Have you ever noticed how many new, inexperienced, poorly educated providers talk about how much they’re allowed to “do” in their EMS organization/system/region?
Today, I was involved in a discussion in EMS social media where an EMT with three months of experience was bragging about taking a sixteen hour course where he would get “training” on administering three additional medications and be allowed to use a supraglottic airway. In the grand scheme of things, all of these medications and the supraglottic airway are relatively benign interventions. There’s relatively low risk for each of the medications and the airway device in question. What is NOT benign is the prevailing mentality in EMS that a card class or an in-service is all that’s needed, especially to teach an entry-level EMS provider skills that are normally reserved for providers with a higher certification. Even with its numerous faults, paramedic education has a depth of education in anatomy, physiology, pharmacology, and patient assessment that an EMT or AEMT course don’t have. While a sixteen hour course might be able to teach the ins and outs of those particular medications and that particular airway device, that course is zero substitute for actually having the education that an advanced provider has. We can teach almost anyone how to do something. Knowing when to do something — or when not to do something — is where education is superior to training.
Sadly, our profession has done little to disabuse EMS providers, especially inexperienced entry level providers, of the notion that EMS consists only of a set of skills that can be added and subtracted at whim. Rather, like any academic discipline, particularly one involving the healing arts, EMS consists of knowledge. And there is no statutory limit on the knowledge that any provider can have, regardless of their certification level. Professional education does not end with initial certification. Rather, initial certification is but a determination of entry level minimal competence. Professionalism involves the relentless pursuit of mastery well above and beyond the minimum standards.
As I’ve joked before, a cook knows and follows the recipes. A chef understands the culinary arts well enough to be able to create their own recipes. The majority of EMS providers are technicians — and as such, we’ve become the short order cooks of medicine.
EMS will become a respected part of the medical system when we stop talking about what we can do and start talking about what we know. There’s a big difference between training and education. When we routinely produce educated clinicians as opposed to trained technicians, that’s when the respect — and the money — will show up.