The Degree Advocates

After a few minutes engaging this morning on the American Paramedic Association Facebook page, I’ve realized that many of those advocating higher education and a degree requirement for paramedics have little understanding of higher education or how higher education works.

There’s tons of people saying they need more science classes and advocating for specific EMS related courses. Meanwhile, there’s a lot of people also advocating against any humanities or liberal arts core curriculum coursework. I would submit to you that a course in research design and methodology like you see in many bachelor’s level social science curricula may be of much more long term benefit to EMS than a specific, technical course in the most recent innovation. Remember when backboards and rotating tourniquets were considered current EMS practice? However, a course in understanding research would enable the paramedic to have a lifetime knowledge base in evaluating EMS innovations and a healthy dose of skepticism, which is a virtual requirement for scientists and clinicians.

Many of these people arguing for an EMS degree don’t understand that college is designed to produce a well rounded education, even if the degree is in a specific field. There’s several people saying that the EMS associates degree needs to be a technical degree. What they don’t understand is that an Associate of Applied Science degree is often a terminal degree for a technical job. (Think ITT Tech or DeVry for those of us that remember the commercials on daytime TV.) And further, an AAS degree often doesn’t easily transition to a BS or BA degree in the future, even further limiting EMS career progression and upward mobility.

Bluntly, the more I see, the more I think an AAS degree will end up dooming EMS to remain a technical education with limited chance for upward mobility or further education. What I’m seeing is largely people engaging in either playing pretend at creating their dream college curriculum or wanting to turn card course curriculum into college hours.

I’m almost willing to come on board with requiring a degree for paramedic providers. However, I think we need to aim for the ideal and negotiate to what’s manageable. In my opinion, I believe that the role of a paramedic is actually that of an advanced practitioner with the ability (and likely the requirement) to exercise critical thinking and clinical decision-making. That critical thinking comes with an expanded knowledge base including the core liberal arts curriculum. And that level of education happens at the bachelor’s degree level.

The political process, which is ultimately how we’ll reach a decision on what education is required to be a paramedic, requires that we negotiate from an ideal solution to get to a realistic solution. The ideal is a paramedic with a bachelor’s degree, whether that’s a bachelor’s degree in paramedicine or a bachelor’s degree in another field, followed by a paramedic transition curriculum (see also the plethora of BSN transition programs for those with a BA/BS degree).

If we end up making the paramedic degree requirement an associate of applied science as many seem to be advocating, we’re dooming EMS to remain a technical field with limited upward mobility. An EMS degree, especially for the paramedic level, should not be in the same category as HVAC technicians or diesel mechanics. (Truth is, the average HVAC technician or diesel mechanic probably has a better salary than the average EMS provider — or even many so-called “white collar” jobs.)

As I’ve said before, we’ve got one chance to get the degree requirement right. Let’s not foul this up. And if we turn this into an echo chamber among ourselves and creating a curriculum that’s solely based on “cool new skills” for paramedics, we’re dooming ourselves with a degree requirement that ends up producing perishable skills that will be outdated within a few years of practice.


  1. Skip Kirkwood says:

    The challenge is this. The current “paramedic certificate” program is almost enough hours, standing alone, to meet the requirements for an associate degree (AS or AAS – in most states, not much difference). Great! We can add a couple of courses, and award a degree for a grossly deficient pre-service paramedic program, designed to prepare paramedics to work in a 1970s EMS system.

    As a first step, an associate might be fine. But it will require more than that to prepare paramedics for what will come between 2020 and 2060. This means a solid, broad-spectrum degree which, as the ‘Chaser says, “an advanced practitioner with the ability (and likely the requirement) to exercise critical thinking and clinical decision-making. That critical thinking comes with an expanded knowledge base including the core liberal arts curriculum.”

    • Awesomily says:

      I started with a certificate EMT-Basic course, realized I only knew enough to be dangerous and then went on for my AAS. I am almost done with my BS, but I’ve come to realize, through coworkers and colleagues, that unless we up the pay for paramedics with degrees, the cost of the BS degree far outweighs the income that I can make. Until we all want that knowledge to be a better clinician, no matter the cost and time spent, it’s a mute point as to what degree we require.
      Most services have trouble just keeping people engaged in the alphabet classes, even if the service is paying the employee to be there.

  2. Steve Pike says:

    I think this is the place where the manifesto dictating that we take charge of our profession comes in to play.
    I can buy in to the logic of adding liberal arts to the curriculum, but the specific courses should be decided by those in the field, not the academics who make money off of tuition.

  3. Jeff Anderson says:

    In the past there has been a big difference between AS and AAS, as you said. Those differences are disappearing. There is going to be some state to state variation but money has made the 4 year schools cut out some of the nonsense that kept classes from transferring. Many 4 year schools are hurting for students.. In Louisiana, all classes taught at state schools transfer. Our legislature has mandated common course numbering and content for at least the first 2 years of general education.

    Part of our problem is that we are pushing forward into higher education when a large portion of the country is questioning the value of higher education as it current exists. The primary benefit of the bachelor’s degree these days is to signal to perspective employers. The actual education is secondary. This coupled with raising costs and out of control student loan debt, has made the future of higher education uncertain. We live in interesting times.

  4. As a paramedic AND a scientist (Yup!), I strongly believe that we need to do the following:

    – Transition from EMT basics to Paramedics. We need to get out of the mindset of having basics any longer. Here in the U.S., we are seriously behind the times when it comes to EMS. It is time to train up, or train out. One of the two. I have heard the arguments on both sides. We need to increase the skillsets of our EMTs (to become paramedics) and paramedics (To have more skills and knowledge), pure and simple.
    – I’m not going earn friends here, but we need to transition EMS OUT OF FIRE! Yes, you heard me. It never should have gone there. They are not the EMS Dept, they are the Fire Dept. And they will continue to stifle growth in EMS in order to protect themselves and their budgets, as evidenced by the most recent position papers. This MUST end. Do we need to fix the system, in terms of for-profit/non-profit/government EMS, YES! Having it with the Fire Dept is not the way to do it.
    – Require within 10 years, that all paramedic have a bachelor’s degree. Again, this can be transitioned. Does it need to be a bachelor’s in paramedicine? I’m on the fence on this one, but the intent of a degree goes to the well-rounded education. Having it be in a science would not be bad (I might be a little biased here).
    – Stop insane hours. There is no reason ANYONE in EMS should have to be awake 24 hours to do their work. It isn’t safe.

    Only then will the argument hold to increase salaries.

    It that so difficult?

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