Under-Appreciated, Under-Compensated and Overworked: The Boston EMS Experience

This article was written by Kendall Richards and Eva Wendeborn and reviewed by the Live Boston Editorial Team

Last night and tonight, Boston EMS hit such low critical staffing levels that the Command Staff activated the practice of RDTs, something that is far from common and far from okay. Historically RDTs, or Rapid Deployment Teams, are the Department’s way of calling in off duty member for major emergencies, not for staffing shortages.

According to numerous sources at the Department the use of Boston EMS RTD 3 last night and tonight was the first time since the 2021 Boston Marathon in October. The practice of calling in off duty members was utilized to staff empty trucks instead of an actual city-wide emergency or event. A department spokesperson told us earlier this month that on average two members are mandated, or forced to work a second shift, every twenty four hours. Clearly the problem has gotten worse.

Boston’s Emergency Medical Service (EMS) workers risk their physical and mental wellbeing daily in an effort to protect the community. As first responders, the regular intensity of their shifts creates a pressure cooker of a work environment.

The amount of time the EMS workers are on the clock can be extremely draining. The average uniformed worker has a 40 hour work week but at the same time, a department also reported at least one member also worked 84 hours in a single week.

“The mental health toll on healthcare workers is real and more must be done to address the needs of employees if we want to keep them around,” said Demarko Cabral, Firefighter, Paramedic and Adjunct Professor of Emergency Medical Studies.

In Emergency Services, protecting the mental wellbeing of first responders is just as vital as their healthcare skills. Fire and EMS agencies are facing challenges keeping qualified personnel in roles that are essential to life safety, protection of property, and environmental conservation, Cabral said.

EMS workers across the nation are generally the second busiest type of public safety provided with the first being law enforcement. However, EMS systems are expected to function with staffing that is only a fraction of what law enforcement agencies and fire departments have.

“EMS workers nationwide are undercompensated and overworked,” Cabral said, “there is a huge disparity between the compensation and benefits packages for EMTs and Paramedics and those of their healthcare and public safety counterparts.”

EMS workers endure daily stressors like high call volume, lengthy shifts as well as taxing incidents involving multiple casualties, which increase chances of developing PTSD for EMS personnel.

Peer Support, the internal mental health service for the department, has been around for 30 years and has had the goal of “promoting member health and preventing critical incident stress reactions and cumulative stress difficulties, as well as to reducing the frequency, intensity and/or duration of any stress related issues”, said a Boston EMS spokesperson.

The Peer Support method commonly seems to be the most effective method to dealing with the mental health of the members, but Boston’s EMS doesn’t stop there. They are also prescribing a meditative, coworker-based wellness program to boost morale called Boston EMS Health and Wellness.

The city service sector initiated a Health and Wellness Program that started focusing on psychological first aid and suicide prevention. They later moved onto helping people recover and their employee’s sustainability on the job. They also encourage members to participate in team building activities, work out sessions and more.

“Recognizing the needs of employees and making them feel valued and supported through professional development is essential to longevity,” Cabral said.

Lt. Patrick Calter, who over sees the Peer Support Unit explained in an article on their website that the program’s efforts are the “fourth leg of the stool” which includes, incorporating training in toxic stress reduction, trauma informed care, fitness classes, stretching and yoga in partnership with Health and Wellness.

Cabral said human capital is the most important asset to any Fire and Emergency Services organization, and providing members with the right tools (like peer support) is essential for them to effectively and efficiently protect the health and safety of the residents and visitors of their community.

Legal action in the state of Massachusetts has been taken to help EMS employees. A new law made in 2019 has made it mandatory for mental health service to be available for all first responders, not just EMS. This bill also protects first responders from being penalized for confiding in their peers about their experiences and troubles.

According to an EMS spokesperson, in the last six months Boston EMS has provided a three-part behavioral health training series to all members. This training series also focuses on diversity and inclusion within the department.

Back in 2019, the Academy has expanded a component to include a more holistic approach, including mental and nutritional health. Boston EMS has also a member that was assigned full-time to support wellness for both EMT-Recruits and members across the department of all ranks. This Wellness Coordinator has support from three other department EMTs that have expertise and certifications in areas of health and wellness.

Even with all of the effort Boston EMS is putting into helping their employees the lack of proper funding and independence as a stand alone agency (they are a subset of the controversially miss-managed Boston Public Health Commission)has caused Boston EMS to run into many issues with smoothly and efficiently delivering services to Boston’s residents and visitors.

Recently it has become common to see Boston EMS Incidents, a page run by on duty BEMS personnel to warn of limited to zero availability of ambulances to respond to emergencies. This is not because Bostons EMTs and Paramedics aren’t doing their job, it’s a failure on behalf of City, Department and Health Commission Leadership. The time for talk is done. Our City’s Heroes and Citizens deserve better.

As of 11:00 am this morning, multiple internal sources tell us, Boston EMS is below minimum staffing in dispatch and field operations. This means that 911 calls for EMS in the City of Boston may take longer to answer, may be answered by un-or-under-trained personnel from the other public safety answering points and that deployment of appropriate EMS assets may be delayed. In addition, operating below minimum staffing means that ambulances are going unstaffed. As a result, it is reasonable to anticipate longer response times as units are responding outside of their districts/primary area of responsibility.

The examples of staffing in the last 24 hours demonstrate a chronic problem. Boston EMS needs the publics support to help the residents and visitors of the City of Boston.