Career Paramedic-Firefighter Staffing Problems: Is Recruiting Women Part of the Solution?

Juan Byron


This case study analyzes the shortage of applicants for career paramedic-firefighter positions and its relationship to the paucity of female firefighters. The research explores causes of the shortage, examines four case fire departments, and suggests how fire departments and communities can address these staffing challenges by including women and girls in recruitment efforts. The focus is on a comprehensive understanding of the employment pipeline from initial job interest through recruiting, hiring, and retention. Fire departments and potential employees make decisions at various points in the process of career exploration, recruiting, and hiring. Analyzing these decisions in demographic, economic, social, and legal contexts uncovers solutions that may be relevant for other occupations and for the volunteer fire and emergency medical services (EMS).

Nationally, the supply of working paramedics is not keeping up with demand for paramedic service. Due to this shortage, career fire departments experience increasing difficulties in hiring paramedic-firefighters, also sometimes locally known as firefighter-paramedics. This staffing challenge is a growing problem for public safety because the fire service is the largest employer of EMS workers.[1] The most common EMS workers are basic emergency medical technicians (EMTs).[2] Advanced providers, termed paramedics, number about half as many as basic EMTs.[3] In 2011, the Emergency Medical Services Workforce Agenda for the Future identified workforce shortages as EMS employers’ largest concern.[4] Pointing to a growing concern, in 2007, the State Senate Committee on EMS Recruitment, Retention, and Training in Georgia also reported that changes in population demographics have created a shortage of EMS employees.[5]

Research demonstrates that women can successfully fill more firefighter jobs than they currently do. As of January 2018, the Bureau of Labor Statistics (BLS) reports that only about 3.5 percent of career firefighters are female.[6] This underrepresentation is the case even though women account for almost 47 percent of the nation’s workforce, over 30 percent of EMTs, 21 percent of paramedics, 17 percent of persons doing work physically similar to firefighting, 15.9 percent of active duty military, and 9 percent of volunteer firefighters.[7]

The misperception that women lack the physical ability or interest to be paramedic-firefighters likely exacerbates the shortage of applicants for these jobs. The reality is that gender is not the determining factor in whether an applicant can develop proficiency in a skilled occupation, even one requiring physical ability. For example, law enforcement is physically demanding, yet the BLS reports that 13.6 percent of police and sheriff’s patrol officers are women.[8] The BLS also reports that 36.4 percent of career athletes, coaches, umpires, and related workers are women.[9] Professional athletes, like paramedic-firefighters, work outside and must be physically strong.[10] Paramedic-firefighters’ medical duties are likely of interest to women, given that 83 percent of U.S. nurses and 35 percent of U.S. physicians are female.[11] These findings suggest that one solution to the paramedic-firefighter shortage may be to target women for recruitment.[12] As preferential treatment of one class may be seen as discrimination against another class, this thesis distinguishes between targeted recruiting and preferential hiring.[13] The former does not violate anti-discrimination laws, but the latter does unless approved by a court in narrow and temporary circumstances.[14]

In 2006, the largest fire-service labor organization made well-researched recommendations on how to integrate the approximately 4,500 career or mostly-career fire departments.[15] These recommendations included using inclusive language and information about job requirements and compensation to target potential applicants and their families, requiring only necessary education, employing advertising and recruiters from non-traditional backgrounds, using a fair hiring process, to providing mentoring, and conveying in all messages—not just in recruiting—that the department values diversity.[16]

This thesis found that deep commitment to inclusive recruiting and lawful hiring likely increases staffing performance as long as these processes are efficient.[17] Departments that arrive at these characteristics on their own appear to have less resentment toward female employees than departments that come to these practices after discrimination lawsuits.[18] The underrepresentation of women among paramedic-firefighters even in the context of a paramedic-firefighter shortage, low unemployment, and concern over the gender wage gap, indicates that the fire service should go beyond the stated recommendations and support increased ambulance reimbursement and greater access to paramedic and firefighter education for women and students from other underrepresented classes. Fire service organizations should partner with others—as case departments do—to provide pre-service camps, cadet programs, explorer programs, reserve programs, internships, and EMS education so that women and other potential applicants have an uninterrupted set of opportunities to develop paramedic-firefighter knowledge, skills, and abilities. At the same time, employment decisions must remain based strictly on ability rather than on gender, race, or other class. Lastly, firefighters and the communities that they serve must accept and mentor applicants hired on their merits, regardless of gender to sustain staffing gains.



[1] Melissa A. Bentley, Abigail Shoben, and Roger Levine, “The Demographics and Education of Emergency Medical Services (EMS) Professionals: A National Longitudinal Investigation,” Prehospital and Disaster Medicine 31, no. Supplement 1 (December 2016): s19,

[2] National Registry of Emergency Medical Technicians, 2014 National EMS Practice Analysis (Columbus, OH: National Registry of Emergency Medical Technicians, 2015), 10.

[3] National Registry of Emergency Medical Technicians, 10.

[4] Susan A. Chapman, Vanessa Lindler, and Jennifer A. Kaiser, The Emergency Medical Services Workforce Agenda for the Future (Washington, DC: National Highway Traffic Safety Administration, 2011), 26,

[5] Senate Committee on EMS Recruitment, Retention, and Training in Georgia, Final Report of the Senate Committee on EMS Recruitment, Retention, and Training in Georgia (Atlanta, GA: Senate Research Office, 2007), 5–6,

[6] “Employed Persons by Detailed Occupation, Sex, Race, and Hispanic or Latino Ethnicity,” Bureau of Labor Statistics, January 19, 2018,

[7] “Women’s Bureau (WB)—Quick Facts on Women in the Labor Force in 2010,” Bureau of Labor Statistics, 2010,; National Registry of Emergency Medical Technicians, 2014 National EMS Practice Analysis, 19, 25; Denise M. Hulett et al., “Enhancing Women’s Inclusion in Firefighting in the USA,” International Journal of Diversity in Organisations, Communities & Nations 8, no. 2 (May 2008): 191,; Department of Defense, 2016 Demographics: Profile of the Military Community (Washington, DC: Department of Defense, 2016), iii,; Hylton J. G. Haynes and Gary P. Stein, U.S. Fire Department Profile—2015, NFPA Research (Quincy, MA: National Fire Protection Association, 2017), 7,

[8] “Employed Persons by Detailed Occupation, Sex, Race, and Hispanic or Latino Ethnicity,” Bureau of Labor Statistics, 2015,

[9] “Athletes and Sports Competitors: Occupational Outlook Handbook,” Bureau of Labor Statistics, April 13, 2018,

[10] Bureau of Labor Statistics, “Athletes and Sports Competitors: Occupational Outlook Handbook”; Todd J. LeDuc, “Are You a Tactical Athlete?,” March 15, 2018,
2018/03/tactical-athlete.html; Stacy L. Gnacinski, Barbara B. Meyer, and David J. Cornell, “Tactical Athletes: An Integrated Approach to Understanding and Enhancing the Health and Performance of Firefighters-In-Training,” International Journal of Exercise Science 8, no. 4 (2015): 341–57, digital; John Hofman, “Tactical Facilitators in Firefighting,” NSCA, 2018,

[11] Henry J. Kaiser Family Foundation, “Total Number of Professionally Active Nurses, by Gender,” Henry J. Kaiser Family Foundation (blog), October 17, 2018,
total-number-of-professionally-active-nurses-by-gender/; “Professionally Active Physicians by Gender,” The Henry J. Kaiser Family Foundation (blog), October 17, 2018,

[12] Hulett et al., “Enhancing Women’s Inclusion in Firefighting in the USA,” 191–92, 197.

[13] Jennifer L. Thompson and Scott B. Morris, “What Factors Influence Judges’ Rulings about the Legality of Affirmative Action Plans?” Journal of Business & Psychology 28, no. 4 (December 2013): 412,

[14] Thompson and Morris, “What Factors Influence Judges’ Rulings about the Legality of Affirmative Action Plans?” 414–15.

[15] Kathryn A. Fox, Chris W. Hornick, and Erin Hardin, IAFF Diversity Initiative: Achieving and Retaining a Diverse Fire Service Workforce (Washington, DC: International Association of Fire Fighters, 2006), 8–28, 35–61,; Haynes and Stein, U.S. Fire Department Profile—2015, v.

[16] Fox, Hornick, and Hardin, IAFF Diversity Initiative, 8–12; Reginald E. Jones et al., Best EEO Practices Task Force Report (Washington, DC: Equal Opportunity Employment Commission, 1997), 262,; Bill Leonard, “Diverse Workforce Tends to Attract More Female and Minority Job Applicants,” HR Magazine, April 2001, 27, http://web.a.ebscohost.
4006; Ellen A. Fagenson, “The Mentor Advantage: Perceived Career/Job Experiences of Proteges Versus Non-Proteges,” Journal of Organizational Behavior 10, no. 4 (October 1989): 309–20,

[17] Michelle Schmitt and Katie Martin, Hiring and Employment in Philadelphia City Government (Philadelphia: Pew Charitable Trusts, 2018), 1–2,; Denise M. Hulett et al., National Report Card on Women in Firefighting (Washington, DC: International Association of Women in Fire and Emergency Services, 2008), 4–51,; Abby Miller et al., Promising Practices for Increasing Diversity among First Responders (Bethesda, MD: Department of Labor, Chief Evaluation Office, 2016), 9–11,

[18] Aisha Krieger, Beyond the Consent Decree (Emmitsburg, MD: National Fire Academy, 2012), 91–93,; Iulia Filip, “Racism Decried in Philly Fire Department,” Courthourse News Service, November 15, 2011,

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