An ambulance waits for the next call at New Hanover Regional Medical Center in Wilmington. The once county-owned hospital was purchased by Novant Health for $5.3 billion in early 2021. Novant, which is now responsible for all EMS services in the county, added four FEMA ambulances to their fleet in late September 2021. Mark Darrough / Wmforo

Before a new batch of 25 FEMA-contracted ambulances arrived in North Carolina in early February, overworked crews at Forsyth County Emergency Services had weathered a rising number of calls amid the winter surge of the omicron variant. 

Like many other EMS agencies across the state, the pandemic heightened demand for their services, but heavy workloads and the ensuing burnout had led to a shortage of qualified paramedics and emergency medical technicians to fully staff Forsyth County’s fleet of ambulances.

Assistant Chief Bryan Gallimore said his EMS division has in recent months operated with 20-30 vacancies — of an EMS workforce typically 100 strong — while call volume increased by roughly 11% from 2020-21. On top of that, the overall level of medical care required to treat patients has gone up, according to Gallimore.

“Our crews essentially come in at the beginning of their shift, and they run calls until they go home,” Gallimore said. “(There’s) very little time for anything else — for documentation and inventory. We’re running calls around the clock.”

Increased calls and more complex medical situations from COVID-19 put pressure on already short-staffed EMS teams across the state. Federal assistance in the form of 50 ambulances from the Federal Emergency Management Agency helped ease the burden in 25 counties since September, and counties are finding ways to bolster the staffing pipeline.

Staffing shortage and federal help

Staff shortages from heavy workloads and burnout through the pandemic, compounded by quarantines of paramedics and EMTs exposed to the virus, strained the system in Forsyth, according to Gallimore.

At the same time, the emergency medical science program at Forsyth Technical Community College — the county’s traditional pipeline of new EMS employees — was disrupted by training delays because of lockdown procedures, resulting in smaller graduation numbers.

In response to the county’s application to the state, Forsyth EMS received four of the contracted ambulances with two EMS staff members per crew. One ambulance was added to the night shift, one to the day shift and two for the peak load time of 1 p.m.-1 a.m. 

For Gallimore and other strained EMS crews around the state, the federal ambulances gave them sorely needed breathing room.

“(The FEMA ambulances) help ease the workload of our staff, but they also shorten call response,” he said. “With more ambulances, we get to calls quicker.”

The additional crews also mean less assistance is required from neighboring counties’ EMS crews, each struggling with its own capacity constraints, to help “keep their ambulances at those borders,” according to Gallimore.

Each county typically plans for a 2.4% increase in annual call volume based on normal population growth, according to Kimberly Clement, who oversees health care preparedness at the N.C. Office of Emergency Medical Services. But from November to December, as omicron cases skyrocketed, call volume among EMS agencies statewide spiked 10.1%.

Several days before North Carolina’s omicron surge peaked in late January — when more than 8,700 new reported cases dwarfed any of the pandemic’s previous peaks — DHHS announced it had applied for another 25 ambulances due to “daily records of hospitalizations throughout January.” The vast majority of those requiring hospitalization were unvaccinated, according to Department of Health and Human Services Secretary Kody Kinsley.

On Feb. 1, NCDHHS announced that its FEMA request for 25 additional ambulances had been approved.

“Our hospitals continue to deal with near-record levels of patients, and this federal support is one of many levers we are using to meet demand,” Susan Kansagra, senior deputy director for the N.C. Division of Public Health, stated in a press release.

The first batch of 25 FEMA ambulances arrived in late September to only nine counties. Two of the approved counties, Mecklenburg and New Hanover, received the lion’s share with a combined nine vehicles and their crews.

North Carolina first submitted a resource request to FEMA on Sept. 10 to assist the nine EMS agencies “experiencing greatly increased calls for service during the COVID-19 pandemic,” according to DHHS. 

Data gathered from counties’ request forms submitted to the state shows critically understaffed EMS crews among the 31 applicants. On average, 12 EMS vacancies were reported per county, representing about 20% of the 1,800 total positions budgeted for the 31 counties. According to the data, 170 daytime EMS units were staffed, although total capacity called for 220 units.

Clement said the 25 approved counties experienced higher call volume and staff shortages than statewide averages.

The FEMA ambulances are scheduled to stay in their respective counties through March 2, according to a DHHS spokesperson, whereupon the department will decide whether to request another extension. As of Tuesday, no additional ambulances had been requested.

Shrinking EMS programs and educational partnerships

Coastal Brunswick County “has not experienced the staffing shortages as severely as other EMS agencies around the state and nation,” said county spokesperson Meagan Kascsak.

Although the county led the state in population growth from 2010-19, EMS crews were considerably less strained than other EMS agencies across the state. Calls per month only increased by 3.7% from 2020-21 — nearly 3 percentage points less than the statewide average of 6.5%. 

The vacancies that do exist in Brunswick are rooted in the same obstacle hampering Forsyth EMS: a shrinking pipeline of emergency medical service students. 

“One of the biggest problems with filling (EMS) vacancies is that we have seen declining enrollment numbers in college paramedic programs over the past two years,” Kascsak said.

“Some of this is due to concerns about the COVID-19 pandemic or because some educational programs may have fewer clinical opportunities available for students to complete their programs.”

In response, Brunswick and Forsyth officials partnered with community colleges to boost enrollment and offer clinical training opportunities for paramedic programs.

Gallimore believes lagging enrollment will not become a stronger trend in the foreseeable future, in part because Forsyth Tech has incentivized students to join its two-year emergency medical science program. He believes these efforts, along with a planned EMT academy in the summer or fall, “can bolster this workforce.”

“We’ve seen a large number of students enroll at the college; the pipeline of new employees is opening up a little bit,” Gallimore said. “So, I think it’s going to be a slow fix, but it will right itself over time.”

Enrollment jumped from 43 students in 2020 to 72 students in 2021, according to communications director Devin Purgason.

“We saw the dire needs in our own county for staffing and knew that we had to do whatever we could to fill in the gap,” Purgason said. “That’s why we worked creatively to fund these incentives, largely through funding from our Forsyth Tech Foundation.”

The program grew in enrollment in 2021, he said, because of targeted marketing efforts in collaboration with Forsyth EMS. The campaign highlighted incentives for potential students, including free tuition, a $500 signing stipend, books, fees, uniforms and a $2,000 “program completion stipend.” 

“We have a responsibility to our community to train competent, really great workers for EMS and EMT,” Purgason said. “And so it's something that we've really taken to heart.”

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