EMS Continuing “Education”

Time for me to bring up a semi-regular rant again. The Texas Bar requires 15 hours of continuing legal education a year, including 3 hours of ethics. Up to 3 hours can be self-study including 1 hour of ethics. And the Texas Bar specifically mentions participating in social media for attorneys as part of self-study.

We all know what our state and/or the National Registry require for continuing education for EMTs and paramedics. And that, at least for National Registry much of it has to be “live.”

Riddle me this, Batman. What’s more educational? Reading a #FOAM article shared by some of the EMS/emergency medicine opinion leaders on social media, discussing low titer whole blood with the actual author of many of studies- or sitting through DVDs of the American Heart Association’s resuscitation awareness schlock or listening to whatever a self-proclaimed “EMS Celebrity” has to say at an EMS conference? While there are certainly concerns about gaming the system, that’s already been a known issue with continuing education, whether it’s people signing off on attending classes they weren’t present for or exceptionally low educational value for certain presentations. (See also: certain EMS celebrities presenting on any topic, regardless of subject matter expertise.)

With the amount of hours required to maintain an EMS certification, I’d say it’s time to start allowing a few hours of FOAM and online participation into the mix.

I’ll commend you to read this article about why we should be embracing #FOAM in EMS. The EMS world needs to embrace the evolution in EMS and medical education by giving credit to those actually looking to improve and advance their professional knowledge versus just sitting through dated material because the state or National Registry says so.

As Dr. Joe Lex says,

  • If you want to know how we practiced medicine 5 years ago, read a textbook.
  • If you want to know how we practiced medicine 2 years ago, read a journal.
  • If you want to know how we practice medicine now, go to a conference.
  • If you want to know how we will practice medicine in the future, listen in the hallways and use FOAM.

In summation, EMS continuing education needs to reflect current practice and actual continuing education as opposed to rehashes of the same dated material that is neither current nor advances medicine.  Neither card courses nor the usual cabal of celebrity EMS conference speakers reflect that.  FOAM and social media often do.  Yet, which gives you actual credit for recertification?

My Love Hate Relationship With EMS Social Media

Sorry for the delay in blogging.  None of my usual pet peeves have inspired me to blog as of late.  The truth is that volunteer EMS still has the same challenges and people still put beans in their chili, so maybe I needed to find something new to write about.  And something I shared last week on social media hit me.

I have a love-hate relationship with the internet, social media, and with EMS social media in particular.  I’ve made some incredible friends all over the world, some of whom I’ve met in real life.  Others I’ve yet to meet in real life, but I feel as if I’ve known them all of my life. But there’s also parts that drive me crazy beyond belief, yet I keep coming back to them like the guilty pleasure of watching Jerry Springer or Cops – or the morbid curiosity of looking at a car wreck.  Namely, I keep coming back to the amount of wrong information and/or dogma being spread online.  I used to try to engage and educate and I’ve stepped back a lot from that.  It’s like most debates with the willfully ignorant online: debating online with a moron is like playing chess with a pigeon —  it knocks the pieces over, craps on the board, and flies back to its flock to claim victory.

Image result for someone is being wrong on the internet

So, as a result, I’ve largely retreated and find my pleasure in sharing the stupid privately with like minded friends.  We largely laugh and bemoan the state of EMS and medicine in that such standards are allowed to exist.

The below average person in EMS (who we regularly mock) copes by making fun of patients, engaging in patient abuse, and the like because it’s their crummy coping mechanism for the things they don’t like, understand, or control about EMS. I think a large part of that comes from seeing the same things over and over.  I get that.

For me and people like me, what bothers us seems to be people repeating dogma, those failing to take personal responsibility for their development, and the general low standards out there. I’m as guilty of this as anyone here, if not more so, but I wonder if seeing that dumb behavior has made us cynical and jaded enough that we automatically assume the worst when we see someone post something that seems dumb as opposed to assuming they have a legit question or need for help? Heck, with the benefit of a bit of hindsight, I wonder how many of my questions as a newer EMT or paramedic came across that way.

I start wondering how many legitimate questions get overlooked because of the amount of chaff (IE dogma and mindless repetition) on EMS social media.   A friend of mine asked the same question and recognized that it’s hard to separate real questions from trolling. And then he asked the most important question, “Where do we draw the line at eating our own versus getting rid of an actual problem?”

I don’t have an answer to that.  What I do know is that the “eating our own” will likely continue as long as EMS education’s entry requirements focus on whether the check bounced and whether educational programs see their obligation as producing qualified clinicians as opposed to maintaining an arbitrary retention rate mandated from on high.

As long as retention remains more important than quality, I don’t think EMS social media will see an end to the “How do I pass National Registry?  I’ve failed four times already.” questions.

The challenge for those of us who want to excel in EMS is how to mentor and guide future clinicians without being jaded.  On a positive note, if it makes you feel any better, the attorney social media groups have enough of the same issues that I regularly wonder how some graduated law school or passed the bar exam.

The Paramedic Shortage

My good friend (and I daresay mentor) Dr. Bryan Bledose recently opined on the paramedic “shortage” in the United States.

The good doctor mentions several ideas worthy of consideration, including limiting the number of paramedics, improving the scope of basic and intermediate level providers, and allowing for transport to alternate destination.  And like many of the current discussions, he advocates a college degree for paramedic level providers, which is a cause that I can support, given the requisite forethought and groundwork prior to a requirement being instituted.

I really don’t know if the numbers support the assertion that there is a shortage — or that there isn’t.  What I do believe is that a degree requirement is going to exacerbate a shortage.  There’s all the usual arguments that the fire service won’t embrace a degree and that rural EMS will suffer from a lack of access to educational programs.  And the truth is that those are valid concerns.

 

But here’s my real concern. Most all of us know and agree that a college education creates a more well-rounded provider and provides a core curriculum in English and the humanities.  (I’d also note that said core curriculum is one of the least recognized benefits of a college education from many of the loudest EMS degree advocates on social media.)

 

We also know that many EMS organizations are poorly managed and have a toxic organizational culture. How many degree educated paramedics are going to stick around this average EMS workplace with the toxic culture and idiotic management? There’s a lot better places to work much of the time and a degree educated provider is typically educated enough to recognize this. College educated folks are a bit less likely to want to drive a truck around town for twelve hour shifts and eat and perform their bodily functions at the nearest 7-11, depending on the whims of dispatch.  And a college educated professional is unlikely to respond well to unwritten policies and upper management dictating policy through email rants.

If we want to fix EMS and address the paramedic shortage, we need to address working conditions first. And that starts with expecting EMS managers and leaders to actually be competent to run a functional organization.  EMS needs more education, but that education needs to extend well beyond a better way to read an EKG.

And So It Goes

Years ago, my friend Mike Levy used to close out his email blasts on local politics with “and so it goes,” implying his despair that things would change or improve.  This morning, I happened to see an EMS colleague post a cartoon about how everyone wants change, yet no one seems willing to change.  Below are my thoughts on where we’re at in EMS.

 

We hear a bunch of people say we need the next generation of EMS leaders step up. Then we step up and we’re told to wait our turn, bide our time, and not speak until spoken to. Meanwhile, the people who created the problems of modern EMS are on all of the blue ribbon committees and consulting teams to fix the problems they created in the first place. Tact prevents me from naming names, but if you’ve been around EMS for more than fifteen minutes, you’ll recognize the names of what Mad Magazine called the “usual gang of idiots.”

And of course, as is the trend in modern politics, EMS continues looking for the single solution that will fix all that ails EMS.  A few years ago, it was community paramedicine.  (By the way, yours truly still thinks that knowing how to navigate the healthcare and social services systems and pointing patients to the right resources is an essential skill for a medical provider of any sort.)  Now, the latest push for EMS success has been distilled into a single catchphrase: “EMS Needs Degrees.”  It may not be as catchy as Bernie Sanders’ catchphrase of “Medicare For All,” but it’s equally simplistic and just as poorly thought out. Almost no one in EMS has thought out how a degree requirement would work, what such a degree would contain, or even found out if the higher education system(s) have the ability or desire to take on the task of educating paramedics. (Hint: Part of the nursing shortage relates directly to a shortage of qualified nursing faculty.  Considering how few in EMS already have EMS specific degrees, I can’t help but think that the shortage of qualified faculty to teach paramedics at the college level will be even worse.) And now, we have the first state proposing an actual degree requirement for EMS, namely North Carolina, which will require an associate of applied science in EMS to obtain paramedic licensure.  For many people and in many situations, this degree will be the end of their higher education journey, at least in part because the AAS curriculum rarely transitions well to bachelor’s degree requirements.  Once again, EMS looks for an easy fix to a complex problem.  As I like to say, good public policy can rarely be distilled to a meme or fit in a single Tweet.

The issues with EMS are complex and heavily tied to public policy, namely how the Federal government’s two financing mechanisms, Medicare and Medicaid, pay EMS as a transportation service as opposed providing healthcare.  That also explains why the historical option for EMS care is to offer a ride to the hospital emergency department.  But right now, instead of recognizing the need for future EMS leaders to have some concept of management, finance, politics, and public policy, we’re confining what constitutes EMS education to a set of technical skills. (I truly think that some of the loudest voices on EMS social media advocating for a degree are basing what an EMS degree should be on a wish list of skills and technology they’d like for an ambulance.  I’d also note that’s not how most educational models work aside from trade or vocational school.) We are not even guaranteeing that EMS providers are educated in the arts and sciences to understand the hows and whys of medicine and the context in which prehospital medicine fits into everything else.  And going back to my earlier comment about the current crop of so-called EMS leaders not wanting to relinquish their positions — you couldn’t think of a better way to keep the “new kids” out of leadership than to deny them the actual skill set and education they need while claiming that you’re helping the profession advance.

And so it goes.  Indeed.

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.

Masters of Our Own Destiny

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.

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

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.

KISS: Keep It Simple Stupid

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.

More on the Four Year EMS Degree

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.

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.