EMS Budget Reflects Reality

Budget cuts and a hiring freeze for Fiscal Year (FY) 2027 did not create the staffing crisis at Caswell EMS, but did highlight a reality that public safety leaders have warned about for years.

Caswell County does not have enough Paramedics and Emergency Medical Technicians (EMTs) to staff every shift and there are not enough Volunteer Firefighters and/or First Responders available to fill the gap.

Local fire chiefs recently received an operational update from Caswell EMS Director John Yarbrough to notify them that beginning July 1, EMS would likely reduce the number of daytime ambulances from four to three. The news came during a week when EMS was frequently forced to rely on mutual aid from neighboring counties because there were not enough staffed ambulances available. It prompted an outcry from many in the community who argued that if budget cuts needed to be made, those cuts should not have been made in public safety staffing.

"I'm sorry, I didn't mean to cause a panic," Yarbrough said, explaining that his intent had only been to inform. "I want to reassure the residents that if they call 911, we will respond."

Caswell County Commissioners cut the FY 2027 General Fund Budget by $3.8 million in an effort to rein in recurring expenses that were not supported by existing revenues. Allocations for Caswell County Schools were the only local spending not cut in the county's FY 2027 General Fund Budget. Some departments such as Public Health may appear to have received an increase on paper, but Interim County Manager Melissa Williamson explained during budget workshops with the Board of Commissioners that those increases were related to programs funded by outside sources, not local funds.

The single largest source of savings came from reducing the vacancy allowance across departments. A vacancy rate is the percentage of budgeted positions that are currently unfilled. Staff explained to Commissioners that a vacancy allowance is a "budget reduction that anticipates all positions will not be filled for every day of the year."

Simply put, the County anticipated having 39 staffing vacancies at the start of FY 2027 but have only budgeted for the equivalent of 10 of those positions to be filled. The other 29 positions have not been eliminated but are subject to a hiring freeze.*

For Public Safety, that means:

• Freezing six of eight vacant positions at the Sheriff's Office
• Freezing one of two vacant positions at the Detention Center
• Freezing one vacant position at 911 Communications
• Freezing four of six vacant positions at EMS

*Social Services has the most vacant positions. The FY 2027 budget allows funding to fill four of the 16 positions currently open.

Yarbrough addressed the Board of Commissioners during their June 4 budget workshop, warning that he would not be able to staff the fourth ambulance without being able to fill those positions.

Only two members of the public offered public comments about the budget - one advocating for the Senior Center and another advocating for County Outreach Ministry.

EMS Staffing Crisis is Daily Reality

Yarbrough clarified this week that the FY 2027 budget did not create the staffing crisis facing EMS. Instead, the FY 2027 budget reflects current reality.

In recent years, the Caswell EMS budget has reflected the staffing model designed by EMS leaders to meet the needs of the county based on historical trends and call data. That model requires four staffed ambulances in the county during peak daytime hours, with three staffed ambulances at night.

The problem, Yarbrough explained, is persistent staffing shortages that require part-time or over-time staff to run that fourth truck. With four to six full-time vacancies, he says it can often be hard to staff three trucks, even with some employees working 36-hour shifts.

He said that staffing shortage existed long before the hiring freeze was implemented.

Williamson explained that the vacancy allowances were based on historical data and trends over the last three years. She said they calculated an average amount of budgeted salaries that remained unspent each year due to vacancies and then reduced the FY 2027 budget accordingly to better reflect actual spending.

"Balanced does not mean comfortable," Williamson repeatedly warned the Board during budget discussions. She told them that the FY 2027 budget should be considered a one-time emergency reset to rein in spending, as they had requested, but that future budgets would require additional revenue to sustain current service levels.

Not Just a Local Problem

The EMS staffing shortage is not limited to Caswell County. It is a demanding job, and the healthcare provider shortage has created more opportunities for Paramedics to work in other settings such as emergency rooms or medical clinics, often making more money. Fewer people are choosing EMS as a career, often citing low wages as a reason.

The American Ambulance Association estimates an annual 20%-30% turnover rate for EMTs and Paramedics.

The national 2025 EMS Trend Survey provides a glimpse into why, with 76% of respondents saying that burnout is a critical issue. The survey report notes that inadequate staffing is a key driver of that burnout and shares that:

• 59% of respondents said their agency does not have enough personnel to respond effectively to 911 emergency calls
• 41% of respondents said they rarely/never get seven or more hours per day of sleep as recommended by the Centers for Disease Control (CDC)
• 41% of respondents report chronic pain negatively impacting their physical health
• 40% of respondents expressed dissatisfaction with mental health services offered by their employers

Filling the Gap

Caswell EMS routinely transports to five area hospitals in Danville, Roxboro, Reidsville, Burlington, and Hillsborough but it is also often medically necessary to transport patients to Greensboro, Durham, or Chapel Hill. Each of those facilities are outside of the county.

If all available ambulances are out of the county, Caswell EMS activates mutual aid agreements with neighboring counties, placing neighboring agencies on standby for additional calls.

Yarbrough said he is grateful for those mutual aid agreements but acknowledges that neighboring agencies may not always be available to respond.

He emphasized the crucial role Caswell's volunteer fire service plays in public safety, pointing out that it is the volunteer first responders from across the county who respond alongside EMS.

Local fire chiefs say that it is getting harder to recruit new volunteers. They report that the county's volunteer first responders are getting older and that younger residents are showing less interest in serving their community by joining the fire department. Some expressed concern that the frozen EMS positions would eventually be eliminated, further straining a system they say is already stretched thin.

Yarbrough and Williamson said that at the end of the day, they want what is in the best interest of county residents. They also do not want residents to worry about whether someone is coming if they call 911.

"The employees of EMS are doing a phenomenal job and will continue to utilize every available resource to provide the care our citizens require," Yarbrough said.

He and Williamson explained that even under the current freeze, the department can hire for two of the vacant positions and will continue to work with Central Finance and the Commissioners throughout the year to monitor expenses, identify savings or additional revenue, and make adjustments as necessary to ensure the continued availability of Emergency Medical Services.