases.

7/14/2003 6

Figure 1.2 Certification and Gender

Certification and Gender

Current level of certification.

OtherRNEMT Paramedic

EMT Intermediate

EMT Basic

First Responder

Perc

ent Male

Female7

3741

1116

34

40

9

Figure 1.3 Type of Agency and Gender

Type of Agency and Gender

OtherRescueAmbulanceFire

Perc

ent Male

Female

11

5

50

34

18

6

17

60

7/14/2003 7

Figure 1.4 Education of Survey Respondents

Education of Survey Respondents

3%

40%

31%

19%

6%1%

Some grad

e/high s

chool

HS diploma/G

ED

Associa

te deg

ree

Bachelo

r's deg

ree

Master's

degre

e

Doctoral

degre

e

Figure 1.5 Census 2000 NV Educational Attainment

NV Census 2000 Educational Attainment

19%

29% 27%

6%12%

6%

Some grad

e, high s

chool

High sch

ool g

raduat

e

Some coll

ege, n

o degree

Associa

te deg

ree

Bachelo

r's deg

ree

Graduat

e or p

rofess

ional de

gree

7/14/2003 8

Length of Time in Community

The typical respondent in our sample had spent 18 years in their community. Our survey

respondents may have a higher proportion of long-time residents than the general population of

EMS personnel, as those who have been in the community a long time may have stronger

feelings and stronger commitment to community well-being and be more likely to return a

questionnaire. The entire distribution is shown below in Figure 1.6. Average number of years in

the community was, somewhat surprisingly, a little higher for urban respondents at about 19

years versus about 17.5 for rural respondents.

Figure 1.6 Histogram of Length of Time in Community

10 20 30 40 50 60Length of Time Residing in Community

0%

5%

10%

15%

20%

Perc

ent

Household Income

Reported household incomes were high. The median category chosen was $60,000 to

$69,999 whereas the Census Bureau shows that Nevada median cash household income in 2000

7/14/2003 9

was about $45,000. 16% of respondents had a household income greater than $100,000 a year

while only 5% of those who reported income said they made less than $20,000 a year. A larger

percentage of urban respondents (33%) reported a household income of more than $90,000 a

year than did rural residents (15%).

49 of the 61 individuals who reported a household income greater than $100,000 said

they were a member of a fire company. The large proportion of firemen responding to the

survey appears to be a factor in the high median incomes reported. Another possible reason for

the relatively high incomes reported by respondents may be that those who respond to mail

surveys typically have higher average incomes than do the general population.

Race

Approximately 90% of the EMS personnel responding to the questionnaire were white.

Categories collected in the EMS survey are not truly comparable to census data, but the data

would seem to indicate that minorities are underrepresented in the EMS workforce.3 To the

extent that the general population of EMS workers is reflective of our respondents, this suggests

recruitment of minorities, especially Hispanics, may represent an important opportunity,

particularly in the urban counties but in many of the rural counties as well (Table 1.2 and 1.3).

Marital Status

About 71% of the respondents were married. Of this group 60% had spouses who

worked full-time and another 19% had spouses who worked part-time. Job titles written in for

spouses were extremely varied: accountants, teachers, nurses, salespeople and other service

workers, construction work, police, homemakers, cooks, business owners, self-employed, miners

3 The Census Bureau collects data on Hispanic origin separately from race, thus an individual may be black, white, American Indian, etc. and Hispanic. The EMS survey allows for choosing either black, white, Hispanic, Asian or American Indian but only one of these categories. On the census form the majority of Hispanics choose the combination of white and Hispanic.

7/14/2003 10

and many other types of workers were represented. 85% of respondents with a spouse or

significant other marked 4 or 5 when rating how supportive their spouse/significant other was on

a scale of 1 to 5 (5 = very supportive).

Write-in Comments

About 30% of respondents (145 individuals) wrote in a comment at the end of the survey.

The comments varied widely. There were critiques of the survey instrument, comments on the

structure of Nevada EMS, needs of particular EMS squads and personal explanations for their

involvement or lack of involvement in EMS. Many comments referred to issues asked about in

the survey: the quantity, type, availability of training programs, inadequate opportunities for

volunteers, inadequate pay, the need for better supplies and better coordination amongst different

services, interfacing with other medical personnel in hospitals and problems of leadership.

Although overall results on survey questions did not indicate that, for example, availability of

training was a top reason for job dissatisfaction, the comments clearly indicate that in some

areas, and for some individuals, it is. Such was the case on many of the issues, which serves as a

reminder that rural areas can be particularly resistant to description by summary statistics.

Table 1.2 Survey Respondents Race/Ethnicity Rural Urban

White 92.3% 85.3%

Black 0% 3.3%

Asian .9% 3.8%

American Indian 3.0% 1.6%

Hispanic 3.9% 6.0%

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Table 1.3 Census 2000 Racial/Ethnic Data for Rural and Urban Counties

Rural Counties(c) Washoe Clark

White persons, percent, 2000 (a)

86.5% 80.4% 71.6%

Black or African American persons, percent, 2000 (a)

1.3% 2.1% 9.1%

American Indian and Alaska Native persons, percent, 2000 (a)

3.1% 1.8% 0.8%

Asian persons, percent, 2000 (a)

0.9% 4.3% 5.3%

Native Hawaiian and Other Pacific Islander, percent, 2000 (a)

0.1% 0.5% 0.5%

Persons reporting some other race, percent, 2000 (a)

5.4% 7.7% 8.6%

Persons reporting two or more races, percent, 2000

2.5% 3.3% 4.2%

Persons of Hispanic or Latino origin, percent, 2000 (b)

12.2% 16.6% 22.0%

White persons, not of Hispanic/Latino origin, percent, 2000

80.1% 73.0% 60.2%

(a)Includes persons reporting only one race. (b) Hispanics may be of any race, so also are included in applicable race categories. (c) Approximated using Census data. http://quickfacts.census.gov/qfd/states/32000.html U.S. Census Bureau State and County Quickfacts, Census 2000 2. EMS Affiliation

NEMA Membership

Only about 19% of the respondents said they were members of the Nevada Emergency

Medical Association. The rural respondents were more likely to have joined with 26% of rural

versus about 10% of urban respondents claiming membership.

Current Certification Levels

7/14/2003 12

The majority of respondents (76%) were certified at the EMT Basic or EMT Intermediate

level. A considerably smaller percentage of rural EMS personnel answering the survey were

certified as paramedics with 23% of urban respondents reporting paramedic certification but only

5% of the rural respondents reporting that level.

Figure 2.1 Current Level of Certification

Current Level of Certification

7%

36% 33%

23%

2%10%

44%39%

5%2%

FirstResponder

EMT Basic EMTIntermediate

EMTParamedic

RN or Other

UrbanRural

Permission to Respond to Emergencies

83% of the total group was part of an agency that is permitted to respond to emergencies.

Of these 52%, over half the respondents, were fire, 27% were ambulance and 5% rescue

agencies. 60% of the urban respondents were members of a fire agency compared to 46% of

rural respondents. Rural respondents reported being in an agency permitted to respond to

emergencies (88%) more often than did urban respondents (78%).

40% of those who were not members of first responder agencies were applying to join

such an agency within the next 6 months. Of the fifty respondents who did not plan to join, an

analysis of write-in comments showed that:

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• 13 worked for a hospital, state park, casino or some other agency.

• 4 mentioned family reasons such as children.

• 5 specifically mentioned low pay but those who mentioned other jobs and training for

other jobs (4) probably had some dissatisfaction with pay also.

• 10 mentioned factors such as not knowing where, how or what agency they would apply

through, political problems or bureaucratic regulation or hassles as a barrier.

• One mentioned that he or she could not get the appropriate training at their location.

• Some were going to retire soon and didn’t want to keep up their certification.

Continuing Education

The most popular form of continuing education for respondents was annual refresher

classes with nearly three quarters (72%) indicating they used them. Rural respondents were

much more likely to have participated in EMS conferences and somewhat more likely to have

used compressed video (see Figure 2.2 below).

Respondents were given an opprtunity to write in other types of continuing education

they used torenew their certification. The type of continuing education mentioned most often

was in-house training, typically provided more often than annually. Many firefighters and others

are provided monthly training sessions at work, according to respondents’ comments. Many also

mentioned taking outside classes to upgrade their certification. Several mentioned internet

training courses, using training compact discs or reading manuals. A few mentioned researching

emergency care subjects on-line in journals or training as often as every week.

7/14/2003 14

Figure 2.2 Continuing Education

Continuing Education

RuralUrban

Perc

ent

EMS Conferences

Compressed Video

Annual Refresher

Other

3431

69

78

32

17

49

19

3. EMS Duties and Service Information

Type of Service

Respondents most often reported participating in ambulance (57%) and fire (54%)

service agencies. The next largest percentage of respondents participated with rescue

organizations (42%). 25% of the respondents participated in quick response, 6% in law

enforcement and 17% in other types of organizations. Other agencies reported in written

comments included air ambulance, casino security, FEMA, HAZMAT, school districts, mining

companies and other large private companies (rescue, safety officers, etc.), hospitals and

educational institutions (EMS educators). All of these types of agencies could represent possible

partners in meeting emergency medical needs. Figure 3.1 below shows the results for all

respondents.

7/14/2003 15

Figure 3.1 EMS Services in Which You Participate

EMS Services in Which You Participate

Oth

er

Law

Enf

orce

men

t

Fire

Res

cue

Qui

ck R

espo

nse

Am

bula

ncePe

rcen

t

17

6

54

42

25

57

The rural contingent reported a much larger percentage in ambulance (72% versus 38%),

rescue (49% versus 31%) and quick response (30% versus 18%). Rural respondents were much

more likely to report multiple roles than were their urban counterparts (see Figure 3.2 below).

54% of urban respondents versus 34% of rural respondents reported participating in one service

whereas 17% of rural respondents reported participating in four different services and only 4% of

the urban respondents did.

Highest EMS Certification and Additional Training

Respondents were asked to report their highest level of certification which could then be

compared to current certification levels asked for in the affiliation section above. A comparison

of respondents’ current and highest level of certification showed that 11% of the EMT

7/14/2003 16

intermediates were no longer certified at that level. 15% reported formerly being certified at the

paramedic level and now no longer being certified at that level. 0% of those certified with EMT

Figure 3.2 Rural and Urban Comparison Total of Services Participated In

Number of Different Services Participated In

6543210

Perc

ent Urban

Rural3

172022

34

3 4

13

24

54

5

Basic reported having lost their certification level. Rural respondents were no more likely to

have lost EMT basic or intermediate certification than were urban respondents. The number of

rural respondents reporting that their highest level of certification was paramedic was very small

(17), four of whom reported losing one or more levels of certification. As a total, 7.9% of urban

respondents reported losing one or more certification levels versus 5.5% of rural respondents.

The most popular additional training units were automatic defibrillation (86%), auto

extrication (75%) and basic trauma life support (69%) and these three categories show little

difference in participation between rural and urban respondents. Urban respondents were

slightly to much more likely to have had any of the other training units mentioned in the survey

such as manual defibrillation (44% urban, 33% rural), IV maintenance (63% urban, 51% rural),

7/14/2003 17

epinephrine administration (56% urban, 48% rural), pediatric advance life support (36% urban,

23% rural), advanced cardiac life support (37% urban, 27% rural) and advanced trauma life

support (28% urban, 14% rural). Respondents overall were least likely to have taken flight

Table 3.1 Loss of Certification by Certification Level Highest Level of Certification

% Losing One or More Levels of Certification

EMT Basic

0%

EMT Intermediate

11%

EMT Paramedic

15%

Total

7%

medical training (10%) and advanced trauma life support (20%). See Figure 3.3 below. Other

types of training written in included types of military, nursing including flight nursing, different

pediatric courses (PEPP, PEP, PPPC, neonatal), rescue including specialized mine rescue,

HAZMAT, wilderness emergencies, psychiatric emergencies, police and fire, American Safety

and Health Institute, bioterrorism, prehospital trauma life support and critical incident stress

management.

Length of Time Involved in EMS and at Current Certification Level

The time respondents had been involved with EMS ranged from half a year to over 40

years with average time involved about 11 years for both rural and urban respondents. Only 10%

of the respondents had been involved in EMS 2 years or less. Respondents had been certified at

their current level for an average of eight years with little difference between rural and urban

respondents. When compared by certification level the paramedics stood out as having both the

longest average involvement in EMS, about 15 years, and the longest average time at their

7/14/2003 18

current level of certification at about 10.5 years. Nurses had even longer average involvement

but constitute only a tiny fraction of the respondent group. The self selecting nature of a

Figure 3.3 Other Training for Rural and Urban Respondents

Other Training

RuralUrban

Perc

ent

100

80

60

40

20

0

Auto Defib.

Manual Defibulation

I.V. Maintenance

Flight Med Crew.

Auto Extrication

Epinephrine Admin.

Pediatric Advance LS

Advanced Cardiac LS

Basic Trauma LS

Advanced Trauma LS

Other

1914 14

28

6770

27

37

23

36

48

56

7374

812

51

63

33

44

8786

mail-in survey again should make for caution in drawing conclusions from this data since people

who care more about the issues of EMS may respond in greater numbers meaning that people

who have been in the field longer may have a greater tendency to be in our respondent group.

EMS Primary Occupation and Compensation for EMS Work

Only 24% of respondents indicated that EMS was their primary occupation. As might be

expected a clear difference between rural and urban respondents was seen on this question. Only

14% of rural respondents affirmed that EMS was their primary occupation while 38% of urban

7/14/2003 19

respondents worked in EMS as their primary occupation. Similarly only 31% of the urban group

said they received no compensation for their EMS work whereas 51% of the rural group worked

Table 3.2 Years in EMS and Time at Certification Level by Certification Level Average Years

Involved in EMS

Average Time at Current EMS Certification Level

First Responder

10.3 7.8

EMT Basic

10.1 8.0

EMT Intermediate

10.7 6.4

EMT Paramedic

15.0 10.5

RN

16.0 11.5

without compensation. The same pattern was quite strong in a comparison of the amount of

money received for EMS work: rural residents reported an average annual compensation of

about $14,000 but urban residents reported an average more than double that amount at about

$31,0004. 50% of the rural respondents reported receiving less than $2500 in compensation

while the 50th percentile mark for urban respondents was ten times more at $25,000.5 Answers to

question 9 about how EMS personnel are compensated continued to affirm the markedly

different pattern of compensation for rural and urban respondents with about 90% of the urban

respondents reporting being paid either by salary or hourly rate versus 46% for rural respondents.

Not surprisingly the rural respondents were far more likely to be paid by the run (33%) than

urban respondents (2%). Around 12% of both rural and urban survey participants said they were

4 Compensation calculations exclude volunteers, i.e. those who reported receiving no compensation. 5Individual answers indicated people had differing interpretations on question 8 about how much compensation they receive for EMS work. For example, a fireman, law enforcement official or casino security guard might not know what portion of his compensation should count as being for an “EMS role” with some marking zero, some a portion or specific course fees that were paid for and some putting down their entire salary. Thus some caution is due in interpreting results.

7/14/2003 20

reimbursed for continuing education. Other forms of compensation written in by correspondents

included primarily a percentage of base salary ranging from 2 to 13%. Others reported

performing EMS duties as a part of their job (i.e. highway patrol, security guard, ranger) without

any portion of their pay specially earmarked as EMS compensation. Still others wrote that they

received monthly incentive pay, inclusion in a retirement plan, standby pay or received money to

cover transportation costs.

A very large proportion of survey respondents (72%) reported having a job other than the

one with EMS-related duties. Both urban and rural respondents reported working, on average,

full-time at some other job. This question may have been subject to differing interpretations for

a worker such as a fireman who might or might not consider their firefighting job “other than

EMS-related duty”, with about 20% of those reporting another job writing in a job that may in

fact include EMS duties. When asked how difficult it is to get time off for your EMS-related

job, less than a quarter of respondents reported a 4 or 5 on a scale with 5 being “very difficult”.

The percentage reporting difficulty was somewhat higher for the rural respondents with 28%

marking a 4 or 5 compared to 16% for urban respondents. Reasons for difficulty getting time off

were similar for urban and rural EMS personnel answering the survey with the number one

reason being schedule or shift work followed by loss of income. Other reasons written in by

respondents included lack of other workers trained to take over their job, teachers who can’t

leave classrooms, appointments and other commitments, supervisory duties, living or working

too far away, having to use sick leave or vacation, babysitting or other family reasons and the

difficulty of juggling a full-time job or business ownership with volunteer EMS work.

7/14/2003 21

EMS Social Events

Question 15 asked respondents how many service or agency specific social events were

sponsored per year by their agency and how many they attended. 32% of respondents said no

events were sponsored and a similar number said they attended no events. The majority of both

rural and urban respondents attended between 1 and 10 events a year with no clearly different

pattern for the two groups emerging.

Hours, Runs and On-call Status per Month

A return to distinctively different patterns for rural and urban respondents is seen in

questions 16 through 20 which asked about the number of hours or runs made per month and on

call status in the month. As seen in the table below the average hours worked for the urban

respondent were about 130, more than double the average 51 hours reported by rural

respondents. 50% of rural EMS personnel responding to the survey worked less than 18 hours

per month whereas the 50th percentile was 120 hours for urban respondents. A similar pattern is

seen for EMS runs. The average number of times rural EMS personnel reported being on call or

on duty was much higher (19) than their urban counterparts (10). This suggests that, as we might

expect, rural EMS workers have fewer emergencies to respond to overall but so few EMS

personnel are available that those who are there must be on call much more often.

Table 3.3 Hours, Runs, Times per Month on Call for Urban and Rural Respondents Hours per month

worked in EMS job. Runs per month worked in EMS job.

Times per month on duty/ on call.

Urban Rural Urban Rural Urban Rural

N

141 179 129 158 150 195

Average

129.8 51.2 56.5 14.7 12.6 18.7

Median

120 18 35 4 10 16

7/14/2003 22

Reasons EMS Personnel Were Attracted to the Work

Question 21 presented a Likert scale where 1 = not a factor and 5 = major factor for 7

aspects of EMS that might play a part in the respondents decision to work in EMS. A full 90%

of respondents felt satisfaction in helping others was a major factor (marked 4 or 5) in their

decision and this was similar for both rural and urban respondents. This factor was followed by

interest in emergency medical care (82%), interest in trauma care (74%) and the challenge of

providing emergency care (67%), again major factors for both rural and urban groups.

Differences between rural and urban groups showed most clearly in some of the less popular

reasons. Rural EMS personnel answering the survey were more likely to choose community

need as a major influence (73% versus 50% for urban respondents). They were also more likely

to say that they were urged by family or friends: 23% of rural respondents versus 11% of urban

respondents choose a 4 or 5. Rural respondents, probably because more are volunteers or do not

make a lot of money, were far less likely to say that earning a living was a major factor (15%

versus 43%).

Other factors that respondents wrote in about what attracted them to EMS were:

• EMS work is a stepping stone to other careers in medicine or can otherwise be

used to gain experience.

• Required as a part of my job (for example, firefighting or law enforcement).

• Hobby or volunteer work such as youth sports or backcountry sports meant I

needed/wanted the skills.

• We get to drive fast!

• Live, work or play in isolated area and want the knowledge so I can help family,

friends, myself in emergency.

7/14/2003 23

• Family member needs medical assistance

• I love it! The nature of the work – helping people, work outside, independent,

diverse situations.

These comments would seem to indicate some potential pools of recruits, for example, those who

are considering a career in medicine other than EMS (although these might not be retained for

long), those involved in backcountry sports and so forth.

How Long EMS Workers Plan to Stay on the Job and Why

Question 22 asked how long respondents felt they would stay in their current EMS-

related job. 73% felt they would continue 5 or more years. This should be interpreted with some

caution however, when making inference about the population of Nevada EMS personnel, as

some degree of self selection bias may be influencing results. Those survey recipients most

invested in EMS are the most likely to return a survey about EMS. Results were similar for both

rural and urban respondents.

If the respondent felt they would leave in 5 years or less he or she was asked to scale each

of 11 reasons for leaving from 1 = not a factor to 5 = a major factor in leaving: time

commitment, training requirement, inadequate pay/no pay, general stress of EMS work, critical

incident stress, physical demands of the work, “I’ve done my time”, personality conflict with

EMS personnel, shortage of EMS personnel to back me up, health hazards or medical liability.6

Those who went on to answer the questions were much more likely to circle 1 or 2 than to circle

higher numbers, perhaps indicating that, amongst the survey respondents, even those considering

themselves more likely to leave had fairly positive feelings towards their job. The most

interesting differences in rural and urban respondents occurred in the reasons most likely to

6 116 of 433 respondents said they would leave in less than 5 years but about 220 went on to answer the questions pertaining to why they would leave.

7/14/2003 24

cause the respondent to leave before five years. For the urban respondents the highest

percentage marked 4 or 5 (5= Major factor) on “inadequate or no pay” (38%). For rural

respondents the corresponding reason was “time commitment” (33%). Rural respondents were

also more likely to see training requirements as a major reason for leaving EMS. It may be that

although rural respondents were less likely to cite inadequate pay as a reason to leave, many

consider the time and training commitments as more onerous because they are not compensated

at all or as much as their urban counterparts. Rural and urban respondents showed a similar

response pattern across reasons not considered as important to as many of the respondents: health

hazards, critical incident stress, personality conflicts and medical liability. Other reasons written

in by respondents included retirement, disability, became a nurse, went back to school, moved,

family demands, new job, military activation, lack of leadership in agency or don’t like particular

agency, moved to a non-volunteer community, attitude towards “Basics” or volunteers, lack of

high quality training available and changed priorities.

Reasons for staying 5 years or more (question 24) reinforced results obtained in the

similar question 21 on what attracted respondents to EMS work. Again respondents were most

likely to circle 4 or 5 (5= major factor) for “Satisfaction in helping others” (86%) followed by

interest in emergency medical care (79%), interest in trauma care (73%) and the challenge of

providing emergency care (70%). Rural respondents were again more likely to circle 4 or 5 for

some of the overall less popular reasons such as community need, influence of family and friends

and “shortage of EMS recruits to take my place”. Respondents responded positively to this

question with greater numbers and percentages circling 4 and 5 on all questions, indicating again

their overall positive feelings towards their EMS jobs. Other reasons written in most often as

reasons for staying were:

7/14/2003 25

• EMS duties are part of my job requirements (firefighter, casino security, law

enforcement, etc.)

• It’s how I earn my living, feed the family, obtain health and retirement benefits.

• It is a way of life, I enjoy it, I love it!

Recruiting and Retaining EMS Personnel

Questions 25 through 28 asked for opinions concerning recruiting and retaining

individuals to perform the respondent’s EMS duties. Recruiting and retaining EMS personnel

was clearly perceived to be a bigger problem for rural respondents than for urban respondents.

59% of rural respondents versus 21% or urban respondents said recruitment for their job title was

a 4 or 5 where 5 = great difficulty. Not quite as striking a difference was seen for the similar

question on difficulty of retaining an individual to perform your EMS job where 48% of rural

respondents circled 4 or 5 and only 28% of urban respondents did. Rural respondents were

more likely than urban respondents to indicate any barrier was a major barrier. Time

commitment (73% circled 4 or 5) and training requirements (62%) again emerged as a problem

for rural respondents. No interest in EMS and poor recruitment efforts emerged as other possible

barriers for rural EMS recruitment. Percentages of urban respondents circling 4 or 5 were much

lower but poor recruitment efforts, training requirements, time commitment and no interest in

EMS were most likely to be marked as a major barrier.

When compared by certification level, those certified at the EMT basic level were most

likely to mark a 4 or 5 (49%), followed by EMT intermediate at 40%. See Figure 3.4 below.

Many reasons were written in about other barriers to recruitment. Low or no pay was

mentioned by 38 of the 60 writing in a reason. Other reasons were problems with particular

7/14/2003 26

management or personnel, lack of leadership, lack of local budget for EMS, can’t get trainers,

don’t get a chance to use the skills we have learned, prejudice towards volunteers from paid

Figure 3.4 Level of Difficulty Recruiting by Certification Level.

Difficulty of Recruiting by Certification Level

Certification Level

EMT Paramedic

EMT Intermediate

EMT Basic

First Responder

% M

arki

ng 4

or 5

35

40

49

32

EMS workers, poor attitude towards new members, no jobs for EMT-Basics, intimidated by the

job, mine closings and family reasons. 50 respondents wrote in other reasons individuals quit

EMS including bad management, took another job or moved, the boom/bust cycle of some

county economies, burn-out, the cost of training, family reasons, retirement, paid EMTs took

over, lack of recognition, lack of professionalism, no trainers, cost of training, pursuit of higher

education and no support from the county.

7/14/2003 27

4. A Look at Volunteers

202 respondents or 42% of the respondents said they were not compensated for their

involvement in EMS. Rural respondents were much more likely to respond that they received no

compensation. Only 31% of urban respondents reported no compensation while 51% of the rural

group did so. The group of volunteers is fairly roughly defined with this question, since some

who reported receiving compensation received very small amounts.

Some Demographics of Volunteers

Non-compensated workers were older on average than compensated workers (see Table

4.1). 46% of females were non-compensated and 41% of the male respondents were non-

compensated. Volunteers came from a wide variety of backgrounds. Approximately 45% of the

total number of non-compensated workers reported a high school degree as their highest level of

educational achievement, 27% reported an associate degree and 19% a Bachelor’s Degree. About

14% of the volunteer pool was made up of those who reported household incomes of less than

$30,000 a year, 42% came from households making between $30,000 and $60,000 a year, 26%

from those making $60,000 to $90,000 a year and 18% made $100,000 or more.

Affiliation, Certification and Work Characteristics of Volunteers

Those who reported receiving no compensation were more likely to have the EMT Basic

level of certification (57%) than any other. 27% of those receiving no compensation were

certified at the EMT intermediate level and 13% were first responders (see figure 4.1). Non-

compensated EMS respondents had been involved in EMS fewer years than compensated

respondents and had been certified fewer years. See Table 4.1 below.

7/14/2003 28

Table 4.1 Compensated and Non-compensated EMS Worker Averages Non-compensated

Compensated

Mean Median Mean Median

Years Involved in EMS

9.0 7.0 12.6 11.0

Years Certified at Current Level

6.7 4.8 8.5 6.2

Hours per Week Worked in Other Job

40.9 40 36.1 40.0

# of EMS Social Events Regularly Attended

3.1 2.0 1.7 1.0

Hours per Month Worked in EMS Job

27.2 11.0 123.5 80.0

Runs per Month in EMS Job

7.7 3.0 49.7 21.0

On Duty/ On Call Days per Month

18.4 19.0 14.5 10.0

Age in Years

41.7 42.0 39.6 39.0

Years Residing in Community 17.7 15.0 18.5 17.0

Figure 4.1 Certification Levels of Volunteers

Current level of certification.

OtherRNEMT Paramedic

EMT Intermediate

EMT Basic

First Responder

Perc

ent Volunteer

Compensated

22

42

29

5

27

57

13

7/14/2003 29

The volunteer worker responding to this survey worked an average of 27 hours a month and went

on almost 8 EMS related runs per month. Half of volunteer workers made more than 3 runs per

month and worked more than 11 hours. On average, the volunteer in our survey was on call more

times per month (18) than the compensated worker (14.5). See Table 4.1 above for comparison.

Volunteers Reasons for Leaving Figure 4.2 Reasons for Leaving EMS for Compensated and Uncompensated

Reasons to Leave EMS < 5 Yrs.

CompensatedVolunteer

% M

arki

ng 4

or 5

Time Commitment

Training Required

Low/No Pay

General Stress

Crit. Incid. Stress

Physical Demands

Done My Time

Personality Conflict

Personnel Shortage

Health Hazards

Medical Liability

9

14

1010

16

10 10

4

25

17

10

14

69 1010

3130

13

2624

32

Volunteer respondents showed as much commitment to their EMS career as compensated

respondents did. Uncompensated respondents were slightly less likely to feel they would leave in

less than 5 years (25%) than were compensated respondents (27%). When respondents were

asked to rate reasons for leaving their EMS position in less than 5 years volunteer and

compensated workers did not show very pronounced differences. The largest percentage of

volunteer respondents circled 4 or 5 on time commitment (5 = major factor). There is some

indication that training and time requirements are more burdensome for volunteers, as one might

7/14/2003 30

expect (see figure 4.2 above). An equal percentage of compensated and uncompensated workers

considered low or no pay a 4 or 5.

5. A Profile of the EMS Worker Who Will Leave in Less Than 5 Years

Respondents who said they would be likely to leave their EMS-related job in less than 5

years were compared to those who said they would stay longer than 5 years. Only 116

individuals, or about 27%, said they would leave in less than 5 years. As noted previously, rural

and urban respondents showed little difference in their response to this question. There was also

little difference between volunteers (75% felt they would stay) and compensated respondents

(73% said they would stay). Again, there was little difference between those who reported their

EMS work was their primary occupation (76% said they would stay) and those who had a

different primary occupation (72% said they would stay). In many respects, respondents who

said they would leave in 5 years or less were very similar to their peers.

The most striking difference was in annual compensation (amongst those who were

compensated for their EMS job, since volunteers are not included in the average compensation

calculation). For those leaving it was only about $17,000 per year compared to $28,000 for those

who said they would stay. They also worked fewer hours per month, about 68 on average, while

those who said they would stay longer worked an average of 96 (see Table 5.1 below). 33% of

EMT basic certified workers said they would be leaving their current job, the highest percentage

of all certification levels. This might indicate that this level of certification tends to have a

higher burden of time and training when compared to money or other compensation (see Figure

5.1 below). Those who did not have another non-EMS related job were a little more likely to

remain on the job (79% versus 72%). Males were more likely to stay 5 or more years than were

7/14/2003 31

females (79% versus 63%). Lower household income also increased the likelihood of leaving

EMS.

When comparing factors that attracted people to EMS, barriers to recruitment, reasons for

job and community satisfaction for those who would leave and those staying, differences were

found to be slight or fairly subtle. A representative example of this is seen in Figure 5.2 below.

Here the percentage of respondents marking 4 or 5 on question 21’s series of factors playing a

role in making the decision to work in EMS is displayed for those who said they would leave in

less than 5 years and those who said they would stay. Most factors show little difference but

“urged by family and friends” appears to have been a major factor for somewhat more of the

group that feels they will leave. A similar pattern was seen when comparing ratings of barriers.

For most barriers, about the same percentage of those who would leave and those who would

stay mark 4 or 5 (5= major barrier) but a small difference is seen on the reason “health hazards”

(30% of leavers versus 23% of stayers perceive it as a major barrier). Other slight differences

were that slightly larger percentages of those leaving in less than five years circled 1 or 2 on job

satisfaction relating to quality of care provided by local EMS, access to continuing education and

time for coworker interaction, close relationships with coworkers, supervisor leadership, time off

from EMS, respect from nurses and respect from citizens.

7/14/2003 32

Table 5.1 Comparison of EMS Workers Leaving in Less than 5 Years and Staying More than 5 Years, Averages Stay < 5 Years

Stay > 5 Years

Mean Median Mean Median

Years Involved in EMS

10.4 7.5 11.7 10.0

Years Certified at Current Level

7.8 5.1 8.1 6.2

Annual Compensation in Dollars (EMS Job)

$16,915 $4000 $27,924 $11,000

Hours per Week Worked in Other Job

37 40 39 40

# of EMS Social Events Regularly Attended

2.4 1.5 2.2 1.0

Hours per Month Worked in EMS Job

68 36 96 30

Runs per Month Worked in EMS Job

39 10 34 10

On Duty/ On Call Days per Month

14.6 10.0 16.8 12.0

Age in Years

41.6 42.0 40.1 40.0

Years Residing in Community 19.7 18.0 18.0 15.0

Figure 5.1 Those Who Will Leave EMS by Certification Level

Stay > 5 Yrs.Stay < 5 Yrs.

Perc

ent

100

80

60

40

20

0

Certification Level

First Responder

EMT Basic

EMT Intermediate

EMT Paramedic

80

20

76

24

67

33

80

20

7/14/2003 33

Figure 5.2 Factors Attracting Those Who Will Leave EMS Compared with Those Who Will Stay

Factors Attracting Respondent to EMS Work

Stay > 5 Yrs.Stay < 5 Yrs.

% M

arki

ng 4

or 5

Community Need

Emerg. Med. Care Int

Trauma Care Interest

To Help Others

Urged by Family

Challenge of Job

To Earn a Living

2927

6964

15

24

9191

7674

8184

6463

6. EMS Job Satisfaction

Negative Aspects

Likert scales for 23 different aspects of job satisfaction were presented in the survey

instrument. Of these 23 aspects, respondents’ most negative reaction by far was to “amount of

local dollars for EMS” with 48% of respondents dissatisfied (circling a 1 or 2 where 1 was

defined as “not satisfied” and 5 was defined as “very satisfied”). The second and third most

negative reactions were to “professional respect from nurses” with 36% marking a one or two

and “professional respect from physicians” with 32% (see Figure 6.1 below which ranks the 23

aspects by percentage of respondents marking 1 or 2). A few less prominent negative factors

were “relationship with other area squads”, “availability of physician support” and "EMS-related

level of stress”.

7/14/2003 34

Positive Aspects

The strongest positive reaction was clearly to “professional respect from local citizens”

with 66% of answering respondents circling a 4 or 5 on this factor. Additional positive factors in

job satisfaction were “close relationships with coworkers” and “quality of care provided by local

EMS workers” with 59% of respondents circling a 4 or 5. 58% circled 4 or 5 for “quality of

equipment and supplies”. Another fairly positive factor appeared to be “degree of

responsibility/autonomy”. The respondents answers overall reflected a positive feeling about job

satisfaction with 4 and 5 answers much more likely to be circled than 1 and 2 (see Figure 6.2

below which ranks the 23 aspects by percentages of respondents marking 4 or 5).

Rural Urban Comparison

A comparison of rural and urban respondents on Likert scales for job satisfaction

revealed surprisingly few large differences. On issues of quantity and quality of care provided

by local EMS, availability of physician support, access to and quality of EMS continuing

education percentages of rural respondents marking 4 or 5 (5=Very Satisfied) were somewhat

higher than percentages of urban respondents doing so. For an example see Figure 6.3 below

which shows percentages of respondents marking each level of the Likert scale for “quality of

care provided by local EMS workers.

Rural respondents were somewhat less satisfied (circled 1 or 2 more often) on factors of

time for co-worker interaction (see Figure 6.4), close relationships with coworkers and

quality/quantity of EMS supplies. Although both urban and rural respondents were not happy

with the level of local dollars for EMS, rural respondents were even more likely to choose 1 or 2

(43% and 51% respectively, Figure 6.5). Rural respondents were more likely to choose 4 or 5

7/14/2003 35

for the factors of “volunteer nature of EMS work” and professional respect from physicians and

nurses.

Figure 6.1 Job Dissatisfaction - Highest Percentage to Lowest 29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied).

Job Dissatisfaction

0%10%20%30%40%50%60%

Local $

for E

MS

Respect

- Nurs

es

Respect

- Physi

cians

Physicia

n Suppo

rt

Relates

hp with

Area Squ

ads

Supervis

or Lead

ership

Quality

of Cont.

Ed.

Access

to Cont.

Ed.

Coworker

Interact

ion Tim

e

Supervis

or Avail

ibility

Time O

ff

Voluntee

r Natu

re of W

ork

Supervis

or Com

peten

ce

EMS Stress

#EMS Provide

rs# of P

eers

Quantity

EMS Suppli

es

Quality

EMS Supplie

s

Quality

of Care

Provided

Peer Emoti

onal Supp

ort

Close Rela

tionsh

ips w Peer

s

Degree

of Resp

onsibil

ity

Respect

- Loca

l Citiz

ens

% Marking 1+2

7/14/2003 37

Figure 6.2 Job Satisfaction Factors from Highest Percentage to Lowest 29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied).

Job Satisfaction

0%10%20%30%40%50%60%70%

Respect

- Loca

l Citiz

ens

Close Rela

tionsh

ips w Peer

s

Quality

of Care

Provided

Quality

EMS Supplie

s

Quantity

EMS Suppli

es

Peer Emoti

onal Supp

ort

Access

to Cont.

Ed.

#EMS Provide

rs

Degree

of Resp

onsibil

ity# of P

eers

Supervis

or Com

peten

ce

Quality

of Cont.

Ed.

Voluntee

r Natu

re of W

ork

Supervis

or Avail

ibility

Time O

ff

Supervis

or Lead

ership

Physicia

n Suppo

rt

Respect

- Physi

cians

Time f

or Cow

orker In

ter...

Relatio

nship with

Area

S...

Respect

- Nurs

es

EMS Stress

Local $

for E

MS% Marked 4 or 5

7/15/2003 38

Figure 6.3 Satisfaction with Quality of Care Provided by Local EMS Workers for Rural and Urban Groups 29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied).

Quality of Care Provided by Local EMS Workers

54321

Perc

ent Urban

Rural

3032

25

9

4

20

33

27

14

7

Figure 6.4 Satisfaction with Time for Coworker Interaction for Rural and Urban Groups 29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied).

Time for Coworker Interaction

54321

Perc

ent Urban

Rural

11

21

39

20

9

19

27

35

108

7/15/2003 39

Figure 6.5 Dissatisfaction with Local Dollars for EMS, Rural and Urban Groups 29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied).

Local Dollars for EMS

54321

Perc

ent Urban

Rural

9

16

24

19

32

12

15

29

20

23

7. Community Satisfaction

In order to measure feelings about community satisfaction, respondents were presented

Likert scales ranging from 1 (not satisfied) to 5 (very satisfied) on eight variables, i.e. size of

community, social/recreational opportunities, overall environment for children, quality of

schools, degree of safety, healthcare system, overall community satisfaction and spouse’s overall

level of community satisfaction. Overall, more respondents circled 4 or 5 than 1 or 2 indicating

that, on average, respondents felt positively about their community. Healthcare was the category

of community satisfaction with the largest percentage of respondents who were not satisfied

(circled 1 or 2) at 35% amongst the group both urban and rural groups. The clearest difference

between rural and urban respondents was on the issue of social and recreational opportunities

where rural respondents were much less satisfied (15% versus 34% were not satisfied, see Figure

7/15/2003 40

7.1) and on the issue of community safety where rural residents appeared to feel more safe (26%

rural versus 10% urban marked very satisfied, see Figure 7.2). Most other factors did not appear

to cause very different levels of community satisfaction for rural as opposed to urban

respondents (see figure 7.3).

7/15/2003 41

Figure 7.1 Satisfaction with Social/Recreational Opportunities of Community for Rural and Urban Groups 30. How satisfied are you with the following factors in your present community? Please rate each item from 1 to 5. (1=not satisfied, 5 = very satisfied)

Social/Recreational Opportunities

54321

Perc

ent Urban

Rural

16

23

27

1617

34

30

21

13

3

7/15/2003 42

Figure 7.2 Satisfaction with Degree of Safety for Urban and Rural Groups 30. How satisfied are you with the following factors in your present community? Please rate each item from 1 to 5. (1=not satisfied, 5 = very satisfied)

Degree of Safety

54321

Perc

ent Urban

Rural

26

36

26

74

10

27

42

15

7

7/15/2003 43

Figure 7.3 Rural and Urban Comparison of Community Satisfaction Factors 30. How satisfied are you with the following factors in your present community? Please rate each item from 1 to 5. (1=not satisfied, 5 = very satisfied)

Community Dissatisfaction

RuralUrban

% M

arki

ng 1

or 2

Size of Community

Social/Recreational

Environment for Kids

Quality of Schools

Degree of Safety

Health Care System

Overall Satisfaction

Spouse Satisfaction

2021

1313

3433

12

22

26

33

2729

33

1517

20

7/15/2003 44

Summary Nevada EMS personnel face many challenges in continuing to provide and improve

emergency services, especially in the vast distances of rural Nevada. As one part of an effort to

better recruit and retain EMS personnel a large amount of data on 491 Nevada EMS personnel

has been collected and analyzed. Data collected includes demographic information, work

characteristics and reasons for working in or leaving EMS. Rural and urban subgroups were

created and compared across all questions. Subgroupings of volunteers and workers planning to

leave their jobs in less than 5 years were also compared to their counterparts. Themes that

emerged from this analysis are as follows.

Respondents in rural counties were older on average than their urban counterparts, while at the same time Census figures show an older than average general population in many rural counties. These two factors add to EMS challenges in rural counties since older and retiring EMS workers will be taking care of a larger number of emergency calls from an older population. On the other hand, retirees might also be considered as a possible resource.

The survey results indicate that the number of minorities as well as women in EMS workforce is low when compared with census data for the state. This might represent another segment of the population to target for recruitment efforts in some counties. The fast growing Hispanic population is especially of interest.

Respondents who were certified at the EMT basic level were the most likely to say they would leave EMS in the next 5 years and most likely to report that recruitment for their title was difficult. This certification level makes up 57% of volunteer respondents.

The most dramatic differences between rural and urban respondents emerged when examining patterns of work and compensation. Rural workers worked far fewer hours and runs, but were on call more often and tended to work for more different services than urban respondents did. Rural respondents received, on average, about half the compensation that urban respondents received. It was also clear that rural respondents overall perceived much greater difficulty in recruiting and retaining EMS workers. More subtle differences were seen between rural and urban perceptions of the attractions of EMS work, barriers to recruitment, job satisfaction and community satisfaction.

Low or no pay and inadequate pay emerged frequently as top reasons for recruitment and retention problems. Another top reason, time commitment and training

7/15/2003 45

requirements, seems to be related to the compensation issue. It was interesting that a larger percentage of urban respondents found low pay to be a major barrier whereas for the rural group a larger percentage found time commitment and training requirements to be a major barrier. 43% of urban respondents and only 15% of rural respondents viewed “to earn a living” as a major factor in deciding on EMS work. One might guess that since rural EMS personnel are less likely to think of EMS as a way of making a living the time constraints are considered more profound whereas the urban worker would more often think of EMS as something one could make a living at and see low pay as an obstacle.

Amongst respondents who were compensated EMS personnel, the single most striking difference between those who would leave in less than 5 years and those who would stay was that they received, on average, much less in compensation. Respondents who were volunteers, however, were no more likely to say they would leave their EMS work than were compensated workers.

7/15/2003 46

Appendix 1 Demographics Results 31. List the age and gender of persons in your household (n=471). Categorical variable created from original.

Count

18-30

98

31-40

142

41-50

140

51-65

82

65 and up

9

Total

471

Missing

20


65 y

rs. a

nd u

p

51 to

65

41 to

50

31 to

40

18 to

30

Perc

ent

17

3030

21

Cross Tabulation with Rural or Urban (n=419)

Count Urban

Rural

18-30

56 34

31-40

62 68

41-50

47 73

51-65

19 52

65 and up

0 8


65 a

nd u

p

51 to

65

yrs

41 to

50

31 to

40

18 to

30

yrs.

Perc

ent Urban

Rural3

22

3129

14

10

26

3430

7/15/2003 47

Gender of Respondent (n=476)

Count Male

307

Female

169

Total

476

Missing

15

Gender of Respondent

FemaleMale

Perc

ent

36

64


Count Urban

Rural

Male

126 139

Female

59 100

Gender of Respondent

FemaleMale

Perc

ent Urban

Rural

42

58

32

68

7/15/2003 48

32. What is your highest level of educational attainment? (n=484)

Count Some grade/high school

16

HS diploma/GED

193

Associate degree

149

Bachelor's degree

92

Master's degree

28

Doctoral degree

6

Total 484 Missing 7

Highest Level of Educational Attainment

Doc

tora

l deg

ree

Mas

ter's

deg

ree

Bac

helo

r's d

egre

e

Ass

ocia

te d

egre

e

HS

dipl

oma/

GED

Som

e gr

ade/

high

sch

oPerc

ent

6

19

3140


Count Ur-

ban Rur-

al Some grade/high school

7 6

HS diploma/GED

65 111

Associate degree

67 64

Bachelor's degree

36 43

Master's degree

11 14

Doctoral degree

3 2 Level of Education.

Doc

tora

l deg

ree

Mas

ter's

deg

ree

Bac

helo

r's d

egre

e

Ass

ocia

te d

egre

e

HS

dipl

oma/

GED

Som

e gr

ade/

high

sch

oPerc

ent Urban

Rural6

18

27

46

6

19

3534

7/15/2003 49

33. How long have YOU lived in your community? (n=479) Categorical variable created from original.

Count 0 - 2 yrs.

26

2 - 5 yrs.

57

6 - 10 yrs.

87

11 - 15 yrs.

80

16 - 20 yrs.

55

21 yrs. & up

174

Total

479

Missing

12

How Long Have You Lived

in Your Community?

21 y

rs &

up

16 -

20 y

rs

11- 1

5 yr

s

6 - 1

0 yr

s

2 - 5

yrs

0 - 2

yrs

Perc

ent

36

111718

12

5

Cross Tabulation with Rural or Urban (n=426) Count

Urban

Rural

0 - 2 yrs.

8 11

2 - 5 yrs.

21 30

6 - 10 yrs.

32 46

11 - 15 yrs.

31 38

16 - 20 yrs.

14 38

21 yrs. & up

79 78

How long have YOU lived in your Community?

21 y

rs &

up

16-2

0 yr

s

11-1

5 yr

s

6 -1

0 yr

s

2-5

yrs

0- 2

yrs

Perc

ent Urban

Rural

32

161619

12

5

43

8

1717

11

4

7/15/2003 50

34. What is your current approximate gross (before tax) household income? (n=454) Count

$0-9,999 9 $10,000-19,999

14

$20,000-29,999

36

$30,000-39,999

37

$40,000-49,999

47

$50,000-59,999

68

$60,000-69,999

54

$70,000-79,999

40

$80,000-89,999

42

$90,000-99,999

34

$100,000+ 73 Total 454 NA7 4 Missing 33

What is Your Gross Household Income?

$100

,000

+

$90,

000-

99,9

99

$80,

000-

89,9

99

$70,

000-

79,9

99

$60,

000-

69,9

99

$50,

000-

59,9

99

$40,

000-

49,9

99

$30,

000-

39,9

99

$20,

000-

29,9

99

$10,

000-

19,9

99

$0-9

,999

Perc

ent

16

799

12

15

1088

32


Count Ur-

ban Rur-

al $0-9,999 4 4 $10,000-19,999 5 8 $20,000-29,999 13 20 $30,000-39,999 11 20 $40,000-49,999 16 30 $50,000-59,999 18 41 $60,000-69,999 23 25 $70,000-79,999 13 22 $80,000-89,999 18 21 $90,000-99,999 17 15 $100,000+ 43 17 Annual Gross Household Income

$100,000+

$90,000-99,999

$80,000-89,999

$70,000-79,999

$60,000-69,999

$50,000-59,999

$40,000-49,999

$30,000-39,999

$20,000-29,999

$10,000-19,999

$0-9,999

Perc

ent

30

20

10

0

Urban

Rural

87910

11

18

13

99

4

24

910

7

13

109

67

32

7 NA = Not Applicable (on this question some respondents wrote this in.)

7/15/2003 51

35. What is your racial/ethnic background? (n=463)

Count White

415

Black

6

Asian

9

American Indian

12

Hispanic

21

Total

463

NA

1

Missing

27

Ethnicity

His

pani

c

Am

er. I

ndia

n

Asi

an

Bla

ck

Whi

te

Perc

ent

90


Count Urban

Rural

White

157 215

Black

6 0

Asian

7 2

Amer. Indian

3 7

Hispanic

11 9

Ethnicity.

Hispanic

Amer. Indian

AsianBlack

White

Perc

ent Urban

Rural

92

6

85

7/15/2003 52

36. What is your marital status? (n=482)

Count Married

343

Never Married

69

Divorced/Separated/ Widowed

70

Total

482

NA

2

Missing

7

Total 9

Marital Status

Divorce/Separate/Wid

Never Married

Married

Perc

ent

1514

71


Count Urban Rural Married

125 182

Never Married

42 24

Divorced/Separated/ Widowed

22 34

Marital Status

Divorce/Separate/Wid

Never Married

Married

Perc

ent Urban

Rural1410

76

1222

66

7/15/2003 53

37. If married, what is your spouse’s occupational status? (n=350)

Count Full-time

210

Part-time

67

Retired

18

Unemployed

55

Total

350

NA

119

Missing

22

Spouse's Job Status

UnemployedRetiredPart-timeFull-time

Perc

ent 16

5

19

60


Count Urban

Rural

Full-time

81 105

Part-time

23 39

Retired

6 12

Unemployed

22 25

Spouse's Job Status

Unemployed

Retired

Part-time

Full-time

Perc

ent Urban

Rural14

7

22

58

17

5

17

61

38. If your spouse is employed, please list his/her primary job title (see text).

7/15/2003 54

39. If applicable, how supportive is your spouse/significant other of your role in local EMS care provision? (1=very unsupportive and 5=very supportive, n=379)

Count 1

6

2

12

3

37

4

71

5

253

Total

379

NA

94

Missing

18

How Supportive is Your Spouse/Significant Other?

54321

Perc

ent

67

19

10


Urban

Rural

1

2 3

2

2 8

3

9 23

4

30 35

5

105 124

How Supportive is Your Spouse/Significant Other?

54321

Perc

ent Urban

Rural

64

18

12

4

71

20

6

For discussion of additional comments written in by respondents see text and Appendix 7.

7/15/2003 55

Rural or Urban (Additional variable coded with zip code information where urban was defined as urban zip codes in Clark and Washoe County, n=435)

Count Urban

191

Rural

244

Total

435

Missing

56

Rural and Urban Respondents

RuralUrban

Perc

ent

56

44

7/15/2003 56

Household Size (Additional variable coded with age and gender information in question 31) Count

1

57

2

162

3

86

4

101

5

46

6

13

7

2

8

6

Total

473

Missing

18

Size of Household

87654321

Perc

ent

3

10

2118

34

12


Count Urban

Rural

1

23 25

2

57 88

3

34 41

4

45 52

5

20 19

6

2 8

7 or 8

4 2

Size of Household

654321

Perc

ent Urban

Rural3

8

22

17

37

11 11

24

18

31

12

7/15/2003 57

Appendix 2. EMS Affiliation Are you a member of Nevada Emergency Medical Association? (n=468)

Count No

380

Yes

88

Total

468

Missing

23

19%

81%

Yes

No


Count Urban

Rural

No

166 171

Yes

18 61

Member of Nevada Emergency Medical Association.

YesNo

Perc

ent Urban

Rural

26

74

10

90

7/15/2003 58

What is your current level of certification? (n=489)

Count First Responder

45

EMT Basic

199

EMT Intermediate

173

EMT Paramedic

62

RN

7

Other

3

Total

489

Missing

2

Oth

erRN

EMT

Para

med

ic

EMT

Inte

rmed

iate

EMT

Bas

ic

Firs

t Res

pond

er

Perc

ent 13

3541

9


Count Urban

Rural

First Responder

14 24

EMT Basic

68 106

EMT Intermediate

63 95

EMT Paramedic

43 13

RN

2 4

Other

1 1

Oth

erRN

EMT

Para

med

ic

EMT

Inte

rmed

iate

EMT

Bas

ic

Firs

t Res

pond

er

Perc

ent Urban

Rural5

3944

10

23

3336

7

7/15/2003 59

1. Are you a member of a service/agency that is permitted to respond to emergencies? (n=486)

Count No

83

Yes

403

Total

486

NA8

1

Missing

4

83%

17%

Yes

No


Count Urban

Rural

No

42 28

Yes

149 213

Member of agency permitted to respond to emergencies.

YesNo

Perc

ent Urban

Rural

88

12

78

22

8 NA = not applicable

7/15/2003 60

If yes, what type of agency? (n=401)

Count Fire

209

Ambulance

110

Rescue

21

Other

61

Total

401

NA

82

Missing

8


Perc

ent

15

5

27

52


Count Urban

Rural

Fire

87 98

Ambulance

38 66

Rescue

6 13

Other

15 37

If Yes, type of agency.


Perc

ent Urban

Rural

17

6

31

46

10

4

26

60

7/15/2003 61

If no, have you applied or intend to apply to join an emergency response agency within 6 months? (n=84)

Count No

49

Yes

35

Total

84

NA

396

Missing

11

42%

58%

Yes

No


Count Urban

Rural

No

21 19

Yes

22 9

If no, have applied to join agency.

YesNo

Perc

ent Urban

Rural

32

68

5149

See text for explanations respondents wrote in about why they would not apply to join.

7/15/2003 62

2. What type of continuing education do you utilize to renew your certification?

Count

Con-ference

Video Annual Other

No

309 366 136 329

Yes

173 116 346 162

Total

482 482 482 491

Missing

9 9 9

OtherAnnual Refresher

Compressed Video

EMS ConferencesPe

rcen

t

33

72

24

36

Cross Tabulation with Rural or Urban (n=430, for other category n=435)

Ur- ban

Ru- ral

Con-ference

No 152 125

Yes

35 118

Video No

156 166

Yes

31 77

Refresh-er

No

42 75

Yes

145 168

Other No

131 161

Yes

60 83

RuralUrban

Perc

ent

EMS Conferences

Compressed Video

Annual Refresher

Other

3431

69

78

32

17

49

19

Note: “Other” category created by recoding “Not Applicable” or “Missing” as no. See main text for more information on other types of continuing education written in by respondents.

7/15/2003 63

Appendix 3 EMS Duties and Service Information 1.(a) EMS Service(s) in which you participate: (check all that apply, n=452, Other category n=491)

No

Yes NA Missing

Ambulance

196 256 5 34

Quick Response

338 114 5 34

Rescue

263 189 5 34

Fire

209 243 5 34

Law En-forcement

424 28 5 34

Other

431 60 0 0


OtherLaw Enforcement

FireRescue

Quick Response

AmbulancePe

rcen

t 17

6

54

42

25

57

Cross Tabulation with Rural or Urban (n=403, for other category n=435)

Urban

Rural

Ambulance No 107 65 Yes 66 165 Quick Response

No 142 160

Yes 31 70 Rescue No 119 118 Yes 54 112 Fire No 84 105 Yes 89 125 Law En-forcement

No 167 212

Yes 6 18 Other No 163 218 Yes 28 26


RuralUrban

Perc

ent

Ambulance

Quick Response

Rescue

Fire

Law Enforcement

Other

1115

8

5451

49

31 30

18

72

38

Note: “Other” new created variable in which no = missing or not applicable and Yes = all else. See text for more on other types of services written in by respondents.

7/15/2003 64

2. Your highest EMS certification: (check one) (n=483) Count

First Responder

38

EMT Basic

178

EMT Intermediate

191

EMT Paramedic

70

Other

6

Total

483

Missing

8

Your Highest EMS Certification

OtherEMT Paramedic

EMT Intermediate

EMT Basic

First Responder

Perc

ent 14

4037

8


Urban

Rural

First Responder

13 20

EMT Basic

56 99

EMT Intermediate

69 102

EMT Paramedic

46 17

Other

4 2

Highest Level of Certification

OtherEMT Paramedic

EMT Intermediate

EMT Basic

First Responder

Perc

ent Urban

Rural7

4341

8

24

37

30

7

7/15/2003 65

3. Please indicate any other training you’ve had: (check all that apply, n=465) Automatic defibrillation (AD), manual defibrillation (MD), I.V. maintenance (IV), flight medical crew (FMC), auto extrication (AE), epinephrine administration (EA), pediatric advance life support (PALS), advanced cardiac life support (ACLS), basic trauma life support (BTLS), advanced trauma life support (ATLS), others. See text for discussion of other training. Count

AD

MD IV FMC AE EA PALS ACLS BTLS ALTS Other

No

63 292 205 421 118 223 333 320 145 373 411

Yes

402 173 260 44 347 242 132 145 320 92 80

Total

465 465 465 465 465 465 465 465 465 465 491

Missing

26 26 26 26 26 26 26 26 26 26 0

Other Training

Oth

er T

rain

ing

Adv

ance

d Tr

aum

a Li

fe

Bas

ic T

raum

a Li

fe S

u

Adv

ance

d C

ardi

ac S

up

Pedi

atric

Adv

. Life

Epin

ephr

ine

Adm

inis

t

Aut

o Ex

trica

tion

Flig

ht M

edic

al C

rew

IV M

aint

enan

ce

Man

ual D

efib

ulat

ion

Aut

o. D

efib

ulat

ionPe

rcen

t

1620

69

3128

52

75

10

56

37

86

7/15/2003 66

3. Please indicate any other training you’ve had: (check all that apply, n=465) Automatic defibrillation (AD), manual defibrillation (MD), I.V. maintenance (IV), flight medical crew (FMC), auto extrication (AE), epinephrine administration (EA), pediatric advance life support (PALS), advanced cardiac life support (ACLS), basic trauma life support (BTLS), advanced trauma life support (ATLS), others. Cross Tabulation with Rural or Urban (n=413, for other n=435)

AD

MD IV FMC AE EA PALS ACLS BTLS ALTS Other

Urban No

24 99 65 155 46 78 112 111 52 126 165

Yes

152 77 111 21 130 98 64 65 124 50 26

Rural

No 31 158 117 219 64 123 182 172 79 204 198

Yes 206 79 120 18 173 114 55 65 158 33 46

Other Training

RuralUrban

Perc

ent

100

80

60

40

20

0

Auto Defib.

Manual Defibulation

I.V. Maintenance

Flight Med Crew.

Auto Extrication

Epinephrine Admin.

Pediatric Advance LS

Advanced Cardiac LS

Basic Trauma LS

Advanced Trauma LS

Other

1914 14

28

6770

27

37

23

36

48

56

7374

812

51

63

33

44

8786

7/15/2003 67

4. How long have you been involved in EMS? ___Years ___Months (n=479) Counts and percentages for categorical variable created from above question (n=479)

Count 0 – 2

50

2 -5

92

5 – 10

109

10 – 15

74

15 – 20

67

20 & up

87

Total

479

Missing

12

How Long Have You Been Involved in EMS?

20 and up

15 to 20

10 to 15

5 to 102 to 5

0 to 2 yrs.

Perc

ent

18

1415

23

19

10

Cross Tabulation with rural or urban (n=423).

Count Urban Rural

0 – 2

24 21

2 -5

39 43

5 – 10

38 61

10 – 15

29 36

15 – 20

21 38

20 & up

33 40 How Long Have You Been Involved in EMS?

20 and up

15 to 20

10 to 15

5 to 102 to 5

0 to 2 yrs.

Perc

ent Urban

Rural

171615

26

18

9

18

11

16

2121

13

7/15/2003 68

5. How long have you held at your current EMS certification level? (n=482) Counts and percentages for categorical variable created from above question.

Count 0 – 2

97

2 -5

111

5 – 10

124

10 – 15

69

15 – 20

38

20 & up

43

Total

482

NA

1

Missing

8

Time Certified at Your Current EMS Level

20 and up

15 to 20

10 to 15

5 to 102 to 5

0 to 2 yrs.

Perc

ent

98

14

2623

20


Count Years

Urban Rural

0 – 2

41 46

2 -5

48 52

5 – 10

43 68

10 - 15

28 34

15 - 20

10 22

20 & up

17 18

Time Certified at Your Current EMS Level

20 and up

15 to 20

10 to 15

5 to 102 to 5

0 to 2 yrs.

Perc

ent Urban

Rural

89

14

28

2219

9

5

15

2326

22

7/15/2003 69

6. Is your EMS position your primary occupation? (n=482)

Count

No

367

Yes

115

Total

482

NA

1

Missing

8

Is Your EMS Position Your

Primary Occupation?

24%

76%

Yes

No

Cross Tabulation with rural or urban. (n=428)

Count Urban

Rural

No

117 207

Yes

71 33

Is Your EMS Position Your Primary Occupation?

YesNo

Perc

ent Urban

Rural14

86

38

62

7/15/2003 70

7. Are you compensated for your involvement in EMS? (n=476)

Count No

202

Yes

274

Total

476

NA

2

Missing

13

Are You Compensated for Your Involvement in EMS?

58%42%YesNo

Cross Tabulation with rural or urban (n=425).

Count Urban

Rural

No

59 120

Yes

129 117

Compensated for EMS Role

YesNo

Perc

ent Urban

Rural

4951

69

31

7/15/2003 71

8. If yes, approximately how much are you compensated for your EMS role? $_____per year (n= 177, continuous variable) Statistics ($) Mean $24,162 Median 7,500

25 1,550 Percentiles 75 47,000

25000 50000 75000 100000If Yes, Annual Compensation in Dollars

10%

20%

30%

40%

50%

Perc

ent

7/15/2003 72

8. If yes, approximately how much are you compensated for your EMS role? $_____per year Statistics, Comparison of Rural and Urban Groups If Yes, Annual Compensation in Dollars

Valid 90N Missing 101

Mean $31,151Median $25,000

25 $5000

Urban

Percentiles75 $50,000Valid 74N Missing 170

Mean $14,070Median $2500

25 $517

Rural

Percentiles75 $25,000

25000 50000 75000 1000000%

25%

50%

75%

Perc

ent

Urban Rural

25000 50000 75000 100000

7/15/2003 73

9. If so, HOW are you compensated for your EMS role? (Check all that apply), n=309, for other category n=491 Count

No

Yes NA Missing

Salary

235 74 160 22

Hourly Rate

177 132 160 22

Per Run

252 57 160 22

Cont. Ed.

273 36 160 22

Other

449 42 0 0

How Are You Compensated for EMS Role?

OtherCE reimburs.

Paid per Run

Hourly Rate

SalaryPe

rcen

t

912

18

43

24

Cross Tabulation with Rural or Urban (n=274, for Other n= 435) Count

Urban

Rural

No

Yes No Yes

Salary

86 47 123 18

Hourly

60 73 94 47

Per Run

130 3 94 19

Cont. Educ.

118 15 122 19

Other

172 19 227 17 How Are You Compensated for Your EMS Role?

RuralUrban

Perc

ent

Salary

Hourly Rate

Paid per Run

CE reimburs.

Other7

1013

11

3333

55

13

35

Note: For discussion of other types of compensation written in by respondents see text.

7/15/2003 74

10. Do you currently have a job other than your EMS-related duties?

Count No

99

Yes

373

Total

472

NA

4

Missing

15

Do You Currently Have a Job Other than

Your EMS-related Duties?

79%

21%

Yes

No


Count Urban

Rural

No

51 36

Yes

133 199

Have Job Other than EMS

YesNo

Perc

ent Urban

Rural

85

15

72

28

7/15/2003 75

11. If yes, what is the title of your other (non-EMS) job? (See text.) 12. How many hours do you typically work in your non-EMS job? _______Hours per week (n=365) Statistics Hours per week worked in other job. Mean 38.6Median 40

25 40Percentiles 75 48

Histogram

0 25 50 75Hours per Week Work ed in Other Job

10%

20%

30%

40%

50%

Perc

ent

7/15/2003 76

12. How many hours do you typically work in your non-EMS job? _______Hours per week Comparison of Rural and Urban Statistics Hours per week worked in other job.

Valid 124N Missing 67

Mean 38.6Median 40

25 32

Urban

Percentiles 75 50Valid 202N Missing 42

Mean 38.6Median 40

25 40

Rural

Percentiles 75 48

Histograms

0 25 50 75Hours per Week Worked in Other Job

10%

20%

30%

40%

50%

Perc

ent

Urban Rural

0 25 50 75Hours per Week Worked in Other Job

7/15/2003 77

13. If applicable, how difficult (on average) is it for you to get time off for your EMS-related duties? (1=Very Easy, 5=Very Difficult, n=376) Count

1

131

2

85

3

75

4

55

5

31

Total

377

NA

63

Missing

51

How Difficult Is It to Get Time Off for EMS?

54321

Perc

ent 8

15

2023

35


Count Urban

Rural

1

55 56

2

37 44

3

23 45

4

16 32

5

6 23

How Difficult to Get Time Off for EMS

54321

Perc

ent Urban

Rural

12

16

2322

28

4

12

17

27

40

7/15/2003 78

14. If applicable, WHY is it difficult to get time off from your regular job? (n=221, for other category n=491) Count

No

Yes NA Missing

No Support -Boss

172 49 173 97

Schedule

97 124 173 97

No Support -Coworkers

208 13 173 97

Lost Income

168 53 173 97

Other

434 57 0 0

Why Is It Difficult to Get Time Off for EMS?

OtherLoss of Income

No Support-Coworkers

Schedule/Shift

Lack of support-BossPe

rcen

t

12

24

6

56

22

Cross Tabulation with Rural or Urban (n=202, for other n=491)

Urban

Rural

No

57 101 Lack of Support From Boss

Yes 11 33

No

26 62 Schedule

Yes

42 72

No

64 126 Lack of Support From Coworkers

Yes 4 8

No

51 104 Lost Income

Yes 17 30

No

178 204 Other Yes

13 40

Why Is It Difficult to Get Time Off From Regular Job?

RuralUrban

Perc

ent

Lack of Support

From Boss

Schedule/Shiftwork

Lack of Support

From Fellow Employee

Loss of Income

Other

16

7

2225

66

54

62

25

16

Note: For discussion of other reasons for difficulty getting time off written in by respondents see text.

7/15/2003 79

15. Approximately how many closed (service/agency specific) social events does your service/agency sponsor? (Categorical variable created, n= 329) Count

0 Events

104

1 Event

54

2 Events

78

3-4 Events

40

5-10 Events

35

11-20 Events

12

21 or More

6

Total

329

NA

16

Missing

146

How Many Social Events Does Your Agency Sponsor?

21 or more

11-20 events

5-10 events

3-4 events

2 events

1 event

0 events

Perc

ent

4

1112

24

16

32


Count Urban

Rural

0 Events

37 54

1 Event

15 33

2 Events

34 37

3-4 Events

9 26

5-10 Events

17 13

11-20 Events

6 6

21 or More

3 3 Number of Social Events

21 or more

11-20 events

5-10 events

3-4 events

2 events

1 event

0 events

Perc

ent Urban

Rural38

15

2219

31

25

14

7

28

12

31

7/15/2003 80

15. (Continuation) Of those, how many do you attend on a regular basis? (n=275, data for categorical variable created from original) Count

0 events

84

1 event

61

2 events

59

3-4 events

45

5-10 events

18

11-20 events

5

21 or more

3

Total

275

NA

13

Missing

203

How Many Do You Attend?

21 or more

11-20 events

5-10 events

3-4 events

2 events

1 event

0 events

Perc

ent

7

16

2122

31


Count Urban

Rural

0 events

30 46

1 event

21 33

2 events

24 30

3-4 events

13 26

5-10 events

9 8

11-20 events

2 3

21 or more

2 1 How Many Events Do You Attend?

21 or more

11-20 events

5-10 events

3-4 events

2 events

1 event

0 events

Perc

ent Urban

Rural5

1820

22

31

913

2421

30

7/15/2003 81

16. How many approximate hours and runs per month DO YOU work in your EMS-related job? (n=357, data for categorical variable created from original)

Count 0-10 hrs.

102

11-20 hrs.

63

21-40 hrs.

41

41-80 hrs.

33

81-160 hrs.

29

161 and up

89

Total

357

NA

15

Missing

119

Number of Hours EMS Work per Month

161 and up

81-160 hrs.

41-80 hrs.

21-40 hrs.

11-20 hrs.

0-10 hrs.

Perc

ent

25

8911

18

29


Urban

Rural

0-10 hrs.

28 65

11-20 hrs.

12 45

21-40 hrs.

15 20

41-80 hrs.

11 18

81-160 hrs.

17 9

161 and up

58 22

Number of Hours Per Month

161 and up

81-160 hrs.

41-80 hrs.

21-40 hrs.

11-20 hrs.

0-10 hrs.

Perc

ent Urban

Rural

12

51011

25

3641

128

119

20

7/15/2003 82

16. (continuation) Number of runs per month in your EMS-related job? (n= 319, data for categorical variable created from original)

Count 0-5 runs

136

6-10 runs

43

11-20 runs

32

21-40 runs

26

41-80 runs

32

81 and up

50

Total

319

NA

18

Missing

154

Number of EMS Runs per Month

81 and up

41-80 runs

21-40 runs

11-20 runs

6-10 runs

0-5 runs

Perc

ent

1610810

13

43


Urban

Rural

0-5 runs

32 91

6-10 runs

8 28

11-20 runs

13 17

21-40 runs

15 8

41-80 runs

22 6

81 and up

39 8

Number of EMS Runs Per Month

81 and up

41-80 runs

21-40 runs

11-20 runs

6-10 runs

0-5 runs

Perc

ent Urban

Rural5511

18

58

30

171210

6

25

7/15/2003 83

19. How many runs per month do you typically make? (n=372, data for categorical variable created from original)

Count 0-5 runs

156

6-10 runs

62

11-20 runs

38

21-40 runs

28

41-80 runs

36

81 and up

52

Total

372

NA

15

Missing

104

Number of Runs per Month

81 and up

41-80 runs

21-40 runs

11-20 runs

6-10 runs

0-5 runs

Perc

ent 14

10810

17

42


Count Urban

Rural

0-5 runs

39 103

6-10 runs

10 43

11-20 runs

10 25

21-40 runs

17 7

41-80 runs

28 5

81 and up

41 9

Number of Runs Per Month

81 and up

41-80 runs

21-40 runs

11-20 runs

6-10 runs

0-5 runs

Perc

ent Urban

Rural54

13

22

54

28

19

1277

27

7/15/2003 84

20. Approximately how many times per month are you on duty or on call status? (n=386, data for categorical variable created from original)

Count 0 to 5

87

6 to 10

97

11 to 20

86

21 and up

116

Total

386

NA

27

Missing

78

Total

105

Number of Times Per Month On Duty or On Call

21 and up

11 to 20

6 to 100 to 5

Perc

ent

30

2225

23


Count Urban

Rural

0 to 5

39 37

6 to 10

53 33

11 to 20

33 47

21 and up

25 78

Number of Times Per Month On Duty or On Call

21 and up

11 to 20

6 to 100 to 5

Perc

ent Urban

Rural

40

24

1719

17

22

35

26

7/15/2003 85

21. Please rank the degree to which each of the listed factors played a part in your decision to work in EMS (1= not a factor, 5 = major factor, n varies – see total below). Counts Community

Need Interest in Emergency Medical Care

Interest in Trauma Care

To Help Others

Urged by Family or Friends

Challenge Of Providing Emerg. Care

Earn a Living

1

49 7 16 8 206 30 225

2

29 18 29 6 88 33 45

3

93 60 74 32 86 90 58

4

118 122 127 136 44 140 46

5

177 261 218 289 37 174 78

Total

466 468 464 471 461 467 452

NA

1 1 1 1 1 1 2

Missing

24 22 26 19 29 23 37

Total

25 23 27 20 30 24 39

Percentages Community

Need Interest in Emergency Care


To Help Others

Urged by Family or Friends

Challenge Earn a Living

1

11% 1% 3% 2% 45% 6% 50%

2

6% 4% 6% 1% 19% 7% 10%

3

20% 13% 16% 7% 19% 19% 13%

4

25% 26% 27% 29% 10% 30% 10%

5

38% 56% 47% 61% 8% 37% 17%

7/15/2003 86

Percentage rankings for not a factor (percentage marking 1 or 2) and major factor (percentage marking 4 or 5). Sorted by major factor, highest to lowest.

Not a Factor

Major Factor

To Help Others

3% 90%

Interest in Emergency Care

5% 82%


10% 74%

Challenge

13% 67%

Community Need

17% 63%

Earn Living

60% 27%

Urged by Family

64% 18%

Factors Attracting You to Work in EMS

To Earn a Living

Challenge of Job

Urged by Family

To Help Others


Emerg. Med. Care Int

Community Need

% M

arki

ng 4

or 5

27

67

18

90

7482

63

Cross Tabulation with Rural or Urban

Degree Factor Influenced You to Work in EMS

RuralUrban

% M

arki

ng 4

or 5

Community Need

Interest in Emerg.

Medical Care

Interest in Trauma

Care

To Help Others

Urged by Family

/Friends

Challenge of Job

To Earn a Living

15

43

6769

23

11

9290

7377

8083

73

50

Note: For discussion of other attractions of EMS work written in by respondents see text.

7/15/2003 87

22. How long do you feel you will stay in your current EMS-related job (n=433)?

Count Less than a year

19

1-2 yrs

40

3-4 yrs

57

5 or more yrs

317

Total

433

NA

12

Missing

46

How Long Will You Stay in Current Position?

5 or more yrs

3-4 yrs

1-2 yrs

less than a year

Perc

ent

73

139


Count Urban

Rural

< 1 year

8 8

1-2 yrs

16 21

3-4 yrs

21 27

5 or more yrs

119 167

How Long Will You Stay in Current Position?

5 or more yrs

3-4 yrs

1-2 yrs

less than a year

Perc

ent Urban

Rural

75

129

73

1310

7/15/2003 EMS Survey Final Report UCED

88

23. If you are likely of leaving your EMS position in less than 5 years, what are the reasons (1=Not a factor and 5= major factor)? Count Time

Commitment Training Requirement

Inadequate Pay

General Stress of EMS Work

Critical Incident Stress

Physical Demands

I've Done My Time


Shortage of EMS Personnel To Back Up

Health Hazards

Medical Liability

1

98 118 132 117 132 129 139 158 134 118 120

2

28 29 9 47 40 35 19 31 30 52 37

3

39 35 15 36 34 33 15 17 28 31 41

4

29 19 27 17 12 12 18 4 14 14 14

5

30 22 40 4 4 15 31 12 15 7 10

Total

224 223 223 221 222 224 222 222 221 222 222

NA

194 194 194 194 194 194 192 194 194 194 194

Missing

73 74 74 76 75 73 77 75 76 75 75

Total

267 268 268 270 269 267 269 269 270 269 269

Note: For discussion of other reasons for leaving written in by respondents see text.


89

23. If you are likely of leaving your EMS position in less than 5 years, what are the reasons (1=Not a factor and 5= major factor)? Percentages Time


Inadequate Pay

General Stress

Incident Stress

Physical Demands

I've Done My Time


Shortage of EMS Personnel

Health Hazards

Medical Liability

1

44% 53% 59% 53% 59% 58% 63% 71% 61% 53% 54%

2

13% 13% 4% 21% 18% 16% 9% 14% 14% 23% 17%

3

17% 16% 7% 16% 15% 15% 7% 8% 13% 14% 18%

4

13% 9% 12% 8% 5% 5% 8% 2% 6% 6% 6%

5

13% 10% 18% 2% 2% 7% 14% 5% 7% 3% 5%


90

23. If you are likely of leaving your EMS position in less than 5 years, what are the reasons (1=Not a factor and 5= major factor)? Percentage rankings for not a factor (percentage marking 1 or 2) and major factor (percentage marking 4 or 5). Sorted by “not a factor” from highest to lowest.

1+2

4+5

Inadequate Pay

63% 30%

Time Commitment

56% 26%

I've Done My Time

71% 22%

Training Requirement

66% 18%

Shortage of EMS Personnel

74% 13%

Physical Demands

73% 12%

Medical Liability

71% 11%

General Stress

74% 10%

Health Hazards

77% 9%

Incident Stress

77% 7%


85% 7%

Reasons You Might Leave EMS Position in

Less than 5 Years

Medical Liability

Health Hazards

EMS Personnel Short.


Done My Time

Physical Demands

Crit. Incid. Stress

General Stress

Low/No Pay


Time Commitment

% M

arki

ng 4

or 5

11913

7

22

12710

30

18

26


91

23. If you are likely of leaving your EMS position in less than 5 years, what are the reasons (1=Not a factor and 5= major factor)?

Reasons to Leave EMS in < 5 Years

RuralUrban

% M

arki

ng 4

or 5

Time Commitment


Low/No Pay

General Stress

Crit. Incid. Stress

Physical Demands

Done My Time


Personnel Shortage

Health Hazards

Medical Liability

1113

8

1314

1310

4

17

25

1312

89

1010

24

38

23

11

33

21


92

24. If you are likely to stay in your EMS position for 5 years or more why are you staying? (1=not a factor, 5=major factor) Count Community

Need Interest in Emerg. Med. Care


Satisfaction in Helping Others

Influence from Family/Friends


Shortage of EMS Recruits to Take My Place

1

45 14 22 13 153 31 138

2

28 14 20 5 55 15 38

3

60 44 51 31 67 57 52

4

79 83 86 84 38 86 42

5

138 195 170 218 38 159 78

Total

350 350 349 351 351 348 348

NA

71 71 71 71 71 71 71

Missing

70 70 71 69 69 72 72

Percentages Community

Need Interest in Emerg. Med. Care


Satisfaction in Helping Others



Shortage of EMS Recruits to Take My Place

1

13% 4% 6% 4% 44% 9% 40%

2

8% 4% 6% 1% 16% 4% 11%

3

17% 13% 15% 9% 19% 16% 15%

4

23% 24% 25% 24% 11% 25% 12%

5

39% 56% 49% 62% 11% 46% 22%

Note: For discussion of other reasons for staying written in by respondents see text.


93

24. If you are likely to stay in your EMS position for 5 years or more why are you staying? (1=not a factor, 5=major factor) Percentage rankings for not a factor (percentage marking 1 or 2) and major factor (percentage marking 4 or 5). Ordered from highest to lowest % marking 4 or 5.

1+2

4+5

To Help Others

5% 86%

Interest in Emerg. Med. Care

8% 79%


12% 73%

Challenge

13% 70%

Community Need

21% 62%

Shortage of EMS Recruits

51% 34%


59% 22%

Reasons You Might Stay In EMS Position for 5

or More YearsShortage of Recruits

Challenge

Family/Friends Influ

To Help Others


Emerg. Med. Interest

Community Need%

Mar

king

4 o

r 5

34

70

22

8673

79

62


94

24. If you are likely to stay in your EMS position for 5 years or more why are you staying? (1=not a factor, 5=major factor)

Reasons Likely to Stay 5 or More Years

RuralUrban

% M

arki

ng 4

or 5

Community Need

Emerg. Care Interest


To Help Others

Influence from

Family/Friends

Challenge

New Recruits Shortag

50

16

7467

27

18

92

85

7570

8276 74

47


95

25. To what extent does your town have problems recruiting individuals to perform the duties associated with your EMS title? (1=No Difficulty, 5 = Great Difficulty, n=417)

Count 1

80

2

53

3

106

4

94

5

84

Total

417

NA

4

Missing

70

Total

74

Level of Difficulty Recruiting for Your Position Title

54321

Perc

ent20

2325

13

19


Count

Urban Rural

1

56 15

2

31 17

3

41 55

4

19 61

5

15 63

Difficulty Recruiting for Your Position Title

54321

Perc

ent Urban

Rural

302926

879

12

25

19

35


96

26. In your opinion, to what extent do the following issues act as barriers to recruitment of local individuals into the local EMS system? (1= not a barrier, 5= major barrier) Time


Stress of EMS Work

Poor Recruitment Efforts

Physical Demands of Work

Health Hazards

No Interest in EMS

Medical Liability

1

78 53 66 88 91 80 88 116

2

35 57 82 76 112 114 88 99

3

76 104 155 106 136 127 96 108

4

119 114 76 103 66 74 70 66

5

134 113 57 68 27 38 98 43

Total

442 441 436 441 432 433 440 432

NA

4 4 4 4 4 4 4 4

Missing

45 46 51 46 55 54 47 55

Note: For discussion of other barriers written in by respondents see text.


97

26. In your opinion, to what extent do the following issues act as barriers to recruitment of local individuals into the local EMS system? (1= not a barrier, 5= major barrier) Percentages Time


Stress of EMS



Health Hazards

No Interest in EMS

Medical Liability

1

18% 12% 15% 20% 21% 18% 20% 27%

2

8% 13% 19% 17% 26% 26% 20% 23%

3

17% 24% 36% 24% 31% 29% 22% 25%

4

27% 26% 17% 23% 15% 17% 16% 15%

5

30% 26% 13% 15% 6% 9% 22% 10%


98

26. In your opinion, to what extent do the following issues act as barriers to recruitment of local individuals into the local EMS system? (1= not a barrier, 5= major barrier) Sorted from highest to lowest percentage marking 4 or 5 (major barrier).

1+2

4+5

Time Commitment

26% 57%


25% 51%


37% 39%

No Interest in EMS

40% 38%

Stress of EMS

34% 31%

Health Hazards

45% 26%

Medical Liability

50% 25%


47% 22%

Barriers to Recruitment into EMSMedical Liability

No Interest in EMS

Health Hazards

Physical Demand

Poor Recruitmen

Stress of Work


Time Commitment%

Mar

king

4 o

r 525

38

2622

39

31

5157


99

26. In your opinion, to what extent do the following issues act as barriers to recruitment of local individuals into the local EMS system? (1= not a barrier, 5= major barrier)

Barriers to Recruitment into EMS

RuralUrban

% M

arki

ng 4

or 5

Time Commitment


Stress of Work

Poor Recruit. Effort

Physical Demand

Health Hazards

No Interest in EMS

Medical Liability

28

22

46

31

2524 25

18

36

41

34

29

62

38

73

35


100

27. To what extent does your town have problems retaining individuals to perform the duties associated with your EMS title?

Count 1

58

2

57

3

128

4

88

5

69

Total

400

NA

4

Missing

87

Difficulty of Retaining EMS Personnel

54321

Perc

ent

17

22

32

1415


Count

Urban Rural

1

34 13

2

24 28

3

52 66

4

26 53

5

17 48

Extent of Problems Retaining Individuals in EMS

54321

Perc

ent Urban

Rural

2325

32

13

6

11

17

34

16

22

101

28. Think about the persons that have quit your service in the past 2-3 years. In your opinion, to what extent did the following play a role in their decision to quit? (1= not a factor, 5= major factor) Counts Time

Commit-ment

Training Require-ment

Nature of the Work

Inade-quate Pay

Poor Recruit-ment Efforts

Poor Retent-ion Efforts

Physical Demands of the Work

Health Hazards

Person-ality Conflict

Shortage of EMS Back-up Personnel

Loss of Interest in EMS

Medical Liability

1

98 100 98 110 131 100 123 124 114 133 84 157

2

45 67 88 42 80 64 119 117 70 71 84 105

3

63 94 110 63 97 84 99 86 89 83 104 76

4

97 91 77 73 53 82 42 48 66 72 82 40

5

106 55 31 115 41 76 20 26 65 44 52 20

Total

409 407 404 403 402 406 403 401 404 403 406 398

NA

11 11 11 11 11 11 11 11 11 11 11 11

Missing

71 73 76 77 78 74 77 79 76 77 74 82

Note: For discussion of other reasons for quitting written in by respondents see text.

102

28. Think about the persons that have quit your service in the past 2-3 years. In your opinion, to what extent did the following play a role in their decision to quit? (1= not a factor, 5= major factor) Percentages Time

Commit-ment

Training Require-ment

Nature of the Work

Inade-quate Pay

Poor Recruit-ment Efforts

Poor Retent-ion Efforts


Health Hazards

Person-ality Conflict



Medical Liability

1

24% 25% 24% 27% 33% 25% 31% 31% 28% 33% 21% 39%

2

11% 16% 22% 10% 20% 16% 30% 29% 17% 18% 21% 26%

3

15% 23% 27% 16% 24% 21% 25% 21% 22% 21% 26% 19%

4

24% 22% 19% 18% 13% 20% 10% 12% 16% 18% 20% 10%

5

26% 14% 8% 29% 10% 19% 5% 6% 16% 11% 13% 5%

Total

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

103

28. Think about the persons that have quit your service in the past 2-3 years. In your opinion, to what extent did the following play a role in their decision to quit? (1= not a factor, 5= major factor). Sorted by highest to lowest percentage marking 4 or 5.

1+2 4+5

Time Commitment

35% 50%

Inadequate Pay

38% 47%

Poor Retention Efforts

40% 39%


41% 36%


41% 33%


46% 32%


51% 29%

Nature of the Work

46% 27%


52% 23%

Health Hazards

60% 18%


60% 15%

Medical Liability

66% 15%

Reasons for Quiting EMSMedical Liability

Loss of Interest

Shortage of Back-ups


Health Hazards

Physical Demands

Poor Retention

Poor Recruitment

Low/No Pay

Nature of Work


Time Commitment

% M

arki

ng 4

or 5

15

3329

32

1815

39

23

47

27

36

50

104

28. Think about the persons that have quit your service in the past 2-3 years. In your opinion, to what extent did the following play a role in their decision to quit? (1= not a factor, 5= major factor)

RuralUrban

% M

arki

ng 4

or 5

Time Commitment


Nature of Work

Low/No Pay

Poor Recruitment

Poor Retention

Physical Demands

Health Hazards


Shortage of Personne

Loss of Interest

Medical Liability

1516

39

26

40

17

41

20 1821

1615

4036

2321

44

51

2628

46

20

63

29

105

Appendix 4 Job Satisfaction Results 29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied). First 12 reasons were quantity of similarly-certified EMS workers, quantity of local EMS providers in general, quality of care provided by local EMS workers, availability of physician support, degree of responsibility/autonomy, access to EMS continuing education, quality of available EMS continuing education and time for coworker interaction quantity of EMS equipment/supplies, quality of EMS equipment/supplies, close relationships with coworkers, emotional support from coworkers. Count (first 12 reasons) # of

Peers #EMS Providers

Quality of Care

Physician Support

Respons-ibility

Access to Cont. Ed.

Quality of Cont. Ed.


Quantity EMS Supplies

Quality EMS Supplies

Close with Peers

Peer Emot. Support

1

24 21 24 53 17 38 35 37 26 27 17 18

2

59 62 47 76 45 77 82 70 51 48 47 47

3

141 134 112 119 153 102 112 157 121 109 116 143

4

134 139 144 95 144 134 130 104 139 149 146 144

5

83 84 114 88 68 90 80 64 100 106 114 84

Total

441 440 441 431 427 441 439 432 437 439 440 436

NA

4 4 4 7 5 4 4 5 5 4 4 3

Miss-ing

46 47 46 53 59 46 48 54 49 48 47 52

106

29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied). First 12 reasons were quantity of similarly-certified EMS workers, quantity of local EMS providers in general, quality of care provided by local EMS workers, availability of physician support, degree of responsibility/autonomy, access to EMS continuing education, quality of available EMS continuing education and time for coworker interaction quantity of EMS equipment/supplies, quality of EMS equipment/supplies, close relationships with coworkers, emotional support from coworkers. Percentages (first 12 reasons) # of

Peers #EMS Providers

Quality of Care Provided

Physician Support

Degree of Responsibility

Access to Cont. Ed.





Close Relation-ship w Peers

Peer Emotional Support

1

5% 5% 5% 12% 4% 9% 8% 9% 6% 6% 4% 4%

2

13% 14% 11% 18% 11% 17% 19% 16% 12% 11% 11% 11%

3

32% 30% 25% 28% 36% 23% 26% 36% 28% 25% 26% 33%

4

30% 32% 33% 22% 34% 30% 30% 24% 32% 34% 33% 33%

5

19% 19% 26% 20% 16% 20% 18% 15% 23% 24% 26% 19%

107

29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied). Last 11 reasons are supervisor’s level of competence, supervisor’s leadership ability, supervisor’s availability for questions/problems, EMS-related stress, amount of time off from EMS duties, amount of local dollars for EMS, relationship with other area squads, volunteer nature of EMS work, professional respect from physicians, professional respect from nurses, professional respect from local citizens. Counts (last 11 reasons) Supervisor

Competence Supervisor Leadership

Supervisor Availability

EMS Stress

Time Off

Local $ for EMS

Relationship with Area Squads

Volunteer Nature of Work

Respect - Physicians

Respect - Nurses

Respect - Local Citizens

1

48 62 47 20 40 117 54 44 58 72 18

2

46 56 59 71 59 86 74 45 80 85 27

3

128 123 124 203 136 111 142 129 119 117 103

4

114 114 113 97 99 66 108 117 109 110 154

5

99 80 89 39 92 44 51 76 61 49 131

Total

435 435 432 430 426 424 429 411 427 433 433

NA

3 3 3 4 7 6 6 9 7 6 3

Missing

53 53 56 57 58 61 56 71 57 52 55

108

29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied). Last 11 reasons are supervisor’s level of competence, supervisor’s leadership ability, supervisor’s availability for questions/problems, EMS-related stress, amount of time off from EMS duties, amount of local dollars for EMS, relationship with other area squads, volunteer nature of EMS work, professional respect from physicians, professional respect from nurses, professional respect from local citizens. Percentages (last 11 reasons) Supervisor

Competence Supervisor Leadership


EMS Stress

Time Off

Local $ for EMS




Respect - Nurses


1

11% 14% 11% 5% 9% 28% 13% 11% 14% 17% 4%

2

11% 13% 14% 17% 14% 20% 17% 11% 19% 20% 6%

3

29% 28% 29% 47% 32% 26% 33% 31% 28% 27% 24%

4

26% 26% 26% 23% 23% 16% 25% 28% 26% 25% 36%

5

23% 18% 21% 9% 22% 10% 12% 18% 14% 11% 30%

7/15/2003 109

Q 29. Job Satisfaction Ranked by highest job satisfaction levels (largest percentage marking 4 or 5). 1+2 4+5


10% 66%

Close Relationships w Peers

15% 59%

Quality of Care Provided

16% 59%


17% 58%


18% 55%

Peer Emotional Support

15% 52%

Access to Cont. Ed.

26% 51%

#EMS Providers

19% 51%

Degree of Responsibility

15% 50%

# of Peers

19% 49%

Supervisor Competence

22% 49%


27% 48%


22% 47%


25% 47%

Time Off

23% 45%

Supervisor Leadership

27% 45%

Physician Support

30% 42%

Respect – Physicians

32% 40%


25% 39%


30% 37%

Respect – Nurses

36% 37%

EMS Stress

21% 32%

Local $ for EMS

48% 26%

7/15/2003 110

29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied). First 12 reasons were quantity of similarly-certified EMS workers, quantity of local EMS providers in general, quality of care provided by local EMS workers, availability of physician support, degree of responsibility/autonomy, access to EMS continuing education, quality of available EMS continuing education and time for coworker interaction quantity of EMS equipment/supplies, quality of EMS equipment/supplies, close relationships with coworkers, emotional support from coworkers.

Satisfaction with These Job Aspects

Emotional Support

Close to Coworkers

Quality - Supplies

Quantity - Supplies

Coworker Interaction

Quality - EMS C. Ed.

Access - EMS C.Ed

Responsibility

Physician Support

Quality of Care

# Local EMS

Quant. Your Certific

% M

arki

ng 4

or 5

52

595855

39

485150

42

59

5149

7/15/2003 111

29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied). First 12 reasons were quantity of similarly-certified EMS workers, quantity of local EMS providers in general, quality of care provided by local EMS workers, availability of physician support, degree of responsibility/autonomy, access to EMS continuing education, quality of available EMS continuing education and time for coworker interaction quantity of EMS equipment/supplies, quality of EMS equipment/supplies, close relationships with coworkers, emotional support from coworkers. Cross Tabulation with Rural or Urban, first 12 reasons.


RuralUrban

% M

arki

ng 4

or 5

# Similar Certificat

# EMS Providers

Qual. Local EMS Care

Physician Support

Responsibility

Access - Cont. Ed.

Quality - Cont. Ed.

Coworker Interaction

Quantity Supplies


Close to Coworkers

Emotional Support

5452 54

66

54

63

50

61

32

4648

46

5051 5050

4343

62

525050

4848

7/15/2003 112

29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied). Last 11 reasons are supervisor’s level of competence, supervisor’s leadership ability, supervisor’s availability for questions/problems, EMS-related stress, amount of time off from EMS duties, amount of local dollars for EMS, relationship with other area squads, volunteer nature of EMS work, professional respect from physicians, professional respect from nurses, professional respect from local citizens.


Respect - Citizens

Respect from Nurses


Volunteer Nature

Relations w Squads

Local $ for EMS

Time Off from EMS

Job-Related Stress

Supervisor's Availib

Supervisor Leadershi

Supervisor Competenc

% M

arki

ng 4

or 5

66

3740

47

37

26

45

32

4745

49

7/15/2003 113

29. Please rate your level of satisfaction regarding the following aspects in your EMS-related job/duties (1=not satisfied, 5=very satisfied). Last 11 reasons are supervisor’s level of competence, supervisor’s leadership ability, supervisor’s availability for questions/problems, EMS-related stress, amount of time off from EMS duties, amount of local dollars for EMS, relationship with other area squads, volunteer nature of EMS work, professional respect from physicians, professional respect from nurses, professional respect from local citizens. Cross Tabulation with Rural or Urban, last 11 reasons.


RuralUrban

% M

arki

ng 4

or 5

Supervisor Competenc

Supervisor Leadershi

Supervisor's Avail.

Job-Related Stress

Time Off EMS

Local $ for EMS

Relations - Squads

th Other Area Squads

Volunteer Nature


Respect from Nurses

Respect from Citizen

6567

40

35

44

35

57

31

40

33

2628

43

47

3330

4646 4543

52

44

7/15/2003 114

Appendix 5 Community Satisfaction 30. How satisfied are you with the following factors in your present community? Please rate each item from 1 to 5. (1=not satisfied, 5 = very satisfied) Counts Size of

Community Social/Recreational Opportunities

Environment for Children

School Quality

Degree of Safety

Health Care System

Overall Community Satisfaction

Spouse's Community Satisfaction

1

43 51 59 61 25 68 17 23

2

39 71 69 73 51 92 42 42

3

126 113 120 133 153 161 140 96

4

124 120 134 117 149 104 179 122

5

139 113 82 71 89 42 91 60

Total

471 468 464 455 467 467 469 343

NA

1 1 5 7 1 1 1 95

Missing

19 22 22 29 23 23 21 53

7/15/2003 115

30. How satisfied are you with the following factors in your present community? Please rate each item from 1 to 5. (1=Not Satisfied, 5 = Very Satisfied) Percentages Size of

Community Social/Recreational Opportunities


School Quality

Degree of Safety

Health Care


Spouse's Satisfaction

1

9% 11% 13% 13% 5% 15% 4% 7%

2

8% 15% 15% 16% 11% 20% 9% 12%

3

27% 24% 26% 29% 33% 34% 30% 28%

4

26% 26% 29% 26% 32% 22% 38% 36%

5

30% 24% 18% 16% 19% 9% 19% 17%

Total

100% 100% 100% 100% 100% 100% 100% 100%

7/15/2003 116

30. How satisfied are you with the following factors in your present community? Please rate each item from 1 to 5. (1=not satisfied, 5 = very satisfied) Percentage Rankings: Factors with highest percentage marking 4 or 5 (5 = very satisfied) listed first in table.

1+2 4+5 Overall Satisfaction

13% 58%

Size of Community

17% 56%

Spouse's Satisfaction

19% 53%

Degree of Safety

16% 51%

Social/Recreational Opportunities

26% 50%


28% 47%

School Quality

29% 41%

Health Care

34% 31%

Satisfaction with Community Factors

Spouse's Satisfactio


Health Care System

Degree of Safety

Quality of Schools


Social/Recreational

Size of Community

% M

arki

ng 4

or 5

5358

31

51

41

4750

56

7/15/2003 117

30. How satisfied are you with the following factors in your present community? Please rate each item from 1 to 5. (1=not satisfied, 5 = very satisfied) Crosstabulation with Rural or Urban

Satisfaction with Community Factors

RuralUrban

% M

arki

ng 4

or 5

Size of Community

Social/Recreational


Quality of Schools

Degree of Safety

Health Care System


Spouse's Satisfactio

54

50

60

55

30

33

63

37

50

33

52

40 39

64

59

51

7/15/2003 118

Appendix 6 Survey Questionnaire

7/15/2003 119

7/15/2003 120

7/15/2003 121

7/15/2003 122

7/15/2003 123

7/15/2003 124

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