Promotion of Emergency Medical Services: A National Analysis of Clinician Willingness to Recommend the Profession.
Prehospital emergency care · 2026-01-01 · Observational study
Abstract
OBJECTIVES: Emergency medical services (EMS) workforce challenges impact prehospital care in many United States communities. One potential strategy to address this challenge is clinicians actively promoting the EMS profession. However, there is limited data regarding the likelihood of EMS clinicians recommending others to join the profession. We aimed to describe professional promotion among EMS clinicians and factors that impact their likelihood of recommending. METHODS: We performed a cross-sectional analysis of nationally certified civilian EMS clinicians (ages 18-85) recertifying between October 2023 and April 2024. Applicants completed a voluntary survey regarding EMS professional promotion measured by the Net Promoter Score®. This validated tool measures the likelihood of recommending a field to others (classified as promoters, passives, or detractors). Surveys were merged with demographic and workplace characteristics from the National EMS Certification database. We calculated descriptive statistics (n, %; median, interquartile range [IQR]) and performed multivariable logistic regression (odds ratio, 95% confidence interval) to identify factors associated with likelihood of promoting EMS by clinicians, including demographics, workplace characteristics, self-reported burnout, and job satisfaction as covariates. RESULTS: We included 33,335 clinicians for analysis (response rate = 28.8%); respondents reflected the nationally certified EMS population (male [74.2%], non-Hispanic White [86.1%], median age 36 [IQR: 29, 49], patient care [90.8%]). Promotion score distribution balanced between promoters (33.8%), passives (33.1%), and detractors (33.1%), yielding a NPS = 0.7 (possible range: -100 to +100), indicating near-zero net promotion. Compared with fire agencies, all other agency types exhibited lower odds of promotion. Higher education levels (associate [0.90, 0.82-0.98], bachelor's [0.80, 0.73-0.87]; [referent: ≤high school/General Educational Development]) and more years experience (3-7 [0.86, 0.81-0.93], 8-15 [0.76,0.70-0.82], >15 [0.83, 0.75-0.91]; [referent: 0-3]) had lower odds of promotion. Clinicians reporting burnout had significantly lower odds of promoting EMS (0.31, 0.29-0.33), while clinicians with high job satisfaction had increased odds of promoting (6.27, 5.08-7.74). CONCLUSIONS: Demographic and workplace characteristics are significantly associated with the likelihood of EMS clinicians promoting the profession. Observed satisfaction and burnout associations suggest areas for further investigation regarding their relationship to professional promotion and broader workforce dynamics.