State EMS director warns of workforce, mental‑health and financial strain; highlights field blood program

Jody Radloff, director of the West Virginia Office of Emergency Medical Services, told the Joint Committee on Volunteer Fire Departments and EMS on Jan. 7 that the state’s emergency medical services are under pressure from staffing shortages, financial shortfalls and worsening provider mental health, even as new programs such as field blood transfusions expand across the state.

Radloff said those pressures are measurable: “Over the past three years we’ve ran 1,600,000 transports,” she said, and “we have 800 active paramedics” whose caseloads are concentrated in a relatively small group of agencies. She said 70 percent of transported patients during that period were carried by the state’s 20 largest agencies and that 34 agencies ran fewer than 100 transports per year.

Why it matters: Radloff and lawmakers said those patterns concentrate work and financial risk in a small number of providers, drive burnout among ALS (advanced life support) clinicians and increase the chance that smaller services cannot remain viable — a combination that could reduce emergency coverage in parts of the state.

Radloff described several policy and operational items underway. A field blood program that began with Campbell County EMS is expanding: Harrison County is already using blood products in the field, Kanawha County and Charleston Fire Department are preparing to start, and Mineral, Camden‑Clark and Roane counties are beginning programs or preparations. Radloff said Mineral County is naming its effort the “Cam Duncan Initiative” after a local patient whose life was saved by timely field transfusion.

Radloff said the state consolidated EMS regions from 12 to five to align more closely with statewide threat‑preparation regions, and the salary enhancement fund distributed to agencies last year has been paid out; the Office expects to issue award letters for the next round by the end of the month. She said new EMS clinical protocols issued in 2024 were initially slow to be adopted but are now widely accepted; the office plans to emphasize transport protocols in 2025 and return focus to 911 response protocols in 2026 to give providers time to adapt.

On funding and reimbursements, Radloff told the committee that Medicare and Medicaid reimbursement levels set by the Centers for Medicare & Medicaid Services (CMS) do not cover the true cost of many calls. “Federal,” she said, when asked whether those reimbursement rules are federal. She said West Virginia’s payer mix is heavy in public programs — “Medicaid is roughly 36 percent; Medicare is 35.1 percent” — and that “about 71 percent” of EMS patients fall into Medicare/Medicaid in aggregate. That pay mix, she said, contributes to financial instability for many providers because reimbursement often does not match operating cost.

Radloff also flagged ambulance offload delays at hospitals as a systemic problem. She cited a state average offload time of 32 minutes on a good day and as long as 92 minutes on a bad day, and called delays an administrative issue at hospitals rather than a deficit of frontline nursing: “This is not a nursing problem. This is an administration problem of the hospitals,” she said, praising Cabell Hospital as a local example of consistent adherence to recommended offload timelines.

Mental health was a central concern in Radloff’s testimony. “We just had another provider take their life recently,” she said, and described extensive outreach by EMS leadership to struggling providers: “We are literally doing everything we can to keep these providers as safe as we can keep them.” She tied provider suicides and burnout to high workloads, long shifts, and the concentration of calls in a sub‑set of providers: Radloff said roughly 1,800 providers (about 800 ALS providers and 1,000 EMTs) ran more than half of the state’s transports in the prior year, and that many individual clinicians routinely work long hours and overtime to keep services running.

Committee members asked follow‑up questions about possible state actions. Radloff said the treatment‑in‑place law passed last year (the statute implementing on‑scene treatment billing) is in effect and that federal policymakers are also studying similar models. She said the state has done what it can with state payments and noted past requests to Congress for higher federal reimbursement rates, which yielded incremental increases in recent years but did not fully close the funding gap.

The hearing closed with members expressing interest in further data and possible legislative options, including targeted state support for high‑volume rural runs, strategies to reduce provider overtime, and outreach to federal representatives on reimbursement policy.

Radloff concluded by offering to provide additional data to the committee on costs and call volumes to help shape potential state responses.