With about one out of four budgeted positions for EMS unfilled, ambulances are often out of service. (Chart by Austin Sanders / Zeke Barbaro)

Negotiations between the City of Austin and the union representing Austin-Travis County Emergency Medical Services employees continue to drag on, with union officials rejecting the city’s latest pay package last week.

On offer from the city was a four-year deal that would provide pay-scale adjustments designed to deal with pay compression issues created when the city and union signed a one-year contract extension last year that increased base pay for entry-level medics. Year 2 of the contract would provide 4% pay increases across the board, with 3% raises coming in Years 3 and 4, at a total cost of $30 million over the life of the contract.

But that offer won’t cut it, according to Austin EMS Association president Selena Xie. She hopes to win a contract that would increase the minimum wage for entry-level medics by 9% – from $22/hour to $24/hour. The city and union are closer on what a fair wage increase looks like in Years 2-4; however, the AEMSA offer, which totals $36 million over four years, asks for other compensation benefits like stipends for Community Health Paramedics, who are required to undergo additional training for which they currently are not compensated.

The lack of competitive pay has directly contributed to the vacancy rate at EMS, Xie says, which has not changed much in the year that the one-year contract extension was signed. Those vacancies mean that it is sometimes difficult to fully staff ATCEMS’ ambulance fleet. When an ambulance can’t be staffed with a paramedic and a basic-level Emergency Medical Technician, as is required by department policy, the ambulance is taken out of service.

Over the past nine months, an average of two ambulances per day have been taken out of service from the ATCEMS system, according to data analyzed by the Chronicle. The data shows that from November 1, 2022 to July 23, 2023, ambulances had been taken offline for part or all of a 24-hour period 631 times – and that’s not including the other types of vehicles ATCEMS uses to provide emergency care. The out of service peak hit in December, with ambulances out of service 104 times. Over the summer, the downed ambulance rate has improved – just 48 instances in June and 35 as of July 23 – which an ATCEMS spokesperson says could be linked to the 15 new cadets who have been cleared for independent field duty along with 20 paramedics who recently finished training at the department’s in-house training program.

Taking an ambulance out of service is a last resort for ATCEMS leadership and it is always tied to vacancies in the daily schedule that can arise from sick or vacation leave, training, injuries, and other regular absences. An ATCEMS spokesperson says when an ambulance is taken offline, others cover the impacted service area and that the dispatch center uses software to direct where units should be moved to ensure gaps in coverage are minimized.

ATCEMS officials contend that the staffing struggles they’re facing are not unique – EMS systems across the country are having difficulty hiring and retaining staff. Part of the problem, the spokesperson said, is that entry-level EMS employees sometimes see their EMT certification as a “stepping stone” to other careers like firefighting or nursing. Other employers within the health care system have begun heavily recruiting paramedics since the onset of the pandemic, and their offers can be difficult to resist. Hospitals and health care clinics often offer better pay and much more comfortable working conditions – the workday is spent inside an air-conditioned commercial building walking from room-to-room rather than running from call-to-call in cramped ambulances, exposed to whatever weather conditions may be present that day. But ATCEMS recently began hiring directly into the department’s paramedic position – a higher rank with better pay – which the department thinks will help recruitment in the long run.

The vacancy rate at ATCEMS barely moved between June 2022 and 2023, but the July year-over-year number shows improvement (24.51% vacancies last year and 16.54% this year). Xie is concerned about how long that improvement will hold without a long-term contract that meets the wage demands AEMSA feels their members deserve.

“Yes, we’re able to fill our EMT-basic ranks, which is helping our vacancy rate,” Xie told us, “but we are still woefully short on our paramedics. And the only way we can improve our paramedic ranks is by offering wages that will allow us to stay competitive with hospitals and clinics.”