This year my department hired a retired battalion chief for a line firefighter/paramedic position. After 20 years with a major urban department, he chose to take an early retirement, move to a new area and return to rescue medicine. In a few short years, he will receive a pay rate and benefits similar to his pre-retirement package. While the motivation has some financial incentive, we have provided an environment that attracted a chief officer to return to hands-on medicine.

As 80% of the fire service mission remains EMS-related, how does a department keep its firefighters motivated to improve their skills, contribute to the organization, and be excellent public servants? Our 2003-04 paramedic class members were asked as an assignment what it would take to attract them to work for a fire-based EMS agency, to be motivated to provide excellent pre-hospital care, and to improve themselves and the organization. The students also were asked what kind of environment they would ask the fire chief to provide for them. Their answers shared several common themes.

Many of the students voiced concerns about having to work with a paramedic or fire department partner who had no desire to take care of people and who only went to paramedic school to be hired at a fire department or earn more money. The graduates said they wanted to work with passionate people. Despite what we have seen from descriptions of Generations X and Y, these students have a genuine concern for patient care.

Most students feared being stuck with a partner who would stifle their passion. A new paramedic begins with the idea of providing a public service, but often develops a bad or apathetic attitude. Looking back at a paramedic's probationary year often reveals a mentor who modeled that behavior. Paramedic preceptors must include those with the best medical skills and passionate attitudes for patient care. People passionate for both the fire service and medicine should be the first introduction a new hire has to the organization.

Most of the students ask to do their job with the best and most advanced equipment for their patients. Paramedics expect to have a vehicle that is mechanically safe, clean and well-stocked. One student told of having to strip equipment from several vehicles just to meet the minimum requirements to put an ambulance on the street. This year's paramedic class is one of the most technically savvy groups of students. Computers and gadgets have been part of their education, and they enjoy applying technology to their work environment.

Some students voiced concerns of being in an organization that doesn't support medicine or make it the first priority. Third-service EMS seems to be becoming extinct in North America, yet it remains one of the most desired employment options for new paramedics. It's no surprise that students want to escape to the private-ambulance industry, talking of the need to provide a future for their family. But fire departments always assume to be the final destination in paramedics' search for a place to develop their careers.

New paramedics often have the desire to be part of a full-service EMS organization and to provide transport. Seasoned paramedics tend to gravitate to ALS engine companies, while new paramedics who are excited about treatment options and want to see the results of their care like to follow their patients from start to finish. Often the fine-tuning of their skills and abilities comes from follow-up at the ER with the physician.

A few students also would like to see a variety of shifts. Union issues present a problem with any shifts that deviate from the traditional fire department 24-hour shift schedule. Peak-load ambulances provide a chance to work an alternative shift. For example, a six-month rotation on an eight-hour ambulance may allow for an employee to enjoy family sporting events, attend college or assist with child care. Fire chiefs may need to strike a deal with the union to use alternative schedules.

Many municipalities are looking to maximize their current resources as compared to hiring additional people. The use of overtime and flexible shifts might be beneficial for attracting employees and containing cost.

Pay, time-off and retirement packaging show up at number five of students' concern list, and this correlates with most national management studies on benefits, where it places at least fifth on the list of employees' desires. Most paramedics didn't enter the profession to get rich; however, they expect financial security and to be comfortable. Again, the students who mention financial security talked about being able to provide for their families and to retire with stability after 20 years of employment.

The one issue that stands out in the benefit package is more time off. This finding, while not well-documented, seems to be a common theme among the Generation X and Y students. Americans would like to see a move toward European vacation models that increase the number of vacation days and help support full employment.

Lastly, a much — talked-about want is access to a challenging continuing education program. Often a paramedic's last formal-education experience is rookie school. Any additional education from the organization is supplemented with substandard continuing education that is designed only to meet the hours or recertification requirement. Also, education often is dumbed down because one person complains it's too hard, so the rest are never challenged. But the Nintendo generation thrives on challenge and increasing levels of difficulty in scenario-based training. These curriculums don't reinforce the desire to be a life-long student.

Offering to send paramedics back to school and pay for their tuition is important. There is such a variety of college courses available to paramedics outside of the fire science or paramedic curriculum that could be offered to employees. One example is sending paramedics to a college-level athletic training course to learn how to evaluate joint injuries or remove athletic helmets. Stress management, sociology and technical writing all benefit the students and the organization.

Conferences and out-of-state travel always are great ways to infuse ideas. Unfortunately, when a fire chief is faced with budget cuts, travel is usually the first thing to go. I suggest that travel be protected as part of the incentive program for your more active medics. Encouraging or making a system available to get your paramedics to national conferences is a challenge with some union contracts, which may require agencies to pay overtime when members are at course out of town.

The ability to give time off for attendance to symposiums and how to distribute the incentives are common obstacles to conference attendance. One way is to let supervisors award a limited number of positions for travel. Another option is to require that the returning attendee present the information learned at the conference. Negotiating a conference or educational attendance program with labor is imperative and reinforces modern quality improvement programs by rewarding and focusing your activities on the star performers and not on those chronically underperforming or unmotivated employees.

The demand for paramedics will continue to outpace the available people to fill these positions for the next few years. Graduating classes provide a snapshot of the wants and needs of the next generation. They require an added effort to approach labor and create an environment that motivates people to improve in this ever-changing profession. The challenge of the fire chief will be to create a collaborative environment that promotes employee development and makes the employee feel valuable.

---

Bruce Evans is the fire science program coordinator at the Community College of Southern Nevada as well as an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. A captain at the Henderson (Nev.) Fire Department, he has a master's degree in public administration and an associate's degree in fire management.

FIRECHIEF.COM

Visit our Web site for more on recruitment and retention, plus an EMS Viewpoints archive.