Pondering the Future of EMS Education

Following up my post about the final EMS Educast episode, the panel discussed what the future of the profession and education would look like.

Greg and Rob both stated that all certified EMS providers should be called paramedics, instead of the alphabet soup of certification levels we have now.  Rob also mentioned how in Canada the term “EMS” is moving towards “paramedic services,” to reflect our role outside of emergencies. I agree with both of these positions.  Firefighters have several different levels of training, but they are all firefighters.  Beat cops and homicide detectives are all police officers.  Some nurses have associates degrees and  some have doctorates in nursing practice, but they are all nurses.  How are we that much different?  If you insist on differentiating EMTs from paramedics, please do not complain about the public not understanding what we do or about being called an ambulance driver.  When someone calls 911 for medical help, the paramedics come.  Period.

Now onto education.  On the Educast Bill encouraged EMS providers further their education in areas not specific to EMS, such as liberal arts.  I have mixed feelings about this.  I have a liberal arts degree.  I did not realize its value at the time, but I learned how to critically analyze problems and become a better writer.  The degree helped me land a teaching job with higher salary.  I think Bill’s advice is good for today, but I would also like to see more formal paramedic education paths in the future.

Take nursing as an example.  There are licensed practical nurses, who receive vocational training and work under the direction of a registered nurse.  Registered nurses may have an associate’s or bachelor’s degree, and degrees are offered at both  community and four-year colleges.  ASNs and BSNs have similar roles, but BSNs are more likely to be selected for higher-acuity unit and supervisor positions.  There are several master’s degree nursing programs that concentrate on clinical care, administration, or education.  There is an increasing number of doctoral programs in nursing for practice as a nurse practitioner, nurse anesthetist, or nurse midwife.  Some LPNs take bridge courses to become nurses, and others start a nursing program right away.  Some nurses become an RN at community college and obtain their BSN after they start working, while others start and finish at a four-hear school.

The roles available for paramedics may not be as broad as in nursing, but I think that EMS can learn a lot from nursing’s educational model.  Vocational training could prepare our current version of EMTs, which would be the equivalent of nursing’s LPN.  An associate’s degree would be the minimum requirement to become a paramedic, which I think is inevitable anyway.  Graduates from paramedic bachelor’s programs would be preferred for work in higher acuity settings, such as critical care transport or advanced practice paramedics.  Paramedic-specific master’s programs could prepare people for higher levels of clinical practice, administration, and education.

In one of my healthcare administration classes, a textbook described how the nursing profession encourages frequent returns to formal education.  These lead to well-defined, diverse career paths that pay well.  There seems to be peer pressure, at least among the nurses I interact with, to go back to school and obtain higher degrees.  I am encouraged to see more paramedics doing this than I ever have before, but would like to see us develop more of a culture that encourages this.

Higher education is good.  Whether it should be paramedic-specific higher education or in another area, I am not sure.


  1. Dan Crots says:

    Enjoyed the post. Towards the renaming of our profession and simplifying our titles it may be a good idea and important. Nursing offers a good road map. Something often overlooked, especially in EMS and I truly believe it accounts for a lot of our troubles in advancing our paramedic profession forward is our lack of professional advocacy at the state and national levels. We do not have a paramedic only professional association and its hurting our future. Yes we have the NAEMT, but less than half of their members are paramedics and when you add all the other “stateholder” associations and groups our advocacy gets waterdown even more. While we have the paramedic only International Association of Flight and Critical Care Paramedics (IAFCCP), its geared towards the flight and critical care specialties. Yet they are on the right track and as a small organization they have achived a lot. They developed the BCCTPC and associated specialty certifications (FP-C, CCP-C, TP-C) and they have advanced their field with the most recent CAMTS standards (9th) and the specialty certification requirement within two years for CAMTS accredited services.

    Towards that nursing road map, let look at the level of advocacy issue for a minute. Yes nurses are nurses but their scope of practice and professional levels are highly regulated and guarded. Nurses understand the fundamental differences in their specialties and professional levels and know that they need professional advocacy at each level of nursing and they know their professional interest are not always inline and at times they are in conflict. There are many issues surrounding scope of practice, licensure, certification and education between LPN and RN and between RN and advanced practice nursing (NP,CRNA and Nurse Midwife). To understand this point look at nursing associations and see how they are organized and influence their profession. For example the ANA and ENA are only open to RNs as full voting right members or associations for advance practice are only open to those practicing at the NP, CRNA, or Midwife levels. These associations have a major and direct impact on their profession nationally in regards to their education and certification and it directly impacts their scope of practice within their given state and their State Board of Nursing. For example an LPN may or not have the same interest in the professional advancement of all RNs (example: medications/IVs/discharge, RN education), so too that an RN may or may not have the same interest as those nurses who are in areas of advanced practice (example: should only advanced practice nurses be allowed to intubate or insert chest tubes?).

    Ok what about us paramedics? So one has to ask, does the 50-60 hour EMR have the same interest as a professional career paramedics? Are their interest inline with ours? Do you think EMTs should be intubating, pushing medications, starting IVs and performing 12 leads with their training that is less than a medical assistant or a lisenced nail technician? Many EMTs do! How does this EMR/EMT influence our profession at the state and national levels? Do EMRs/EMTs have the same ideas about education, training, and oversight as paramedics? Do they understand the growing diversity of paramedic practice? Should an EMR be allowed to have a voice in the future of paramedic education program in the United States, when they themselves have never been though a paramedic program? Again, Howdoes this EMR/EMT influence impact our professional advancement as paramedics?

    And what about the influences of those other stakeholders on our profession? These stakeholders include, ambulance associations (both national and state specific), fire chiefs and like minded organizations, EMS educators and State EMS Offices, and other allied health care providers who have a stake and interest in EMS and critical care (nursing, PA, RT, etc., etc). For example, what private ambulance service wouldn’t love to charge ALS1 or ALS2 Medicare rates with EMTs performing ALS procedures? How do we protect our patients and our profession from this inside/outside influence? What organizations will be there to protect our patients and our paramedic profession? NAEMT? American Ambulance Association? Fire Chief Association?

    Some in the EMS profession believe we (paramedics) shouldn’t have seperate associations and levels of advocacy and we should all speak in one unified voice for all EMS provider and that this will give us streghth in numbers. At what cost I ask you? Low expectations, poor training and waterdown paramedic advocacy?

    So simplifying our titles may be a good thing for greater public understanding of our profession, I also think we need to follow nursing and the IAFCCP model of professional advocacy at the paramedic level only to ensure our profession doesn’t continue to stagnant and become waterdown by other non-paramedic interest. Dont get me wrong, the NAEMT is a great association has done a lot for our industry (and yes I am a member), but we also need to start advocating for ourselves (paramedics only) to move our profession forward.

    Thanks Dan Crots

    • emspatientperspective says:

      Thanks Dan. I echo your concerns about advocacy. I am active in NAEMT, but it is watered down by groups with competing interests. I do not believe that a paramedic-only organization will be of much use. That would just add noise to the voices from the fire, private, and volunteer advocacy groups that hinders real progress across all delivery models. By making everyone a paramedic, I hope that eventually the education requirements for the basic level would increase. I hope that the days of 120 hour EMT courses that can be held almost anywhere, taught by almost anyone, with no real clinical requirements or field internship are going to end soon.
      A few years ago I wrote about what I hope EMS in this country looks like in 20 years.

      I would like to see paramedics in the US look more like Canada’s. Primary care paramedics in Canada have a similar skill set to EMT’s in the Us, but have the same length of education as about the same as what is required for US paramedics. Advanced care paramedics require an additional year to practice at the ALS level. They are all paramedics, and they have strong, united advocacy groups. Just look at what the Ontario Paramedic Association accomplished a few days go by securing funding for Community Paramedic programs.
      I would argue that an organization from one province in Canada has more political clout than any national organization in the US. I think we can learn a lot from them.

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