Case report: Should all states lower the minimum age for EMS training to 16?

The pros and cons of growing the talent pool

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From recruitment videos to retention bonuses, growing the talent pool is a hot topic being discussed at the agency, state and national levels.

According to the National Conference of State Legislatures, almost 40 state legislatures and Washington, D.C., considered bills in 2022 related to various aspects of EMS staffing and service.

One idea to expand the EMS workforce pool is to remove age restrictions, as the NREMT did in 2019 (it had previously been 18), Pew reported. At least six states have lowered the minimum age for EMT training to 16 or 17.

Should all states follow suit? We asked the famed duo, Inside EMS podcast Hosts Chris Cebollero and Kelly Grayson, to weigh in.

The ground rules: As in an actual debate, the pro and con sides are assigned randomly as an exercise in critical thinking and analyzing problems from different perspectives.

Our debaters:

Should all states lower the minimum age for EMS training to 16?

Kelly Grayson: The staffing crisis in EMS is nothing new, and has reached crisis levels in the U.S. for both volunteer and paid EMS systems. It's a hotly debated subject in the Grayson household for some time. My girlfriend and business partner Nancy Magee believes that volunteer EMS agencies need to focus recruitment on empty nesters and middle-aged professionals rather than young people just entering the workforce. That is not to say, however, that she doesn't think that young people have a place in EMS; she simply points out that, where volunteering is concerned, there is no segment of our society that more desperately needs a paycheck than young singles just entering the workforce.I tend to agree with her. But for paid EMS professionals, high school graduates and seniors remain a fertile and mostly untapped recruiting ground. This is the place where – if we play our recruitment cards right – we can create career EMTs, people who will remain in the EMS workforce for 20 years or more, rather than suffer career burnout at around five years as is so often cited. Even if we don't keep them in the workforce and they move on beyond EMS, we have the potential to create a future healthcare professional or public policy-maker who has fond memories of EMS and a deeper understanding of the challenges we face.

I think the youth movement is a good idea.

Chris Cebollero: I was lucky enough to graduate high school at 16 years old. I did not go to my ninth or eleventh year; the benefits of a Catholic School education before transitioning to public education. Just before graduation, I was approached by a Navy recruiter that did his best to get me to join. All I needed was my mother's signature. My mother was not having it one bit. Her biggest argument was that I was too immature to join the Navy. No matter how hard I begged, she was not relenting. In her wisdom, she was correct. I thought I was ready, but looking back, my level of maturity was not even close to handling a stint on an aircraft carrier.

Let's now look at the experience we all have gained in EMS. We see death, dying, physical abuse and murder. We all have experienced the horrors of being EMS professionals and these terrors burn deeply into our conscious minds. Too many of our peers suffer from substance abuse or have been lost to suicide. We are trying to find ways to save these souls that need our guidance and comfort.

Fast forward to reducing the minimum age to 16 years old to become an EMS provider. What about that makes people think this is a good idea at all? Think about a 16-year-old you know and put them into a scenario that we see on a regular basis – oh, not just one scenario, but 12 hours’ worth of scenarios 4 or 5 days a week for a year. What do you think would happen to the life of that 16-year-old – a 16-year-old still gaining perspective about the world, wondering about life? Instead of preparing for their senior trip or deciding who they will go to the prom with, they are trying to get the vision out of their head of their last gruesome scene.

Kelly Grayson: Chris, you’re projecting. Effectively, what you’re saying is, "If I, with my maturity and my decades of developing coping mechanisms can still get emotionally scarred, what makes you think an innocent 16-year-old kid won't?"

The fact is, your examples belie your argument and lend credence to mine. We haven't developed effective coping mechanisms. We haven't gained the maturity we think is an effective shield against psychological trauma. If we had, less of our brethren would suffer from PTSD and our suicide rates would be far lower. What coping mechanisms we’ve developed against psychological trauma and moral injury is analogous to a blacksmith botching the annealing process when he forges a knife or sword: the finished product is indeed very hard … and brittle. At the first sharp blow, it will break.

What new EMTs need – adults or adolescents – are the tools to develop emotional and psychological resilience, something you and I have discussed at length in our podcast. If you think that adolescents can't develop those tools, you’re mistaken.

In fact, it's already being done successfully at Post 53 in Darien, Connecticut, and has been for 53 years. These kids don't just ride along in the ambulance, they run the ambulance service. These kids provide modern EMS services to their town, to the tune of 1,600-plus calls a year.

Post 53 has more applicants each year than they have slots, and they pick the cream of the crop. Almost all of these kids go on to college and seek careers in medicine or as business executives; many at Ivy League schools. They’re not only proof of concept that high schoolers can excel at EMS, they’re a model for how a volunteer agency should be run.

So how do they do it? Mentorship. These kids are shielded from nothing, but they have adult oversight every step of the way – someone older and more experienced who can help them deal with the things they see in a healthy way.

That's something that every new EMT needs, regardless of age, and it's sorely lacking in our profession.

Chris Cebollero: Kelly, you sound like the EMS leaders who are trying to justify a butt-in-the-seat approach to EMS staffing. Let's find anyone we can to ensure we are meeting our response time compliance for the city we are serving. Kelly, you’ve discussed your experience and the challenging calls you have run in your career on the podcast and written about them in a PTSD anthology.

Another thing I know about you is the love and admiration you feel for your daughter, KatyBeth. Now, your baby girl comes to you at 16 years old and wants to join the local 911 service. Think about where your daughter was emotionally at 16 years old. Do you consent to allow her to take this plunge? Now, Kelly, maybe the answer is yes, your daughter was emotionally stable and mature enough at 16 to see the horrible side of humanity, the death, the trauma a body goes through, and continue to grow into an emotionally stable adult. But there are some 16-year-olds who will not meet that definition of emotionally sound and mature.

If you’re the leader of an EMS system, you have a responsibility to your workforce, your stakeholders and the citizens you serve. Do you feel comfortable bringing a 16-year-old EMT into the system and telling them to go forth and heal? In my opinion, that's putting your workforce into harm's way as these professionals are charged with helping people on what could be the worst day of their lives. Now, they not only have to answer the call for help, but they are also looking after a 16-year-old who should not be on the street. By the way, who is driving that patient to the hospital?

Kelly Grayson: There's a whole lot about EMS that I’d change, Chris. Those arbitrary and unproven response time standards you accuse me of trying to satisfy are first among them.

But if we’re going to transform EMS into what it should be, first we have to examine what it is and reject what doesn't work. Reimagining our workforce is a huge part of that. Protecting the workforce we already have, taking better care of them and showing them that we value them as the most important asset of any EMS system is paramount.

The steps we’d take to do that are exactly the steps necessary to make sure a high school kid can handle the rigors of an EMS career. It's not about protecting the fragility of youth, it's about redefining what strength is. Kids can be far stronger than we give them credit for, if we take the time to teach them. We don't take that time with adults because we equate chronological age with emotional maturity. The fact that we have so many PTSD sufferers in EMS demonstrates how wrong that assumption is.

And, to answer your question, if KatyBeth had come to me as a 16-year-old wanting a career in EMS, I’d have discouraged her, but not because of her age or maturity level. She's not a good fit for EMS, and she knows it. You might even call that degree of self-awareness a sign of emotional maturity. As you well know, most people are not a good fit for EMS, and age has little to do with it.

I’m sure you’ll still disagree, but I’m emotionally mature enough to allow you to be wrong.

EMS: Anyone could do it; not everyone should

"EMS is a privilege that has been entrusted to you for safekeeping"

Chris Cebollero: But, your maturity was built over your 30 years of being a paramedic. The realization of this whole topic is we need to stop trying to find a Band-Aid for what is ailing EMS. We must pay our providers more, offer them leadership training and prepare them for the next step in their careers. Focus on training our low performers, coach them and assist their growth. Assist our middle performers in becoming high performers and recruit the high performers to be field leaders in our systems.

Just because we are having an EMS shortage does not mean we need to lower the certification age to bring in younger members to our workforce. My belief is this will not only be a detriment to our systems and our current workforce, but to these young adults who are still in their cognitive stage of development. Our job is to take care of people: that includes our workforce.

The community paramedic model of care is helping EMS agencies to treat people and give them what they need to stop the revolving door at the emergency department. Patients go to the ED, they get some medicine and some care to fix the problem, but neglect the system that is affected. This Band-Aid approach only works until the next time the same problem flares up. Then, the patient will call 911, we will do our magic, the doc in the ED does their thing – Boom! Band-Aid! – and out the revolving door until next time. We must take a lesson from this travesty and not look for the next Band-Aid and revolving door to solve our staffing shortage issue.

What do you think? Should all states lower the minimum age for EMS training to 16? Weigh in below and share your thoughts with us at [email protected].