A friend, grizzled EMS veteran, and sage (all the same person) recently opined about the state of EMS and it got me to thinking. So, allow me to share my thoughts on initial EMS education and perhaps offend everyone in EMS and EMS education all at once.
I’m not sure that accreditation or degree requirements improve EMS one iota. What they do is create artificial barriers to non-college-based programs. There are plenty of good programs that aren’t affiliated with a college. And there are colleges that turn out crap EMS providers. Speaking purely anecdotally, the colleges know this. The local college in my area offers the paramedic program only as a full-time, daytime only program. There’s no alternative. Some of the required courses make sense. (Anatomy and physiology come to mind.) But especially for someone who’s already got a degree, it makes little sense to require general education classes all over again — much less a physical education class.
As for EMTs. The EMT basic curriculum is way too short and way too superficial. In most places, it’s little more than teaching first aid and some basic medical knowledge. It creates people who think they’re heroes with less than 200 hours of training. We end up with people who practice medicine based on dogma and “my instructor said” and who truly believe that BLS saves ALS and they’re heroes. Meanwhile, we have more than a few places where EMTs can’t administer over the counter medicines that the lay public can and are legally prohibited from using the same glucometer that a child is taught to use.
And let’s talk about one other thing. The various ALS skill monkey levels that exist between EMT-Basic and Paramedic. These people get some or ALL of the ALS skills that a paramedic gets with none of the understanding. It’s a recipe for malpractice and for killing patients. Don’t give me the BS that it’s “for the volunteers.” There are plenty of us who volunteer who took the time and effort to educate ourselves. I’ve never worked full-time paid as either an EMT or a Paramedic and I’ve reached a decent place in the EMS world. Whether paid or volunteer, certification standards remain the same. And allowing someone without a foundation in anatomy, physiology, pharmacology, and patient assessment to perform high risk skills like rapid sequence intubation, even with calling a physician for a radio/phone order, is a recipe for a disaster.
My solution to all of this? Enhance the educational standards for EMT-B to be more like the current AEMT. The current EMT standards should be the standard for the first responder, not one who staffs an ambulance. And I’m not sure that paramedic should be an associate’s degree. What about entering paramedic education after already having a bachelor’s degree? It’s a lot easier to teach prehospital emergency care to someone who already has critical thinking and communications skills than it is to teach critical thinking and communications skills who’s got a paramedic certification and only a vocational/technical education.
These are just my thoughts. I don’t pretend that these changes will improve EMS overnight, lower the cost of healthcare, or raise EMS wages. What I do believe is that these are the right changes for better patient care. And patient advocacy demands just that.