The EMS Labor Movement - or Lack Thereof? What's the story?

Many of the posts on this network site, and others, bemoan the plight of poor, overworked, underpaid, and under-respected EMS providers.

Yet, the EMS community does not seem to have an active labor movement working to improve this environment.

I must confess that I'm not a union guy - I'm a chief in a right-to-work, no collective bargaining for public employees state. So the situation probably works to my advantage - maybe. But I am curious.

It seems that much of the economic and political success in the fire service comes as a result of the efforts of the IAFF, which claims 292,000 members. The EMS workforce study places the EMS workforce at between 200,000 and 700,000 members, which ought to be a formidable force. Yet I couldn't name a single large, EMS-only labor organization that might represent more than 2% of the EMS workforce. I see EMS folks represented by the SEIU (service workers), AFSCME (general public employees, heavy on the clerical), the Teamsters (truck drivers), police locals, fire locals, and a variety of others.

Is there an explanation for this phenomenon, or for the lack of a single focus EMS labor organization? Or is it just another example of that saying (cleaned up for publication) that "EMS folk can't organize a sandwich in a kitchen"?

Standing by for enlightenment.......


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Comment by Juan M Garcia on June 6, 2010 at 1:43am
I've had experience with the SEIU on several occasions, twice: in the initial unionization of a Hospital (part-time ambulance) and an ambulance company, respectively and being directly involved on the negotiating team during a threatened 'strike'.
I am not actually a fan of unions per se, but there are times they are the only recourse. At one time the service I was working for was proffering a contract which included no raise for EMTs or Intermediates, and (If I remember correctly) 10 cents per hour for Paramedics. No other changes. During the preceding 10 years, the contract had been negotiated 3 times and the total raises in that period had been 10 cents, not including EMTs. The only raises the EMTs had received were in coincidence with the Federal minimum wage. This translated to a very high turnover, in EMTs in particular, which meant you were constantly working with a new hire--and all the bad things that go along with that. Unfamiliarity with streets, and inexperience driving or assisting... Not good.
Traditionally the field supervisors were the ones who met with management to negotiate. (Of course there was no conflict of interest... ;-)

At that time I was actively involved in efforts to address a number of system issues, including the common practice of working crews 36 or 48 hours--sometimes longer, due to manpower shortage. I'd decided to become proactive in this regard as a result of a bad outcome following an incident in which I requested to hand off a street person whose chief complaint was that it was raining and he was hungry and cold, while talking with this patient we heard a BLS unit being dispatched for a cardiac arrest only a few blocks away; I advised dispatch that our patient had no-medical need, only wished a ride to the hospital to get warm and fed. I asked that the BLS unit be diverted for our patient so that we (ALS) could handle the CPR. There was a delay while management were contacted and the decision that came back down was negative. I was of a mind to respond anyway, and advise the BLS unit to divert, but my parter, an excellent EMT; calmed me down and talked me out of it (I would have been fired, of course). I cannot say that I feel I did the right thing, though.
The next day I met with the company owner and asked why permission had been denied to hand-off the patient, I was advised that the County contract forbade it, but that I was welcome to try to change it, and that I wouldn't be the first... along with a prediction of failure.
It's a very long and complicated story but the bottom line is that system is now drastically different, crews work 8 or 12 hour shifts and there is union representation. I did not fail, but It certainly was not easy. I mention the union activity as that is what you're asking about, but there were other efforts underway at the same time, all of which was triggered by the call above, the 'final straw', if you will.

It was extraordinarily difficult to achieve. Our attempts at organizing were met with threatened firings, promotions and preferential treatment of those not supporting the union, and black-balling of those most active in union activities by some companies.

It all became rather dramatic in the media, when we threatened to strike. Our strike threat was simply this: At midnight on X date we will continue to respond to calls and staff ambulances as normal; but we will cease to collect billing information." We were unwilling to compromise patient care and felt this was an acceptable form of 'strike'.

It was our efforts, mine and those of like mind who joined together that were able to hold most of the staff of the companies involved together well enough to withstand all the pressures applied, many caved, and many were 'bought off' in various fashions, but in the end we made a very positive difference. The union (SEIU) was very helpful, probably central to achieving this, we did have the backing of the local firefighters, collectively, not individually. But moral support only does so much. In short, based on my experiences, it was very difficult keeping the bulk of the workers united, one ploy that almost worked was management offering raises only to those ALS personnel who forswore to unionize. Our primary negotiation goal was an increase in pay for the EMTs, as we felt that would have the greatest impact in improving the system within that framework. This we did with a 1$ per hour increase, and lesser raises for others. In short, it was VERY difficult, and the most difficult was keeping the unified support of the bulk of the workforce. The tactics used by management were, though predictable, difficult to counter. In less desperate straits, I doubt we would have succeeded.

We also met with a decided lack of support from most of our EMS brethren in other areas; not familiar with the situation, who had nothing good to say about our efforts. This was the only time I ever thought ill of James Page, by the way as he condemned our 'Strike' threat without ever knowing what it was we had threatened to do. But then the media had sensationalized it and you had to read carefully to see what it was we had actually threatened... which was NOT to walk off the job. The very shortage that caused dangerous overtime levels--(these were busy units 16 calls in a 24 was a slow day)--also contributed to our victory, I suspect.

In a situation where management takes a more enlightened approach, this sort of thing need never happen... but when the workers have no place else to go, the union is a damn good thing...
So, if management is NOT enlightened, and you need help, you might try it.
Yes, management will play hard-ball, they will fire you if they can get away with it, yes, you may be blacklisted. But if you can get enough people to hang together long enough, you CAN achieve very positive outcomes.

After the dust settled, I was approached by the owner and asked if I would manage the company, the prior manager was, in fact promoted to that position during the union efforts and because he was anti-union. As Co-manager with another medic, we changed a number of things, and in less than a year we had more units on the streets, higher wages than in the union contract and the company was in the healthiest financial shape it had seen in decades... When I and the other medic left to work in Kuwait, the owner sold out to a national chain, but it remains a union shop.

You might want to listen to field personnel, they know what's happening. And;
If you take a reasoned approach to labor negotiations, play above-board and are honest and fair, you can easily keep the union out while providing a good service and maintaining a nice profit.
If not... your workers should all go union!
Comment by Johnson Smithwood on July 31, 2009 at 11:22am
This is pretty much a no brainer. EMS can't decide on anything, from service delivery models to a uniform licensure/certification scheme. How is there supposed to be a single national voice for EMS labor, when we cannot even have a single national definition of what an EMT or paramedic is?

In my travels across the US as a working medic, I have found that many agencies that decide on union representation do so with significant limitations. The first limitation they face is a fairly unreal concept of what exactly it is that a collective bargaining agreement can, and can not do for the employees of the organization. Additionally, many employee labor organizations do not fully realize that the only weapons the have to achieve their goals is almost universal support by the employees, and a complete willingness to interrupt the organizations flow of revenue. EMS management will not negotiate in good until employees are threatening to strike. When it comes to EMS labor negotiations, a house slightly divided cannot stand.

While EMS street providers are adequately served by a certificate or associates degree level education. EMS managers, supervisors, labor leaders and national advocates are not. There needs to be more educational opportunities and better EMS orientated leadership training made available to providers. We need to speed the process of turning the lessons learned into educational programs. Companies need to treat information less like trade secrets, and more like an opportunity to improve the EMS community.

Lastly, before anything can move forward, we need for existing agencies to place value on the retention of highly experienced personnel. We need to address the issues in our systems that are driving experienced providers out of the business. Until we make EMS a place people want to be, and a place people want to stay, nothing we do will drive any significant changes on the national level. RFP's for new contracts issued forth by municipalities need to have requirements that address employee retention. If companies like AMR, Paramedics Plus, Rural/Metro et al. are allowed to burn through as many EMT's and Paramedics as they want to salaries low and profits up, they will.
Comment by Rick Callebs on March 8, 2009 at 6:52pm

I agree with a lot of what Kathy said. I'm a 27 year employee (now working as an operations-level supervisor) for a third service government EMS agency. About 15 years ago, the United Mine Workers conducted a successful organizing drive. I served two terms as Union President. The first contract was difficult, but a lot of issues back in that day were resolved regarding promotions, benefits, job transfers, layoff and recall, longevity pay, et al. The one thing we didn't get was any kind of a substantial pay increase. Management was only willing and able to put so much money on the table for employee compensation, and you had to divide the pie in a way that the UMW membership would approve the contract. It ended up being a trade off -- a little bit here, a little bit there, but no one really got a wheelbarrow of cash to take to the bank.

I think there's a huge element of truth in the comment about EMTs and paramedics hiring on with an EMS agency with no real thought or interest in retiring from that place. Our turnover in a third service, 9-1-1 only environment is horrendous, but part of that problem is that we hire part-time employees because they're cheaper. I don't know how much that would change if we became an "all full time employee" agency. EMS is still regarded as a stepping stone to a better job in health care or the fire service, sort of like being a lifeguard at the beach during summer break while you're in college.

After decades of hating third service EMS, the IAFF did a 180 degree turn and now openly embraces representing third service EMS agencies. They have a lot to offer in terms of research and safety, although most of that research is fire service and Fire/EMS oriented. The last time I checked, the IAFF still refused to represent part-time employees, because they saw part-timers as a way to cut costs and to keep from hiring career employees. I do not believe the IAFF will represent the employees of any private EMS company.

I've heard of the IAEP but I'm not sure what they offer or don't offer as opposed to other options out there. Police unions like the FOP are out because they represent law enforcement officers exclusively. AFSCME is an option in many locations but they're not an EMS specific union.

I think the biggest reason EMS doesn't have a single labor union to represent workers is that EMS is so varied across the country. In some locations, it's part of the fire department. In other locations, it's a third service agency. And in other locations, you have private companies under government contract, or private companies operating as a not-for-profit corporation, or hospital based ambulance services, or private companies operating as a stand-alone for-profit business. With so many utility models in place, it's hard to "get your ducks in a row" to argue and win effective contracts, especially with a sometimes transient workforce that couldn't care less about things like retirement or longevity pay.

I think pay increases will come from a labor shortage. When you can't find paramedics who will work for $9 or $11 or $13 an hour with no benefits (like you can in our area right now) then the market will be forced to adapt. Nursing experienced a similar come-uppance years ago. I don't know if any of this will benefit me in my working lifetime, but I do hope we can raise the bar for future EMS providers.

Comment by Christopher Ellis on March 3, 2009 at 8:43pm
International Association of EMT's and Paramedic's (IAEP), has a local shop at my ambulance agency. Members of the bigger SEIU/NAGE and brother union to the IAFF. They have been expanding there membership over the last year. I think we do need something to unify us as a group, not sure if that is unionization....I do believe that is a licensure national based system tho.
Comment by Skip Kirkwood on February 19, 2009 at 7:56pm
There you go, throwing the P word around again!

Sad but true.....
Comment by Katherine Fuchs on February 19, 2009 at 7:34pm

Let's not forget politics: in-house, regional, city, town, national, etc. That certainly adds another level of complexity to this.

Comment by Katherine Fuchs on February 19, 2009 at 7:28pm
I won't say that all labor forces see the union as being “them”, but I think that there is certainly an element of "them" present depending upon the level of trust labor has for its officers, past performance and personal investment. I don't think that union corporate is as disconnected as some of its members may think. I know that the union I was in and its executive board wanted the same things that everyone else wanted. Who doesn’t want benefit and pay parity?

I believe that benefit and pay parity won’t happen at the bargaining table. I believe to make that level of progress, you have to fight. No one fights at the bargaining table. We spar. Labor is always at a disadvantage there because it is presenting its demands to management. Management knows what labor wants, but labor doesn’t know what management is or was willing to offer. Whether you’re negotiating for a wooden box at a bazaar or for an economic package, whoever talks first is setting the bar.

Labor management meetings and negotiations are not collaborative events where both parties walk away with everything they wanted. They are competitive, and at best you might walk away with some level of compromise that puts you on a road for a term and then brings you back to start all over again.

As for the fight, historically any major strides that labor has made were the result of some level of litigation. Who has the money to fight, the case or cause that will win the fight and the fortitude to see it through is the question. Many folks out there are working more than one job to make ends meet and satisfy their responsibilities: children, parents, student loans, mortgages, etc. It’s difficult to muster people to work together for a cause.

Outside of my own little world, you all have hit on some of the very real challenges the EMS workforce faces. I don’t have an answer, but we’ll never find one if we don’t talk about it.

Comment by Skip Kirkwood on February 19, 2009 at 8:12am
Hi Kathy,

So you think the members of the labor force see the union as being "them" (something separate from the members) as opposed to being "us" joined together for the common good?

Have the "union corporate" become so separate from the workers that the workers don't care to join and participate?

Is this a generational thing? The same phenomenon where the individual does not make any meaningful commitment to any organization?
Comment by Katherine Fuchs on February 18, 2009 at 10:44pm
I was an officer of one of our unions not too long ago. I think that one of the problems with the labor movement is that there is a disconnect between what labor expects from their union and what they get at the bargaining table. I think they also want the returns with as little personal involvement as possible. Just my opinion.
Comment by Ben Waller on February 17, 2009 at 11:28pm
I was going to add that the largest EMS union representation is from IAFF locals whose employees are members of fire-based EMS systems, but a post that's not really there seems to have covered it.
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