# Your Reaction to Increased Education Requirements



## MMiz (Jul 11, 2006)

If an entry-level position in EMS required two years of college or vocational school, and a full-fledged Paramedic+ position required four years, would you do it?

I say entry-level and not EMT-B only because I would assume an EMT would learn far more skills and techniques.  Maybe the Paramedic program is the entry-level and the four year program is something more?

I understand that for many of you pay would need to increase to make the education requirements worthwhile, but what do you think?


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## Jon (Jul 11, 2006)

I like the idea. as you said, the pay would have to go up... 
However:
If medics were 4-year educated, they would be *GASP* on par with nurses. If we are better educated and better paid, then our skill sets would probaby increase... we might start doing more "treat and release" things, etc.

EMT's might see their skill sets with their pay as well.

BUT, if EMT's and Medics started getting paid more, then who would do the "routine transfer" stuff? Would there be a new class of person who could do "ambulance" transport of stable patients?


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## Ridryder911 (Jul 12, 2006)

The bare minimum should be an associate degree. We should allow anyone to take Basic EMT, since it has become basically an advanced first-aid course.  (Please compare objectives with ARC Adv. F.A.). 

For this so called profession to ever gain and be recognized as it should, medics are going to have to realize that there are more than to medicine than technical skills. Having a basic education level such mathematics, science, psychology, and above sophomore reading level is essential. With the onset of increasing medical care, more patients, and more patients being discharged early from hospitals our role has and is continuously changing. 

I know, I just met with a technical school administrator last week, and decided on closing of the Paramedic program. Clinical sites without preceptors on site, failure to meet employer demand of having medics that can spell, write, and yes figure calculations based on knowledge and mathematical knowledge. Yes, they passed the NEMT, but administration wants to hire the biggest bang for their bucks. Paramedics wanting & deserving to make salaries comparable to other health care workers. Can you imagine seeing medics, only to have work only one job?......wow! What do you think the work place would be like, and the patient care?

Within 5 years, BS programs with optional MS programs will be developing. In order to have research in EMS, academia requires the minimal of graduate level to perform such. We want better treatment, better working conditions, better pay, all in which we deserve, we have to meet the requirements like our health care peers. It is happening, just like it did in nursing (remember diploma nurses.. thing of the past). Now, let us incorporate those that have reached that level prior and grandfather them in, then cease further ones.

It is time EMS be responsible, it is a health care industry. We are the only one that does not require at least a minimum associate degree, that has direct patient contact.

R/r 911


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## disassociative (Jul 12, 2006)

I would like to see more BS of Paramedical Science programs become available,
as well as Paramedic Practitioners. In my opinion I think paramedics should
be trained in research as well as in-hospital critical care approaches not just
pre-hospital.

TN is actively working to bridge the gap by offering Paramedic to RN transitional
programs. I would absolutely take part of a 4 yr paramedic course if it were
available in my area. Right now, the only option that I know of is BS, Emed.


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## disassociative (Jul 12, 2006)

Forgive me for making 2 posts, however; I have recently found evidence
of a point I made a while back in regards to first responders(3 Month Course Certified) being able to use Combitubes and PTL's.



> Rule 1200-12-1-.16 Emergency Medical First Responders is amended by adding the following language as
> bew subpart shall (2)(b)(1)(iv):
> 
> (iv) First responders *AND* Emergency Medical Technicians participating in a recognized first responder
> ...



Here is a link to the entire article: http://www2.state.tn.us/health/Downloads/EMS_Rule061704.pdf

I think that if they are going to give first responders abilities such as these;
why not extend the required time for the courses and simply make the minimum EMS requirement an EMT-IV, or why not extend the abilities
of an EMT-IV(such as Ekg interpretation, more advanced pharmacology, etc).


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## gradygirl (Jul 12, 2006)

I agree that there should be some sort of education prerequisite to receive licensure. I also agree with disassociative that there should be more BS programs. I know of too many EMTs and medics who have been able to skate through programs and essentially be handed certs. There is one service in particular in Conn that is notorious for having incompetent EMTs and medics, so much so that it is almost routine for the hospital medics in the area to be called out to assist the service's medics in ALS situations.

The most rigorous medic program in Conn, or nearly so, is offered at Hartford Hospital. All applicants are required to take some sort of A&P course prior to the class and have to pass many other requirements. That being said, there is no sort of education requirement whatsoever. I am most likely going to be enrolling in this program in a few years, which now is being offered through a professional college in conjunction with HHEMS, but it will only be as a cert program, not as a degree.

I'm actually quite concerned about the lack of formal higher education of so many EMTs and medics. Whenever any of our campus squad talks to other EMS professionals, they are fairly surprised that we would be students as well as EMTs. Along with that is the surprise that we take on training on our own time; as all of our training is offered through the hospital and not an accredited school, we receive very little to no academic recognition for our time in class.

Base line: is this lack of education an epidemic? Yes, absolutely. Will requirements be made for degree programs instead of certs? Hopefully, but like many other parts of EMS, people will most likely be resistant to change.


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## Ridryder911 (Jul 12, 2006)

Resistance will occur, but briefly. Insurance companies, Medicare, and cities are tired of paying for "glorified taxi cabs" or commonly known as cabulances, Nursing went through the same regime about 15-20 years ago, no one wanted the degree, so many hospital programs, etc... simple, Medicare, JCAHO, etc... mandated higher education programs or no payments. 

Amazing, where the pocket book is the hearts will follow. I have been follow, EMS advocates and noticing many discussions of Insurance companies wanting EMS to perform more a screening for patients to be transported. I predict very soon, one will have to meet criteria for transport, other wise insurance will not be covered or responsible. 

Hence, the need for education, NOT training. More responsibility and liability, will be placed upon medics. Yes, these will increase, but if we are smart the salaries will as well. 

R/r 911


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## disassociative (Jul 12, 2006)

Can't help but remember the days of LPN.

Honestly; Nurses get the short end of the stick too. A paramedic spends
11 mo in class and can use ET Tubes; however an RN spends a minimum
of 2 yrs and cannot. 

I think if they do setup more AAS or BS programs in paramedical science
the pre-reqs should be no different than that of an accredited RN course:

Proficient in Math, Science, English, etc(ACT)
Anatomy & Physiology I & II


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## FFEMT1764 (Jul 12, 2006)

The salaries will only increase if the county or whoever funds the agency decides that EMS is not the red headed stepchild any more...which wont likely happen around here, after all we went 5 years with NO cost of living increase...we would have had them but hey when you try to raise taxes on a populous living on medicaid, welfare, and SSI, you cant get any money from them hence you cant give your people salary increases...but thankfully through our new billing structure we have received rasies and increases to our benefits...hopefully council can now find new industry to attract and grow our poor county into something great!


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## sarahharter (Jul 12, 2006)

i think that they should make it possible for emt's to do IV's because i am a medic in the air force and thats where i got my emt. i have done iv's and read ekgs, and found it more effective that emt's knew how to do it and we didn't have to wait for someone who was a paramedic, and that was good because we didn't have many. We were trained how to do it we went through all the training we had to and i think that civilian emt's should get the same option.


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## disassociative (Jul 12, 2006)

EMT's can do IV's.

In TN the minimum requirement to ride on an ambulance is EMT-IV. They
have adopted IV therapy into the EMT-B curriculum.


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## Ridryder911 (Jul 12, 2006)

With having the knowledge of reading ECG's, establishing IV's it comes with the responsibility that also requires the education and knowledge why, the side effects, and pathophysiology, etc... If one does accomplishes this, then they would be considered advanced. That is why is there is differential between advanced and basic. 

Skills such as intubation, IV, etc. are easily to master, knowing the how, why, risks, and detailed circumstances is the difference.

R/r 911


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## Guardian (Jul 12, 2006)

Ridryder911 said:
			
		

> With having the knowledge of reading ECG's, establishing IV's it comes with the responsibility that also requires the education and knowledge why, the side effects, and pathophysiology, etc... If one does accomplishes this, then they would be considered advanced. That is why is there is differential between advanced and basic.
> 
> Skills such as intubation, IV, etc. are easily to master, knowing the how, why, risks, and detailed circumstances is the difference.
> 
> R/r 911




Amen.........


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## Flight-LP (Jul 13, 2006)

sarahharter said:
			
		

> i think that they should make it possible for emt's to do IV's because i am a medic in the air force and thats where i got my emt. i have done iv's and read ekgs, and found it more effective that emt's knew how to do it and we didn't have to wait for someone who was a paramedic, and that was good because we didn't have many. We were trained how to do it we went through all the training we had to and i think that civilian emt's should get the same option.



You are comparing apples to oranges there.......

The Air Force's Medical Services Apprentice course does not remotely provide the training needed to function beyond an EMT Basic when it comes to pre-hospital. Their NREMT pass rate is below average and at one time was one of the worst in the country. Now, they do offer some more insight and training in the basics of nursing, but any specialized advanced skills that are allowed are strictly individualized and are dependent on your supervisor's o.k. and appropriate 5 or 7 level training.


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## disassociative (Jul 13, 2006)

Ridryder911 said:
			
		

> With having the knowledge of reading ECG's, establishing IV's it comes with the responsibility that also requires the education and knowledge why, the side effects, and pathophysiology, etc... If one does accomplishes this, then they would be considered advanced. That is why is there is differential between advanced and basic.
> 
> Skills such as intubation, IV, etc. are easily to master, knowing the how, why, risks, and detailed circumstances is the difference.
> 
> R/r 911



Personally, I think IV's are fine for this level(maybe because I'm an EMT-IV, however, I do agree that the govs decision in not allowing(B or IV's) to push
drugs such as morphine, dilaudid, etc. or administer ET tubes; was a good one. There are too many "What if's" in these situations for the class time
alloted.

Basics are really just led to accept that occurences happen and have already
happened rather than knowing "What, Why, Or How". Personally; I wouldn't
want someone administering morphine to me that did so because, "It's the protocol" rather than making a conscious decision based on the clinical
data of that specific case. I think knowing the pathophysiology of ANY
medical condition is extremely important; in my personal studies, I make
a conscious effort to read up, ask why, and to learn as much as I can;
but not everyone does. Personally, I think a more in depth approach
to respiratory physiology(AA gradients, HC03, Acidosis, etc) would be great for Basic classes as well as some biochemistry.

I wouldn't have minded an extra semester or two.


I


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## Stevo (Jul 13, 2006)

ems never used to attract so much attention in the past, it was quite literally a good nieghbor community service. 

now that it's gained the attention of every acedemic faction medicine has, we'll bear the burden of every excuse to fix what really wasn't broke in the first place

now don't get me wrong, those sorts that continually write text after text have their place, yet don't always realize the cost/benift ratio of instituting doctrines that would be a detriment to sheer people power, which ems is first and foremost

~S~


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## Ridryder911 (Jul 13, 2006)

Stevo said:
			
		

> ems never used to attract so much attention in the past, it was quite literally a good nieghbor community service.
> 
> now that it's gained the attention of every acedemic faction medicine has, we'll bear the burden of every excuse to fix what really wasn't broke in the first place
> 
> ...



I don't know where you have been?.. But I have been a Paramedic for 29 years in a rural area, and received my degree in EMS 24 years ago. Ever heard of Johnny & Roy?.... Shame that almost 48% of America still cannot receive even the care that they delivered in 1973. You don't call that broke? 

Let's reduce Project Homeland on WMD budget, and place the money on everyday occurrences that are REALLY happening. Not that it does not have its place, but the sky is falling attitude, has prepared us really for what? Meanwhile, EMS runs are doubling, soon to be tripling in numbers. As well there is NO possible way the number of ER and hospital beds will be acceptable for the number of medical cases within 5 years. 

The days of having a local hospital in every community is over, as well as firefighters not responding on EMS calls, those days are over. Now the new trend is suing the local community for not 'providing adequate EMS care".. and yes they are loosing, ( I will find the link, later), It is cheaper to do it right, the first time than play around with it. 

Be safe,
R/r 911


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## Stevo (Jul 14, 2006)

well there's the health care crisis, and there's ems Ridryder911

two seperate issues that do affect each other.

most of ems (as a whole) is rural, and not of your caliber

why is that? , simply because there's no $$ in it out here, as i'm sure you well know. Now if you ask the average recruit to do college time in order to join a service, what do you honestly think we'll all end up with? 

even if it became a reality, the $$$ of an average transport will turn that 48% into a majoriy # mighty quick

talk about loosing....

this is why i mentioned cost/benift ratio Ridryder911, and if i'm reading you correctly you seem to believe people come first 

so do i btw

the powers that be, namely the brownshoes up the ems ladder don't because they've long been displaced from where the rubber meets the road, and are generally too busy feathering their own carears with self serving changes

~S~


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## Ridryder911 (Jul 15, 2006)

I do understand your point, but be very aware where there is heath care crisis; EMS is part of it. We are in the health care business.. period. 

Actually, rural EMS is not the majority anymore. More and more communities are seeing and realizing that not every town and community will able to have a hospital, clinic, therefore EMS will have to fill that void. This along with the increasing number of responses, and required medical knowledge, is placing a large burden on small, and volunteer agencies, to the point of disbandment. 

Many communities are contracting or mutual aid with larger urban EMS and are just providing First or Initial Response to reduce costs, liability, and maintain their functional level. This appears to be working better and better as time goes.

As far as money goes, yes there is money out there... it all depends on the priorities of the community. Instead of baseball fields, parks, city sponsored parade, EMS may have to be funded. Patients billed appropriately, with received payment. Again, EMS is a health care business... yes, the business is to save lives, but it has to be operated like a business for itself to survive. 

There are no easy answers but, it is not going to get better... wait until about 5 years when the average age of the population age is 65 or >... Communities need to prepare now, it is only going to get worse!....

R/r 911


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## Stevo (Jul 15, 2006)

well one doesn't need to be in ems long to realize the health care crisis Ridryder911

and if the true measure of a nation is how the people fare within it, we're not cutting it are we?

ems used to be called health care's orphaned child, as i'm sure your aware, we didn't warrant much notice, changes happened slowly and when they did it came from the Johnny & Roy's , not bueracrats

not so in today's ems.... 

i see some factions of health care's intervention as just dragging us down with their sinking ship

i say we should distance ourselves from them, for starters any ems orginizations stance should be pro street, (meaning us) instead of boot licking in conventions with the brownshoes

WE should be dictating what levels of education allow for what

WE should be able to lobby for state and federal protocalls

WE should have some control of the streets, because WE know what's best for the people we serve

~S~


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## Firechic (Jul 15, 2006)

I believe that more education will turn our "job" into a profession. We are a part of the medical community, a community that highly values education. I think once we get up to par with that aspect, we will gain more acknowledgment and respect within the medical field. Until then, I think we are still considered "ambulance drivers" by many.


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## Stevo (Jul 15, 2006)

while i agree with the sentiment, i also live in the real world Firechic

let's say they did away with the first responder level tomorrow

how many are left to 'drive the ambulance' ?

~S~


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## Ridryder911 (Jul 15, 2006)

I highly agree with you and part of that comes with removing the mentality of training versus education. To really represent a profession you must have a body to be professionals though. Having texts written at the junior high level and worse yet have to be because the majority of the work force does not have above a sophomore reading level or comprehension. 

Making sure that even entry points have the basic education requirements as any other health care profession has. Basic science, algebra, psychology and college level English composition. This only would not just strengthen our basic level, but as well demonstrate that we can logically represent ourselves. 

I have been Chairperson and set up State and National ad hoc meetings, I can assure you the general educational level of most EMT's is very lacking and has a way to be desired. This is similar to what the nursing profession has to do... prove themselves, not only in the workplace, but having equivalent educational standards as well.

Hopefully with time and encouragement this profession can truly mature.

R/r 911


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## MMiz (Jul 16, 2006)

EMS was initially a reactionary profession.  EMS would respond, follow protocol, and treat what was seen.  They were trained to perform skills, and often performed them with great skill.

More recently we're seeing a move to actually diagnosing and treating a patient, with an EMS professional / medic having additional knowledge and anatomy, physiology, and a better understanding of the medicine of EMS.  

I have a degree in History, Social Studies, and English, and am certified to teach.  This would require 120 credits in college.  I've taken the traditional courses in History, English, Geography, Economics, and Political Sciences, and but also have taken many additional courses.  There was two Math classes, two classes in speech and speech acquisition.  I've taken Geology, Psychology, and Sociology.  I've taken Art History, Biology, and Environmental Sciences.  There there are those four Spanish classes I took, in addition to Linguistics.  These classes have almost nothing to do with _teaching_, but provide a teaching candidate who has a great academic understanding of the world and society.

To be an EMT I took a course to become an EMT.  There was *one day* concentrated on anatomy and physiology in general.  I passed the national registry on my first try.

One of the best Paramedic programs in the state requires:

- EMT-Basic
- Anatomy & Physiology I
- Anatomy & Physiology II
- EMS Communication
- "Paramedic Classes"

Now I understand that there is a lot crammed into the paramedic classes, but I feel like we're lacking.

Where is:
- Psychology and Sociology
- Speech
- Writing courses
- Advanced A & P


I think there is a need for more, but currently the industry/field isn't ready to go in that direction.  There is little money in EMS, and much of the country is still on a volunteer program.  Around here when one uses "career" in front of a title it refers to a FF/Medic working for a municipality.

I believe that EMS is still seen as a splint and transport service.  I can't tell you how many times I've been asked "Will there be someone in the back with him?"  I see a huge part of this as being a general lack of understanding and public education.

I'm not sure I have a solution, but I'd like to see medics gain additional training and knowledge.  I'm not sure how anyone can argue against that.


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## Stevo (Jul 16, 2006)

nobody is going to argue that ems could use an educational tune up Matt

yet as is stands isn't America served by more vollies than anything else?

if not in terms of populance, surely in terms of area served

as such it becomes a choice, *would the general public like less of us that are of a higher caliber, or more of us that are not*

a valid real world Q.....no?

that's the cost/benifit ratio i;ve been asking since you've started this thread, and i'm sorry but i don't see where ems can have it's cake and eat it too 

~S~


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## gradygirl (Jul 16, 2006)

Ok, this may have been posted somewhere else because I remember seeing it.

The title is Fewer Paramedics Means More Lives Saved. So, fewer, more highly trained medics=more patients living.


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## disassociative (Jul 16, 2006)

Take a look: http://www.caems-academy.com/paramediccourses.htm

This is just a random result of a Google search. I feel that Pre-Paramedic
or who knows even Pre-EMT courses(First Responder As Pre-Req would be nice)
should be widely available. For instance; there is Pre-Med, Pre-Nursing, but you 
don't see too much abt Pre-Paramed; isn't EMS just as important?

Also; in regards to raising academic requirements; I think I agree with most
everyone here when I say, "Absolutely".

Also, I ran across this page:

http://www.blinn.edu/twe/mhs/


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## Firechic (Jul 18, 2006)

stevo said:
			
		

> while i agree with the sentiment, i also live in the real world Firechic
> 
> let's say they did away with the first responder level tomorrow
> 
> how many are left to 'drive the ambulance' ?


Perhaps you misunderstood my comment.

Ridryder911 ~ You mentioned that nursing had to still prove itself as a profession. I was under the impression that they have already accomplished this by fulfilling the criteria required of a profession. The history of nursing is similar to that of EMS; however, EMS is still in its infancy by comparison.
I think the biggest detriment to the evolution of prehospital care into a true profession is the attitude of the people who are working in EMS. I know this is a wide generalization, but I have heard more opinions like Stevo's rather than Matt's or Ridryder's.


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## disassociative (Jul 19, 2006)

Ok; let's take this in a slightly different direction:

 Are there any 4 yr (DEGREE not Cert) Paramedic programs offered in your
 areas?


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## Stevo (Jul 20, 2006)

> Perhaps you misunderstood my comment.



no i don't think i did Firechic

while i value education as the crucial element of validating any profession, i also live in the real world

90% of ems calls are a taxi ride, it's the other 10% where we actually make a difference

there is no need for higher levels of intervention for much of what we do, however it would be a good start to _educate the public_ to the value of paramedic intercept for that 10% (actually they get called in more, but turned around)

that would be a worthy and realistic goal for ems, and quite likely a good stepping stone toward what posters in this thread desire

the evolution of ems is going to take time, public awareness would need to be key imho

to legislate overnight requirements would be leaving the system shorthanded, and the brownshoes who have been juggling ciricculums in the recent past have produced just this result

just look at what they've done to the I level.  they obviously haven't had every state on the same page either, have they? individual states are cherrypicking what they'd like, and it's not working too well for us

if ems wishes to progress, WE need to take it back to make these desicions collectively under a realistic orginization that seeks realistic goals

~S~


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## gradygirl (Jul 20, 2006)

Stevo said:
			
		

> 90% of ems calls are a taxi ride, it's the other 10% where we actually make a difference



That's the sad truth. The epidemic in Hartford of "superfluous" calls are made by immigrants who have been under-/mis-informed about how the emergency system is to be used.

A picture on The Lunatick's site drives the point home. Just look at the sign in the window.


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## Firechic (Jul 21, 2006)

> while i agree with the sentiment, i also live in the real world Firechic





> a valid real world Q.....no?





> while i value education as the crucial element of validating any profession, i also live in the real world



Congratulations on living in the real world!
I agree with a few of the previous comments you have made and disagree with the majority; however, it is YOUR opinion and I respect the difference. You and I will not see eye to eye, so please do not patronize my opinion or the "world" I live in. Your assumptions are wrong. 
Please leave it at that, thank you.



			
				disassociative said:
			
		

> Are there any 4 yr (DEGREE not Cert) Paramedic programs offered in your
> areas?


Not a 4 year degree for a bachelors in Paramedicine, but a 2 year associates degree. My state also has Certified Paramedics and Licensed Paramedics. No real difference except in education level.


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## Stevo (Jul 21, 2006)

> Please leave it at that, thank you.



another time, another place , and i'd gladly debate your views Firechic

i'd even buy the first round...

until then we can agree to disagree

peace out

~S~


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## Flight-LP (Jul 21, 2006)

disassociative said:
			
		

> Ok; let's take this in a slightly different direction:
> 
> Are there any 4 yr (DEGREE not Cert) Paramedic programs offered in your
> areas?



Both UT - San Antonio and Texas Tech have bachelor's level degree programs in EMS.............


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## Glorified (Mar 21, 2007)

http://www.smccme.edu/catalog/2006-2007/index.php?section=5&navid=121&docid=320

There's a link to my local paramedic program's curriculum.  It's an Associate in Applied Science deree.  They require 6 months as an EMT-B and 50 documented service calls.  Education is important, and as professionals we should care about it.  If the minimum education level is increased we should be grateful that we are respected more. Compensation should be second on our mind.  It's not like we do it for the money anyways.


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## Stevo (Mar 21, 2007)

> t's not like we do it for the money anyways.



and that statement, *Glorified* is what truely makes us health cares orphaned child...

~S~


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## Glorified (Mar 22, 2007)

Stevo said:


> and that statement, *Glorified* is what truely makes us health cares orphaned child...
> 
> ~S~



My name is irrelevant to that statement.  It is merely a nickname I chose shortened from Glorifiedg, a song from the pearl jam album vs. about americas obsession with firearms.  I was sick of using glorifiedg so i shortened it.  It has nothing to do with my belief in some low pay kind of martyrdom.  

In fact, this wasn't what I was trying to say.  I am just trying to say that yes, education is a good thing, regardless of compensation.  I'm not saying we shouldnt be compensated for higher education, we should.  I just meant that education in and of itself is a good thing.


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## fm_emt (Mar 22, 2007)

Glorified said:


> http://www.smccme.edu/catalog/2006-2007/index.php?section=5&navid=121&docid=320
> 
> There's a link to my local paramedic program's curriculum.  It's an Associate in Applied Science deree.  They require 6 months as an EMT-B and 50 documented service calls.  Education is important, and as professionals we should care about it.  If the minimum education level is increased we should be grateful that we are respected more. Compensation should be second on our mind.  It's not like we do it for the money anyways.



I would like that. Unfortunately the only programs around here are basically "medic mills." :-(


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## Stevo (Mar 22, 2007)

> My name is irrelevant to that statement.



i'm merely addressing you by your handle Glorified



> americas obsession with firearms.



the moderators insist guns have nothing to do with ems , _sorry_....no comment



> I just meant that education in and of itself is a good thing.



yes it is, however i'll add here that _who or what_ entity imparts it is relevant, in Vermont we are seeing a steady increase in courses being rather displaced from the testing being administered.


if any course offered results in a 50% failure rate , including seasoned personel , i'd say it's time to write the legislature 

~S~


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## Glorified (Mar 22, 2007)

Yeah, definitely.  I agree.


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