On The EMS Degree

So, because of a prominent fire chief’s article against EMS degrees, all of the usual EMS advocates are coming out for a gradual phase-in of a degree requirement. And it stands to reason that the fire service wants a low entry standard for EMS.  Most fire departments, especially the larger urban ones, see EMS solely to justify their existence.  Smaller fire departments often see taking on the EMS mission as a way to get increased funding, most of which will go toward the big red trucks and not the ambulance.  In many fire departments, the ambulance is actually called the “penalty box.”

In theory, I’m in favor of a degree requirement to be in EMS, especially at the paramedic level. More education can and should produce better paramedics. But with some experience in both consuming and regulating higher education, I know that giving power to higher education can have unexpected consequences.

So, since this train seems to be gathering some steam, let me throw out my conditional support.  I hope the advocates for EMS education and those accrediting college based EMS programs will listen before we hear about these issues arising once a degree requirement is truly and fully implemented.

  1. Grandfather current providers. I’m told that’s already in the works, but requiring everyone to back and upgrade to an EMS-specific degree would likely overwhelm each of these college based programs.  And for those who already have a bachelor’s or higher in a field outside of EMS, it would be unnecessarily repetitive.
  2. As a condition of accreditation, college-based EMS programs should be required to explicitly state how they plan to meet the needs of EMS students, especially those who are currently in the workforce. Such a commitment should address hours that the courses are offered, locations of the courses, transfer-ability of hours for non-EMS specific courses, and availability of clinical sites.  If you ask why I have a paramedic certificate instead of a paramedic degree, I’ll give you a simple answer.  The community college based program serving my area only offered the paramedic program on a full-time basis during daytime hours only.  With an outside career and already having three degrees, attending a certificate-only program was a no-brainer.
  3. Distance education is a must.  It stands to reason that those against an EMS degree will use the “poor volunteers” as a stalking horse to protect those who stand the most to benefit from poorly educated EMS providers — namely the fire service and the larger private EMS systems. Ensuring that EMS degree programs have distance learning AND nearby clinical rotation sites will ensure that rural and volunteer systems have their needs addressed — and eliminate one more argument against an EMS degree.
  4. In an ideal world, I’d like to see some sort of promise or commitment of an alternate entry degree program for those who already have a bachelor’s degree or higher. Such a program should be tailored to get people the scientific background they need for prehospital medicine (primarily anatomy and physiology) and the coursework necessary to function as a paramedic.
  5. Finally, the accrediting bodies need to ensure that these commitments and promises from higher education are kept ongoing. It will be entirely too easy to start backpedaling once the initial accreditation occurs.

I sincerely hope that those who advocate for an EMS degree take this in the spirit in which it’s meant — a reasonable way to ensure that we actually accomplish the goal of creating better educated paramedics and not solely in guaranteeing higher education a continued revenue stream. If we don’t plan now to address the needs of EMS providers and foresee unintended consequences, we are guaranteed to create even more of a shortage of providers (although some might argue that’s not an entirely bad thing) and creating a group of providers with significant student loan debt to go into a field not known for the highest wages.

We have one chance to get this right.  Let’s make sure that happens.

Comments

  1. Scott Lancaster says:

    Bravo.

  2. I agree with you sir. Very well stated as usual.

    • Me? As a certificate paramedic for 20 years, I am all in favor of the bar being set for an associate degree as the entry point to be a paramedic. But I am not in favor of a blanket grandfathering. To me, if you have less than 10 years left on a 20 or 30 year career, then fine. But if you just got it within the past 10 or so years, then you have to upgrade.

      With that said, it HAS to be offered on a work friendly schedule involving distance education, flip-flop schedules, etc.

      Also, it HAS to accommodate the source of the vast majority of EMS paramedics- working EMT’s. Like it or not, that is where most paramedics come from. Way back in 1984 my fire science degree was offered on a schedule that accommodated the firefighters of the time that worked the four day break schedule of 24/28.

      It can be done. Hell, I tried to sell the community college I used to work for on it, but was told “that will not work”. So I left.

      • Scott Souter says:

        From my experience it’s the medics who have the oldest training that most need the additional education. I think grandfathering is an issue of natural justice rather than education. It’s a way of allowing them to continue to earn an income and acknowledging their current competency whilst advancing the profession and setting a progressively higher bar. I like the idea of incrementally increasing education like we did in Australia. We went from associate diploma to diploma to bachelors degree over about 15 years.

  3. Great points

  4. Frankie Jordan says:

    👍👍👍👍👍👍

  5. James Sudik says:

    How does this differ from the “licensed paramedic” program that we implemented 10+ years ago? Honest question. And we grandfathered a lot of folks then.

    • Steve Cole says:

      I can’t speak for anyone else but myself… One of the biggest points about paramedic level degrees, and one that I don’t think Wes addressed adequately enough, is that the paramedic degree in the future is more than just a simple Bachelor of Science degree. It must be a clinically focused paramedic focused EMS focused degree much like the bachelor nursing is for the nursing profession. In doing so this would allow us to strip off some of the stuff that may not be of real value to a paramedic and replace it in the coursework with stuff that is.

      That is the difference between the few states that have some provision for paramedics who happen to have a degree of some flavor right now, and a paramedic specific degree of the future.

  6. Robert Ball says:

    Some excellent points (as is most often the case).

    I agree with one of the commenters that perhaps “blanket” grandfathering is not ideal. Of course, one thing to consider is our other health professions (like nursing) who used to be diploma programs and changed to degree. What did they do? It’s a question to ask to avoid reinventing the wheel.

    I also like the idea of an alternative entry program for degree holders in other fields. Minnesota requires an Associates Degree in Law Enforcement to become a police officer. However, if you have a bachelors or higher in any other field, you need only take 2 classes (plus skills, which is like a statewide academy). Why? Because the system recognizes and values the degree and only asks for the more “police specific” (there’s a specific sociology course and something else) to be added on. Many of the EMTs my agency hires are bachelors prepared. I see little reason for them to go through the entire AS program to get their paramedic, provided they have the appropriate prerequisites.

    Maybe we can move forward with this…

  7. Gene Gamndy says:

    Having developed and run an Associate Degree Paramedic program, I am all for requiring an Associate Degree for paramedics at some time. I am not in favor of outright grandfathering certificate medics, but I am in favor of development of programs that will take into consideration their prior education and experience. In today’s world more than at any other time one size does not fit all.

    The greatest deficiency I find with my students today is lack of communications, research, and critical thinking skills. We teach critical thinking through extensive and complex scenario practice both face-to-face and tabletop. We teach research by requiring students to do it regularly and helping them figure it out. But teaching communications skills is something we cannot do in an EMS course.

    Now that distance learning is available in almost every curriculum, obtaining an Associate Degree or a Bachelor Degree should be easier than ever before.

  8. People in EMS want to industry to be respected, but want a low entry point into the field. The two don’t go together. Distance/online learning doesn’t work for a “hands-on” field, especially with the quality of medical simulators now available.

  9. Joby Berkley says:

    Wes you stated that providing a grandfather clause, from your understanding, is in the works. My question is who and/or what (organization) is working on this? I would like to get some additional information from them.

    In reference to a college degree requirement, as I’ve advocated for for many years, it’s really a question of why haven’t we already required this. The State of Texas several years ago implemented the Licensed Paramedic, but other than a different patch being worn by the paramedic, has no benefit over a Certification paramedic. I, as well as you I’m sure, can recall the discussions, arguments and reasons why paramedics could not function inside a hospital facility by the nursing associations. They always said paramedics we not “licensed” and therefore could not function at their respective certification level inside a hospital. After the LP program was implemented and went into effect nothing has changed to my knowledge. Until the states actually address this issue it never will change.

    FF’s are not required to have a degree to enter the fire service, yet they have a much higher retention and pay/benefit structure. LE is the same way, except for a few departments, that actually require a candidate to have a Bachelors degree to even apply. The Arlington, Texas Police Department has required a Bachelors degree for years in order to apply and that was implemented by the Police Chief years ago. This didn’t involve state legislative action just an individual in a leadership position who wanted applicants with a higher education level.

    When departments and service providers start demanding a candidate have a college degree to either hire in and/or promote then I feel this issue will always be that, an issue.

  10. Watch Australia is going through paramedic registration as we speak. They do have a grandfathering clause with three paths of entry I believe. However, they have bachelors degree programs up and running for a number of years already.

    In NZ my previous bachelors wasn’t recognised but my certification from work was, so I had to redo a number of non clinical papers. This is the way my employer has gone that all new paramedic’s must be degree qualified, they still run internal EMT so we keep our volunteer’s. I have seen an issue with providers straight out of uni being young and not having many life skills such as talking to patients, wide empathy, how to interact with diverse agencies and situations. They know the book stuff but lack that undefinable quality those of us that have been around the sun a few times have learned.

  11. This is a truly interesting debate. I am retired now. I have a B.S. and it, truthfully, never was directly responsible for advancing my career!! Being a Paramedic requires the ability to perform a LOT of complex skills and to follow an established treatment protocol. Don’t get me wrong, but holding a degree does not automatically mean a better performing Paramedic. Brick layers, and many other skilled tradesm, it is more beneficial to en also use a lot of complex skills and follow accepted building guidelines. Be careful if the only winner is the Ivory Towers and THEIR increased revenue. I am outright opposed to any ‘Grandfathering”. As in any profession, if you are not constantly training and advancing your skill set….you are stagnating. I tend to believe that, rather than requiring a degree, it would be more beneficial to require ITLS, PALS NALS, CCCP, etc. My experience has been that peer, and other HCP, respect comes from how well you manage your patients and not the letters after your name.

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