Not Just 9-1-1 - The Expanded Work Environment of United States Emergency Medical Service Clinicians - Abstract

Sep 23, 2026

Annual increases in EMS demand alongside clinician shortages drive the need to map how U.S. EMS clinicians function across emergent and non-emergent settings. This cross-sectional national analysis surveyed nationally certified civilian clinicians recertifying from October 2021 to April 2022, asking about primary and secondary roles, including emergent response, clinical services, medical transport, and mobile integrated health. Among 33,335 respondents, roles varied by sex, and nearly half reported needing more than one job. The findings support sustained attention to EMS roles and compensation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Background on EMS demand and shortages

Need for clearer work-environment definitions

Materials And Methods

Review began 10/11/2024 Review ended 10/25/2024 Published 10/31/2024 © Copyright 2024 Gage et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.72779 Open Access Original Article Not Just 9-1-1: The Expanded Work Environment of United States Emergency Medical Service Clinicians Christopher B. Gage 1 , Jonathan R. Powell 1 , Christine B. Cooke 1, Jacob C. Kamholz 1, Shea van den Bergh Jordan D. Kurth 2 , Ashish Panchal 3 1. Emergency Medicine, National Registry of Emergency Medical Technicians, Columbus, USA 2. General Internal Medicine, Penn State College of Medicine, Hershey, USA 3. Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, USA Corresponding author: Christopher B. Gage, [cgage@nremt.org](cgage@nremt.org) 1 , Abstract Introduction: Recently, there have been annual increases in emergency medical service (EMS) demand with concurrent clinician shortages. Understanding the diverse number of EMS clinicians available for emergent roles is vital for planning and resource management. Our study aims to understand the roles and environments of US EMS clinicians. Methods: This cross-sectional study analyzed nationally certified civilian US EMS clinicians recertifying from October 2021 to April 2022, ages 18-85, with at least one EMS job. Respondents answered questions regarding their primary and secondary EMS roles, including emergent response (with/without 9-1-1), medical transport (non-emergent), clinical services, mobile integrated health (MIH), or none of the above. Next, respondents were asked about the number of jobs needed to make ends meet. All responses were combined with self-reported National Registry profile data (e.g., age, sex) . Descriptive statistics were performed. Results: The study included 33,335 EMS clinicians (response rate: 34.0%) . The primary role reported was emergent response with 25,086 (75 .3%), including ground ambulance and non-ambulance response. Clinical service roles were reported by 2,427 (7.3%), including settings such as the emergency department and outpatient clinics. Medical transport roles accounted for 2,346 (7.0%), including ground interfacility and critical ground care. Educators and administrators made up 1,453 (4 .4%) . Overall, roles varied by sex, and 48.8% of respondents reported needing more than one job to make ends meet. Conclusions: Our evaluation highlights various US EMS clinician roles. These findings suggest the need for continued focus and attention on EMS roles, compensation structures, and sex distributions to ensure a resilient, diverse, and adequately supported EMS workforce. Categories: Emergency Medicine Keywords: advanced emergency medical technicians, emergency medical technicians, ems workforce, paramedics, primary job roles Introduction Emergency medical service (EMS) systems are a critical pathway of access to acute prehospital care in the US [1], with over 54 million documented activations in 2023 [2] . The demand for EMS is increasing annually, with workforce projections showing 5% growth from 2022 to 2030 [3] . However, clinician shortages in many US communities contribute to challenges in delivering timely and effective care [4-7]. Expanded roles of EMS in the healthcare continuum include integrating EMS clinicians into various healthcare specialties and settings outside the prehospital field [8] . Though these expanded work environments are an important aspect of the long-term vision for EMS clinicians, this gradual expansion of EMS clinician roles beyond 9-1-1 emergent care may have unintended consequences that influence workforce dynamics and the effectiveness of EMS agencies in meeting community and patient needs [9] . One challenge in understanding the extent

FAQs

What problem does the study address regarding U.S. EMS clinicians?

The study addresses rising EMS demand paired with clinician shortages, emphasizing the need to understand the diverse roles and work environments of EMS clinicians to support planning and resource management.

How was the research conducted and who were the participants?

This cross-sectional study analyzed nationally certified civilian U.S. EMS clinicians recertifying from October 2021 to April 2022 who were ages 18–85 and had at least one EMS job.

What were the main findings about clinician roles and job needs?

Among 33,335 clinicians, the most common primary role was emergent response, while overall roles varied by sex. 48.8% reported needing more than one job to make ends meet.

Sep 23, 2026

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