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Aug 09, 2023

Ada County Paramedics shift to 56

Subscribe More than 20,000 new people moved to Ada County since COVID-19 hit Idaho and they’re bringing more than just traffic and economic growth with them. In the past three years, call volumes

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More than 20,000 new people moved to Ada County since COVID-19 hit Idaho and they’re bringing more than just traffic and economic growth with them.

In the past three years, call volumes coming into Ada County Paramedics spiked along with population growth. This, along with the pressures of the pandemic itself, put pressure on the county’s first responders forcing mandatory overtime and requiring more calls to new areas of the county that have never needed service before.

Call volume shows the county’s new sprawling growth and the new pressure it put on the agency as well, not just the number of calls. For decades, the biggest hot spot for the agency was downtown Boise. But, now with the rapid growth of subdivisions in previously undeveloped parts of Meridian populated by older residents coming to Southwest Idaho to retire, new hot spots popped up almost overnight, including areas surrounding The Village. New subdivisions and apartment complexes start immediately drawing calls, instead of taking five years to start putting demand on the system like before, Rayne said.

“The call volume kept increasing even as we stopped seeing the pandemic surges,” Ada County Paramedics Chief Shawn Rayne told BoiseDev. “There was another surge with the first omicron variant and that wasn’t pushing us too hard, not the Covid itself, but it was the influx of people during the pandemic. We were seeing calls in places that were corn fields or wheat fields two years prior. That was very unusual.”

Ada County Paramedics ran 31,510 calls in 2020 and the agency’s workload jumped more than 10% in 2021 with 34,847 calls. It hiked again with 36,129 calls in 2022, with likely more expected in the future. The agency aims for 90% of its call response times to be 9 minutes or less, but right now the growth strained 90% of response times to 11 minutes and 42 seconds or less. This is up from 11 minutes and 22 seconds for 90% of its calls in 2017.

To handle the demand and to increase pay to keep Ada County competitive with other industries or EMS jobs in the region, Rayne opted to switch the department to a 56-hour work week to ensure there were enough people on staff at any one time to respond to the calls. This structure matches the same schedule as fire departments and because it has workers clocking more hours a week significantly ups their pay.

It became abundantly clear in recent years that Ada County Paramedics had to do something different to meet the demand.

Rayne said during early budget planning discussions last year agency leadership realized they would not be able to answer the growing number of calls and keep response times down just by adding new people. The combination of a limited budget constrained by a low property tax levy, capped reimbursement rates for transporting Medicare patients, and a national shortage of EMTs due to low pay backed Rayne into a corner.

“I was telling them the conundrum is I can hire more people or pay people more, but I can’t do both,” he said.

As volumes rose in 2021, Ada County Paramedics was calling in workers on their days off to staff ambulances “beyond what was reasonable.” Rayne’s staff calculated they needed another 26 staff members to address the growth in call volume, but even if they added the positions, they would not be able to get enough qualified applicants to get close to filling the slots.

This was due to both a national EMT shortage, which saw more than a third of paramedics nationwide quitting the profession due to pressures of the pandemic that year, and Ada County’s low pay. Before shifting to the 56-hour work week, an EMT basic was paid roughly $35,000 per year, which is comparable to $673 a week before taxes. Paramedics, which require an associate’s degree, were starting at $54,000 a year.

Currently, Ada County Paramedics has 15 stations throughout the county, compared to 30 fire stations countywide, even though Ada County Paramedics runs a higher call volume than the Boise Fire Department. So, in order to both hike pay for staff and make the staffers Ada County Paramedics do have to go further, Rayne opted to shift to the 56-hour work week last fall.

Rayne says the fire departments in Ada County will have their staff work 48-hour shifts followed by four days off, but he said this was not doable for his agency because of how busy staffers are throughout their entire shift without any downtime to cook meals or rest.

“We just couldn’t do that to our people,” he said.

Instead, Ada County now runs its staff on an alternating schedule of three alternating 24-hour, 24-hour off shifts with four days off. It translates to 3 shifts in nine days instead of two shifts in seven days.

The change was announced to the staff in May of 2022 and there was a six-month period for staffers to plan for childcare or to make other arrangements. Rayne said they saw “quite a few” employees leave the agency, but now have gotten back to 8 vacancies out of 143 field staff positions.

The change adds 416 new work hours per year, which all are clocked as overtime pay. This raised the starting pay for an EMT basic to $55,000 and a paramedic to $76,000. This led to more applicants for the agency and better retention rates, instead of more staff cycling in and out to transition to higher-paying jobs as nurses, firefighters or comparable paramedic positions at local fire departments.

Rayne hopes changes coming in reimbursement rates for Medicare patients that will bring in more revenue will help Ada County shift back to his staff working fewer hours in the future, with staff getting five days off instead of four after they work a series of alternating 24-hour shifts.

The rapid pace of growth and sky-high construction costs mean Ada County Paramedics will need to be creative with how to expand their footprint.

Instead of building their own standalone stations, Rayne said his agency is working with putting his staff inside of fire stations coming online in collaboration with other departments as a way forward. For example, Ada County Paramedics will soon pay $1.5 million to the City of Meridian for its staff to have stations inside of the new Fire Stations 7 and 8. This will help the agency to better cover rapidly growing areas in south Meridian, south Boise as well as Kuna and western Meridian, Star, and western Eagle.

“Just being able to go out and find commercial land and building a structure on it now, we couldn’t do that for $1.5 million for one station let alone two,” he said. “That really gives us a lot of bang for our buck being able to colocate with the fire department.”

Rayne said he’s also in talks about potential partnerships with the Eagle Fire Department and the Boise Fire Department on another co-location at the station near Micron due to the growth planned in the area. Ada County Paramedics already co-locate at three other Boise stations.