The Right EMS Degree

Because I haven’t thrown out any EMS dynamite in a while, here we go…


I oppose the idea of a mandated associates degree for paramedics. Much of what it will do is to guarantee a monopoly to community college programs. These programs are often judged by completion, not success on the licensing exam. Additionally, these programs are often unavailable in rural communities. Many of the community college programs have shown an unwillingness to provide distance education and/or adjusted schedules for students unable to do a full-time day program.


My solution? Make paramedic a post-bachelor’s certificate. By doing so, you’ve already guaranteed that you will have students who’ve demonstrated an ability to think critically, complete a course of study, and to communicate. In other words, much of the affective domain has already been evaluated and validated. I’d also surmise such a paradigm shift will have lower attrition and have graduates, who by the very nature of their education, have the familiarity with standardized testing to succeed at the National Registry as opposed to viewing it as a mysterious hurdle that represents the pinnacle of professional accomplishment. Whereas, the reality is that the National Registry represents the minimal competence to safely function as an entry level provider.

We’ve all said it’s easy to teach the skills of a paramedic, but it’s much harder to teach someone to think critically and relate to patients. By requiring a college degree before becoming a paramedic, we’ve already found people who know how to think and (hopefully) relate to others.


And before you say that paramedicine doesn’t pay well for someone with a bachelor’s degree, I’d encourage you to look at the salaries for teaching and social work, both of which require a bachelor’s at a minimum. The truth is that EMS can and does pay a decent salary to the motivated individuals who seek employment with the more professional EMS systems as opposed to the employers who operate on a “patch and a pulse” mentality. Eventually, bachelors’ level paramedics will require two things that many EMS systems are unwilling or unable to provide — namely a decent salary and a less toxic work environment.

This won’t (and can’t) happen overnight. I’d argue that we need to look at making this the requirement in the next ten to fifteen years. And to remove one obstacle, let’s agree from the outset to grandfather in everyone who’s licensed as a paramedic before that.

Further, let’s do two more controversial things at the same time. First, we need to demand that paramedic is the ONLY advanced provider in the field. No more “cardiac techs,” “Intermediate-99s,” or the like. Next, like any other real healthcare field, we should not require completion of a lower certification to enter a paramedic program. Paramedicine is a separate profession from the technician level providers and it’s time we recognize this.

In short, paramedicine needs to be a professional education, not a technical education — even if said technical education leads to a terminal level associate of applied arts/sciences with limited mobility into a bachelor’s degree.

If we don’t dream big, EMS professionals are destined to remain viewed as ambulance drivers by those in healthcare, business, and government who act surprised when you tell them there’s a difference between an EMT and a paramedic.

The Lawyer Says Enough

Many of you who know me, whether in person or via social media, know that I complain about people expecting free legal advice. Between you, me, and the fencepost, I’ve actually done quite a bit over the years for the EMS world, whether it’s for personal friends, EMS organizations, EMS publications, or EMS conferences.

This morning, I received a Facebook message from a college EMS faculty member with a very specific legal question that was clearly about an ongoing issue for their institution. When I told them that I did not have an immediate answer and would require research, they began to pout and ask where they could find the answer.

Here’s some reality. First, legal questions don’t always have a simple yes/no answer. As such, they require legal research. Second, legal questions, even seemingly innocent ones, can raise ethical issues. Notably, these issues can be made even more treacherous when you (typically your organization) is already represented by counsel. As I’ve noted in previous blog entries, asking for legal advice has the potential to create an attorney-client relationship. When such a relationship is created, it also creates obligations and responsibilities on me as an attorney that go well above and beyond answering a simple question.

I find it ironic that there are a lot in the EMS world, especially online, who state that volunteer EMS prevents EMS from receiving the compensation it deserves. There may be some validity to this argument, but said argument loses much of its support when EMS folks expect free legal advice. As I stated to today’s offender privately, this is the equivalent of me asking a paramedic to provide me with free transport or treatment — or asking an EMS instructor to provide me with an ACLS class for free. In other words, knowing how to research and how to synthesize the law is how I make my living to pay for my EMS hobby. (Slight sarcasm and exaggeration goes without saying there.)

I’ve heard from several of these types how they’re only asking me as a fellow EMS provider. I call BS on this. Most of these folks know more than a few EMS providers, often who have significantly more EMS experience that I do — whether as an EMS field provider, educator, or manager. What said other “peers” don’t have is a professional degree and license to give legal advice. They’re looking for “a lawyer told me XYZ is the answer.” As I’ve said earlier, that answer carries certain ethical as well as legal ramifications for me — and those aren’t things I’m likely to undertake for free for a Facebook friend I hadn’t talked to in years.

Over the years, I’ve considered some of what I do in the EMS legal realm a form of paying back to the EMS community that has given so much to me. I’ve made a ton of friends over the years, gained a ton of confidence, and occasionally used the knowledge to help others. But the sense of entitlement from others has gone too far.

I’ve given freely of my time and expertise at my own sacrifice for too long. I’ve always been willing to support our EMS community and advance the profession. But freely answering legal questions is not something I can do.

And since this isn’t the first time I’ve mentioned this — and how it causes ethical issues for me as a legal professional — I’m less likely to be as nice as I have been in the past. To the last person who asked for advice, congrats. You’ve given me the courage and impetus to start saying “no” to much of the EMS world.

If you want legal advice, understand you’re asking an attorney for it. Said professional expertise comes at a price. And that price includes a retainer agreement and payment for said expertise.

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