title: Over-commitment of EMS personnel in North Carolina with implications for disaster planning.
abstract: BACKGROUND
  While large-scale disasters are uncommon, our society relies on emergency personnel to be available to respond and act. Faith in their availability may lead to a false sense of security. Many emergency personnel obligate themselves to more than one agency and so may be overcommitted, leaving agencies with unfilled positions in a disaster. We sought to describe the frequency of overcommitment of emergency medical services (EMS) personnel in North Carolina.
  
  
  METHODS
  We conducted a cross-sectional study utilizing the Credentialing Information System (CIS) of the North Carolina Office of EMS. The CIS database manages demographic and certification information for all EMS personnel in North Carolina. The state is divided into 100 EMS systems based on county boundaries. Utilizing de-identified provider data from the CIS, we collected system(s) affiliation(s) and level of certification. To calculate an overcommitment rate per system, we divided the number of personnel with more than one system affiliation by total number of system roster personnel. To compare urbanicity and certification level with overcommitment, analysis of variance and the chi-square test were used, respectively.
  
  
  RESULTS
  North Carolina credentials 14,717 EMS providers (8,346 EMT, 1,709 EMT-intermediate (EMT-I), 4,662 EMT-paramedic (EMT-P)). Of these, 10,928 (74%) are affiliated with a single system. Of the 3,789 committed to more than one system, 3,020 (21%) were committed to two systems, 571 (4%) to three, 138 (1%) to four, and 60 (<1%) to five or more. EMT-Is and EMT-Ps were more likely to be overcommitted when compared to EMTs (37, 32, 20% respectively, p < 0.0001). Statewide, the median overcommitment rate for EMS systems was 24% (IQR 16-37%). Personnel working in systems servicing less densely populated areas were more likely to be overcommitted: 33% wilderness, 29% rural, 20% suburban and 11% urban (p < 0.0001). Additionally, 40% wilderness, 23% rural, 4% suburban, and 0% urban systems had >37% of their personnel engaged in 9-1-1 response in more than one system.
  
  
  CONCLUSIONS
  Many EMS personnel have multiple EMS commitments. Disaster planners and emergency managers should consider overcommitment of emergency responders when calculating the work force on which they can rely.
authors.forename: Cameron
authors.initials: C
authors.lastname: Watkins
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Delbridge
authors.forename: Greg D
authors.initials: GD
authors.lastname: Mears
authors.forename: Jeff
authors.initials: J
authors.lastname: Robertson
authors.forename: Jane H
authors.initials: JH
authors.lastname: Brice
mesh_terms: D002568:Certification; D003430:Cross-Sectional Studies; D004189:Disaster Planning; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D006801:Humans; D007256:Information Systems; D009657:North Carolina
keywords: Disasters; Emergency Medical Services/organization and administration; Emergency Medical Technician