By: Krystal Kunz
With a cumulative 6.5 million COVID cases and almost 83,350 deaths just in Texas, the healthcare profession can be a dangerous one to work in. Paramedics play a huge role in the healthcare system. As the first point of contact, they’ve experienced new difficulties on top of the stress inherent in their work. Williamson County paramedic Kevin Saxton got right to the point.
“I do not want to expose my children or wife to this.”
EMS and paramedic personnel face various challenges in the field that have been exacerbated by COVID. Like hospital staff, paramedics are in frequent contact with individuals who have COVID. Not only are paramedics more likely to be more exposed, but people’s lives also depend on them. This puts them at a greater risk of physical challenges, like catching COVID, but it also increases other challenges that don’t get the same attention.
A study in the Journal of Emergency Medical Services indicated increased challenges among emergency service responders such as EMS and paramedics. Seventy percent of paramedics reported their mental health was worse than compared before the pandemic, 88% reported feeling significantly more stressed, and 33% of responders were thinking about changing their careers due to the severity of the pandemic.
Fear and stress are clearly taking a toll. The Journal of Emergency Medical Services reported as the pandemic has continued for two years, an increasing number of paramedics have left the force, leading to a nationwide shortage of paramedics. And yet, people still need emergency care for injuries, heart attacks… and yes, COVID. “Fear transitioned to more fatigue and a general constant level of stress and heightened awareness that slowly eats away at you,” Saxton said. He experienced the pandemic at its peak and has witnessed first-hand the mental health impact that COVID has had on paramedics.
“As the time dragged on about one year into the pandemic, thoughts and hope of finding the end started to appear,” Sexton said. “But with the delta variant and the latest variant, the waning feeling of hope turns to exhaustion. Staying vigilant for two years can be a very difficult mental state to stay in.”
Throughout the pandemic, paramedics have faced a multitude of challenges. The biggest challenge being the paramedic’s own health and risking their lives when out in the field. The National Association of Emergency Medical Technicians reported in April, 2021 that over 18% of EMS practitioners have contracted COVID, despite their use of protective equipment and COVID protocols. The Johns Hopkins University COVID database estimates one in five Americans (20%) had contracted covid by early 2022, so that number among paramedics is almost certainly higher now. Nearly 27% of EMS workforces had to quarantine at some point. More alarming, 8% of those workforces have experienced the death of a colleague due to COVD. Paramedics are essentially risking their lives to give medical care and help to others.
Design by KrystalAgencies had guidance to try to minimize the risk of exposure for paramedics, like Personal Protective Equipment (PPE), protocols for patient care, ambulance cleaning, and other COVID safety procedures. These policies promised to help ease the stress of the risk of COVID infection. But the stress of the extra workload and lack of stability in the healthcare system still plays a big part in paramedic’s mental health, especially when personnel shortages mean fewer paramedics must do more work.
Danny Johns is Captain of Clinical Practices for Williamson County EMS. He oversees the data on calls, transports… and now, the challenges in the field. Call volumes increase during viral surges, the most recent being the delta and omicron variants. Each time that happens, it increases not only the workload but also paramedics’ chances to get COVID. It’s an exasperating problem. “We have had paramedics get COVID, sometimes even after being fully vaccinated and boosted,” said Johns. “Others have had to work overtime to fill those gaps. This affects work-life balance and the families of these medics.”
Some paramedics already work 12 or more hours and are often required to work mandatory overtime. An article from the Government Technology website reported often paramedics are clocking in almost 90 more hours in a week with shifts extended past 35 hours. Piling on more hours and shifts because of the pandemic can severely affect the paramedic’s personal and mental health. The Journal of Emergency Medical Services reported that the lack of support for emergency responders and long hours can result in burnout, worsened job performance, and can lead to depression.
The pay – $19 an hour without hazard pay – combined with staff shortages and increased workloads, can have detrimental effects on medics’ mental state and has driven some out of the business. The Hill reported that there is a 30% turnover rate among paramedics, up from about 25% before the pandemic. For the same reason, agencies are finding that it’s more difficult to recruit replacement staff. The shortages can impact response time and availability to respond at all to emergency situations.
The shortage of emergency medical technicians and paramedics is so severe that ambulance service providers warn of cuts to services and longer waits to respond to 911 calls, even if the situation is a matter of life or death. With individuals leaving the field and fewer entering, along with the public health crisis of the pandemic, it has put the emergency responders, EMS, and paramedics in crisis mode.
KXAN reported that 116 medics in the Austin-Travis County area left their positions since the start of the pandemic, more than over the previous four years. In the Austin area it takes 100 paramedic staff to run a 24-hour workday, so when a medic is sick – or leaves the service – it gets complicated in a hurry filling out a schedule, especially adding extra hours onto other paramedics.
One paramedic who wishes to not be identified believes the problem is rooted in the failure of the healthcare system, exposed by COVID. “In general, the EMS systems alone have taken a beating, causing personnel to leave and quit the medical field altogether,” he said. “This problem cannot be solved solely with changes to staffing schedules or a pat on the back.”
COVID has put the spotlight on the fragility of the healthcare system and Emergency Medical Services in America. America may have been less prepared for the pandemic than countries with universal health care systems. An article in Vox reported the U.S. has one of the worst health care systems among developed countries. The largely privatized medical-industrial complex has, at times, been ill-equipped to respond effectively. The U.S. performs worse than average among similarly large and wealthy countries across nearly all measures of preparedness for a pandemic.
Furthermore, Americans delay getting care because of high deductibles and insurance bills. Even during the pandemic, cost barriers hit patients at several points. Individuals have avoided check-ups and testing for COVID because of the possibility of hospitalization and hospitalization bills.
Americans face higher out-of-pocket costs for medical expenses than residents of almost any other country. The United States sits in second place for the most average out-of-pocket health care spending of $1,103, while Switzerland has an average of $2,326 (Swiss residents are required to purchase private health insurance). According to Swiss Info, a division of the Swiss Broadcasting Corporation, healthcare as an industry accounts for 17% of gross domestic product in the U.S.; Switzerland is second at 12% of GDP. Because of this, American patients are 33% more likely than most other countries to have a cost-related barrier to getting medical help.
The New York Times reported that, among the developed countries, only American patients risk high medical bills for seeking help during a pandemic. Healthcare companies have billed some Americans for hospitalizations and medical care for $4,000 or more during a government-imposed quarantine. Cost consciousness – among both patients and providers – and stress among health care workers, also contributes to shortages inside hospitals, of beds, physicians and nurses.
America has fewer hospital beds and fewer doctors per capita than most other countries in the developed world. The New York Times reported the country average of 5.4 hospital beds per capita, the United States sit with some of the lowest countries of 2.8 hospital beds per capita. With a global average of 3.5 doctors per capita, the United States only has 2.6 doctors per capita.
Additionally, due to the capacity shortage, Paramedics and EMS responders sometimes must spend more time moving patients, reducing their availability for other medical emergencies. A CNN article reported that as hospital beds and ICUs fill up, paramedics often must make trips of an hour or longer, taking them out of the rotation for new calls.
Frontiers in Psychology reported that paramedics are not being adequately trained to protect and care for their own mental well-being during a global pandemic. The paramedic who asked to not be named had strong words about paramedics and the larger field of medicine.
“Our healthcare system is no longer on the brink of collapsing, it is collapsing. Every day we are closer to disaster.”
On a very early cloudy Friday morning, a Williamson County ambulance pulls into the station. Paramedics are starting their shift change. Some paramedics getting off after a long shift, others coming in ready to start their day. 
As the shift change starts, paramedics switch out ambulances. One ambulance sit-outs the station, prepped and ready before it takes off for an incoming emergent call. While the other get’s cleaned out and sanitized thoroughly. 
Next to the ambulance resides a command vehicle. Command vehicles are used specifically by commander paramedics only to respond to critical calls and to meet an ambulance at the emergent location. 
Paramedic Alexander Thrasher restocks the ambulance equipment after being out in the field, dealing with a life or death situation: transporting a patient from the hospital due to going into cardiac arrest. 
Inside the ambulance, Paramedic David Gonzalez sanitizes and cleans all of the equipment inside the ambulance to prepare beforehand for any emergent calls and to provide a clean, sterilized space for the next patient. 
Paramedic David Gonzalez continues sanitizing equipment, this time the oxygen mask. 
The Williamson County ambulance logo up close and personal. 
The lights in the side compartment shine brightly in the dim-lit station garage. The side compartment of the ambulance stores the stretchers and baseboards. After these are used they are thoroughly washed down, cleaned, and wiped down with disinfectant. There is also an ultraviolet (UV) disinfectant lighting line inside the compartment to provide further sanitization. The inside of a Williamson County ambulance stocked up and shining. Inside ambulances, you will find an extensive amount of equipment. From monitors, oxygen tanks, IV equipment, to ventilators. The cabinets inside the ambulances provide ultraviolet (UV) disinfectant lighting. 
As the paramedics clean, the commander Dan Ketchum helps out and unloads personal protective equipment and other necessary medical supplies needed for the ambulance. Van drop-offs come at every morning shift change. 
When it’s unloading time, the Williamson County paramedics take the boxes of PPE, other medical equipment, and radios to a large back room inside the station. All equipment necessary to possibly save an endangered life. 
Inside the equipment room, Commander Derrick Schneider and paramedic Alyssa Jensky joke around while they unload the recent equipment that was dropped off. Breaking down boxes to recycle. Stocking everything carefully, neat, and organized. 
After unloading the equipment Paramedic Alexander Thrasher, David Gonzalez, Alyssa Jenksy and Commander Derrick Schneider relax and chat in the station break room. Taking advantage of the little downtime they have. But as always, duty calls. 
An emergent call is received. Paramedic Alexander Thrasher races to finish prepping the ambulance. Thrasher shut the doors of the ambulance and hops in, ready for action. 
The Williamson County ambulance shines its familiar red and blue lights, ignites it siren, and takes off from the station to help and possibly save the next Williamson County resident.
