The 5:15 am alarm would have been a shock, except that I’m already awake in nervous anticipation. My plan for the day: spend 10 hours on a Hennepin Healthcare EMS ambulance with my husband, Gabriel Keller, a paramedic who is also founding principal at PKA Architecture. Although—or maybe because—Gabe has shared stories with me about what happens on his shifts, I’m nervous about high-stress situations, combative patients, exposure to bodily fluids, and whatever else causes someone to call 911.
Still, I want to see what it’s like to work on an ambulance at a time when our country faces a shortage of emergency medical service providers, including EMTs and paramedics. In many places, these shortages are exacerbating worker burnout and delaying ambulances from getting to patients.
So, I get out of bed, dress in layers, and follow Gabe out into a cold December morning.
It’s barely above zero and still dark when we arrive at Hennepin Healthcare (formerly HCMC) in downtown Minneapolis. By 6:30 am, Gabe’s driving ambulance number 412 out of the hospital garage. His partner for the day, Sarah McQueen, rides shotgun—I’m in the jump seat behind them.
At 6:39 am, we stop at a Starbucks. But coffee will have to wait. Just as we get to the counter, four high-pitched tones erupt from Gabe’s radio, followed by a dispatcher’s voice: “Beep beep beep beep. 412.” That’s us. Next comes an address and essential information: “Code 3. Shortness of breath.” Unlike Code 2, which means it’s OK to drive normally, Code 3 means hurry.
With lights and sirens blaring, Gabe weaves through a mess of cars while Sarah reads aloud the notes that appear on a screen attached to the dashboard. The patient has a swollen tongue but no hives. With a calm I can’t quite fathom, they discuss the possibilities. It might be life-threatening. Or it could be nothing serious.
A call to 911 is an act of faith: that an ambulance will show up, that it will arrive quickly, and that you will be cared for and delivered to a hospital that can help you.
As soon as Gabe pulls up to a home in a quiet neighborhood of Minneapolis, a firefighter approaches with the patient, a man in his 60s, who is soon in the back of the truck. His tongue is so swollen he can’t speak. If it gets worse, his airway will close completely. He needs to get to the hospital—now.
We’d arrived on scene at 6:46 am. Within minutes, the patient is on a stretcher in the ambulance with an IV delivering steroids, epinephrine, and antihistamines in his arm. By 6:54 am, we’re back on the road, lights and sirens on again. Sarah’s at the man’s side, monitoring his condition. By 7:01, 21 minutes after the call came in, Gabe and Sarah are rolling the patient into a room reserved for critical patients at Hennepin Healthcare.
After chatting with the ER doctors and nurses, cleaning up the ambulance, and documenting the call on a tablet, we’re back on the streets. It’s not yet 8 am. As we drive out of the hospital garage this time, I realize the sun has come up. On a normal day, right now is when I’d be sleepily getting my kids off to school. As it is, I’ve been up for hours and haven’t had coffee, and yet I’m wide awake.
A call to 911 with a medical emergency represents an act of faith: that an ambulance will show up, that it will arrive quickly, and that you will be cared for and delivered to a hospital that can help you. That system depends on a fully staffed ambulance service that may serve a large area.
In many places, those expectations have become precarious, and staffing shortages are a reason why. In a 2022 survey of over 12,000 people at 119 EMS organizations across the United States, the American Ambulance Association found an annual loss of 20 percent to 36 percent of the EMS workforce, including first responders, supervisors, and dispatchers. That adds up to 100 percent turnover every four years.
In Minnesota, nearly 21,000 people who were certified as EMS professionals have let their certifications lapse since 2017, the Minnesota Emergency Medical Services Regulatory Board reported in November 2022. The pandemic exacerbated these problems, says Marty Scheerer, chief at Hennepin EMS. Many paramedic programs shut down or limited class sizes. Test centers also shuttered, making it difficult for students to complete their certifications.
In the meantime, demand for emergency care has grown. In the last 18 months, Scheerer says, Hennepin EMS has seen a 35 percent increase in calls. The service, which responds to about 90,000 calls each year, currently employs about 150 medics but would ideally have more than 190.
“Nationwide, there’s a big shortage of paramedics,” Scheerer says. “Like health care in general, they’re really struggling.”
There are multiple reasons why so many EMTs and paramedics leave the profession. One of the most common, the Minnesota survey found, is low pay. In 2021, full-time employment as an EMT (a certification that requires at least 170 hours of training) earned an average of $35,470 a year, according to the U.S. Bureau of Labor Statistics. Paramedics, who train for as much as 1,800 hours, made an average of $46,770.
By comparison, the median salary for nurses is $77,600, even though, advocates argue, paramedics take on similar responsibilities with more risks. Many EMTs make less than Amazon drivers, and it’s been that way for a while, says Scott Moore, an employment lawyer and human resources consultant to the American Ambulance Association. Moore, who is based near Boston, took a pay cut of $1 an hour from his job at a grocery store when he started on an ambulance in the ’90s.
And it’s not a low-stress job. For first responders on the night shift, dinner routinely comes from a gas station in the very early morning, says Moore. EMS providers miss a lot of Thanksgivings, Christmases, and other holidays with their families. And of late, bystanders frequently film EMS workers on the streets, he adds. Calls can be traumatic. His first call as an EMT was for a woman who had been set on fire.
“Over time,” Moore says, “it does take its toll on the individual.”
Around 8:30 am, coffee finally acquired, we’re outside a Minneapolis home where we’ve been sent to check on an alert from a medical alarm. Sarah rings the doorbell. No response. Gabe goes around back to knock. Then the homeowner comes to the door and apologizes. It was a mistake.
“No problem,” Sarah says.
“Glad you’re OK,” Gabe adds. “That’s what we’re here for.”
Paramedics, I’m beginning to see, are not just health care workers. They are social workers, taxi drivers, therapists, and community liaisons. They respond to whatever happens in a world where anything can happen. On one call, we race to a school shooting that turns out to be a false alarm. And we visit several people who only end up needing evaluation at home.
Paramedics, I’m beginning to see, are not just health care workers. They are social workers, taxi drivers, therapists, and community liaisons.
My first chance to use the bathroom comes at 9:45 am, right after we brought a severely dehydrated woman in her 80s to North Memorial. While Gabe charts the call, Sarah and I snack on Doritos and chocolate milk in the hospital break room.
“The unusual is our normal,” she says.
An ambulance is like a ball in a pinball machine—all day long, the rigs get moved around to ensure coverage throughout the county. During our shift, we drive to Deephaven, Eden Prairie, St. Louis Park, and Uptown, ultimately covering more than 100 miles, often getting diverted before we even arrive. On each drive, the radio beeps incessantly, and the dashboard screen fills with calls: nosebleed, unconscious, seizure, stroke, cardiac arrest, chest pain, overdose.
There is no quick fix to hiring more paramedics, but services, including Hennepin EMS, are working on it. Since 2007, the hospital has offered a paramedic training program. But in 2020, the program began to offer an “earn-to-learn” option, covering tuition and paying EMTs to go through accelerated paramedic training. In exchange, students agree to work as medics at Hennepin EMS for three years. Covering costs boosts diversity, Scheerer says. So far, 100 percent of the students who completed the course passed the National Registry exams. Retention is high.
Scheerer has fielded calls from services around the country that are interested in starting similar programs, he says, and he expects the program to help fill Hennepin EMS’s paramedic shortfall over the next six months. In the meantime, medics often end up working late to cover the holes.
We drop off our last patient at Abbott Northwestern a little after 4:00 pm and are back at Hennepin Healthcare by 4:30 pm. I’m told it’s a rare on-time end to the shift. Gabe and Sarah hose the ambulance down, restock it, and check out. We arrive home around 5:00 pm. I collapse on the couch, go to bed early, and sleep for 10 hours.
For me, it was an exhausting day’s work, but for Gabe and Sarah, it was one of the slowest days they’ve had in ages.