EMS director urges AEMT pay grade to address staffing; board to decide April 20

Caswell County’s interim EMS leadership told the Board of Commissioners on April 6 that the county should establish a dedicated pay grade for Advanced EMTs (AEMTs) to address paramedic staffing shortages.

John Yarbrough (presenting for Caswell County EMS) said the county faces longer recruitment cycles, unfilled positions and increasing overtime; he proposed an AEMT pay grade and suggested a starting rate of $18.76 per hour. Yarbrough described the change as cost‑neutral by redirecting salary dollars budgeted for vacant paramedic positions to the new pay grade rather than creating new positions.

Commissioners questioned the budget analysis and asked what would happen when vacancies are filled. Yarbrough said current practice uses lapsed paramedic salary dollars to fund operations and that the proposal would not add positions or require additional funding beyond existing salary allocations. Commissioners also asked about the training difference between EMT and AEMT; Yarbrough explained additional training typically takes 3–4 months beyond the initial EMT course and allows AEMTs to provide IV therapy, additional medications and more advanced airway management.

Board members requested a fiscal review before formal action; the chair said the item will be considered for decision at the April 20 meeting so staff can confirm budget availability. The presentation noted EMS staffing numbers at the time: about 30 full‑time positions, approximately 10 part‑time positions, and four vacancies.

Yarbrough said the proposal would create a career ladder to encourage EMTs to advance toward paramedic certification and said many rural counties increasingly rely on AEMTs because paramedic training throughput has declined.

By consensus, the board scheduled a decision on the proposed pay grade for the April 20 meeting.