Randy Guyton, chief of Klondyke-Chadbourn Fire and Rescue, talks inside an ambulance.

Low pay, high stress: EMS agencies in rural NC struggle to recruit workers and volunteers

By Sarah Nagem


When Randy Guyton turned 18 nearly four decades ago, he signed up to be a volunteer at Klondyke-Chadbourn Fire and Rescue in Columbus County. But it took months for him to get a foot in the door. 

“Believe it or not, there was a waiting list to get on the department,” Guyton said. “That’s how much times have changed.”

Guyton, now 56 and chief of the department, has seen the number of volunteers dwindle over the years. To fill the gap, the nine rescue squads in Columbus County have brought in paid staff – but the recruitment effort has been tough. 

The situation in Columbus County, nestled in the southeastern corner of North Carolina, is playing out at fire departments, EMS stations and rescue organizations across North Carolina and the United States. Many of the most loyal volunteers are nearing retirement age, fewer young people are signing up, and training requirements have become more rigorous. 

Meanwhile, experts say the coronavirus pandemic worsened staff and volunteer shortages in the high-stress, low-pay arena of emergency medical services. 

“EMS has what you would call a high burnout rate because of what you’re seeing day in and day out,” Guyton said. “It can take a toll on you over time, mentally and physically.” 

Columbus County is now looking at ways to improve EMS. With help from the N.C. Association of County Commissioners, a committee made up of local rescue chiefs, government officials and others are conducting a study to look at strengths and weaknesses. 

A "volunteers wanted" sign for Klondyke-Chadbourn Fire and Rescue in Columbus County, North Carolina.
Klondyke-Chadbourn Fire and Rescue had more volunteers than it could handle 40 years ago. But that has changed drastically. Photo by Les High

Most North Carolina counties have moved away from volunteer-only systems to county-run programs that use paid staff and some volunteers. Columbus relies on volunteers more than perhaps any other county in the state, according to data from the N.C. Department of Health and Human Services. 

Some people, including Guyton, say they don’t want to change the system that’s in place. Columbus County property owners pay a “rescue tax” of 2 cents per $100 valuation to help fund the rescue squads, which also rely on payments from Medicaid, Medicare and private insurance companies.   

However, Guyton said, the squads need more money to hire paramedics and emergency medical technicians and pay them competitive wages. 

‘Money talks’

The median pay for paramedics and EMTs in the United States in 2020 was $17.62 per hour, according to the U.S. Bureau of Labor Statistics. In North Carolina, the median pay was 7 cents higher. 

But pay scales vary by county, and Guyton said some first responders are leaving Columbus to work in neighboring counties. 

In Scotland County, the starting pay for paramedics is about $48,000, said Public Safety Director Robert Sampson. Part-time EMTs earn $13 an hour. 

“Money talks,” Sampson said. “And if we’re not competing with these other counties, we know we’re going to lose staff.” 

Bladen County, which has transitioned from volunteers to a county-wide paid EMS system over the past 25 years or so, offers a starting hourly wage of $14.99 for entry-level EMTs and $16.36 for Advanced EMTs, said EMS Director David Howell. Paramedics begin at $18.94 an hour. 

The pay is lower at Klondyke-Chadbourn Fire and Rescue, where entry-level EMTs make $12 an hour and Advanced EMTs make $15 an hour, Guyton said. 

Raising the pay for EMS workers is especially important because of the training requirements for the job, Guyton said. Certifications can require more than 100 hours of classroom work, and then there are continuing education requirements as well. 

Paramedics, who must undergo significantly more training than EMTs, are allowed to administer a longer list of drugs to patients and perform more procedures. 

Depending on where they live in Columbus County, residents experiencing a health emergency might receive different care. That’s because only two of the rescue squads have paramedics – Whiteville and Tabor City. The others have EMTs and Advanced EMTs. 

“Our goal is to provide the same level of service countywide,” said Nick West, assistant county manager for Columbus. 

But it’s expensive to hire enough paramedics to respond to every call. One option, West said, would be to put quick response vehicles – commonly called QRVs – in the most rural parts of the county and staff them with paramedics. 

Bladen County transitioned to paramedic-level care throughout the entire county about 12 years ago, said County Manager Greg Martin. 

“It’s important to know that there is staff available to respond in a very timely fashion when a call is received,” Martin said. “By having paid staff, you’re better able to do that.” 

Finding qualified paramedics to fill jobs can be tough, however, as agencies struggle – and compete – to recruit candidates. 

Howell said Bladen County is currently trying to hire two paramedics and one EMT. 

“I was short five paramedics as of three weeks ago,” he said. 

Pay is certainly a factor as EMS agencies across the country struggle to find workers, Howell said. And more than two years after the start of the coronavirus pandemic, some EMS workers might be looking elsewhere for work. 

“COVID is part of it,” he said. “Just the fatigue, the burnout dealing with COVID.” 


Nancy Magee, an EMS consultant and managing partner at Medic Training Solutions in Louisiana, said rural agencies must do more to help recruit staff and volunteers.  

For starters, she said, agencies should focus on becoming more diverse and reach out to young people, including young women. 

“If you’re 25 years old and all you see is a bunch of 70-year-olds running a fire department, it’s not going to be the first place you want to sign up for,” Magee said. 

Scotland County wants to bring back its EMS Explorer program for youth this summer, Sampson said. 

“They can actually ride with us on the weekends and see firsthand, ‘Hey, yeah, this is exactly what I want to do.’ Or, ‘I wasn’t sure, but now that I see, I love it.’”  

The goal, Sampson said, is to create a pipeline for future EMS workers. Teens who successfully complete an EMT course at high school and participate in the Explorer program could be guaranteed a part-time job with the county. 

“You’ve got a job as soon as you graduate from high school,” Sampson said. “Start putting some money aside while you decide what your next steps are going to be as far as your education.”

Guyton, who serves as president of the Columbus County Fire and Rescue Chiefs’ Association, said he’s hopeful for the future of EMS in Columbus County. 

“All you can do is keep moving forward,” he said, “and eventually we’ll get it there.” 

Follow Sarah Nagem on Twitter: @sarah_nagem

Randy Guyton, chief of Klondyke-Chadbourn Fire and Rescue, talks inside an ambulance.
Randy Guyton, right, is chief of Klondyke-Chadbourn Fire and Rescue in Columbus. Here, he talks with paramedic Crystal Parker. Photo by Les High