# Why EMS degree could be the standard come 2025



## Kavsuvb (Dec 3, 2019)

Saw this article and what do ya think. According to the 2009 National Emergency Medical Service Educational Standards, they want to make Paramedic an Associate degree Requirement and those who specialize in Community Paramedic, Flight Medic and Critical care paramedic, get a Bachelor's degree. One quote from the article states " *If we do not change, then we can look to another 50 years of low paying careers with little mobility as other healthcare professionals perform the out-of-hospital clinical tasks we are best suited for."*








						Why a Degree Requirement has Nothing to Do with Old School Medics and Everything To Do with the Future of Out-Of-Hospital Care
					

If we do not change, then we can look to another 50 years of low paying careers with little mobility as other healthcare professionals perform the out-of-hospital clinical tasks we are best suited for



					companycommander.com


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## Lo2w (Dec 3, 2019)

Won't happen if the fire unions have their say.


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## Peak (Dec 3, 2019)

Realistically consider what level of skill needs to be on a transfer bus or fire engine, that is going to be the minimum in the US. 

For better or worse EMS is to a large degree married to the fire service (and there are some benefits). Those that aren't are mostly for profit companies doing close to the minimum to maximize their returns. True third services are rare.

You also have to consider the cost (fiscal, time investment, and so on) versus benefit for the majority of services, especially in rural and low volume areas. Can you realistically support a minimum of associates or bachelors level training in rural America that sees a few calls a month? Can you even keep up training in these areas? Or do you mutual from a farther out service (or contract and provide nothing) delaying transport and definitive care? 

In the ideal world every ambulance would only be called to emergencies and staffed by physicians, nurses, RTs, and paramedics with level one trauma and referral medical experience, but that just isn't reality. Where the compromise ends depends on a lot of factors, but isn't going to be the same across a single state let alone the US.


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## Achilles (Dec 3, 2019)

Lo2w said:


> Won't happen if the fire unions have their say.


FD is hurting enough as it is on members, unless cities are going to pay the extra salary, why get an as in something that's not needed for the job


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## Lo2w (Dec 3, 2019)

Achilles said:


> FD is hurting enough as it is on members, unless cities are going to pay the extra salary, why get an as in something that's not needed for the job



I'm not disagreeing with staffing issues but the attitude that pre-hospital medical staff don't need any more education or a higher degree of education is ridiculous. As was stated earlier, the makeup and support for EMS varies so widely across the US it's hard to imagine how you could realistically change the standards.


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## Kavsuvb (Dec 3, 2019)

Have anyone ever read what the 2009 National Emergency Medical Service Educational Standards are asking and advocating for. 
Here's the link https://www.ems.gov/pdf/National-EMS-Education-Standards-FINAL-Jan-2009.pdf


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## SandpitMedic (Dec 4, 2019)

The repeater is back I see.

NRP should require AAS or AS... then states can choose to stick with NREMT standards or be left in 1969. That solves the issue of the low volume/volunteer rural states and areas if that is the greatest concern. My greatest concern is widening the scope of education (and practice by virtue), doing away with “a pulse and a patch,” and advancing the career.

Additionally, such questionable EMS areas have adequate police and fire coverage. They can figure out how to provide EMS to their communities, and citizens can encourage and vote for change if they want ALS staffed access to EMS. For those that do not have such services, people choose to live that lifestyle knowingly.

I think we have many threads on this topic.


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## FiremanMike (Dec 4, 2019)

Before we blindly say "education is the answer to everything" I think it's time we redefine what our educational pathways are and what we envision our role in the street to be.

I just checked our local Community College EMS degree program and it's primarily the paramedic certification class plus A&P and a handful of general education classes.  Having just finished up gross anatomy (it was not a pre-req for medic school back when I went), I can say that it's overkill for most paramedics.  So this leaves us with a block of gen ed classes which offer little to the day to day practice in America.  If we're going to get serious about this, we need to develop an EMS curriculum that actually contribute to the day to day practice of paramedics in the area.

Next I think we need to take a hard look at actual expectations of paramedics in this country.  Like it or not, in modern EMS most of the calls are non critical in nature and our public expects to be taken to the ER without much debate.  This does not require a degree, and I would agree with what you're naturally thinking "it doesn't require a paramedic either" and I'd agree, but for many areas of the country this is yet another major system overhaul.  

I'm not opposed to a complete overhaul of the system, going back to a true tiered system, and even adding advanced practice providers into the mix.  Don't forget, though, that in this push we'd likely lose a lot of actual paramedic positions across the nation.  While paramedics would likely make more, there would be less, and I think you could argue that overall EMS salary average would actually drop.  

Finally, to the jab at the IAFF as being the stonewall to EMS.  Is it at all possible that it has more to do with a cost/benefit analysis, given the current practice environment, as opposed to just a hatred towards EMS?  Departments in my area can't get enough applicants as it is and are regularly exhausting lists without filling all positions.  It already takes approximately 2-3 years to complete FF-2, EMT-B, and then Paramedic.  Imagine adding 1-2 more years of college level coursework on top of that.  So what about hiring somoene and then sending them to school.. Who pays for their classes?  Who pays for their time off?  I've yet to see a college program that was unit-day friendly (online classes notwithstanding, but online classes aren't for everyone). 

TLR - this issue is FAR more complicated than just "require more education to advance the profession".


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## mgr22 (Dec 4, 2019)

A college education isn't just about matching students to professions; it's also about giving students broad-based knowledge that may help them in ways not known in advance -- e.g., opportunities for advancement, unanticipated career changes, self-employment, etc. It's difficult to do a cost-benefit analysis of such possibilities when the benefits are so varied and speculative. It's also unrealistic, I think, to expect an industry-wide consensus on this matter. 

Each of us gets to decide how to value knowledge. If you don't think it's worth pursuing a degree, you probably shouldn't.


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## Summit (Dec 4, 2019)

@FiremanMike OH NO! THERE MIGHT BE LESS PARAMEDIC POSITIONS IF WE BOOST EDUCATION!

Yes. You are right. Because you don't need every FF to be a Paramedic.

You are right, you don't need 6+ paramedics going to every non-emergent urban BLS call.

You are right, you can't justify more education when that ridiculousness is the FF response model used to justify the mill levy or whatever the FF funding is.

BUT that is just the way IAFF wants it.


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## FiremanMike (Dec 4, 2019)

The decrease in overall paramedic positions was a fraction of my post, but let’s focus only on that teriary point and find a way to turn it into a bash of the FD.


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## FiremanMike (Dec 4, 2019)

Here's an idea, lets turn this thread into a discussion about what education could do to change the overall delivery of EMS in this country.. 
Lets talk about what a good bachelors program in EMS might look like.. 
Lets talk about how to implement these changes in a manner that's realistic in terms of affordability and schedule (an issue that would plague private and third service EMS just as much as FD based EMS) 
Lets remove the fire-medic chip from our shoulder.. 
Just this once?


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## SandpitMedic (Dec 4, 2019)

FiremanMike said:


> Having just finished up gross anatomy... I can say that it's overkill for most paramedics.  So this leaves us with a block of gen ed classes which offer little to the day to day practice in America.


I could not disagree with these statements more.



FiremanMike said:


> Here's an idea, lets turn this thread into a discussion about what education could do to change the overall delivery of EMS in this country..
> Lets talk about what a good bachelors program in EMS might look like..


We were talking about that what an EMS degree might look like, and then you said you think it’s all a waste and overkill. So you contradict yourself.
What’s it going to be? Also, an AS or AAS is not a bachelors degree, and if we want to evolve we have to take all those classes that leave us with “little.” That’s how higher education works in America; we have to play the game.


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## FiremanMike (Dec 4, 2019)

SandpitMedic said:


> I could not disagree with these statements more.



I'm open to hearing why?

As I have said before on this forum - I have a bachelors degree with honors, currently working on pre-requisites for NP school.  While my schooling has helped me immensely in my administrative and teaching roles, I feel they offer little for the day to day activities of a paramedic.  I have stated this repeatedly while also asking repeatedly in these threads for SOMEONE to define how it changes anything about taking care of an ill person at 3am.  I'm actually open to hearing why!  Converse, my brother, stop trying to poke holes!

You can choose to expound on that, or you can "not disagree with these statements more" without qualifying your position, other than the fact that you disagree.



> We were talking about that what an EMS degree might look like, and then you said you think it’s all a waste and overkill. So you contradict yourself.
> What’s it going to be? Also, an AS or AAS is not a bachelors degree, and if we want to evolve we have to take all those classes that leave us with “little.” That’s how higher education works in America; we have to play the game.



I'm really scratching my head at why you're being both aggressive in your stance towards me while at the same time you seem to be making an effort to only responding to snippets of my posts.  I only contradicted myself because you're either refusing or unable to read and digest my entire post before firing off at the keyboard.

What I said was, EMS degrees in their current iteration don't seem valuable to me (and in fact, I was referencing the Community College AAS program, as mentioned).  What I also said is "lets start talking about what a useful EMS degree would look like".  Sorry if I skipped a step and went straight to bachelors.  If you'd like, we can start with what a higher yield AAS degree would look like and then move on to bachelors?


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## Tigger (Dec 4, 2019)

FiremanMike said:


> I just checked our local Community College EMS degree program and it's primarily the paramedic certification class plus A&P and a handful of general education classes.  Having just finished up gross anatomy (it was not a pre-req for medic school back when I went), I can say that it's overkill for most paramedics.  So this leaves us with a block of gen ed classes which offer little to the day to day practice in America.  If we're going to get serious about this, we need to develop an EMS curriculum that actually contribute to the day to day practice of paramedics in the area.


To me those gen ed credits give students the ability to develop study habits, the ability to do a little research, and think critically. All of these are important to pretty much every profession, the same goes for paramedics. Could you get by without, I suppose? Will you see a difference in street level medicine? Maybe? It seems like many paramedics lack the critical thinking skills to appropriately treat patients without formulaic guidelines. Will a switch away from such a model improve care? I don't think we know, and I don't think we even know how to measure improvement at this point?

And frankly, if we practice medicine and are a (smallish) part of healthcare, should we not have similar education programs to the rest of the industry? Every other degreed provider has gen-ed classes, are we different? I am not going to say that those courses make them better providers as a matter of fact. But if we want a seat at the adult's table, it might be worth looking the part. 

As for the A&P part, it would be nice if lower level clinically-oriented anatomy courses existed. I do not wish to get rid of A&P requirements but I agree that the practicality could be improved.


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## Tigger (Dec 4, 2019)

SandpitMedic said:


> I could not disagree with these statements more.
> 
> 
> We were talking about that what an EMS degree might look like, and then you said you think it’s all a waste and overkill. So you contradict yourself.
> What’s it going to be? Also, an AS or AAS is not a bachelors degree, and if we want to evolve we have to take all those classes that leave us with “little.” That’s how higher education works in America; we have to play the game.


This goes for everyone, I am not specifically picking on you:
Instead of pointing out contradictions and making statements, lets have an actual discussion instead of a debate? Let's try to talk like I dunno, people.


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## FiremanMike (Dec 4, 2019)

Tigger said:


> To me those gen ed credits give students the ability to develop study habits, the ability to do a little research, and think critically. All of these are important to pretty much every profession, the same goes for paramedics. Could you get by without, I suppose? Will you see a difference in street level medicine? Maybe? It seems like many paramedics lack the critical thinking skills to appropriately treat patients without formulaic guidelines. Will a switch away from such a model improve care? I don't think we know, and I don't think we even know how to measure improvement at this point?
> 
> And frankly, if we practice medicine and are a (smallish) part of healthcare, should we not have similar education programs to the rest of the industry? Every other degreed provider has gen-ed classes, are we different? I am not going to say that those courses make them better providers as a matter of fact. But if we want a seat at the adult's table, it might be worth looking the part.



Yeah, I suppose I can agree about that benefit of gen-ed classes.  My issue is that of the programs like the one at my local community college is pretty much just the core paramedic certification class, a&p, and then a handful of gen-eds (5ish, maybe?).  So in that case, I'd argue that the AAS really isn't that beneficial.  Maybe if it was intermixed with more courses on actual medical research, public education, something.. I dunno, I just feel it should be more impactful if we're going to move in that direction.



> As for the A&P part, it would be nice if lower level clinically-oriented anatomy courses existed. I do not wish to get rid of A&P requirements but I agree that the practicality could be improved.



Lol you ain't kidding.  I had a discussion with my contact person with the advanced standing medic to RN (still not committed to this, but it will make NP school cleaner, albeit longer).  The college offers both an integrated A&P 1 and 2 course which are designed for healthcare folks, as well as a traditional gross anatomy semester 1, physiology semester 2.  I asked my contact person if I could take the integrated class instead, and she didn't even know it was being taught there (relatively small school, mind you).  When she looked into it, she got back to me and said "No, the RN program only accepts the traditional gross anatomy, physiology series.."


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## VentMonkey (Dec 4, 2019)

I don’t think having and EMS degree has anything to do with what type of service you work for (fire-based, private, public, aeromedical, etc.). At least, not yet; it’s currently a personal choice.

Mandating will take some time and effort. There was a good podcast discussion on this a month or so ago—the 2025 timeline. IIRC, Dave Olvera spoke on it, as he and his cohorts are all in favor and lobbying for it.

I don’t oppose the mandate. I will say, as a current non-degreed “specialty” paramedic (i.e., flight paramedic), it would certainly pique my interest to have a 2, or 4 year degree aimed at topics and applicable to my specific arena of paramedicine.

I agree that it’s hard to fathom how for the “day-to-day medic” the degree currently makes sense. But I can also see how the basic fundamentals that a degree affords can help many who lack intrinsic critical thinking skills.


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## FiremanMike (Dec 4, 2019)

VentMonkey said:


> I don’t think having and EMS degree has anything to do with what type of service you work for (fire-based, private, public, aeromedical, etc.). At least, not yet; it’s currently a personal choice.
> 
> Mandating will take some time and effort. There was a good podcast discussion on this a month or so ago—the 2025 timeline. IIRC, Dave Olvera spoke on it, as he and his cohorts are all in favor and lobbying for it.



I’d love to hear that podcast!  Do you remember where it was?


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## VentMonkey (Dec 4, 2019)

FiremanMike said:


> I’d love to hear that podcast!  Do you remember where it was?


Most likely in one of the three FBE podcasts. It’s essentially an overview of what’s often discussed here rallying for the mandate.

If I find it, I’ll post it.


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## Lo2w (Dec 4, 2019)

VentMonkey said:


> I agree that it’s hard to fathom how for the “day-to-day medic” the degree currently makes sense. But I can also see how the basic fundamentals that a degree affords can help many who lack intrinsic critical thinking skills.



I think any degree for a line medic would have to branch out of the typical trauma and medical care that's currently the curriculum. Those core skills would certainly be the backbone but I think a degree that incorporates elements of mental health and crisis intervention, addiction issues, aging populations, management of chronic illness - to name a few - would go a long way to better addressing the needs of many of our patients.


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## VentMonkey (Dec 4, 2019)

Lo2w said:


> I think a degree that incorporates elements of mental health and crisis intervention, addiction issues, aging populations, management of chronic illness - to name a few - would go a long way to better addressing the needs of many of our patients.


Respectfully, none of those topics interest many in my position who don’t have degrees. The same could be said for EMS management degrees.

They also don’t address the majority of the patients we encounter. How will this benefit our sector, let alone pique our interest long enough to hang in there for the whole two to four years?


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## Lo2w (Dec 4, 2019)

VentMonkey said:


> Respectfully, none of those topics interest many in my position who don’t have degrees. The same could be said for EMS management degrees.
> 
> They also don’t address the majority of the patients we encounter. How will this benefit our sector, let alone pique our interest long enough to hang in there for the whole two to four years?





VentMonkey said:


> Respectfully, none of those topics interest many in my position who don’t have degrees. The same could be said for EMS management degrees.
> 
> They also don’t address the majority of the patients we encounter. How will this benefit our sector, let alone pique our interest long enough to hang in there for the whole two to four years?



Maybe we run in different circles? I'm just pointing out that with changing patient populations those are areas I feel, at least in the areas I've worked, where training/education  has lacked and would be beneficial as part of a degree. As someone else pointed out getting away from a purely protocol driven mindset to having a better understating of the hows and whys with physiology might help improve service as well.


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## VentMonkey (Dec 4, 2019)

Lo2w said:


> Maybe we run in different circles?


Same, but different. What you’re advocating is more along the lines of the day-to-day street paramedic dealings.

It would absolutely have benefited me as a new paramedic. It would more than likely enlighten many new paramedics to be.

My question was more rhetoric than anything.The aeromedical subset has typically  been at the forefront—at least in The States—when it comes to degrees, none of which are aeromedical related.

My question is, what about those who’d be game for a 2, or 4 year critical care driven degree?


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## SandpitMedic (Dec 4, 2019)

Critical care training should be the basis for any Bachelors Degree- if that’s what we’re talking. A&P, pharm, medical terminology, hard sciences, and gen ed for an AS.

Mike, to your point of our specific disagreement, general A&P is not overkill for line paramedics IMO. And general education course factor in as Tigger mentioned.

It isn’t just about what day-to-day utilization of such higher education courses would do. It is about moving the entire profession forward and evolving much like other professions in the healthcare world. The benefit is that we have better educated (generally and medically) line paramedics who will have an expanded and much more rounded knowledge base when treating the 3am granny - or when they are treating us when we are ill  injured...

(Just kidding about that last part, I’ll drive myself to the hospital with one arm before calling 911 😂)

I didn’t mean to come off so strong, but saying higher education is not warranted for line medics are fighting words_. If at the very least_ such education could open doors to paramedics seeking upward mobility and having the background to obtain it, and get out of EMS... then to me it is worth it. Although, there will be other benefits (which I have stated as nauseam in other threads)  to higher education as demonstrated by our colleagues in the healthcare arena.


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## Peak (Dec 4, 2019)

I will say that getting my biology degree did make me a better medic, both on the streets and back at the station. Math classes helped when we were building out apparatus, social arts with dealing with the public, anatomy/phys/pathophys on patients (I took the 400 level classes as well as the standard A&P 1&2). I've seen plenty of medics with a variety of non-EMS/fire degrees that benefited them. 

I do think that there is some fear in the fire service from officers about medics having degrees. I had some officers with masters degrees who were all about us going to school, but we had some officers and chiefs who didn't even have a bachelor's and you could tell that they fely like their leadership was threatened.


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## Bishop2047 (Dec 5, 2019)

Peak said:


> I do think that there is some fear in the fire service from officers about medics having degrees. I had some officers with masters degrees who were all about us going to school, but we had *some officers and chiefs who didn't even have a bachelor's and you could tell that they fely like their leadership was threatened*.



This is one of the major hindrances to any profession that is attempting to bolster credentials, or raise the point of entry. Not only from those in leadership but those with seniority. 

It is as shame and I hope I am never the type that will try to keep others down for my benefit. Call me a wide eyes Newbie (only 9 years in) but I want to do this job for a long time, and want the profession to be in a better place when I leave. 

The argument that class X goes too far in depth and is not applicable to the job, is a silly argument, and will only keep the profession where it is. We encounter all manner of patients and I can never understand someone who says something akin to "Meh my knowledge is good enough".

General Ed classes are great and make you a more well rounded clinician. I took a bunch or nutrition, human resource, and research based classes for my general ed courses. Those most certainly have helped me in my EMS career. 

I live and practice outside the US but in my time there there is no question that this needs to happen, and allowing such low level training to continue only hurts the profession's reputation overall.


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## SandpitMedic (Dec 5, 2019)

Before I say anything (else)- I just wanna sayyyy....
I know this is like... a safe space and all.... but can everyone stop being so sensitive? Or have SJW feelings become so pervasive in EMS that we can’t have a man to man conversation without getting butt hurty. I have spent a lot of time on a rig, and it ain’t no place for the meek or delicate. This is our forum, so neither should it be meek or delicate.

I can take it- just as good as I can give it. We can have a discussion without singing Kumbaya, and every disagreement is not a debate. Anyone who has worked around the rig and the station should know this.

Maybe I’m on my own here in my thinking. I’m okay with that. “Moderation is for Canadians”


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## Tigger (Dec 5, 2019)

SandpitMedic said:


> Before I say anything (else)- I just wanna sayyyy....
> I know this is like... a safe space and all.... but can everyone stop being so sensitive? Or have SJW feelings become so pervasive in EMS that we can’t have a man to man conversation without getting butt hurty. I have spent a lot of time on a rig, and it ain’t no place for the meek or delicate. This is our forum, so neither should it be meek or delicate.
> 
> I can take it- just as good as I can give it. We can have a discussion without singing Kumbaya, and every disagreement is not a debate. Anyone who has worked around the rig and the station should know this.
> ...


Yea, this is the attitude that we are trying to avoid in this forum. It is not social justice to ask for people to just speak with a civil tone, it is common courtesy. Look no farther than facebook EMS pages to see people fling barbs at each other all day long in an attempt to make a point.  If your point is completely lost in your bravado, did you really make a point?

This community is envisioned to function at a higher level than the average page and part of that is speaking to each other with respect.

Also if you don't wish to talk to me, our crew, or patients with respect, you can find your way out my truck too. This whole attitude about EMS being a place for "tough" people is getting old. It isn't helping our staggering mental health issues, that's for sure.


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## SandpitMedic (Dec 5, 2019)

Then as gentlemen, we can disagree.
Here is my counter- Just because I can debate and disagree does not mean it is or has to be rude, disrespectful, or uncivil.

I suppose it is all a matter of perception. One man’s insult is another man’s joke

My perception is the “attitude that we are trying to avoid in this forum” is not congruent with real life. Functioning at a higher level sounds nice, but it’s an EMS forum- not the JPL or Fine Art forum...No one said you have to be a tough guy, just that you don’t have to choose to get offended by everything.

I made a simple post that translates to encouraging people to use their words with logic and rationale instead of emotions and feelings and feeling slighted by being opposed.  Bravado has nothing to do with it.

(And not to toot everyone’s EMS horn, but it does take a special kind of person and mindset to do the things that EMS does, tougher one could say. That doesn’t mean we should ignore the mental health issues plaguing public service [not just EMS]but that is a topic for an entirely different thread).


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## SandpitMedic (Dec 5, 2019)

Also- “functioning at a higher level.” I love the verbiage.  

I find humor in the irony of this being a thread about upping the ante to paramedic education while some are opposed to it.

I mean- aren’t we just trying to function at a higher level around here?


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## jgmedic (Dec 5, 2019)

In the better EMS oriented CA fire depts, degrees are mandatory to promote past Cpt and in some depts to make Cap. It doesn't have to be an EMS or Fire related degree. Higher education is a good thing, and while it may not have a direct effect on your ability to function as a medic, I really feel like it does make you a more well-rounded provider. Funny thing is, a few years ago a dept in NorCal didn't give anyone without minimum a BA a chance at the written test. First time I've ever seen that. not every Fire agency is anti-education, in fact, the better ones are all for it.


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## SandpitMedic (Dec 5, 2019)

Right @jgmedic, higher education is something we should strive for as individuals and as a profession. Some agencies and jurisdictions already acknowledge that. Those departments probably have great paramedics.

I’ll say that I complained about having to do generalEd coursework as well. I found that it eventually paid off in multiple ways... even if I don’t care about Fine Art, Native American Studies, or Intro to Computers... or Algebra...

Additionally, this is how it works. You have to jump through the hoops. We can’t parcel out degrees only for paramedics that aren’t part of the continuum of accredited higher education.


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## Summit (Dec 5, 2019)

Exceptional (fire) agencies are not the problem. 

The problem is they are the exception to the traditional agenda of big status quo players, like IAFF.


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## mgr22 (Dec 5, 2019)

FiremanMike said:


> I have stated this repeatedly while also asking repeatedly in these threads for SOMEONE to define how it changes anything about taking care of an ill person at 3am.  I'm actually open to hearing why!



I realize I'm only addressing a very small part of your post, but since you're asking for an opinion, I'll give you mine.

Around 3AM (and other times), I encountered patients who seemed to enjoy discussing matters that had nothing to do with their illness/injury during transport. The subjects they raised involved other industries (besides EMS), other occupations, history, philosophy, current events, finance, books, movies, personal relationships, science, politics, religion, and probably another half-dozen I've forgotten. I was not an expert on most topics, but my broad-based education -- a requirement of the school I attended -- helped me carry on those conversations and even introduce some of my own thoughts on those matters. The give and take seemed to relax those patients and make them less preoccupied with their medical conditions. I realize none of that is scientific.

At our destinations, I sometimes had the same kind of dialog with doctors, nurses, etc. I'd like to think they helped establish working relationships that were mutually beneficial, although I can't prove it.

I don't think those examples are the best reasons to get a degree, but they might be the best reasons at 3 AM.


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## FiremanMike (Dec 5, 2019)

SandpitMedic said:


> Critical care training should be the basis for any Bachelors Degree- if that’s what we’re talking. A&P, pharm, medical terminology, hard sciences, and gen ed for an AS.
> 
> Mike, to your point of our specific disagreement, general A&P is not overkill for line paramedics IMO. And general education course factor in as Tigger mentioned.
> 
> ...



I envision a degree pathway that sets medics up for the next level.. An educator pathway, an advanced practice provider pathway, or a management pathway.  With that said, I could see the value in a critical care pathway, one that includes advanced physiology courses, clinical rotations with MICU/Rotor, ICU, etc.. One of the semester coursework could be a prep course for the FP-C/CCP exams..  Could be interesting..

I reiterate an earlier comment I made, that we have to get either colleges or management on board with being flexible in scheduling.  My wife is a nurse going back to school and her job didn't give her a whole lot of grief about working around her school schedule.  Historically EMS and Fire/EMS management have little motivation to work around college schedules, and Lab every Monday at 2pm doesn't work for the majority of EMS schedules..


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## SandpitMedic (Dec 5, 2019)

FiremanMike said:


> I envision a degree pathway that sets medics up for the next level.. An educator pathway, an advanced practice provider pathway, or a management pathway.  With that said, I could see the value in a critical care pathway, one that includes advanced physiology courses, clinical rotations with MICU/Rotor, ICU, etc.. One of the semester coursework could be a prep course for the FP-C/CCP exams..  Could be interesting..
> 
> I reiterate an earlier comment I made, that we have to get either colleges or management on board with being flexible in scheduling.  My wife is a nurse going back to school and her job didn't give her a whole lot of grief about working around her school schedule.  Historically EMS and Fire/EMS management have little motivation to work around college schedules, and Lab every Monday at 2pm doesn't work for the majority of EMS schedules..


I like it. I love it. Great idea for degrees and future opportunities. Hopefully, with this kind of educational requirements though, paramedic would not be a stepping stone to other professions, but rather it’s own viable career entity with increased compensation.

The scheduling thing is an interesting take. If you are working as an EMT and want to advance to Paramedic, you already have to take time off and not work through a full time program. (At least when I went to P school that was the case, and working full time wasn’t really an option if you wanted to be successful in the program). I’m picking up that you are talking about people going back to school in a sense; however, any degree mandate implemented would likely be for newcomers. Existing paramedics would be grandfathered in as is the case with most changes in educational standards.


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## Kavsuvb (Dec 5, 2019)

IMO, I think an EMS degree would be a great idea for any Paramedic who wants to specialize in Critical care, Advance practicing Paramedic and Community Paramedic. It would put medics on the same footing with Associate Degree Nurses. The way I would look at it, is look at how LPN's transition to RN as a model for EMS. For example, you can come in with an EMT, get your Paramedic cert and work Street EMS. When you want to Move up into critical care Paramedic or Flight Paramedic, you would need to get an Associates degree. Advance practicing paramedic, Community Paramedic, Emergency Management would be a Bachelors degree requirement.


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## Kavsuvb (Dec 5, 2019)

Tigger said:


> To me those gen ed credits give students the ability to develop study habits, the ability to do a little research, and think critically. All of these are important to pretty much every profession, the same goes for paramedics. Could you get by without, I suppose? Will you see a difference in street level medicine? Maybe? It seems like many paramedics lack the critical thinking skills to appropriately treat patients without formulaic guidelines. Will a switch away from such a model improve care? I don't think we know, and I don't think we even know how to measure improvement at this point?
> 
> And frankly, if we practice medicine and are a (smallish) part of healthcare, should we not have similar education programs to the rest of the industry? Every other degreed provider has gen-ed classes, are we different? I am not going to say that those courses make them better providers as a matter of fact. But if we want a seat at the adult's table, it might be worth looking the part.
> 
> As for the A&P part, it would be nice if lower level clinically-oriented anatomy courses existed. I do not wish to get rid of A&P requirements but I agree that the practicality could be improved.



Question Tigger, would you ever see the day where the states mandate paramedics be at an associate degree level in order to work in the field


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## Tigger (Dec 5, 2019)

Kavsuvb said:


> Question Tigger, would you ever see the day where the states mandate paramedics be at an associate degree level in order to work in the field


Sure, I believe Kansas and Oregon already require this. I really do not think it is an unattainable goal for most states, but there just isn't a want to do it. The National Registry requires you to have gone to a CAAHEP (Commission on Accreditation of Allied Health Education Programs) accredited program and of their requirements is that the programs need to be affiliated with an institution of higher learning (ie community college). So for most folks going to medic school now, they're well on their way to getting an AAS.


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## FiremanMike (Dec 5, 2019)

SandpitMedic said:


> I like it. I love it. Great idea for degrees and future opportunities. Hopefully, with this kind of educational requirements though, paramedic would not be a stepping stone to other professions, but rather it’s own viable career entity with increased compensation.



I’m going to go out on a limb and assume the folks going for the 4 year degree aren’t the ones planning on staying on the line forever, so I don’t personally have a huge aversion to setting them up for other professions, but that probably pulls bias from my own situation of not wanting the fire department to be my terminal career...



> The scheduling thing is an interesting take. If you are working as an EMT and want to advance to Paramedic, you already have to take time off and not work through a full time program. (At least when I went to P school that was the case, and working full time wasn’t really an option if you wanted to be successful in the program). I’m picking up that you are talking about people going back to school in a sense; however, any degree mandate implemented would likely be for newcomers. Existing paramedics would be grandfathered in as is the case with most changes in educational standards.



Yeah, you’re not wrong on any of that.  I’ll again reference my own bias from struggling to complete my bachelors while on company, it took me almost 8 years to get it done (and that was after taking into account the credit for my paramedic and firefighter which I completed 10 years prior to starting back to college)..  I would have jumped all over an easier way to accomplish this..

I don’t have strong feelings one way or the other about grandfathering current medics, but it’s probably the right thing to do.  With that said, if we move towards more robust paramedic education, there would certainly be experienced guys like me and you and probably most of the people on this thread who would love the opportunity to pursue that, only to be frustrated by the scheduling hassle.  I’d love to find a way to accommodate those folks.


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## RocketMedic (Dec 5, 2019)

Nothing changes until financial changes drive change.


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## Peak (Dec 5, 2019)

Kavsuvb said:


> ...It would put medics on the same footing with Associate Degree Nurses.



Keep in mind that in most areas nurses without prior experience are unlikely to get a critical care job (ED/ICU/PICU/NICU...) with only an ASN and not a BSN. In many places new ASN nurses have a hard time finding jobs outside of psych, nursing homes, and home health. There is a lot of regional variability to this, but that's the overall trend.


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## Tigger (Dec 5, 2019)

FiremanMike said:


> I don’t have strong feelings one way or the other about grandfathering current medics, but it’s probably the right thing to do.  With that said, if we move towards more robust paramedic education, there would certainly be experienced guys like me and you and probably most of the people on this thread who would love the opportunity to pursue that, only to be frustrated by the scheduling hassle.  I’d love to find a way to accommodate those folks.


I think that any plan for a degree requirement that doesn't include grandfathering current providers would be met with such outrage that it could never move forward. Incremental steps, right?


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## SandpitMedic (Dec 6, 2019)

Tigger said:


> I think that any plan for a degree requirement that doesn't include grandfathering current providers would be met with such outrage that it could never move forward. Incremental steps, right?


Agree, definitely would be a non-starter.


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## Bishop2047 (Dec 6, 2019)

Tigger said:


> I think that any plan for a degree requirement that doesn't include grandfathering current providers would be met with such outrage that it could never move forward. Incremental steps, right?



I assume we would follow nurses to some extent. Everyone is still a "Paramedic" but slowly over time those with diplomas/certs die off and are replaced with a new bread. It has been this way since days of old when nurses merely had to have a good heart or be a Nun. Unless there is additions to the scope of practice I don't really see any gap training being required either. 

The old guard should welcome these changes as it legitimizes their career more and requires minimal effort.

The big question is what comes first the additional schooling or improved salaries?


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## SandpitMedic (Dec 6, 2019)

FiremanMike said:


> I’m going to go out on a limb and assume the folks going for the 4 year degree aren’t the ones planning on staying on the line forever, so I don’t personally have a huge aversion to setting them up for other professions, but that probably pulls bias from my own situation of not wanting the fire department to be my terminal career...
> 
> 
> 
> ...


I know what you mean. I did a private medic school and went on to get my EMS associates a couple of years later a couple of classes at a time when I realized that I wanted to keep moving. It ended up helping me get through the FP-C self studying and getting a HEMS gig, and furthermore to where I am now.

As far as staying on the line with higher education... I think I would have. I love being a medic. I love the never knowing what’s coming next. I love emergency medicine. I love the camaraderie. I love being outside in the elements on the scene.

I imagine a world where single role professional paramedics have degrees, and they respond to true emergencies where EMTs and AEMT’s (ILS) tackle all of the “Non emergent” and “urgent” calls. A medical professional incorporated into the healthcare continuum as a true professional and not regarded as an ambulance driver. Single role medics that make what fire service medics make nowadays($80k-$150k depending on time in service and rank) at agencies run by municipalities and county governments with their inherent protections. Retirement, vacation, liability insurance, legal protection, and benefits that rival any other in healthcare or public service. No more street posting, no more IFTs, no more stubbed toes, no more fender benders, no more incarceritis. (It’s going to take a revamping of dispatch protocols as well)(I’m fully aware that sometimes those bogus calls turn into true emergencies, but if ALS is needed it can be summoned)
Maybe in fantasy land... I’d still be a line medic.


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## Tigger (Dec 6, 2019)

RocketMedic said:


> Nothing changes until financial changes drive change.





Bishop2047 said:


> The big question is what comes first the additional schooling or improved salaries?


Currently, we are reimbursed as a transportation benefit. Until we are not that anymore, I doubt any payer will have a reason to change what they pay. To provide a service worth reimbursing for (whatever you envision that might be), collectively we are going to have to have more education. So where does this leave us?


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## SandpitMedic (Dec 6, 2019)

Tigger said:


> Currently, we are reimbursed as a transportation benefit. Until we are not that anymore, I doubt any payer will have a reason to change what they pay. To provide a service worth reimbursing for (whatever you envision that might be), collectively we are going to have to have more education. So where does this leave us?


While that does have merit, I would say that when companies like Envision, AirMethods, and other private companies are netting hundreds of millions to billions per year—- there is money to go around. But when you are the Walmart of medical transport you pay Walmart wages. If we could become more than Walmart employees we would force the issues of legitimacy and supply&demand.
That leaves us at upping the education first as you alluded to.


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## Tigger (Dec 6, 2019)

SandpitMedic said:


> While that does have merit, I would say that when companies like Envision, AirMethods, and other private companies are netting hundreds of millions to billions per year—- there is money to go around. But when you are the Walmart of medical transport you pay Walmart wages. If we could become more than Walmart employees we would force the issues of legitimacy and supply&demand.


These are high volume low margin companies. Their revenue might be impressive but their profits are really not for the size. Not to mention that they're owned by investment firm that you know also wants their cut of the profit. 

And again, it's a transportation benefit. EMS is not deemed a provider, which means neither AMR or any other service is being paid what their services are actually worth. I can't really expect AMR to pay more when they are trying to turn a profit in an industry that is known for artifcially low reimbursement.


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## SandpitMedic (Dec 6, 2019)

Tigger said:


> These are high volume low margin companies. Their revenue might be impressive but their profits are really not for the size. Not to mention that they're owned by investment firm that you know also wants their cut of the profit.
> 
> And again, it's a transportation benefit. EMS is not deemed a provider, which means neither AMR or any other service is being paid what their services are actually worth. I can't really expect AMR to pay more when they are trying to turn a profit in an industry that is known for artifcially low reimbursement.


I understand there are many dynamics, but they still net an egregious amount in profits for what they are doing, artificially subdued reimbursement or not.

Meanwhile line people make pennies- for various reasons. There is a business dynamic. I’m not a socialist or communist by any means, so I get that a business will only pay what labor is worth in a given market. BUT KKR’s shareholder earning report for Q3 2019 reports that they are worth $208 billion doll hairs. What is the average annual salary of a paramedic? $34,320 in 2018 according to the Bureau of Labor Statistics.
I get that KKR has a diverse business portfolio. In 2017, Envision posted $5B in earnings.

I’m not an economist- My point is that they are making money... that’s why they are in business. In order for us to get more doll hairs we need to make ourselves worth more.


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## DrParasite (Dec 6, 2019)

jgmedic said:


> In the better EMS oriented CA fire depts, degrees are mandatory to promote past Cpt and in some depts to make Cap. It doesn't have to be an EMS or Fire related degree. Higher education is a good thing, and while it may not have a direct effect on your ability to function as a medic, I really feel like it does make you a more well-rounded provider. Funny thing is, a few years ago a dept in NorCal didn't give anyone without minimum a BA a chance at the written test. First time I've ever seen that. not every Fire agency is anti-education, in fact, the better ones are all for it.


Here is the problem.... you're bringing up a point that is pretty irrelevant.

Mike's article (and the majority of this argument) is for the entry level standard; you are discussing a supervisor position, one that the better EMS agencies are also requiring degrees.  But I will also say that having a degree with 0 experience doesn't mean you have a leg up to be a supervisor; and having a degree might check the HR/job description box but if the degree is in an unrelated field, or you haven't even tried to advance your education in a relevant area since you started, it's pretty much a waste when it comes to that job description.




FiremanMike said:


> Before we blindly say "education is the answer to everything" I think it's time we redefine what our educational pathways are and what we envision our role in the street to be.


I agree.  artificially raising the bar doesn't do much except give more money to the local community colleges.





FiremanMike said:


> Having just finished up gross anatomy (it was not a pre-req for medic school back when I went), I can say that it's overkill for most paramedics.


the current "A&P for paramedics" class is a joke.  some offer it online; most paramedics forget everything they learn about a week after they finish the class.  A&P 1 and 2 (with lab) is one of those classes that definitely should be a pre or co-requisite for any paramedic program.

I was listening to a podcast about paramedic going to medical school, and one of the comments made was that while a paramedic can do more skills (and are often more proficient in them), they don't know nearly enough of the why the stuff is being done.  If we want to stop being thought of as simply skill monkey's, we need to increase our medical education so we can understand why we are doing them.  having a better understanding of anatomy and physiology is one of those core building blocks.


FiremanMike said:


> Yeah, I suppose I can agree about that benefit of gen-ed classes.  My issue is that of the programs like the one at my local community college is pretty much just the core paramedic certification class, a&p, and then a handful of gen-eds (5ish, maybe?).  So in that case, I'd argue that the AAS really isn't that beneficial.  Maybe if it was intermixed with more courses on actual medical research, public education, something.. I dunno, I just feel it should be more impactful if we're going to move in that direction.


I agree.  if you are going to mandate the all paramedics needs degrees, then those degrees should have to be in EMS, and the course curriculum should be focused on EMS, with minimal gen ed classes (those should be pre-reqs)


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## EMDispatch (Dec 8, 2019)

I wanted to add some more food for thought, here are 3  degree outlines:

AAS in EMS


			Acalog&#8482 - Site Unavailable
		


BS in Emergency Health Services (paramedic concentration)








						Coursework
					

EHS PARAMEDIC CONCENTRATION LOWER-DIVISION REQUIREMENTS Emergency Health Services (9 credits required) EHS 115: Medical Terminology EHS 202* Emergency Medical Technician I EHS 203* Emergency Medical Technician II *Current acceptable EMT certification may fulfill these requirements...




					ehs.umbc.edu
				




And a 3 year degree from Canada:





						Paramedic Care (formerly Pre-Hospital Emergency Care) (181.A0) - John Abbott College
					

Students who require a mise à niveau English or French course will be required to pass it before they can take their introductory course. Students will be required to pass... Continue reading



					www.johnabbott.qc.ca
				




For my 2 cents, I appreciate the movement to a degree requirement, but the issue is much bigger.


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## Bishop2047 (Dec 8, 2019)

Most degree programs for Paramedics in Canada are post Diploma (We do not have Associates degrees with the term Diploma used for most 2 - 3 year programs). I was not aware of this school at all being that it is in Quebec (where the french folks live) and MAN that is a lot of classes each semester! Check out the schedule below.






						Paramedic Care (formerly Pre-Hospital Emergency Care) (181.A0) - John Abbott College
					

Students who require a mise à niveau English or French course will be required to pass it before they can take their introductory course. Students will be required to pass... Continue reading



					www.johnabbott.qc.ca
				




These are the more traditional style of Paramedic to BHs programs around these parts. The last showing that many of the community colleges have direct partnerships with other universities. I know this happens often in the US as well.






						Paramedicine | University of Prince Edward Island
					






					www.upei.ca
				









						Paramedic| Medicine Hat College
					






					www.mhc.ab.ca
				









						Joint Programs
					






					www.utsc.utoronto.ca


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## Kavsuvb (Dec 9, 2019)

DrParasite said:


> I was listening to a podcast about paramedic going to medical school, and one of the comments made was that while a paramedic can do more skills (and are often more proficient in them), they don't know nearly enough of the why the stuff is being done.  If we want to stop being thought of as simply skill monkey's, we need to increase our medical education so we can understand why we are doing them.  having a better understanding of anatomy and physiology is one of those core building blocks.
> I agree.  if you are going to mandate the all paramedics needs degrees, then those degrees should have to be in EMS, and the course curriculum should be focused on EMS, with minimal gen ed classes (those should be pre-reqs)



I think, if EMS wants to have a seat at the table with the Adults aka Doctors, Nurses and PA's. Then EMS has to really step up their standards in order to have a seat at the table. Otherwise, we will wind up like CNA's with no future. That would mean phasing out Certificate Paramedic programs and making Paramedic an associate degree requirement. If you want to be a Flight Medic, Critical care Paramedic and Advance practicing Community Paramedic, then it should be mandatory to get a Bachelor's degree. I think the requirements for Paramedic should mirror ADN Nursing school requirements such as A&P 1 & 2, General Chem , Microbiology, Statistics, English Comp Gen Psych, gen Sociology and even Lifespan Development. I also think the Paramedic Degree should Mirror the ADN Program.


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## SandpitMedic (Dec 10, 2019)

Kavsuvb said:


> I think, if EMS wants to have a seat at the table with the Adults aka Doctors, Nurses and PA's. Then EMS has to really step up their standards in order to have a seat at the table. Otherwise, we will wind up like CNA's with no future. That would mean phasing out Certificate Paramedic programs and making Paramedic an associate degree requirement. If you want to be a Flight Medic, Critical care Paramedic and Advance practicing Community Paramedic, then it should be mandatory to get a Bachelor's degree. I think the requirements for Paramedic should mirror ADN Nursing school requirements such as A&P 1 & 2, General Chem , Microbiology, Statistics, English Comp Gen Psych, gen Sociology and even Lifespan Development. I also think the Paramedic Degree should Mirror the ADN Program.


Say it again.


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## DrParasite (Dec 10, 2019)

Kavsuvb said:


> I think, if EMS wants to have a seat at the table with the Adults aka Doctors, Nurses and PA's. Then EMS has to really step up their standards in order to have a seat at the table. Otherwise, we will wind up like CNA's with no future.


What is this table you are referring to?  I hear this a lot, but I think it's a hypothetical concept that many don't really grasp.

In many hospitals, the only way to get a seat at the "table" is to have MD after your name.  Many doctors won't even listen to people who aren't doctors (i know of one attending who actually hung up on a resident from another hospital who was looking to transfer a patient to him).  Not saying it's right or wrong, but all the letter after your name still don't equal MD.  Nurses have clawed their way to that table (and some doctors still don't consider them peers), and have made themselves critical to the healthcare and hospital environment.  But I think that has more to do with making themselves indispensable to hospital operations vs increasing the degree levels. 

In some states  (rhode island comes to mind), the FD unions have more EMS clout than the doctors, yet many of those FFs only have HS diplomas.

If you think having an associate's degree will suddenly make a doctor or nurse look at your differently, than you are fooling yourself.   A Bachelors degree in EMS (which I think all people in specialized medic roles should be required to obtain) won't give you a seat at the table, but it will ensure you have a much deeper understanding of emergency medicine than a simple ambulance driver.  

but you still might not get the respect and seat at the table that you are hoping it will bring.

And until we raise the standards for ALL providers and mandate those changes for EVERYONE, we will still be seen as ambulance drivers.


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## NomadicMedic (Dec 10, 2019)

DrParasite said:


> What is this table you are referring to?  I hear this a lot, but I think it's a hypothetical concept that many don't really grasp.
> 
> In many hospitals, the only way to get a seat at the "table" is to have MD after your name.  Many doctors won't even listen to people who aren't doctors (i know of one attending who actually hung up on a resident from another hospital who was looking to transfer a patient to him).  Not saying it's right or wrong, but all the letter after your name still don't equal MD.  Nurses have clawed their way to that table (and some doctors still don't consider them peers), and have made themselves critical to the healthcare and hospital environment.  But I think that has more to do with making themselves indispensable to hospital operations vs increasing the degree levels.
> 
> ...



It's certainly not hypothetical. There are plenty of jobs that are custom designed for a paramedic that have RN after their name. Including emergency department manager. Emergency services coordinator. EMS outreach and education manager. I can point to a dozen job descriptions on indeed right now for positions that oversee EMS operations and management and require an RN. That should be a degreed paramedic position. 

That is the table we need to sit at.


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## Summit (Dec 10, 2019)

RNs were always indispensable to hospital operations.
RNs are not peers to  MDs, but we are considered colleagues.
RNs used increased education to increase scope, autonomy, and added more professional roles and professional aspects to previously purely vocational roles (e.g., EBP process improvement executed by bedside nurses).

The culmination was increased respect and clout which resulted in increased pay in order to draw enough supply to meet the demand generated for these more educated healthcare professionals.

Remember, in the hospital, education drives scope and then people are trained in the skill with the educational underpinning. Without education, the more educated executor of the complex or merely risky skill will not entrust delegation, because why should they?

EMS was caught in training-drives-scope without education because nobody else will do it. But EMS has hit the scope wall where anything else they might do is met with "that can be done at the hospital by someone with a degree" rather than let someone with a highschool diploma add more skills.

Follow the nursing model and the paradigm shifts.


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## FiremanMike (Dec 10, 2019)

Education without depth isn't going to cut it.  One simply has to look at the nonstop bashing of online NP -> DNP diploma factories to see that.


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## PotatoMedic (Dec 10, 2019)

FiremanMike said:


> Education without depth isn't going to cut it.  One simply has to look at the nonstop bashing of online NP -> DNP diploma factories to see that.


There is a wonderful saying that goes sometimes like this.  If all you do is stare at the tree you will miss the forest.

My point being is look at the bigger picture and stop finding the one example where it doesn't work.  Kid of like you said about the two part series of anatomy and physiology.  Do I use the metabolic krebs cycle at work daily?  No, I think never.  But the class over all does make me a better clinician as I understand the physiology of what is going on better.


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## FiremanMike (Dec 10, 2019)

PotatoMedic said:


> There is a wonderful saying that goes sometimes like this.  If all you do is stare at the tree you will miss the forest.
> 
> My point being is look at the bigger picture and stop finding the one example where it doesn't work.  Kid of like you said about the two part series of anatomy and physiology.  Do I use the metabolic krebs cycle at work daily?  No, I think never.  But the class over all does make me a better clinician as I understand the physiology of what is going on better.



I'm not trying to focus on the tree, but I think DNP is a perfect example of more education doing little to advance the field.  Even a good number of nurses feel that the DNP is an utterly worthless piece of paper.

I am all for education, but I am not for spending tuition dollars just for the sake of spending tuition dollars..  Yes, I understand this is an indictment of the high education system as a whole, but if we're going to shift the paradigm of EMS education, lets make it worthwhile..


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## PotatoMedic (Dec 10, 2019)

FiremanMike said:


> I'm not trying to focus on the tree, but I think DNP is a perfect example of more education doing little to advance the field.  Even a good number of nurses feel that the DNP is an utterly worthless piece of paper.
> 
> I am all for education, but I am not for spending tuition dollars just for the sake of spending tuition dollars..  Yes, I understand this is an indictment of the high education system as a whole, but if we're going to shift the paradigm of EMS education, lets make it worthwhile..


I see your point, and can't think of a great need for a DNP, but I'm also by no means an authority on that.  I still think that the example is irrelevant to the discussion as it is more of an extreme example of education not providing any benefit.  I think if we were saying medics need masters degrees I think it would be relevant, but we're not there yet.

And I agree.  Any change must have a benefit.  As much as I want a bachelors to be the minimum... I think an associate degree is feasible.


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## SandpitMedic (Dec 10, 2019)

FiremanMike said:


> Education without depth isn't going to cut it.  One simply has to look at the nonstop bashing of online NP -> DNP diploma factories to see that.


Apples to oranges. We are not even close to that kind of discussion; light years ahead of yourself on that one. - The debate of NP->DNP is due to DNP being about research and management, not increasing clinical knowledge.

We’re trying to get from vocational medic mill ambulance driver -> AS degree with an emphasis on clinically applicable courses.

The evolution will follow, as @Summit stated.


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## Summit (Dec 10, 2019)

The EMS educational progression is best compared to nursing and the diploma to ADN/BSN progression for RN education.

Focusing on the relative value of current DNP model over MSN is a distraction to a conversation about EMS where textbooks are written at the 10th grade level.


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## FiremanMike (Dec 10, 2019)

I'm sorry if I picked a distracting example, my point was that there already exists educational pathways in healthcare that are quite possibly more about revenue generation than "gaining a seat at the table" and have been shown to add little momentum on that front. 

We should strive to not make EMS degrees like that.


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## DrParasite (Dec 10, 2019)

NomadicMedic said:


> There are plenty of jobs that are custom designed for a paramedic that have RN after their name. Including emergency department manager.


you misunderstood what I said (and I agree with you).  There is 0 reason an RN should be required.  There are plenty of reasons a degreed paramedic should be more than acceptable.  

However, the positions you are describing are supervisory positions, or positions beyond the normal ambulance paramedic.  They typically require education, as well as years of experience.

As I said earlier:


DrParasite said:


> A Bachelors degree in EMS (which I think all people in specialized medic roles should be required to obtain) won't give you a seat at the table, but it will ensure you have a much deeper understanding of emergency medicine than a simple ambulance driver.


And if you want to add degree requirements to any and every EMS supervisory position, lets do it; but that position will require experience too, not just a degree





Summit said:


> RNs were always indispensable to hospital operations.
> RNs are not peers to  MDs, but we are considered colleagues.
> RNs used increased education to increase scope, autonomy, and added more professional roles and professional aspects to previously purely vocational roles (e.g., EBP process improvement executed by bedside nurses).


yes.  They have expanded their roles with added education (which is what EMS should be doing; if you want to be more than just an ambulance driving medic, you need a degree).


Summit said:


> The culmination was increased respect and clout which resulted in increased pay in order to draw enough supply to meet the demand generated for these more educated healthcare professionals.


plus, they unionized...... 


Summit said:


> EMS was caught in training-drives-scope without education because nobody else will do it. But EMS has hit the scope wall where anything else they might do is met with "that can be done at the hospital by someone with a degree" rather than let someone with a highschool diploma add more skills.


sad by true.





Summit said:


> Follow the nursing model and the paradigm shifts.


unless it doesn't, and the  nursing lobby is able to keep EMS from taking on roles that could be held by nurses...


SandpitMedic said:


> We’re trying to get from vocational medic mill ambulance driver -> AS degree with an emphasis on clinically applicable courses.


Except for those who are already certified.... or have been doing the job for years.... and there is no consistency as to what those clinically applicable courses among the community college system... and not EBM that shows that there is a clinical need to raise the education standards for entry level EMS providers.  Fix those 4 problems and I bet you will find a lot more support.


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## SandpitMedic (Dec 10, 2019)

@DrParasite
For clarification and brevity, why are you opposed to AS degree requirements for new paramedics?

Why do you believe there would be no benefit/evolution if the National Registry enacted requirements for all new P certs to have an AAS/AS?


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## DrParasite (Dec 10, 2019)

SandpitMedic said:


> @DrParasite
> For clarification and brevity, why are you opposed to AS degree requirements for new paramedics?


Because it's only for new paramedics.  If the increased education was needed, than the degree requirement should apply to ALL paramedics, so even the old paramedics have to gain the additional knowledge and education to provide better patient care.  Give everyone 5 years (ok, make it 10 years, for the slow people), if not, no more paramedic cert.  aggressive plan, absolutely, but doesn't the public deserve the best?  It's not right to put new requirements on the next generation, but not the us, no, we don't need further education. 

After all, if a new provider earns their paramedic cert today, they can have a 30 year career with only a HS education and a cert.  Lets aggressively raise the standards for the entire industry, because all the smart people say more education is needed.  If that is where the industry is moving to, let's do it for everyone.  don't the patients we treat deserve the best? 





SandpitMedic said:


> Why do you believe there would be no benefit/evolution if the National Registry enacted requirements for all new P certs to have an AAS/AS?


I'm an EBM guy; what evidence shows that an AAS/AS would make a better street medic? higher written scores on the NR-P exam? lower 1st time failure rates on the NR-P exam?  better cardiac arrest save rates when the lead paramedic has an AAS vs a cert only? 

Let's follow the scientific method, since we are looking to prove a fact.  The theory/claim/hypothesis is that a paramedic with a degree is better than one with just a cert.  That's a valid claim.  What research has been done to either prove or disprove the claim?  what data has been gathered to support the claim?  Once this has been obtained, what analysis has been done, based on the objective findings of the data?  And what conclusions can be drawn based on the results of the data analysis?

Before someone says "well, it's obvious, just look at what happened with nurses, it's obvious that this is true," for how many years did we strap every MVC injury to a long hard piece of wood or plastic, because "it couldn't hurt" and "it would prevent them from being paralyzed following the crash" (because it was obviously common sense), and oxygen can't hurt, and not giving it can cause people to die, so everyone gets NRB at 15LPM, unless they can't tolerate the mask, then they get the N/C at 6lpm? after all, it's obviously common sense.

oh, and an AS in whatever (I'd say underwater basketweaving, but someone accused me of hyperbole last time) doesn't make a person a better paramedic.  Make it an AAS in EMS so every class in the degree is focused on making a better clinical provider, just like nursing, and then we are getting somewhere.


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## DrParasite (Dec 10, 2019)

also @SandpitMedic the current "minimum baseline" for paramedic criteria is successful completion of the NR-P psychomotor and written exams.  So in theory, a person can barely skate by on everything else, but the NR-P finals exams evaluate whether or not they are knowledgeable enough to earn their certifications (and it's the same for EMT).   Or you can ace every exam in class, but if you fail the NR exams, than none of the other exams matter; you still aren't a paramedic.

So if I come in off the street, and am able to pass both the exams despite never having attended paramedic school (maybe I went to nursing school, medical school, PA school or just like to read a lot), then I have demonstrated competency at the paramedic level, and should be awarded a paramedic cert. However, if the education is lacking, or the person taking the exam doesn't have the minimum required EMS knowledge, than there should be no way they can pass, nor should they, because they are unable to demonstrated competency at the paramedic level (which is the same reason why their used to be AS PA programs back in the day, a few BS PA program, and now mostly MS PA program; at the end of the day, everyone takes the same PA-C exam).

If cert course students are failing at higher rates then their degree counterparts, than that's a good reason to mandate degrees for everyone.  But simply mandating degrees simply makes a lot more money for the community college system (which is why many in education are pushing for degree programs), and doesn't necessarily result in a better provider (unless you can provide actual research that says otherwise, which I'd love to see)


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## Summit (Dec 10, 2019)

DrParasite said:


> plus, they unionized......


No, really they didn't. Only 20% of RN work for a unionized employer and a large chunk (about half) are fed (VA), which really limits any union power.



> unless it doesn't, and the  nursing lobby is able to keep EMS from taking on roles that could be held by nurses...


There aren't that many jobs that should be degreed medics but are RNs instead, nor are they numerous enough to rankle the RN ranks to view medics as competitors. Mostly this is just flight management, EMS coordination, and EMS quality roles.

RNs are not a primary force retarding EMS advancement unless EMS's goal is to get out of EMS.


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## SandpitMedic (Dec 10, 2019)

DrParasite said:


> Because it's only for new paramedics.  If the increased education was needed, than the degree requirement should apply to ALL paramedics, so even the old paramedics have to gain the additional knowledge and education to provide better patient care.  Give everyone 5 years (ok, make it 10 years, for the slow people), if not, no more paramedic cert.  aggressive plan, absolutely, but doesn't the public deserve the best?  It's not right to put new requirements on the next generation, but not the us, no, we don't need further education.
> 
> After all, if a new provider earns their paramedic cert today, they can have a 30 year career with only a HS education and a cert.  Lets aggressively raise the standards for the entire industry, because all the smart people say more education is needed.  If that is where the industry is moving to, let's do it for everyone.  don't the patients we treat deserve the best? I'm an EBM guy; what evidence shows that an AAS/AS would make a better street medic? higher written scores on the NR-P exam? lower 1st time failure rates on the NR-P exam?  better cardiac arrest save rates when the lead paramedic has an AAS vs a cert only?
> 
> ...


I thought we disagreed on most of this; my question was misspoken. Turns out we agree. We’re both on the same page, almost.

Any degree for EMS should be in EMS/Paramedicine or other BS degrees in hard sciences in which the core prerequisites were met (Bio/Chem/BSN/etc). I do not support unrelated degrees being equal qualifiers either.

The starting point should be either AS or AAS for all new P certs with 4 years for the rest of existing paramedics to obtain one (let’s be real- this implementation, while hypothetical, won’t occur for at least another 3-5 years, so the old timers and opposers have plenty of time to adjust, retire, or leave).

As far as EBM goes, we mostly disagree on that point. A degree is more than just about the medicine. Yes, it makes better clinicians with a more rounded and foundational knowledge base as well as offers critical thinking and life skills. I don’t need a study to tell me that, maybe you do but I think you’ll find you’re in the minority opinion. However, this also gives us standing and credibility in the business world. It is a move forward, not exactly like the nurses, but very similar to them and every other field in clinical medicine. You can say what you want about nursing be unrelated, but is a very very close proxy; I’m sure that nurses back then were doing the same bickering about upping the standards then as we are now. However, it paid off big for them; we should look at their profession as an equal of sorts, but also as a role model. A degree in your field gives more worth, more standing, and more trust than a simple certification card. It is a first step. Rome wasn’t built in a day.

There is more to it, but I wanted to be brief.


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## Carlos Danger (Dec 10, 2019)

DrParasite said:


> What is this table you are referring to?  I hear this a lot, but I think *it's a hypothetical concept that many don't really grasp*.
> 
> In many hospitals, *the only way to get a seat at the "table" is to have MD after your name. * Many doctors won't even listen to people who aren't doctors (i know of one attending who actually hung up on a resident from another hospital who was looking to transfer a patient to him).  Not saying it's right or wrong, but all the letter after your name still don't equal MD.  Nurses have clawed their way to that table (and some doctors still don't consider them peers), and have made themselves critical to the healthcare and hospital environment.  But I think that has more to do with making themselves indispensable to hospital operations vs increasing the degree levels.
> 
> ...



Parasite makes a really good point with this post. I couldn't agree more.




NomadicMedic said:


> It's certainly not hypothetical. There are plenty of jobs that are custom designed for a paramedic that have RN after their name. Including emergency department manager. Emergency services coordinator. EMS outreach and education manager. I can point to a dozen job descriptions on indeed right now for positions that oversee EMS operations and management and require an RN. That should be a degreed paramedic position.



I know it's not the point here, but there's no way that a paramedic has any business working as an ED manager. Not any more than an RN does working as Director of Operations for an EMS agency, anyway. 

I have seen non-RN's do a fine job in roles such as the other two mentioned several times. It just depends on how the job descriptions are written and the background of the individual doing the job. Hospitals _typically_ hire nurses into positions like that because they are familiar with the education and skill set of RN's, not because either an RN license or experience is necessary. And, quite frankly, because hospital administrations tend to be biased in favor of RN's if not completely unaware of paramedics. None of that will change if every paramedic on the street suddenly has an associate or baccalaureate education.


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## Tigger (Dec 10, 2019)

SandpitMedic said:


> As far as EBM goes, we mostly disagree on that point. A degree is more than just about the medicine. Yes, it makes better clinicians with a more rounded and foundational knowledge base as well as offers critical thinking and life skills. I don’t need a study to tell me that, maybe you do but I think you’ll find you’re in the minority opinion. However, this also gives us standing and credibility in the business world. It is a move forward, not exactly like the nurses, but very similar to them and every other field in clinical medicine. You can say what you want about nursing be unrelated, but is a very very close proxy; I’m sure that nurses back then were doing the same bickering about upping the standards then as we are now. However, it paid off big for them; we should look at their profession as an equal of sorts, but also as a role model. A degree in your field gives more worth, more standing, and more trust than a simple certification card. It is a first step. Rome wasn’t built in a day.


I feel this completely. I really don't think you'll see a huge increase or improvement in care as a result of more degreed providers. That's not why I support it though. If you want a seat at the big kids table, act the part. I understand that others disagree with this. I think having degreed providers might affect reimbursement down the line as well, which is an important aspect of "sitting at the table." Doctors might not respect us, but it go a long way if CMS paid us. 

I hope someday that the current paramedic scope of care of is restricted to providers with an expanded EMS specific education and we go to a more Canadian/AUS/NZ scope of practice with "paramedics" who can handle 80-90% of calls on their own. The last ~10% is the responsibility of degreed (4+ years) "intensive care paramedics."

A New Zealand Paramedic has a three year degree that we could consider to be a bachelor's. Their formulary is about 20 medications and they do not intubate (just for example's sake, there are other differences). Yet they probably understand medicine to a greater degree than our less than AAS credentialed paramedics do, despite a much broader (and frankly riskier) scope.


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## SandpitMedic (Dec 11, 2019)

So the consensus is we should implement degrees.

Now let’s talk solutions, how do we get this ball rolling?


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## DrParasite (Dec 12, 2019)

SandpitMedic said:


> So the consensus is we should implement degrees.
> 
> Now let’s talk solutions, how do we get this ball rolling?


I believe the consensus is that the field can benefit from increased education for all provider, with the goal being a degree that increases the medical knowledge of the provider.... which is slightly different than a simple "we should implement degrees."

You want my solution?  every current paramedic has 5 years to get an AAS in EMS degree.  Make it 10 if you want.  no exceptions for any other degree.  The reason being if the degree is so focused on EMS, and EMS specific than Nurses, doctors, chemists, biologists, etc, would not have the EMS specific academic education to meet the degree requirements.  Their pre-req classes (psych, a&p, sociology, microbiology, early childhood development, etc) could be used, but the EMS specific classes (like rescue scene management, community paramedicine in EMS, EMS in unusual conditions, or whatever the course requirements are, etc) need to be taken.  Just like nursing.  the standards would raise for everyone; if you don't like it, you expire after 5 or 10 years.  and if you do have an advance degree, or advance medical training, than the EMS specific classes should be a breeze for you.  and if you chose not to get the EMS degree, than thank you for your service, and enjoy your retirement. or maybe your job is management enough or not clinical enough where a valid paramedic cert is required (think EMS manager where MPA or MBA is more important than clinical skill, or EMS educator where MS or PhD with EMS history is more valuable than a currently valid EMS cert).

The reality is the implementation will need to start at the top, where EMS executives will need to complete their AAS in EMS, and mandate their senior EMS managers and supervisors do the same.  They also need to stop hiring paramedics who only have a cert, not a 2 year EMS degree, to demonstrate that the market has restricted the cert only market, as well as pay the degree holders more to demonstrate financially how the degree is a worthwhile investment.  And in 5 or 10 years, you don't have any paramedics without an associates in EMS, and the bar will be raised for the entire industry.

we also need to be realistic: raising the bar won't gives our industry more respect.  there is no guarantee we will get more funding from CMS.  the public will still see us as simply ambulance drivers.  some people will still use EMS as a stepping stone to another career.  the fire service will fight it tooth and nail, because, despite 80% of their job being EMS, they only want to spend 20% of their time and funding on EMS.  and yes, some dumb people will still find a way to fall through the cracks and become paramedics, which should both scare and embarrass most of us. But raising the bar will increase the level of education and clinical knowledge that we will be able to deliver to the general public.


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## mgr22 (Dec 12, 2019)

When I was in the corporate world, I don't remember degrees being required by anyone except employers. There was no national deadline for, say, managers or planners or marketers to have degrees. And most technical fields didn't have organizations mandating degrees for their members.

Employers set standards based on supply and demand. For example, when there were enough degreed engineers to ensure every engineer-like position could be filled by college graduates, employers made it so. It was up to prospective employees to satisfy prospective employers' prerequisites.

I don't think EMS will be any different. Right now there are more paramedic jobs than degreed paramedics (I assume), so degrees aren't required by most agencies. Perhaps that will change someday. Meanwhile, it's up to individuals to judge the value of higher education without guarantees of placement or payback.


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## VentMonkey (Dec 12, 2019)

Great discussions as usual when it comes to the professional growth of our field.

Maybe I need to be _forced_ to complete my associates degree, I don’t know. I do know I like the idea of an EMS-focused degrees, especially for those who have done this long enough to know they’re most likely not going to do something else career-wise.

Creating degree paths for people such as myself who don’t feel obligated to complete a bachelors in something such as EMS management would be nice.

Lets face it, not all career paramedics are cut out, nor desire to affect change via managerial or supervisor roles.

The EMS management bachelors is about the only online bachelors degree readily available for working stiffs with a family and a mortgage such as myself. Sure it may be an excuse, but it’s a valid one.

Why would I invest 4 years of my life for something of little interest to me?

I also can’t imagine I am the only paramedic who enjoys learning more about their respective sub-specialty but has yet to see a degree pathway for it.

Will their advancement in the field be limited beyond their major? Maybe, but like mentioned above, it’s ultimately up to the individual what that education is worth to them personally.


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## SandpitMedic (Dec 12, 2019)

NAEMT, IBSC, IAFCCP, and other professional organizations as well as you and I have to lobby for the NREMT to implement an EMS AAS requirement for new and continued certification. It will be much easier to get industry leaders and the single national credentialing body (in a sense) to do something rather than an untold number of employers. That’s the best strategy in my opinion.


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## mgr22 (Dec 12, 2019)

SandpitMedic said:


> It will be much easier to get industry leaders and the single national credentialing body (in a sense) to do something rather than an untold number of employers.



I agree, but to what end? Suppose the NREMT says a degree is required. Implementing that wouldn't be quick or easy. Wouldn't lots of medics simply pass on NREMT certification, rather than invest time and money in more schooling?

Maybe higher education, like religion, isn't supposed to be mandated by anyone. I mean, how do you force people to learn -- or to have faith?


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## DrParasite (Dec 12, 2019)

SandpitMedic said:


> NAEMT, IBSC, IAFCCP, and other professional organizations as well as you and I have to lobby for the NREMT to implement an EMS AAS requirement for new and continued certification. It will be much easier to get industry leaders and the single national credentialing body (in a sense) to do something rather than an untold number of employers. That’s the best strategy in my opinion.


until you realize that the IAFF, IAFC, and every other hose handling department and hose supporting union would lobby against it.  Also don't forget, the fire service is the largest provider of EMS in the US (at least according to the National EMS Assessment).

Don't get me wrong, I'm not saying it shouldn't happen, and it would be the most efficient way to implement this change for all new hires, however there are a few HUGE hurdles to overcome (namely the fire service and all of their public supporters and lobbyists).  it's easier to start locally, where you have more pull, vs starting nationally and fighting those groups that don't want there to be any degree requirements, because it's not a primary responsibility of their organization.


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## Summit (Dec 12, 2019)

In nursing the change came when professional organizations pushed degrees, students sought degrees, enough of the hiring pool had degrees, that ultimately the employers gave preferential clinical placement spots to students in degree programs, and then preferentially hired degreed RNs, and ultimately started requiring degrees with expectations for non-degreed RNs to get degrees. This cycle is repating in the motion towards BSN as entry level, and it is the de facto standard in many markets.

That model may not work for EMS because of the reasons that DrParasite points out: Fire Services are the primary employer of medics and the primary opposition to degrees as a medic standard. The opposition is entirely about model: is EMS public safety vs healthcare?


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## FiremanMike (Dec 12, 2019)

Interesting side note, as I continue workign towards RN/NP, any college class I take that is patient care related is approved by my state as 3 hours per week per credit hour towards continuing education.  My 10 week accelerated microbiology class (4 semester hours) counts as 120 hours of continuing ed.. 

I'm going to try to get 1,000 hours towards this cycle 🤣


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## FiremanMike (Dec 12, 2019)

DrParasite said:


> until you realize that the IAFF, IAFC, and every other hose handling department and hose supporting union would lobby against it.  Also don't forget, the fire service is the largest provider of EMS in the US (at least according to the National EMS Assessment).
> 
> Don't get me wrong, I'm not saying it shouldn't happen, and it would be the most efficient way to implement this change for all new hires, however there are a few HUGE hurdles to overcome (namely the fire service and all of their public supporters and lobbyists).  it's easier to start locally, where you have more pull, vs starting nationally and fighting those groups that don't want there to be any degree requirements, because it's not a primary responsibility of their organization.



It comes back to the IAFF a lot.. Serious question - can anyone provide any documented evidence of the IAFF fighting education requirements?  I'm not saying they aren't, but I haven't seen it around here..  Heck, in this area, there are several departments that require degrees in order to promote, there are also departments across the nation that require college credit to even apply.  I don't think this would be a thing if the IAFF were so aggressively anti-education as it is portrayed here..

In my state, it is historically the volunteer fire chiefs who fight education changes "this is going to cost me a fortune" or "I'll lose all my manpower", as opposed to the IAFF..


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## Lo2w (Dec 12, 2019)

FiremanMike said:


> It comes back to the IAFF a lot.. Serious question - can anyone provide any documented evidence of the IAFF fighting education requirements?  I'm not saying they aren't, but I haven't seen it around here..  Heck, in this area, there are several departments that require degrees in order to promote, there are also departments across the nation that require college credit to even apply.  I don't think this would be a thing if the IAFF were so aggressively anti-education as it is portrayed here..
> 
> In my state, it is historically the volunteer fire chiefs who fight education changes "this is going to cost me a fortune" or "I'll lose all my manpower", as opposed to the IAFF..











						IAFC, IAFF, NFPA, NVFC oppose required degrees for medics
					

In a joint statement, four national organizations state the reasons they oppose requiring college degrees for entry-level paramedics




					www.firerescue1.com


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## PotatoMedic (Dec 12, 2019)

Their recent position papers I think are the clearest example of them fighting degrees for people in EMS.  I find the hypocrisy funny when they're actively promoting degrees in firefighting.  But degrees in fire science panders to their base so it makes sense.


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## Summit (Dec 12, 2019)

PotatoMedic said:


> Their recent position papers I think are the clearest example of them fighting degrees for people in EMS.  I find the hypocrisy funny when they're actively promoting degrees in firefighting.  But degrees in fire science panders to their base so it makes sense.


I think it is because many/most of them think of EMS as something they took over as a secondary purpose and as a financial stream. Fire first, EMS second. Pushing EMS degrees takes away from the Fire first focus.


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## SandpitMedic (Dec 12, 2019)

Well. It will be an uphill battle. However, the EMS organizations and specifically the NREMT are not beholden to the fire unions.

To a question posed asking why the NREMT should do it... Virtually every state requires NREMT registration and “certification” for state certification (at least initially). It is the only metric utilized to demonstrate proficiency in paramedic competencies and skills in the majority of markets.

The fire unions can be vehemently against it all they want. If they can sway their state legislators to do away with NREMT requirements for certs and rebuild a new system and metric... more power to them. But it’s going to cost them.


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## mgr22 (Dec 13, 2019)

SandpitMedic said:


> To a question posed asking why the NREMT should do it... Virtually every state requires NREMT registration and “certification” for state certification (at least initially). It is the only metric utilized to demonstrate proficiency in paramedic competencies and skills in the majority of markets.



It's true national registry is required for initial certification in most states. I wonder how that would change if a degree were added to the prerequisites. I think there'd have to be some sort of waiver process to prevent a dramatic reduction in the labor pool.

I really hope you're right and I'm wrong about this whole degree thing, but there are so many special interests, and EMS seems very far from a consensus. For now, I think soft-selling the value of knowledge is a better use of resources than forcing people to get more education.


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## Carlos Danger (Dec 13, 2019)

mgr22 said:


> When I was in the corporate world, I don't remember degrees being required by anyone except employers. There was no national deadline for, say, managers or planners or marketers to have degrees. And most technical fields didn't have organizations mandating degrees for their members.
> 
> Employers set standards based on supply and demand. For example, when there were enough degreed engineers to ensure every engineer-like position could be filled by college graduates, employers made it so. It was up to prospective employees to satisfy prospective employers' prerequisites.
> 
> I don't think EMS will be any different. Right now there are more paramedic jobs than degreed paramedics (I assume), so degrees aren't required by most agencies. Perhaps that will change someday. Meanwhile, it's up to individuals to judge the value of higher education without guarantees of placement or payback.



Good point, and I would always rather see required education levels be dictated by the market rather than bureaucratic fiat.

However, in engineering and most other corporate world professions that I can think of off the top of my head, no sort of licensure is required, leaving required qualifications to be determined solely by the employer. 

Healthcare is very different in that we need permission from our governmental overlords to practice our profession, and one of the requirements to even apply for that permission (license) is typically completion of an educational program that the educational industry (and other interested groups) has convinced the state government is necessary in order to keep competition at bay ensure competence.

It may be surprising to many in this discussion to learn that, for all the growth in opportunity and influence that the nursing field has seen over the past decades, most states have only somewhat recently gotten around to requiring degrees of any kind of RN's. Quite a few states still don't require a degree to apply for RN licensure, and many that do, haven't for very long. 

The best way to advance education in EMS is just to walk the walk. Earn a related degree - preferably an EMS specific one. Encourage others to do the same. Encourage employers to incentivize higher education. And stay involved in EMS. It took nursing a long time to reach a point where a degree was the standard, and it will take EMS a long time. It may take EMS even longer, and EMS may never look just like nursing in terms of the educational model. Paramedicine in the US might never look like it does in Australia. 

I also think we oversell the importance and benefit of college degrees. Initial education for paramedics definitely needs improvement, and I think an associates degree program as the entry-level course makes sense. But if every paramedic in the US earned a degree next year, not much would change. Pay would not skyrocket. Scope of practice wouldn't change. New roles would not instantly be invented. And the proverbial "seat at the table" is largely a myth. 

If every paramedic earned a degree next year, not a lot would change immediately, but it would be good for the profession in many ways. More importantly, it would be good for the individuals in the profession.


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## FiremanMike (Dec 13, 2019)

Remi said:


> I also think we oversell the importance and benefit of college degrees. Initial education for paramedics definitely needs improvement, and I think an associates degree program as the entry-level course makes sense. But if every paramedic in the US earned a degree next year, not much would change. Pay would not skyrocket. Scope of practice wouldn't change. New roles would not instantly be invented. And the proverbial "seat at the table" is largely a myth.



I do believe that A&P is a pre-req to get into medic school now (it wasn't when I went).  At this point, with the paramedic class being longer than it was when I went, you almost have an AAS just between EMT-B, A&P, and the paramedic class alone..


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## FiremanMike (Dec 13, 2019)

Lo2w said:


> IAFC, IAFF, NFPA, NVFC oppose required degrees for medics
> 
> 
> In a joint statement, four national organizations state the reasons they oppose requiring college degrees for entry-level paramedics
> ...



I wasn't aware that occurred, thanks for posting it.

With that said, is what they concluded really any different than what folks have been saying in this thread?


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## FiremanMike (Dec 13, 2019)

Anecdotally - most of the departments in my area offer pretty liberal tuition reimbursement.  Speaking personally, my chief has been pretty flexible about my college schedule..


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## DrParasite (Dec 13, 2019)

FiremanMike said:


> It comes back to the IAFF a lot.. Serious question - can anyone provide any documented evidence of the IAFF fighting education requirements?  I'm not saying they aren't, but I haven't seen it around here..  Heck, in this area, there are several departments that require degrees in order to promote, there are also departments across the nation that require college credit to even apply.  I don't think this would be a thing if the IAFF were so aggressively anti-education as it is portrayed here..


the IAFF and most FDs are finally coming around to the idea that their leaders should have degrees..... for decades it's just been time on the department and OJT... you can't deny that...

However, the topic that you are describing is the mandate of a degree to get promoted, not to get hired as an entry level position.  those are two different times in a person's career, with the only thing they have in common is a degree is required.  The fire service as a whole is (finally) recognizing that their leaders needs bachelors degrees and masters in PA or BA to run a large organization, but there are still plenty that are only asking for experience and a HS diploma.  But if you need to be a paramedic, they are fighting that push to mandate associates degrees, because it 1) they are fire departments, and paramedicine is just an ancillary service that they provide and 2) many in the fire service (not you specifically) would give up EMS and their paramedic certs tomorrow if they could, because they have no desire to do EMS for the rest of their career.


FiremanMike said:


> In my state, it is historically the volunteer fire chiefs who fight education changes "this is going to cost me a fortune" or "I'll lose all my manpower", as opposed to the IAFF.


that's a different topic altogether, although I will say that often fight those changes because the education before forced on them isn't always entry level stuff.  But if they can't handle the new requirements, thank them for their service, have them enjoy their retirement, and bring in someone who will do it.

and if the fire service doesn't want to mandate degrees for paramedics, than it's time to thank them for their service, create a new government funded agency that is ready to walk the walk (and reallocate the funding to the new EMS department to handle EMS from the department that used to do EMS), and raise standards to a level that the public deserves.


FiremanMike said:


> I do believe that A&P is a pre-req to get into medic school now (it wasn't when I went).


it is, sort of.  all medic programs require some form of A&P. All too often this is A&P for EMS, possibly held online, not a full 8 credit college level anatomy and physiology, with lab, where students are educated and evaluated by non-EMS instructors.





FiremanMike said:


> At this point, with the paramedic class being longer than it was when I went, you almost have an AAS just between EMT-B, A&P, and the paramedic class alone..


not even close.  As associates degree is 60 credit hours.  EMT class is 8 credits (2 days a week, for a semester, from 6pm to 10pm).  A&P  is 8 credits (4 for part 1, 4 for part 2, including lab).  Assuming paramedic is two 4 hour days a week for 12 months, that is 24.... add another 6 for clinical time, and you are are at 46 credits... still 14 short of an associates degree, almost 25% short for a full degree (and most paramedic programs don't require college level A&P with lab).


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## SandpitMedic (Dec 13, 2019)

Good ideas coming out. Many who want the same thing with different paths to get there.


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## SandpitMedic (Dec 13, 2019)

DrParasite said:


> An associates degree is 60 credit hours.  EMT class is 8 credits...A&P  is 8 credits .... plus paramedic.....still 14 short of an associates degree, almost 25% short for a full degree.


I snipped the quote for brevity, and while different colleges have slightly different degree requirements- this math adds up.
When I went back for my degree I had to get exactly 15 credits, which is five 3 credit courses of general ed. (English/math/IT/biology/psychology).

It wasn’t hard. Anyone can do it, it’s just a matter of actually doing it. You just have to find a school that will give you credit for your EMT/paramedic certs and schooling. I did it in 2016 and it cost me around ~$1200.

To the argument that it thins the labor pool- that is one of the desired effects I’d like to see.


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## VentMonkey (Dec 13, 2019)

SandpitMedic said:


> To the argument that it thins the labor pool- that is one of the desired effects I’d like to see.


I read this as more of a point than an argument.



SandpitMedic said:


> When I went back for my degree I had to get exactly 15 credits, which is five 3 credit courses of general ed. (English/math/IT/biology/psychology).
> 
> It wasn’t hard. Anyone can do it, it’s just a matter of actually doing it. You just have to find a school what will give you credit for your paramedic certs.


You’re right, it really isn’t. I have no rebuttal here. 

Also, one click of the mouse and you can find a handful of online degrees both associates and bachelors that allow licensed paramedics to utilize their card as a good amount of credit hours that counts towards the degree.


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## SandpitMedic (Dec 13, 2019)

VentMonkey said:


> I read this as more of a point than an argument.
> 
> 
> You’re right, it really isn’t. I have no rebuttal here.
> ...


Exactly. They’re out there. Get it now while it’s cheap.

To the thinning the herd thing- I meant it was brought up as though it is a problem for FDs to get on board with entry level degree requirements. I concur, but it is a manufactured problem. We all know we don’t need 6 paramedics showing up on scene.


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## FiremanMike (Dec 13, 2019)

DrParasite said:


> the IAFF and most FDs are finally coming around to the idea that their leaders should have degrees..... for decades it's just been time on the department and OJT... you can't deny that...
> 
> However, the topic that you are describing is the mandate of a degree to get promoted, not to get hired as an entry level position.  those are two different times in a person's career, with the only thing they have in common is a degree is required.  The fire service as a whole is (finally) recognizing that their leaders needs bachelors degrees and masters in PA or BA to run a large organization, but there are still plenty that are only asking for experience and a HS diploma.  But if you need to be a paramedic, they are fighting that push to mandate associates degrees, because it 1) they are fire departments, and paramedicine is just an ancillary service that they provide and 2) many in the fire service (not you specifically) would give up EMS and their paramedic certs tomorrow if they could, because they have no desire to do EMS for the rest of their career.



Yeah, I don't really have much of an argument with this..



> it is, sort of.  all medic programs require some form of A&P. All too often this is A&P for EMS, possibly held online, not a full 8 credit college level anatomy and physiology, with lab, where students are educated and evaluated by non-EMS instructors.not even close.  As associates degree is 60 credit hours.  EMT class is 8 credits (2 days a week, for a semester, from 6pm to 10pm).  A&P  is 8 credits (4 for part 1, 4 for part 2, including lab).  Assuming paramedic is two 4 hour days a week for 12 months, that is 24.... add another 6 for clinical time, and you are are at 46 credits... still 14 short of an associates degree, almost 25% short for a full degree (and most paramedic programs don't require college level A&P with lab).



I mean, 14 credits is 3-4 classes.  1 semester full time or 2 part time..


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## DrParasite (Dec 13, 2019)

SandpitMedic said:


> It wasn’t hard. Anyone can do it, it’s just a matter of actually doing it. You just have to find a school that will give you credit for your EMT/paramedic certs and schooling. I did it in 2016 and it cost me around ~$1200.


That's my point exactly.  It's not hard to do, unless you don't want to do it.  the college level A&P courses are probably the toughest and most time consuming part, but the reality is, if the current providers don't know it, than it's good that they learn it, and if the current providers know it, than it would be a breeze for them.

Just picking on NC, here are the requirements from Carroll CC, with the NRP ones being taken care of by having an NRP cert











						Emergency Medical Science (EMS) Bridging – Coastal Carolina Community College
					






					www.coastalcarolina.edu
				








						Paramedic, National Registry Paramedic AAS
					






					www.carrollcc.edu
				








						Emergency Medical Science Bridge Program
					

The Emergency Medical Science Bridge Program is designed to allow currently certified non-degree paramedics to earn an Associate in Applied Science (A.A.S.) degree in Emergency Medical Science.




					www.abtech.edu
				





It's not ridiculously hard, the schools are working with existing people (and I'm sure some places could even find an online program), but you need to be willing to put forth the effort to get it done.  And the other courses are all there to make you a better provider and ensure that you meet the new paramedics standards.  So if we are going to require this of the next generation, shouldn't the existing generation also step up and raise the standards, and show the new guys how it should be done?


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## SandpitMedic (Dec 13, 2019)

DrParasite said:


> That's my point exactly.  It's not hard to do, unless you don't want to do it.  the college level A&P courses are probably the toughest and most time consuming part, but the reality is, if the current providers don't know it, than it's good that they learn it, and if the current providers know it, than it would be a breeze for them.
> 
> Just picking on NC, here are the requirements from Carroll CC, with the NRP ones being taken care of by having an NRP cert
> View attachment 4695
> ...


Well. I did. Others here also did. I’m a recipient and an advocate for upping the Ed.
There are options; heck, someone even said it would be good for them to be forced to get a degree.
Good finds for those in NC.


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## VentMonkey (Dec 13, 2019)

Where would this put the basics? Are we strictly focusing on the paramedics for now?


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## mgr22 (Dec 13, 2019)

VentMonkey said:


> Where would this put the basics? Are we strictly focusing on the paramedics for now?



I was thinking EMT certification could be part of a two- or four-year degree in a related field -- e.g., public health, athletic training -- rather than the endpoint of an EMS-focused curriculum.


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## DrParasite (Dec 13, 2019)

that's a completely different argument.  this change has been pushed for paramedics; changing the EMT curriculum would be a thread in and of itself.


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## SandpitMedic (Dec 13, 2019)

Agree with the above. This topic is about paramedic thresholds.
 Basic is basic.


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## RocketMedic (Dec 13, 2019)

The only way to compel increased educational requirements is to tie education to reimbursement. Convincing CMS and major payors to require a degree as a condition of ALS payment would be the most realistic and direct way to get that result.


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## PotatoMedic (Dec 14, 2019)

RocketMedic said:


> The only way to compel increased educational requirements is to tie education to reimbursement. Convincing CMS and major payors to require a degree as a condition of ALS payment would be the most realistic and direct way to get that result.


The good news is that since most major payers follow CMS with billing requirements we just have to convince CMS.  I think with the ET3 we have a chance to say only xyz educated paramedics are able to decide on alternate destinations or treat and release and bill for that care.


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## Carlos Danger (Dec 14, 2019)

RocketMedic said:


> The only way to compel increased educational requirements is to tie education to reimbursement. Convincing CMS and major payors to require a degree as a condition of ALS payment would be the most realistic and direct way to get that result.





PotatoMedic said:


> The good news is that since most major payers follow CMS with billing requirements we just have to convince CMS.  I think with the ET3 we have a chance to say only xyz educated paramedics are able to decide on alternate destinations or treat and release and bill for that care.



Except this would never happen because, 1) you are going to need a VERY compelling justification (dramatically improved outcomes and/or dramatically lower costs) in order to get CMS to even consider such a sweeping change to their reimbursement rules, which would never happen because 2) CMS would have to increase their reimbursement significantly under such a requirement in order to even keep EMS agencies open, and 3) every single EMS agency and organization in the county would file class action lawsuits against it.

There is a whole lot of crap that can be said about it, but CMS as an agency _has_ done a pretty solid job of not allowing itself to be politicized and used as a means of enforcing agendas such as this one. Thankfully.


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## SandpitMedic (Dec 14, 2019)

I agree with Remi. 
Changes to CMS, on top of what he said, is like moving a mountain. I maintain it should come from the NREMT.


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## MackTheKnife (Dec 14, 2019)

Achilles said:


> FD is hurting enough as it is on members, unless cities are going to pay the extra salary, why get an as in something that's not needed for the job


It is needed. FD notwithstanding, EMS is a critical part of the medical arena and needs to be on par with everyone else. I think an Associate Degree would be commensurate for paramedics' knowledge level.


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## Kavsuvb (Dec 14, 2019)

DrParasite said:


> it is, sort of.  all medic programs require some form of A&P. All too often this is A&P for EMS, possibly held online, not a full 8 credit college level anatomy and physiology, with lab, where students are educated and evaluated by non-EMS instructors.not even close.  As associates degree is 60 credit hours.  EMT class is 8 credits (2 days a week, for a semester, from 6pm to 10pm).  A&P  is 8 credits (4 for part 1, 4 for part 2, including lab).  Assuming paramedic is two 4 hour days a week for 12 months, that is 24.... add another 6 for clinical time, and you are are at 46 credits... still 14 short of an associates degree, almost 25% short for a full degree (and most paramedic programs don't require college level A&P with lab).


 You also forgot the Gen Ed requirements that are required by the College such as Psych such as General Psych and Lifespan Development, Sociology, Math such as Statistics, History or Government & Art or Music to round out the Gen Ed requirements.


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## SandpitMedic (Dec 15, 2019)

Kavsuvb said:


> You also forgot the Gen Ed requirements that are required by the College such as Psych such as General Psych and Lifespan Development, Sociology, Math such as Statistics, History or Government & Art or Music to round out the Gen Ed requirements.


We discussed those.


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## SandpitMedic (Dec 15, 2019)

I guess we’ll just have to wait for more white papers and a push to get the ball rolling on this or wait around to see if states continue doing it themselves.


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## Achilles (Dec 21, 2019)

MackTheKnife said:


> It is needed. FD notwithstanding, EMS is a critical part of the medical arena and needs to be on par with everyone else. I think an Associate Degree would be commensurate for paramedics' knowledge level.


Anyone can get a piece of paper, qualifications often outweigh certifications


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## mgr22 (Dec 21, 2019)

Achilles said:


> Anyone can get a piece of paper, qualifications often outweigh certifications



How would you measure and validate those qualifications in a way that could be shared by, say, prospective employers?


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## CCCSD (Dec 21, 2019)

NREMT....bwahahahahaha. Sorry.


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## SandpitMedic (Dec 21, 2019)

CCCSD said:


> NREMT....bwahahahahaha. Sorry.


Lol. Yes, they are laughable, but they *might* be able to become relevant and useful with something like this.


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