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There are many variables that affect retention rates on EMS providers. For this study the
primary independent variable to be evaluated is how call volume per provider affects the
retention rate. Figure 1 above is a visual representation of the conceptual model of the important
variables and their relationship to the retention rate among EMS providers.
Call volume per provider influences provider retention rate due to the fact that the more
calls a provider runs per shift the more likely that provider is going to feel “burnout.” Burnout
can be described as “a state of chronic stress that leads to: physical and emotional exhaustion,
cynicism and detachment, and feelings of ineffectiveness and lack of accomplishment” (Carter,
2013). There are three primary factors that affect the call volume rate which are the location of
service, staffing number, and the work schedule. All these three factors above, may affect the
call volume rate.
The location of the service whether it is located in areas with high population density or
not. The location of service could influence provider retention due to large systems usually
having a larger call volume. This call volume could influence a provider’s decision to leave the
If a provider is working in a service with a high call volume, but they are being paid the
same as a provider in a less busy system, the provider may be more likely to leave the busy
system due to a lack in compensation compared to work “effort”. Salary and benefits are
important to cover all the EMS needs and keep them in the service.“The most important reasons
for leaving the profession were choosing to pursue further education and moving to a new
location. A desire for better pay and benefits was a significantly more important reason for EMTParamedics’ exit decisions than for EMT-Basics.” (Blau, Gary, Chapman, Susan A, 2016).
The number of the staff should be increased as the call volume increases, so the working
schedule would be more flexible to the providers. If a provider works too often or does not have
enough time off between shifts retention rates may be affected. If a provider does not take the
time or have the option to recover after a long shift he/she will begin to feel the effects of
“burnout” previously mentioned. One of the signs of burnout is fatigue. This fatigue “may feel
[like] a lack energy and tired[ness] most days. In the latter stages, you feel physically and
emotionally exhausted, drained, and depleted, and you may feel a sense of dread for what lies
ahead on any given day” (Carter, 2013).
If a provider is unable to spend time with family and friends due to work demand then a
provider may feel more about to transfer into a different system that has low call volume in order
to equalize between work and family demands. Burnout can cause irritability which “…can
destroy relationships and careers” (Carter, 2013). Providers must be able to take care of
themselves in order to function at their highest ability. In order for a provider to be at their best
they must have time to spend at home with their families.
As providers age they may want to retire and leave the system. As people age the
likelihood of health issues increases. As previously mentioned burnout causes several physical
symptoms, which could compound the effects of normal age-related disease processes. This
compound effect could be detrimental to a provider’s health and career.
Physical demand on a provider may influence a provider’s decision to leave a system. If
the provider is physically overworked injuries are more likely to occur and a provider will not
want to stay in a system that he is more likely to be injured in. One study mentioned that the
back injury was the highest indicated medical issue made the provider leave (Blau, 2011).
Decreased perceived physical health was related to higher notion to leave the EMS.“The EMS
work is physically demanding. Studnek et al found that 26% of their large EMS sample was
obese and that three-quarters of the respondents did not meet the Center for Disease Control
recommendations for physical activity. Mandatory ongoing physical fitness assessments of EMS
professionals at their places of employment may be needed.”(Blau, Gary, Chapman, Susan A,
Adequate amounts of sleep is very important to the providers in order to perform high
quality job as well as their health. If a provider is experiencing a lack of sleep or negative health
effects due to working in a busy system the provider is more likely to leave the system. In a
study done by the Career Development International, studying the impact of the sleep-related
impairments on the health of the EMS providers found that the providers tend to leave the EMS
profession. (Blau, 2011)
Furthermore, the retention rate is more affected by the call volume so, If a system is
appropriately staffed call volume per provider will be lower than one that does not have enough
units staffed. With a system being appropriately staffed providers will not feel overworked and
could stay with a system for longer time.
Blau, G., & Chapman, S. A. (2016). Why do Emergency Medical Services (EMS) Professionals Leave
EMS?. Prehospital & Disaster Medicine, 31S105. doi:10.1017/S1049023X16001114
Carter, B. S. (2013, November 26). The Tell Tale Signs of Burnout… Do You Have Them? Retrieved
from Psychology Today :
Exploring the impact of sleep-related impairments on the perceived general health and retention intent of
an Emergency Medical Services (EMS) sample. (2011). CAREER DEVELOPMENT
INTERNATIONAL, 16(3), 238-253.

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