Masters of Our Own Destiny

Posted on March 28, 2019 Written by

EMS is dependent on others to get what little we do.  Whether it’s getting physician involvement for clinical changes or convincing those with the money that a new ambulance is needed, we have to get others involved in our destiny.

If you listen to the current voices on EMS social media, you’ll hear the lamentations that EMS is broken.  The current consensus, promoted by all self-proclaimed EMS save those in the fire service, is that EMS degrees are what will surely fix EMS and make us respected.  Mind you, the EMS consensus has brought us some other sure-fire winners as system status management, declaring EMS an “essential service” (Hey, where did that go?), and community paramedicine.  We’re on EMS 3.0 or something now and we still haven’t mastered the basics of getting the right patients to the right hospital and treating people right, both as people and as patients.

I agree that more education is needed for EMS. But the last thing we need to do is follow the rest of the healthcare professions and have a solely clinically focused degree.

Too many people in EMS (and the rest of healthcare) think that all you have to understand is the medicine. If you don’t understand (or participate) in the policy and business aspects, others make those decisions for you. If you don’t believe me, look at our modern American healthcare system. For years, physicians refused to be involved in the business of medicine.  As a result, hospital and healthcare administrators developed to handle the business of medicine.  And ultimately, we have ended up where we are currently — where a lot of decisions about medical care are made by the business office rather than by those providing the actual care.

It often seems that there’s a belief in the world of healthcare that being involved in business or policy is somehow “unclean” or beneath the profession.  As a good friend of mine said, “Even if you aren’t interested in politics, politics is interested in you.”

So, in short, I’m not opposed to increasing EMS education.  But what an EMS degree should NOT be is a degree focused solely on the clinical practice of medicine.  Too many of the EMS degree advocates on social media would promote a degree that awards three hours of college credit for a course entitled “Latest Clinical Fads Capstone.”

EMS, like the rest of the healthcare world, does not exist solely in a clinical vacuum. For EMS to advance, we need to understand the business of healthcare.  That means an EMS degree needs to include coursework in the political and regulatory process, finance, personnel management, and the research process.

In other words, it needs to be a well rounded degree as opposed to a narrowly focused clinical pathway that will be doomed to irrelevance with every change in medical practice. But without this kind of education, an EMS degree is doomed to become an expensive addition to the current workplace.  If the current people pushing for a degree requirement better understood the non-clinical aspects of what we do, they’d see the potential pitfalls of an EMS degree such as a lack of buy-in from higher education and the availability of appropriately educated EMS faculty to teach in a college setting. By the way, the same shortage of faculty is partially responsible for the current nursing shortage. This is but one example of why healthcare education (including EMS) needs to understand business and policy. Take ultrasound.  It’s the current EMS clinical fad on social media.  Everyone wants it.  But has anyone developed a position as to how ultrasound saves money, improves care, or how EMS can get paid for ultrasound.  I’ll wait here for that answer.

And if you don’t believe that healthcare providers (including paramedics and EMTs) don’t need to understand the big picture of healthcare outside the actual provision of medicine to patients, then you’ve illustrated exactly why healthcare administrators often make even more money than the doctors do.

Filed Under: EMS, EMS Education

We Need More Lawyers

Posted on March 20, 2019 Written by

Shakespeare wrote in Henry VI, “The first thing we do, let’s kill all the lawyers.” Even as a practicing attorney, I can empathize.  As I like to say, ninety-nine percent of attorneys give the rest of us a bad name.  Or there’s my other favorite attorney joke, “What do attorneys use for birth control?  Their personalities.” But joking aside, the Shakespeare quote is often misinterpreted. In fact, many have argued that the villain in Henry VI proposed killing all the lawyers because they ensure the rule of law exists, that is a fair system where people understand the rules and are held accountable to follow said rules. In other words, we need lawyers for the system to work.  And I’d submit to you that one of the reasons why the EMS system isn’t working is precisely because we need more lawyers.

As I stated above, lawyers make sure the rules are understood and followed.  All too often in EMS, that doesn’t happen.  In EMS, people make arbitrary decisions that are rarely applied fairly, much less with an understanding of the law.  In the National Registry testing and renewal process, I’ve heard and witnessed stories of various EMS functionaries refusing to sign renewal paperwork, all without giving an explanation of why.  The National Registry even has a process for a former paramedic to recertify provided certain conditions are met, including obtaining the signature of your state’s EMS director.  In Texas, a previous state EMS director refused to engage in this process based on the vague claim that he did not believe he had “authority” to sign the document.  Again, an EMS provider harmed by an arbitrary and probably incorrect view of the law.

Another example of EMS arbitrariness routinely comes up with state licensing laws, particularly relating to reciprocity, the process of moving your certification from one state to another.  More than one state has laws and regulations requiring state residency and/or employment prior to granting reciprocity. The problem is that such a requirement appears to fly in the face of legal precedent established by the United States Supreme Court in the case Supreme Court of New Hampshire v. Piper, 470 U.S. 274 (1985).  In the Piper case, the Supreme Court found that a New Hampshire state law requiring one to be a resident of their state before being admitted to practice law was unconstitutional.  The parallel to several states requiring state residency and/or employment for EMS reciprocity is striking, yet EMS continues to ignore it, either from sheer ignorance or perhaps believing that EMS is “special enough” that a Supreme Court case might not apply to it.

Much of my day as an attorney is spent counseling clients on what the law means, how it applies, and how we can use the law to mitigate risks. In EMS, we routinely seem unwilling to seek such guidance, preferring instead to rely on “we already know what a lawyer is going to tell us.” We see this all the time with policies. The classic examples in EMS often seem to revolve around HIPAA. People routinely use HIPAA as an excuse for failing to get patient follow-up or why EMS can’t see transfer paperwork.  EMS managers routinely sign contracts and make personnel decisions without the benefit of legal counsel and may end up subjecting themselves and/or their employers to liability as a result.

Even with education, EMS “leaders” are often unaware of the regulatory and legal hurdles that may exist with the current push toward EMS degrees. Namely, most of the accrediting organizations that accredit colleges and universities require that college faculty possess a terminal degree in their academic field. This oversight may, again, be an example of EMS “leaders” not seeking the counsel they need.

Finally, EMS needs lawyers to keep our profession honest and to uphold standards. The latest viral video on EMS social media is of two South Carolina EMTs appearing to refuse to treat or care for a patient lacking the adequate mental capacity to make a decision. At some point, a lawyer needed to be involved, whether in the initial EMS education process to teach actual medical-legal concepts as opposed to myths and urban legends, providing legal advice as to capacity and refusals, or in the aftermath of liability or licensure.

I’ve had very little overlap between my legal career and my volunteer work in EMS.  (Having said that, if you have the ideal position that combines both, I’m open to discuss…) However, for EMS to grow and develop as a profession, we need more lawyers, not less.  EMS needs the protection that lawyers provide, both from risks outside the profession and in many cases, from ourselves.

Filed Under: EMS, EMS Legal

Community Paramedicine

Posted on March 4, 2019 Written by

Years ago, I attended a Citizen’s Police Academy program sponsored by my local police department.  It was designed to give the general public an insight into how the police department works and foster communications between the police and the public.  (And for what it’s worth, EMS is massively behind the times on our public outreach.  Fort Worth MedStar is the only non fire-based EMS system I’m aware of that operates a citizen’s academy for EMS.)

One of the best things that I got from this program was an explanation of community policing. The officers presenting this material explained that the police might have an idea of the community’s needs, but without actually engaging with the community and determining what the community wanted, there wasn’t community policing. The example was that the police might assume that the community wanted something done about an uptick in car burglaries, but the community might not even know about this and might well be more concerned with people speeding through a school zone. In other words, the police figured out that community policing doesn’t work without community engagement.

And now, let’s flip the conversation to EMS. EMS is talking a lot about “change” to meet call volume and demand.  We’re talking about alternative destinations for patients.  We’re talking about triage and different response models for “non-emergent” calls. But more than anything, we’re bandying about buzzwords and have convinced ourselves that the public is “abusing” the EMS system. We’ve almost become the police in the “bad old days” of policing where the cops were “us” and the public was “them.”

In other words, we’re doing what the police did before the community policing model developed.  We’re developing an EMS system based on what we think the public wants.  Perhaps we might even be developing an EMS system based upon what EMS wants. What we’re not doing is engaging the public to determine what they want, need, and expect from their EMS system.  Absolutely, we have a professional obligation as medical providers to first do no harm. That responsibility has some obligations.  As does the responsibility to be responsible stewards of the money provided to the EMS system.

But outside these obligations, how many EMS systems or political leaders engage the public to find out what they want or expect from their EMS system?  How many EMS systems educate the public what EMS is or does beyond “call 911 for an emergency?”  How many EMS systems teach that there haven’t been mere ambulance drivers for decades — or that EMT and paramedic aren’t necessarily interchangeable terms? And have we asked the public if they want mobile integrated health?  Or if they judge an EMS system by cardiac arrest survival rates and response time?  My strong guess is that many member of our public would be very happy with their EMS system if the medics showed up on time, were nice, gave them a safe ride to the hospital, and just maybe everyone’s medical records were synced together.

But if we don’t ask the public what they want from us and how we can help, we’re doomed to irrelevance and distrust, just like the police were — before they engaged the community.

Filed Under: EMS, EMS 2.0

A Farewell to the NAEMT

Posted on January 28, 2019 Written by

Dear Mr. Zavadsky:

First of all, I appreciate your offer to reach out last week after my blog entry regarding my views on what appeared to be NAEMT’s no position of a position statement on the ongoing discussion regarding a degree requirement for paramedics.  Unfortunately, our schedules have yet to match up.  But I did find the explanation provided by one other NAEMT insider to be interesting to say the least – namely that the NAEMT position statement had been in the works for a while and was unrelated to the competing positions from other EMS and fire organizations regarding a paramedic degree requirement.  I might have been willing to believe such a statement had NAEMT (or you) provided such a background statement in conjunction with NAEMT’s position statement. However, such an explanation at this point, when prior opportunities were available, strikes me much more as an attempt at damage control than providing a nuanced policy statement. The fact that NAEMT hasn’t publicly clarified this statement speaks even louder as to the organization’s unwillingness to take a position. I stand by my original position that a degree requirement is worth exploring for paramedics, but will also require significant planning and buy-in from higher education stakeholders.

I was almost willing to view this position statement as merely another failed opportunity for NAEMT to advocate for the EMS profession until today.  As you know, last week, New York City Mayor Bill de Blasio spoke against EMS pay increases for New York City EMS professionals in comparison to Fire Department, Police Department, and Sanitation Department employees claiming, “The work is different.”  EMS social media roared. NAEMT was, once again, silent. Today, however, the National Association of EMS Physicians released a position advocating for EMS pay to be commensurate with the responsibilities of EMS providers. Again, I note – NAEMT, the supposed voice for “advancing the EMS profession,” was silent.

Two such notable flubs in the span of less than two weeks speaks volumes as to the culture and leadership of NAEMT.  I’ve criticized NAEMT before for a variety of issues, namely a focus on quixotic efforts to lobby the Federal government for programs that may not benefit our profession as a whole, a lack of advocacy at the state levels, and an overreliance on revenue from card courses.

More than anything, what I’ve seen from NAEMT is a continued failure to advocate for EMS for fear that it may ruffle some feathers.  What I also see is a culture that has the same usual crowd of EMS insiders and their cronies placed in positions of leadership. (In all fairness, I do have a great deal of respect for you and several of the board members.) This culture has created an organization that is slow to respond to the needs of EMS and to the news cycle as EMS is impacted. When applications for new positions and committee members are sought, it’s always the same names that you always see in EMS.  NAEMT has failed to develop a next generation of EMS leaders and advocates.

Finally, I see an overreliance by NAEMT on revenue from a plethora of card courses. NAEMT’s reliance on said revenue and the partnerships with textbook publishers mean that these largely repetitive card courses are seen as much as a cash cow as they are an actual source of current medical education. I’ve taught Advanced Medical Life Support for years and have even been affiliate faculty for the program.  However, the rise of social media and FOAM efforts means that many continuing education programs on a four-year cycle are, by their very nature, outdated.  Yet, NAEMT produces new courses every year and the publishers produce new updates and required materials on the same basis.

To me, NAEMT’s main benefit consists of the various discounts provided and discounted admission to the EMS World Expo.  While there have been some quality speakers at EMS World Expo, I’d also note that there are many presenters and topics at the conference which do not advance EMS and instead serve the “meets minimum standards” and “lowest common denominator” level of the EMS trade.  Note that I did not say “profession” in this case.

I fully expect that there will be consequences from my communication.  I say this not out of spite, but out of the recognition that my interests as an EMS professional aren’t always recognized by NAEMT.  I will quote another paramedic colleague of mine who says, “I am a member of NAEMSP, but not of NAEMT. I like my money to go someplace useful.”

Accordingly, I choose to speak with a clear action.  I hereby resign my membership in the National Association of Emergency Medical Technicians.

 

Filed Under: EMS, EMS Politics

Lead, Follow, or Get the Hell Out of the Way

Posted on January 23, 2019 Written by

If you’ve been following any EMS news as of late, you’ve read about the position paper that paramedics should have a minimum of a two year degree. The position paper was issued by the National Association of EMS Educators, the National EMS Management Association, and the International Association of Flight and Critical Care Paramedics. The position paper was peer reviewed and published in the academic journal Prehospital Emergency Care.  Shortly thereafter, what could charitably be called a rebuttal was issued by the International Association of Firefighters and the International Association of Fire Chiefs. Needless to say, the fire service, with some notable exceptions, has little interest in advancing EMS except as a continued source of revenue and mission creep.

So, you ask where our national “voice for EMS” was and what they had to say. Basically, what they said was that there were competing positions worthy of further study. In other words, they took no position.  Regardless of my feelings about the IAFF, the IAFC, and the fire service in general terms, the fire service took a position and they advocated for what they believe to be in the best interest of their members and their trade. I’ll give them respect for that.  And they’ve, by and large, been successful in crafting public policy to their benefit.  The NAEMT?  Not so much.  They took no position. As the famed Texas liberal populist Jim Hightower once said, “There’s nothing in the middle of the road but a yellow stripe and dead armadillos.”

One can argue that by taking no position, the NAEMT took a position in favor of the status quo, which may actually be closer to the IAFC/IAFF position which can be summed up by Pink Floyd, “We don’t need no education.” In all candor, I do think there are significant challenges and hurdles that face EMS if we advance to a degree requirement and that such challenges need to be seriously discussed, especially with higher education leaders.

But NAEMT is an enigma in the world of professional associations.  NAEMT’s primary connection to most members is its development, marketing, and delivery of a plethora of card courses, which are NAEMT’s primary revenue source. NAEMT’s lobbying efforts are primarily directed at the Federal level, while the majority of EMS regulation and legislation happens at the local and state levels. The one clearly identified national level solution, namely a change to how the Centers for Medicare and Medicaid Services (CMS) funds EMS, doesn’t appear to be on NAEMT’s radar. For me, as an EMS provider, the main benefit that NAEMT provides me are member discounts.  NAEMT’s real challenge is that it claims to represent any and all with an EMS certification. As I’ve said before, there’s not a ton of common ground to be found between everyone in EMS.  A flight medic working in rural Nevada has very different needs and wants from their professional association than does a firefighter/EMT who maintains their EMT certification because it’s a condition of employment at their department.

Maybe it is time to realize that NAEMT doesn’t speak for EMS.  And just maybe it’s time for paramedics to demand a separate voice for the advancement of paramedics. After all, the American Bar Association doesn’t represent attorneys, paralegals, law clerks, and legal assistants. The American Bar Association represents lawyers and lawyers alone.

Anyone for a National Association of Paramedics? And the acronym also reminds me of many paramedics’ favorite pastime, me included, namely NAP.

It’s time for paramedics to be our own voice and advocate for ourselves.

Filed Under: EMS, EMS Education, EMS Politics

Election Night (Not what you think)

Posted on November 7, 2018 Written by

Election Night brings out the worst in many of us. In large part because of the 24 hour news cycle amplified by social media, we get way too invested in politics and sometimes let our mouth overload our rear. (Pro-tip for those of us who love politics and love discussing it, private groups are the way to go on Facebook.)

I saw some of the worst behavior come from my fellow members of the Bar. Many attorneys I know were posting things that I wouldn’t have expected from dispassionate professionals.  The comments (and they were from both sides of the political aisle) ranged from sour grapes, veiled passive-aggressive statements, or out and out statements that they’d be unfriending people. (Another pro-tip here.  I do know some of these people and it speaks volumes as to their professionalism and whether I might believe they have the temperament to handle a case I might refer their way.)

Late last night, a post started making its way through EMS social media showing a paramedic saying (in part), “I’ll start asking if you are a trump (sic) supporter – if you are, y’all will die in my ambulance.”  The response from EMS was swift and gave me a great deal of hope for our emerging profession.  Everyone denounced it.  Whether you wanted to “make America great again” or identified as a democratic socialist, everyone agreed that this sentiment had no place in EMS.  And they spoke up.  Not only did they speak up, they made a point to notify this guy’s employer and the various licensing entities that they didn’t want him in our profession.  At least one employer terminated their relationship with him by morning and at least one licensing agency is aware of his temperament to practice as a paramedic.

Regardless of whether the gentleman deserves to remain employed or certified as a paramedic, our profession spoke with one voice and said that we won’t tolerate such a mindset. And my other profession, the profession of law, has become so politicized and activist (on both sides) that we have, at least in some part, lost track of what we’re supposed to be doing, namely zealously representing our clients and providing them with sober counsel.

Last night, EMS stepped up and took a stand for our profession.  And for a change, we did it better than the lawyers.  Pardon me while I brag on being a paramedic. We’ve beat the other professionals at being professional and separating the personal from the professional.

Filed Under: EMS, Law, Politics

KISS: Keep It Simple Stupid

Posted on November 6, 2018 Written by

When you’re involved with EMS social media, you see a lot of stuff scrolling through.  Some of it, like FOAMfrat, does a great job of making advanced life support and critical care concepts easy to understand. Someone much smarter than me said “Smart people take difficult concepts and make them easy to understand.”

Unfortunately, you also see some material that does the opposite.  A few moments ago, I saw a proposed post for an EMS education group that I help manage.  The post was about a flowchart than an instructor developed for EMT students to assess and manage patients. Unfortunately, the flowchart was poorly laid out and looked more like a bad Microsoft Project diagram for IT project management.  I’d be surprised if the average EMT student could follow it, much less master it.  And if by some fluke they did, they’d be convinced that they had achieved some level of mastery of medicine. (Spoiler alert.  A lot of EMT training is based on the same stuff that our ancestors learned in Boy Scouts or from the green American Red Cross first aid book.)

Friends, whether you’re a new student in a first responder class or an experienced flight paramedic, EMS isn’t all that complex.  Let’s stop trying to make it complex.  For at least some of it, we make it complex so as to justify our ego and sense of self-importance.  The average EMS textbook is written at roughly a tenth-grade reading level.  That fact alone should bring you right back to Earth.

At all levels, prehospital care can be summed thus.  For trauma care: control the bleeding, protect the airway, and get the patient to an appropriate trauma facility.  For medicine: assess, diagnose, treat, and get the patient to the right hospital the first time to fix their problem.  If you can do those things, do two other things as well.  First, be nice.  Second, make the patient comfortable.  Both of these additional guidelines also apply to being nice to the patient’s family, bystanders, and other healthcare professionals.  The only variation between an entry level first responder and a flight nurse will be in the treatment options and assessment tools you have available to you.

EMS doesn’t have to be hard.  But if all of this is still too hard or complex to understand, I’ll leave you with some sage advice that I got from an experienced flight medic the day I got my paramedic certification. “If you don’t know what else to do, it’s a good idea to take the patient to the hospital.”

EMS.  No, it doesn’t have to be hard.

Filed Under: EMS, EMS Education, EMS Social Media

Another Volunteer Crisis

Posted on October 23, 2018 Written by

As sure as the day is long, we can count on the EMS news sites to do a post on the volunteer crisis in fire and EMS organizations. And EMS1 did its part yesterday.

And of course, y’all know I have to comment.  So, let’s do a rehash and repeat.

Folks, it’s real simple. Too many organizations make it hard to volunteer, whether its applying or what’s required to remain a member. I’ve lost count of the number of volunteer organizations that don’t have their membership application online. Likewise, I’ve lost count of the number of “all hazards” departments that will allow volunteers to remain exclusively firefighters but won’t allow for EMS only volunteers, even when well over half of most departments’ call volumes are for medical calls. I’ve also lost count of the number of departments that are combination departments that only offer their “mandatory” training during the week when we “normal” people with an office job are already pulled in multiple directions. (Hint: There are infinite platforms online to make these classes available on demand or as webcasts.)

I’ve always held the position that standards should never be lowered. All that most volunteers (or potential volunteers) ask for is a bit of flexibility in how you reach those standards. Something as simple as allowing a volunteer more time or the ability to work with different field training officers could be a huge asset in getting a volunteer cleared to independent duty, especially as an advanced life support provider.

If you don’t believe that there’s a pool of volunteers out there, do this.  Look at how many people out there hold a fire and/or EMS certification and are currently unaffiliated with any service, whether paid or volunteer. If the National Volunteer Fire Council, NAEMT, or any of the other fire and EMS groups are truly serious about volunteers, I’d recommend a survey targeted at those people to find out why they’re not currently volunteering.  If you wanted to go above and beyond, survey those people who are active volunteers with departments not near their home.  Find out why they’re not affiliated with a closer department. Dollars to doughnuts, the answers will the same — there will be some artificially created barrier preventing them from volunteering nearby.

I’ll also note that the value of a volunteer group, especially in a combination department, isn’t immediately obvious until you have a disaster or other incident that’s stretched your department thin and/or exhausted mutual aid resources.  That guy who’s just a volunteer EMT can now free up the paid firefighter/EMT staff from medical calls.  That lady who’s qualified to drive and operate a tanker/tender means that apparatus is now in service and the paid crew isn’t cross-staffing it.

Unless of course, your goal is solely to show that you “can’t find volunteers” and really need that sales or property tax to hire paid staff. If that’s your real agenda, then, by all means, keep on doing what most departments seem to be doing. Sadly, in my neck of the woods, this strategy has been effective as a jobs program for paid firefighters and EMTs.

Filed Under: EMS 2.0, Volunteers

More on the Four Year EMS Degree

Posted on September 10, 2018 Written by
So, I’m thinking more about the push for an EMS degree. In theory, I think it’s a great idea. But here’s a couple of observations.
 
The “other countries have it” argument. Those other countries also have a national healthcare system where EMS is integrated into healthcare. We don’t have that in the United States. Additionally, some of these other countries don’t have a tradition of mid-level practitioners that the United States does like advanced practice nurses and physician assistants, so in some of these cases, paramedic providers are stepping into roles that might be filled by other healthcare professionals here.
 
As a corollary to that, much of our EMS is provided by the fire service and by large private EMS companies. The fire service does EMS because it “has to” in order to maintain some justification for its existence. It has no interest in EMS save for staffing and budget. They’re not going to be advocates for EMS. As for the privates, they want low wages and lower educational standards, since they’ve got a long history of churning through employees and needing a steady inflow of new people.
 
Volunteers. Yeah, truthfully, it’s going to be hard to require a four year degree to volunteer on the ambulance. And unfortunately, there are parts of the USA where the local authorities have chosen not to fund an EMS system or there’s not sufficient people to do it. As the old adage goes, you get the EMS system you pay for.
Clinical outcomes. Everyone talks about evidence based medicine, including me, until they don’t like what it says. Is there any evidence that a more educated paramedic provider has better clinical outcomes. Australia and Canada both have college-educated providers and that’s become the norm there. Yet, these paramedics often have a more limited scope of practice than many locations in the United States.  Is there any evidence to indicate that American paramedics with a lower educational standard and (often) a broader scope of practice have worse clinical outcomes than their more educated foreign colleagues? As a further question, would a four year degree expand the current scope of practice for American paramedics?  As a liberal arts graduate myself, I believe the real value of a four year degree comes from the critical thinking and communications skills that a core liberal arts curriculum develops, but the majority of EMS degree advocates seem to believe that only a four year EMS specific degree is going to “save” EMS.

Actual logistics. Let’s assume that we do decide to put in a degree requirement for paramedics. Let’s further assume that it’s going to be a four year degree. How many degree programs exist? Are there sufficient faculty with an “appropriate” terminal degree in the field to satisfy the higher education accreditation authorities?  And on that note, what is an appropriate terminal degree for EMS?  Would we now end up inadvertently or intentionally creating a doctorate in EMS education?  Would current EMS educators be ineligible to continue what they’re already doing? The demand for nurses and nursing education has already created a shortage of nursing educators.  What would EMS education do to meet that demand on day one?

What would happen with an actual EMS degree requirement?  The skeptic and cynic in me says that most places wouldn’t have degree-educated paramedics.  Instead, the “powers that be” will do one of two things.  They will continue the current paramedic education and call it something else.  Or they will water that down even further and create another “paramedic light” certification. See also: Rhode Island’s EMT-Cardiac, New York’s Advanced EMT-Critical Care, NREMT Intermediate-99 (thankfully being phased out), Virginia’s EMT-Intermediate, or Iowa’s “paramedic” based on the NREMT I-99 standard (the actual “full” paramedic in Iowa was called a “paramedic specialist). And I will make you a bet that the majority of large EMS operations in this country will immediately default to providing service at this “paramedic light” level.

 

If we want degree educated paramedics and believe that’s for the best, we’re going to need to answer these questions.  And we’re also going to need find the funding for this. That probably means getting the primary payer of EMS services, the Federal government, to change Medicare/Medicaid so that EMS systems are paid for treatment and services rendered rather than just transport mileage.  But to do that means that we’re going to have to be more involved in the political process rather than the occasional appearance on a designated “lobby your politician” day where you wear a uniform that looks something like a third world dictator. The truth be told, increased EMS education and increased EMS reimbursement are like the chicken and the egg.  I don’t know which comes first.

 

I’d also point out something said by a former EMS director of mine.  He said he’s paying paramedics (and EMTs) what he can afford to pay them, not what he wants to pay them.  Again, until reimbursement changes, there’s no magic source of increased paramedic compensation, even with higher education.

Before you think I oppose an EMS degree, let me say that I don’t.  I believe that a four year degree is appropriate for a medical professional. I also don’t know that all of the advocates of an EMS degree have fully thought out the impact of such a requirement, even if gradually phased in.

I believe that our current America EMS system may be like Churchill’s definition of democracy. Churchill said that “Indeed it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.…”  I believe that we may find this to be equally true for American EMS if we suddenly change our educational paradigm without considering the consequences.

These concerns and this rant was brought to you by a mostly proud graduate of a certificate granting paramedic program who also had a bachelor’s degree in liberal arts followed by a graduate and a professional degree. Higher education taught me to think. Paramedic education taught me to do. And coming into a paramedic program with a college degree taught me to think and consider what I do as a paramedic.

Filed Under: EMS, EMS 2.0, EMS Education

On The EMS Degree

Posted on September 6, 2018 Written by

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.

Filed Under: EMS, EMS 2.0, EMS Education, EMS Politics
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