Former EMS Union Leader Says First Responders Are Overworked

Lee Nudelman retired as a captain from Austin’s EMS department in the spring of 2024, but he hasn’t stopped worrying about the crushing workload his fellow medics struggle through.  

“Every single person in the field right now is living on some form of survival instinct,” Nudelman said. “They’re just trying to make it, because it’s exhausting. We’ve been at a critical moment for so long in staffing that people stop talking about it as critical.” 

Nudelman spent his 18 years at EMS “on the box,” as a paramedic in an ambulance. He was also the vice president of the medics’ labor union, the Austin EMS Association, from 2009 to 2019. He said he met with a succession of EMS chiefs, most recently in 2023, to share his concerns that medics are “over-obligated” – working more calls than they have the resources for – and to ask that the department adopt an analytical tool to gauge the health and welfare of front-line staff. Nudelman said such an approach has never been adopted. 

“We have to study the industry, study the people,” Nudelman said. “We have to talk about: What is burnout? What is compassion fatigue? How can we avoid it?” 

The Chronicle asked a field medic who had just come off a standard 24-hour shift about the workload. The medic, who wished to remain anonymous, said that in the past responders would have time to sleep for a few hours at night, after calls died down. “It’s a lot more common now for people to get calls throughout that entire 24-hour period, to a point where they just really don’t get any sleep,” he said.

In a statement to the Chronicle, an Austin-Travis County Emergency Medical Services spokesperson acknowledged that medics are dealing with situations that can impact their well-being. The spokesperson said the department gathers data on calls and uses it to inform staffing and deployment decisions. Regarding employee wellness, the spokesperson said EMS offers peer support services, employee assistance resources, and wellness-focused initiatives, and is evaluating ways to reduce unnecessary workload. “While ATCEMS is not currently participating in a peer-reviewed academic research program on burnout, we do analyze operational and wellness-related data to help guide policy and program decisions,” they added.

City leaders have acknowledged that EMS is overobligated for at least a decade. During the pandemic, former EMS union leader Selena Xie, now running for City Council, described medics as exhausted and hopeless. She pointed out that EMS was transporting more and more people to hospitals for issues that were not life-threatening: things like minor injuries and mental health crises, where they would wait in emergency rooms for hours. 

The medic we spoke with estimated that roughly eight out of 10 calls he handles are for non-emergencies. “We can look back at entire shifts and we’re just like, ‘Did any of those people need to go to an ER?’” he said. “And then we can usually pick out one or two patients.” 

Nudelman said that at the time of his retirement, Austin police were requesting ambulances approximately 50 times a day, but half of the requests were for non-emergencies. “That’s about an hour that an ambulance is tied up for a non-emergent thing,” Nudelman said. “You’ve got [42 full-time] ambulances for a million people. That’s not a lot. They should be treated as a precious resource.” 

Austin’s 42 full-time ambulances are what are known as “Advanced Life Support” units. James Monks, an EMS captain and the president of its labor union, told us that each provides full-service healthcare delivered by one paramedic and one emergency medical technician. Monks said that with EMS responders playing an ever-larger role in the healthcare safety net, cities like Boston and Seattle have incorporated “Basic Life Support” ambulances into their fleets – cheaper versions of the ALS ambulance, staffed with two EMTs, to handle less-critical calls. 

During last year’s budget negotiations, City Council voted to purchase two BLS ambulances and fund 62 new personnel for EMS. But then the tax increase known as Proposition Q, which would have paid for the new ambulances, was rejected by voters. Council rewrote the budget to remove the BLS units and new personnel and to provide $3 million in additional overtime funding for EMS instead. 

Monks believes EMS needs between 10 and 20 more ambulances; the ATCEMS spokesperson said the department is considering the use of BLS units. Meanwhile, it continues to develop programs designed to relieve pressure on the medics. The Community Health Paramedics Program helps patients who frequently call EMS or have complex medical needs, for example, homeless people suffering from mental health issues. The Collaborative Care Communication Center, or C4, helps low-income residents who often use EMS as a way to handle relatively minor healthcare needs. Under the program, EMS sends medics in SUVs instead of full ALS units to arrange care. The ATCEMS spokesperson said the department is also studying the implementation of a telehealth response. 

Monks and Nudelman worry that EMS’s high workload is hurting its ability to hire and retain medics. They cited studies showing that the average tenure of EMS medics has declined significantly in recent years across the country. Monks said EMS’s retirement package is part of the problem. Since 2012, EMS has required its personnel to work until they’re at least 62 before receiving full retirement benefits. The city’s police officers and firefighters can begin receiving benefits much earlier, some before they are 50 years old, if they have enough service credit. 

The EMS medic we spoke with said he doesn’t expect to make it to retirement. “For most of my realistic co-workers, we look around and we realize there really are no 60-year-old paramedics,” he said. “They don’t exist. The job is just too physically demanding, it’s too sleep deprivation demanding, it’s too PTSD demanding to last 30 years on an ambulance.”

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