Paramedic Education

[ah2388]

Hello All,
Long Time lurker, first time poster here at SDN.

First, a little back ground, I am a 25 year old paramedic working in the Central U.S. I am also a full time student considering the possibility of pursuing medicine as a career. I work full-time on an ambulance and PRN in a large community ED/regional referral center that sees basically anything outside of trauma.

I've read a tremendous amount of posts about Paramedic education, and the overall consensus among many of you in EM that the level of education needs to change in order for the field to advance.

My question to the brilliant minds on this forum, is where to we go from here? Is it mandating a degree similar to our Australian/NZ counterparts? What is your take? Is the answer to limit the scope of practice for non-physician pre-hospital providers?

I am hoping to open some dialogue here.

-A

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[deleted6669]

My state already requires new medics to have an a.s. degree. I don't think that is a bad thing. I went to medic school > 20 yrs ago after getting a b.s. and was surprised at the # of folks in my one year certificate medic class who could not do simple math in their heads or spell to save their lives.
I would like to see medic education separated further from fire science. many programs do both together and if you have no interest in fire and really want to work in ems doing medicine you should be able to get an a.s. in paramedicine. mandating a degree beyond the a.s. for medics seems pointless. if someone wants to spend 4 yrs getting a degree to do something that can be taught well in 1-2 years then they should look at ems management type degrees, etc if they envision a long time career in ems. I know in the past there have been masters in ems programs which incorporate a medic certification. that seems way overkill. at that point one might want to look into other degrees ( pa, rn, rt, md, do) that give a better return on investment. makes no sense to spend 100k to get a degree that gets you a job paying 50k/yr.
there are a few bs ems programs designed for folks who don't plan on staying in ems long term. loma linda and u.wa both have them. in theory they give someone the prereqs to later attend another program without having to go back to school while working in ems. not a bad plan for folks who only see themselves doing ems for a few years.

 

[ah2388]

My state already requires new medics to have an a.s. degree. I don't think that is a bad thing. I went to medic school > 20 yrs ago after getting a b.s. and was surprised at the # of folks in my one year certificate medic class who could not do simple math in their heads or spell to save their lives.
I would like to see medic education separated further from fire science. many programs do both together and if you have no interest in fire and really want to work in ems doing medicine you should be able to get an a.s. in paramedicine. mandating a degree beyond the a.s. for medics seems pointless. if someone wants to spend 4 yrs getting a degree to do something that can be taught well in 1-2 years then they should look at ems management type degrees, etc if they envision a long time career in ems. I know in the past there have been masters in ems programs which incorporate a medic certification. that seems way overkill. at that point one might want to look into other degrees ( pa, rn, rt, md, do) that give a better return on investment. makes no sense to spend 100k to get a degree that gets you a job paying 50k/yr.
there are a few bs ems programs designed for folks who don't plan on staying in ems long term. loma linda and u.wa both have them. in theory they give someone the prereqs to later attend another program without having to go back to school while working in ems. not a bad plan for folks who only see themselves doing ems for a few years.

Many of the current B.S. programs related to paramedicine seem to focus on a management track, rather than a clinical track.

Do you think that mandating an A.S. or B.S. where the primary focus is clinical rather than management/leadership would in time drive up pay?

Part of me feels that driving up the entrance requirements to the field would only serve to move the profession forward. No offense to anyone, but we seem to cater to the lowest common denominator in some instances.

 

[deleted6669]

Do you think that mandating an A.S. or B.S. where the primary focus is clinical rather than management/leadership would in time drive up pay?

Part of me feels that driving up the entrance requirements to the field would only serve to move the profession forward. No offense to anyone, but we seem to cater to the lowest common denominator in some instances.

I would like to see all medic programs go to a 2 yr a.s. model then we would be on the same level as a.s. rn's and all of that rivalry could decrease. also would likely increase pay in time. that would also get rid of many of the yahoos who become medics because they want to spiff their applications to to fight fire. 2 totally different things and should be 2 different pathways. some of the worst medics I ever worked with were guys trying to get on as firefighters who felt medic school was just a required hoop to jump through so they gave it only enough effort to pass but not to excel.

 

[joeDO2]

I would like to see all medic programs go to a 2 yr a.s. model then we would be on the same level as a.s. rn's and all of that rivalry could decrease. also would likely increase pay in time. that would also get rid of many of the yahoos who become medics because they want to spiff their applications to to fight fire. 2 totally different things and should be 2 different pathways. some of the worst medics I ever worked with were guys trying to get on as firefighters who felt medic school was just a required hoop to jump through so they gave it only enough effort to pass but not to excel.

 

[Deranged Medic]

I would like to see all medic programs go to a 2 yr a.s. model then we would be on the same level as a.s. rn's and all of that rivalry could decrease. also would likely increase pay in time. that would also get rid of many of the yahoos who become medics because they want to spiff their applications to to fight fire. 2 totally different things and should be 2 different pathways. some of the worst medics I ever worked with were guys trying to get on as firefighters who felt medic school was just a required hoop to jump through so they gave it only enough effort to pass but not to excel.

I agree with this 100%. There were only 3-4 of us in my class of 45 students who actually wanted to be medics. The others were doing the class so they could be a firefighter. I still haven't figured out why they don't call it "EMS based fire."

I feel the professionalism in EMS could be much better if paramedic certification was an associate degree. The unprofessional emails I receive from my bosses and other upper-level EMS management could improve a whole lot with a little bit of education.

As for the bachelor degree, I went to Pitt's Emergency Medicine program. I feel more education is always better; however, we focused mostly on management stuff, with the UMBC CCEMTP class being the only clinical education for the senior year. I can see how street medics could do without the 4 year degree, but I feel like it has made me better as a person and at what I do.

Addition: While at Pitt, I was able to do a week-long internship with Wake County EMS's Advanced Practice Paramedic program. As for the future of EMS-I am all about educating paramedics to provide community healthcare. Every single patient we visited did not have their pills in their pill minder correctly. Being able to help patients take their pills at the correct time should speak for something. We were also able to run to the physician's office to pickup a prescription and schedule an appointment for a deaf patient who had no way of completing those tasks alone.

They also have a really cool alternative destination protocol for mental health patients. By taking them to the correct mental health resources instead of the ED, they have freed up several ED bed hours for critical patients. Last I knew, they were looking into an alternative destination protocol for nursing home fall patients. I don't know if they instituted that or not, but I think I saw a JEMS article a few months ago with an update.

I could be wrong, but I believe Eagle County Colorado and REMSA both have similar programs.

 

[Cmaj7th]

I see alot of animosity for fire based EMS and I don't understand it. In my state only fire based EMS can respond to 911 calls so there is a huge disprarity in skillset and motivation between the fire based people compared to the private companies. Besides you make more money in fire based ems, have more room for advancement, better benefits and pension packages, and can function in multiple roles outside of medicine. It also helps justify the staffing at fire departments as we adapt to a society with significantly less fire.

Sure there are some guys who do it just to get hired, but there are alot who really want to be paramedics too. I think the idea of having such a broad range of skills and responsibilities coupled with a decent salary and a pension make for a fulfilling career.

 

[alpinism]

Yeah I'm not a fan of the get your EMT/medic cert 1st then apply for FF jobs.

Aside from the military, medics were originally meant to be firefighters who went on to get extra medical training, not the other way around. The first paramedic programs in the 1960s (LA county, Miami, and Columbus) were all started by FDs.

 

[Cmaj7th]

The last time the closest FD to me was hiring they had 2000 applicants. Only a dozen or so were paramedics. It makes sense that they're the guys getting hired since they have the more marketable skillset. Not that people from other walks of life don't have skills to bring to the table but if 70%+ of a departments calls are EMS then they're going to need medics.

 

[medicsb]

Yeah I'm not a fan of the get your EMT/medic cert 1st then apply for FF jobs.

Aside from the military, medics were originally meant to be firefighters who went on to get extra medical training, not the other way around. The first paramedic programs in the 1960s (LA county, Miami, and Columbus) were all started by FDs.

There is a wide variation in what the purpose of paramedics/advanced prehospital care was early on. The first service to ever train people in advanced medical care for the prehospital setting was Freedom House in Pittsburgh, which predates Miami, Columbus, and LA. Also, in the late 60s there was Mobile CCU staffed by hospital nurses that operated out of Hanover Hospital in PA (actually predates LA county by a month or so), and later was staffed with paramedics. Paramedic training was never intended to just be an add-on for fire-fighters. The reasons fire-fighters were chosen for medical training in certain areas was purely out of convenience (they were already hired, they were available, and they were strategically located to respond). In the case of Seattle, the FD was NOT Dr. Cobb's first choice; it was actually a private ambulance service.

 

[joeDO2]

I hate to say it but FDs NEED the medical runs. It is what justifies their staffing and budgets. If you only have 1 actual fire a month, its tough to get taxpayer dollars to support having a bunch of full time guys sitting around in a station. On the other hand, in the same city with a fire a month you might have 1000 ems calls. Makes sense to dispatch fire units to all of them to increase the call volume numbers. Some fire guys are interested in the medicine piece, others not so much. Either way, all want to be medics because it will help with hiring and/or bump their pay when they get on.