Fire chiefs continue to identify the shortage of paramedics as a growing problem in America's fire and emergency services. Some agencies continue to struggle to find paramedics to staff lesser-paying, stagnant or high-volume fire-based EMS.

Over the last decade and for the first time in the history of the American fire service, we have seen a rising trend in lateral movement of line personnel between fire departments, in particular experienced firefighter/paramedics. Paramedics in Southern California often jump from department to department based on the highest bidder or better working conditions. Many are leaving Midwestern and East Coast fire services due to stagnant wages and lack of a promotional avenue. Still others leave due to excessive call volume in departments that seem unconcerned about work load.

The lack of interest in being a paramedic also is being precipitated by the unpleasantness of dealing with a health-care system that's broken. One of the most common complaints by paramedics is the complications of ER overcrowding. Several other issues will continue to drive down the number of paramedics in the future. The fire service has made no real change in the selection processes. The continued shortage of good people will force fire and EMS agencies to get creative in their recruitment practices.

When you put it in perspective, a headhunter contracted to hire a fire chief will usually get one-third of the annual salary of that position as a commission to fill the job. Is the same effort being made to secure a paramedic who will provide quality care to the public and protect the interest of the agency? A front-line paramedic has the opportunity to cause a catastrophic loss to an agency more than a fire chief. Yet the most critical positions that expose the organization to risk often are hired without a comprehensive screening. The fire chief is the one then left answering the questions and being accountable to city and county managers for those actions that generate litigation.

Fire chiefs complain about not finding enough paramedics or that the ones they are hiring present a liability, or that they don't come ingrained with the good customer service skills or core values we look for in a public servant. This has resulted in sending people who don't want to be paramedics to school because it's a condition of their firefighting employment. It doesn't matter what job people do, if they don't have a passion for the work, rarely will it be done well. Expect this trend to worsen over the next few years as pop culture influences the perception of how fire and emergency services conduct business. The popular TV show Rescue Me will bring a different person to the recruitment process with a different set of expectations.

Recruiting for new firefighters and paramedics is an expensive and time-consuming process that's often disrupted by litigation and, in some departments, complicated by the large numbers that need to be screened just to find qualified candidates. In the truest sense, what most fire and EMS agencies do is not recruitment — it's an antiquated hiring process done by casting a giant net that relies on numbers without a focus on quality or commitment. The recruitment problem revolves around an age-old argument, quantity versus quality.

The perceived paramedic shortage is really a matter of deployment and understanding proper usage. In systems that strategically place their paramedics and do not overstaff vehicles with them, a small number of paramedics can cover the city. Most standards don't justify two paramedics per ambulance, and there's little science to indicate that more than one paramedic on a response vehicle is needed. The question is if the fire chief can identify an alternative staffing pattern that makes better use of paramedics and uses EMTs for the majority of calls that require only BLS skills. Maximum Medicare reimbursement no longer pays for paramedics unless they perform actual paramedic skills.

Many of these decisions are about work load, and it isn't uncommon to find that the predominant attitude among college students entering the emergency services is that you should pay them more for less work. Even more problematic are people who expect to have a high-paying job with little or no education.

The opportunities for a person with only a high school education are dwindling in this country as high-paying manufacturing and skilled labor jobs go overseas. Graduating high school seniors will have fewer options if they do not attend college or a trade school. This leaves the fire service to draw from the same pool of low-skilled and uneducated workers as Wal-Mart, McDonald's, and the uniformed or armed services. This is even more of a challenge for departments looking to meet their needs related to diversity in an attempt to find paramedics and firefighters representative of the community they serve. People of color don't seem to be entering the medical profession or enrolling in fire- and EMS-based college programs despite significant financial aid, grant monies and scholarships.

The answer to the recruitment problem requires two strategies. The first issue relates to quality. Once a firefighter or paramedic is in the fire service, you will most likely employ that person for the duration of your time as a chief. If that person hasn't been selected on the core values of public service, honesty and integrity, you may be rolling the dice with a person who landed in the right place on a list or is a well-trained test-taker. That employee then becomes retired in place a day after probation.

An argument can be made that requiring applicants to have a Firefighter I certificate taught to the NFPA, IFSAC or Proboard standards, including an EMT or paramedic certification, may help secure a better employee. While some chiefs may see this as a barrier, requiring a degree or specialty training shows that the candidate is serious. Achievement of an academic goal demonstrates organizational skills, commitment and motivation. If the applicant comes with fire training and EMS training, that gives the organization a chance to reduce the time necessary to conduct a rookie school. One study found that by hiring certified firefighters from a college academy who have already obtained an EMT certification, a metro fire department could reduce costs by $200,000 on a rookie school of 30. Valuable training officer time then could be reallocated for in-service training and multi-company drills.

The issue of quantity requires more effort on the part of fire and EMS resources. If you want a better candidate pool to select from and more people of color, then you have to recruit. Serious recruiting requires more than just community announcements or human resources seminars. It requires every department member to be on the lookout for people who can physically do the job, be part of a team and have a desire to be a public servant. College and high school athletic teams represent an excellent source of diverse candidates. One metropolitan police department routinely has female officers visit the local university's women's softball teams to encourage players to take criminal justice courses and seek employment as a police officer. This effort has resulted in generations of female police officers.

The fire service needs to take a lesson from Fortune 500 companies and start sending firefighters or recruiters to the schools that are putting out paramedic students. Several years ago, private ambulance firms identified the community college and paramedic training programs that were turning out quality paramedics. The big West Coast ambulance services sent recruiters to the Midwest, where schools were turning out more students than there were jobs in depressed communities. As relationships developed among education coordinators, paramedic training institutions and specific EMS agencies, the schools would encourage their best and brightest to look at those agencies.

Fire-based EMS must start to think differently about how to find and secure paramedics. The demands of finding paramedics will only become more difficult as Baby Boomers place a higher demand on the medical system. Other allied health positions and employers that provide a more flexible career path and a focus on medicine will be able to offer more to those who are interested in medicine.

NHTSA has commissioned a study with the University of California — San Francisco called EMS Workforce for the 21st Century that will identify the trends anticipated in the EMS market-place. The idea is to ensure a stable, well-trained work force for the future. If we are going to combat the lack of core values and external influences that are changing the paramedic work force, the fire service will need to start applying private industry recruiting tactics for paramedics.

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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 an associate's degree in fire management and a master's degree in public administration.