Personnel turnover in Austin-Travis County EMS has increased more than 63 percent in the past two years, according

to the latest city audit. Turnovers-or separations-include any kind of resignation, termination, or retirement of an Austin-Travis County EMS employee. So far in 2013, there have been 41 separations, the highest number on record. It is up from 36 in 2012, more than double the 15 in 2011. The only other numbers that resemble this year was in 2008, when Starflight, which is a 24/7 emergency response helicopter service, became its own entity and was counted in the separation rate. If you take that factor out, there were still only 23 separations in 2008. Tony Marquardt, who is president of the Austin-Travis County EMS Association, says he thinks there are many contributing factors to the growing separation rate, but that they all stem back to a weak management that has no direction or clear vision. At the end of the day, it comes to the chiefs desk, and these things are all symptoms of a poor leadership system, says Marquardt. One of the biggest factors in the high rate is the newly implemented Medic I/Medic II program, in which there is one EMT (Medic I) and one paramedic (Medic II) on every truck instead of two paramedics. Marquardt says the program is adding stress to paramedics because they are responsible for training the EMTs, which can only perform on basic calls. Since the program was implemented in March of 2012, there have been 64 separations. Anne Schaak, who was a paramedic for 10 years, resigned in June after nine years with Austin-Travis County EMS because of the Medic I/Medic II program and because she lost faith in management. I did love being a paramedic and I thought I was really good at it so it was kind of sad to let it go, but it just became really difficult under the way things were going there, says Schaak. Schaak says her biggest problem with the new program was the fact that she was expected to train new EMTs when she never had any experience or instruction on how to do that. They put me in a very uncomfortable and poor situation which then puts a community and somebody elses health in a very poor situation. Michael R. Levy, who is the vice chair of the Public Safety Commission, refers to the program as a daily disaster and agrees that it is adding too much stress on paramedics who are already working extra because of the high number of open positions. Marquardt says a main concern is that the number of open positions, or vacancies, are high among Medic IIs, which are the tenured paramedics. This is leaving the city with a less mature EMS system. Of the 41 employees that left the system in 2013, 25 of them were paramedics, which is about 61 percent. One thing you can say about tenure is does have its advantages in patient care, says Marquardt.

There are currently 68 vacancies out of 476 total positions. Paramedics account for about 34 percent of them. Levy says that management has been invisible throughout the process. Marquardt says that the Office of the Medical Director has been targeting medics in order to get to a 60-to-40 ratio of paramedic to EMT. He says to accomplish this, they began finding problems with medics and terminating them, which also contributes to the high number of separations. In an email to Paul Hinchey, who is the medical director for Austin-Travis County EMS, Levy says that he has no doubts that the Medic I/Medic II program will significantly compromise patient care. Another factor is the newly passed Civil Service law that was passed in November 2012. Marquardt says the law itself is not the problem, but managements reaction to it because the system has quickly gone from promotion based on favoritism and nepotism to promotion by compliance. He says management is using it as a threat to discipline medics. We have a division command that has one mode of managerial leadership style, which is intimidation, says Marquardt, and unfortunately they didnt learn to adapt as quickly to Civil Service as we had hoped. The end result of this process is increased suspensions, terminations, and resignations. Schaak says leaving was a tough decision because she liked everything about her job, but that the poor management style made it too stressful for her to continue. It has gone from something she used to have pride for, to a system that has lost respect from the public. We dont have that respect in the hospitals anymore and to me that is very sad. To me its very sad that such a great thing that I had so much pride about is being lost, says Schaak. Marquardt says the association is taking several steps to slow down this drastic separation rate over the next three years. Those include switching to a fire-based EMS system, creating a promotion process for EMTs, who currently do not fit into any process, doing a better job of defining current responsibilities of employees, and 360 reviews, which allow staff to evaluate their supervisors. There are also a record number of recruits applying this year, so as long as paramedic separations can be controlled, Marquardt says things should get better. I think it will improve along the way somehow, but its just going to be time and energy spent to make it happen. Schaak worries that talented paramedics are leaving at such an alarming rate. Even those who are passionate about their job and the public have no choice but to leave. I never ever would have thought in a million years that I wouldnt be doing EMS, that I wouldnt have retired from Austin. Never.