# To Degree or Not to Degree. That is The Question.



## MedicMcGoo (Jan 7, 2019)

Article outlining the recent joint statement against a degree requirement for paramedics. http://www.snotsmedic.com/2019/01/07/to-degree-or-not-to-degree-that-is-the-question/


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## DesertMedic66 (Jan 7, 2019)

A fire association not wanting EMS/paramedics to get degrees but also pushing for firefighters to have degrees in order to promote? Color me shocked. 

Seems like you would want the people who deal with 80-90% of the fire departments call volume (if they are a medical responder) to have a degree just like the vast majority of all healthcare...


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## DrParasite (Jan 7, 2019)

DesertMedic66 said:


> A fire association not wanting EMS/paramedics to get degrees but also pushing for firefighters to have degrees in order to promote? Color me shocked.


You have issues with supervisors needing to have degrees?  damn, I've worked with so many good ole boy EMS supervisors in my career, who barely have a HS diploma.  it's stupid not to mandate degrees for supervisors and management.

Some highlights from the article:



> We took a straw poll of 86 current and former paramedics. I was interested in find out what their take was on the matter. The poll showed that 69% of respondents currently have an associates degree of some form. Around 71% of those who participated in the poll think that the current required education necessary to become a paramedic in the United States is not adequate. 50% felt they didn’t spend enough time in school learning the required material. On a more global scale 66% did not feel professionally competitive with paramedics from other parts of the world.


Moreover, these 71% of the 86 current and former medics all felt their education was in adequate, yet how many went back to school to earn degrees in EMS?

 69% had some type of associates (likely in underwater basket weaving), but if it's not in EMS, than it's not beneficial to EMS.  If I have a bachelors in civil engineering, how does that help me as a paramedic?  unless your degree is in EMS, it doesn't count.



> Just because there is no current evidence that suggests any difference between a degreed and a non-degreed paramedic doesn’t mean there is no evidence. Requiring someone to obtain more education doesn’t have a downside, period.


So the author admits there is not current evidence, but then states that doesn't mean there is no evidence?  There is no current evidence that I can walk on water, but that doesn't mean there is no evidence?

And yes, there is a downside.  increased cost to the student, increased time in class for the student when they aren't making money.  and increased student debt if they are taking out loans.  if they are currently employed, that's more time when they are not able to work because they are in class.

Should all paramedics need to earn AAS in EMS in order to keep their certifications?  if it's beneficial to the patients, absolutely, once they get their paramedic cert and some experience, a degree can only help.  To do flight, community paramedicine or CCT, AAS should be the minimum, as well as several years of experience (at which the degree builds on).  Should all supervisors have bachelors degrees, and all managers have Masters level education?  absolutely.

But for entry level ambulance work, when the certification has been sufficient for how many decades?  There is no evidence that it is needed, or that it benefits anyone other than the college system.  And as the author says, just because there is no evidence that it will hurt the profession, doesn't mean there is no evidence, but there are several downsides.


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## DesertMedic66 (Jan 7, 2019)

DrParasite said:


> You have issues with supervisors needing to have degrees?  damn, I've worked with so many good ole boy EMS supervisors in my career, who barely have a HS diploma.  it's stupid not to mandate degrees for supervisors and management.
> 
> Some highlights from the article:
> 
> ...


I have zero issues with management having degrees and IMPO it should be mandatory.

Its not just as simple as “as long as your degree isn’t in EMS, then it doesn’t matter”. Degrees all require general education classes such as English, reading comprehension, mathematics, sciences, etc. It’s a far reach to say those classes don’t benefit healthcare providers. 

The argument of “the certification has been sufficient for how many decades” IMO is not a valid reason. That sounds very similar to “but we have always done it this way” which is a horrible way to do anything healthcare related. Do we really know it is sufficient? How do we know this? Can we look at other countries who mandate a degree and look at their statistics, patient outcomes, skill set? Does our system still stand water?

We want to be considered healthcare and clinicians however we are the only ones to not require a degree. In my area RTs need an AS, Rad Techs need an AS, RNs need a BSN, NP/PA need a masters, Etc. Really the only people who do not need a degree are CNAs and LVNs.


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## DrParasite (Jan 7, 2019)

DesertMedic66 said:


> Its not just as simple as “as long as your degree isn’t in EMS, then it doesn’t matter”. Degrees all require general education classes such as English, reading comprehension, mathematics, sciences, etc. It’s a far reach to say those classes don’t benefit healthcare providers.


Actually, it does.  If you look at most AAS EMS degrees, out of 60 credits, usually 15 or so are gen ed.  My BS didn't have any BIO classes, no Chem classes, and if it required a LAB, I didn't take it.  My math was calculus, which isn't very useful in EMS (at last not what I can recall).  

There is a reason every degree programs has different prereq classes.  My BIO 101 and 102 would likely not help me as much as all the math classes needed for an engineering degree.  Each degree has specific prereqs to that degree.  Accepting any associates degree in lieu of an associates degree in EMS signifies that the EMS degree doesn't matter, because any AAS is acceptable.


DesertMedic66 said:


> The argument of “the certification has been sufficient for how many decades” IMO is not a valid reason. That sounds very similar to “but we have always done it this way” which is a horrible way to do anything healthcare related. Do we really know it is sufficient? How do we know this? Can we look at other countries who mandate a degree and look at their statistics, patient outcomes, skill set? Does our system still stand water?


Sounds like you are asking for evidence that our system is lacking in education.  You want hard facts that show that a degree is beneficial.  Good, so do I.  Show me that certificate paramedics students are failing the NR-P exam with greater frequency than degree paramedic students.  Show me actual data that paramedics without degrees have a higher mortality rate than those with degrees.  If our system doesn't "still stand water," show me where the leaks are actually occurring, don't just tell me "there must be a leak somewhere.... I don't see any proof of a leak, but I know it's there, so you should definitely update to a more expensive system."


DesertMedic66 said:


> We want to be considered healthcare and clinicians however we are the only ones to not require a degree. In my area RTs need an AS, Rad Techs need an AS, RNs need a BSN, NP/PA need a masters, Etc. Really the only people who do not need a degree are CNAs and LVNs.


Do RNs really need a BSN?  meaning, do you not know any RNs who don't have BSNs, and are still working?   Know any PAs that got their PA cert through Bachelors programs?

Do you really think healthcare thinks a certificate paramedic isn't a clinician, but once they get an associates, they will magically be viewed as a clinician, esp in a world where most "clinicians", defined as the person making the treatment plan for the patient, have masters degrees or went to medical school?  

If every current paramedic needed to get an AAS in EMS, like NYS is mandating with BSN or else their nursing license is suspended, I would support this 100%.  As the recommendations are currently being made, the existing paramedics don't need this "much needed" education, but the next generation def needs it.  It's massively hypocritical.


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## mgr22 (Jan 7, 2019)

It's hard to do research on the value of a degree. How does one measure success, or any other perceived upside of a college education? We could focus on wages, but we'd still have to make allowances for all kinds of variables. Plus, there are many small, subtle advantages that are mostly anecdotal (therefore begging the question, How can I even prove they exist?).

I look at degrees as a form of insurance. College gave me something to fall back on in case nobody wanted to hire me just for my charm , and helped me earn a living before starting in EMS and after getting hurt and leaving EMS. I've accepted jobs and turned down jobs I probably wouldn't have been offered without a degree -- their rules, not mine. I also know some stuff about the planet, its people and history that I wouldn't know if I hadn't taken a few classes.

If your hypothesis is that degrees aren't worth the time and/or cost, I doubt you'll find proof to the contrary. On the other hand, maybe it's time to move along to other topics and just concede that a college degree, like other kinds of insurance, won't hurt.


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## DrParasite (Jan 7, 2019)

mgr22 said:


> If your hypothesis is that degrees aren't worth the time and/or cost, I doubt you'll find proof to the contrary.


 that is not my hypothesis at all.  What I said was a degree requirement for a paramedic isn't worth the time and / or cost for someone who is currently able to do the exact same role with a certificate course.  I fully support education, and would encourage a paramedic who took the medic to AAS in EMS bridge program after a year or two on the truck., especially if their employer was paying for it, as it would open up other EMS career paths besides what is available to an entry level paramedic.


mgr22 said:


> On the other hand, maybe it's time to move along to other topics and just concede that a college degree, like other kinds of insurance, won't hurt.


sure, it won't hurt (other than the time spent in class and cost for the actual piece of paper), but it won't help as much as everything thinks it will.


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## mgr22 (Jan 7, 2019)

DrParasite, you sound like you thought I was addressing you. I wasn't...until now.  When you say "It won't help as much as everyone thinks it will," what does that even mean? Is "everyone" really everyone? How much do they think it will help, and does it even matter what "they" think? It's like me saying "It won't hurt," which is just as speculative and imprecise.

My original point was that the OP's attempt at researching this topic didn't bear much fruit because the value of degrees is so hard to quantify. We're all just throwing opinions around. I think that's fine as long as none of us tries to characterize them as research or facts.


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## VentMonkey (Jan 7, 2019)

That is the question to ponder for myself...often. In the event that I was permanently unable to return to work from some gawd awful injury, then yes, a degree would serve its purpose. Can, or will it happen? I don't know. 


DrParasite said:


> I fully support education, and would encourage a paramedic who took the medic to AAS in EMS bridge program after a year or two on the truck., especially if their employer was paying for it, as it would open up other EMS career paths besides what is available to an entry level paramedic.


_Full disclosure: I am not arguing my point, it's a legitimate question._

Where does this leave folks such as myself who have all of the "experience", and no degree with no honest desire to pad their resume with an associate's? I believe if anything, this is sort of your point as well. I am seriously asking though, because I don't see it happening right now. It offers little value to my current predicament.

I want to say that this topic is brought up almost weekly and can be discussed endlessly with varying opinions. I do agree that providers should seek higher education; basic math and English skills and the like. I also believe ultimately even an Associates in Paramedicine will afford more opportunities than not for providers new to the field.

But for now, does this make people such as myself hypocritical for not having a degree since most paramedic degrees that I've researched have zero buy in from me curriculum-wise? I think people such as myself may benefit from college-level courses even if they're non-matriculated, but what if there's absolutely no genuine interest in any of the courses taken? Does this make said paramedic any less competent, any less intelligent, or obtuse? 

I've known college-educated individuals who would have you think otherwise, or make you think twice about its value; I believe we all have. I'm legitimately torn on this subject matter for now, and as a result remain in the "pending further college-level education" category.


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## DrParasite (Jan 7, 2019)

@mgr22 the value of degrees is very hard to quantify.  the costs are not as difficult, nor is the time required.  And by "they" I mean the groups that write position papers on these topics.  We can also evaluate test scores on the NR-P exam, first time pass/fail rates, length in the field (how many years total), patient satisfaction scores, patient complaints/compliments, and many other objective things.  And then people waaay smarter than me can analyze the data to see if they can identify the causes.  



VentMonkey said:


> Where does this leave folks such as myself who have all of the "experience", and no degree with no honest desire to pad their resume with an associate's? I believe if anything, this is sort of your point as well. I am seriously asking though, because I don't see it happening right now. It offers little value to my current predicament.


That is exactly my point.  If a college educated (and by that, I mean an AAS in EMS, not any generic degree) makes for a better paramedic, than every paramedic should have to get it.  It's not about padding a resume, it's the belief that an AAS in EMS will make you a better paramedic, as well as the whole better recognition in healthcare.  if you (referring to every experienced and smart paramedic who doesn't have a degree) are as smart as you think you are, than you should have no problem with any of the material, especially since you have already been doing the job for several years.  

my challenge to you (@VentMonkey) would be 1) if the requirement to keep your medic required you to complete a paramedic to AAS in EMS bridge program in so many years (lets say 5, since you are doing it part time), wouldn't you want to do it?  and would you want a paramedic treating your loved one who wasn't dedicated enough to the field to hold him or herself up to the same standards as every newly graduated medic school? and 2) if the course work is all related to EMS (which is your FT job), other than the foundation courses which everyone needs to take to make sure they meet the basic college standards, shouldn't every course appeal to you? 3) and if you don't want to get your degree, than maybe it's best for the industry that you retire from EMS, because the standards have risen and you have chosen not to rise with them?

JUST SO THERE IS NO CONFUSION:  I am picking on @VentMonkey because I know he's an experienced CCEMTP who doesn't have a degree.  I am not saying he's a bad provider, or lacks competency, or is unintelligent, or lacks dedication, or smells bad or anything like that.  But he is a great example of an experienced medic who does not want to go back to school to get an AAS degree, and I'm sure there are plenty of experienced medics in the exact same position; including some who are advocating for all new medics to have AAS in EMS before they take the NR-P exam.


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## mgr22 (Jan 7, 2019)

VentMonkey, I don't think you're hypocritical at all. You're wondering and asking. I think lots of us would benefit by simply doing that and keeping an open mind. One bit of advice I can offer is to consider all sorts of majors -- not just those that are EMS related. For example, my degree is in engineering. I don't think my major had much to do with any EMS jobs I got, but I know having a degree did.

I dislike most formal classes, so I can definitely relate to your mixed feelings about signing up for semesters full of them. Try finding a curricula that you think you can tolerate. You don't have to love it, but you'd have to stick with it. I've done lots of hiring in two industries, and I can tell you that the major almost always mattered less than the degree (and the person, of course).


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## DrParasite (Jan 7, 2019)

mgr22 said:


> For example, my degree is in engineering. I don't think my major had much to do with any EMS jobs I got, but I know having a degree did.


My degree is in information management and technology.  I also double majored in History.  my graduate degree will be an MBA, and I am going to try to get a Grad certificate in cyber security management too.  None of that helped me get an EMS job.  none of it helped me get a fire job. the only thing that matter was that I had the certs,decent interview skills, and above average networking skills.  it did help me get an IT job though.

Please explain how your degree helped you get the job more than having your paramedic certificate.  Other than maybe filling out a checkbox for HR for "has bachelors degree."


mgr22 said:


> I've done lots of hiring in two industries, and I can tell you that the major almost always mattered less than the degree (and the person, of course).


While the major might not have mattered. the coursework likely did.  If your degree is is in engineering, and mine is in underwater basket-weaving, and we are both new grads applying to work in an engineering firm, who would you think has the upper hand?

One of colleagues on the college ambulance squad was also an information management and technology major.  But he was also pre-med.  While all of my non-core classes went to history, he took a full load of bio and chem and all the other premed stuff.  So yes, while our majors might have been the same, our coursework was much different, and I can assure you that if we both applied to medical school, he was waaaay more prepared for their curriculum.


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## StCEMT (Jan 7, 2019)

An associates gives a damn good amount of course work to tailor to this field though. Having a degree that has a writing course, A&P 1/2, pharmacology, etc. gives a much better foundation than going in with essentially nothing. 

My medic program was a year long. It was a very good program, but that is a lot of information to try to compress into a year and have a high level of comprehension of it all. 

There will always be a learning curve when starting out with this job, but we can still raise the standard of where they start. I know some newish medics that I dont trust and it is a mix of either just newness and trying to climb that learning curve, or being cocky and not knowing their ability is not on par with their confidence.


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## Tigger (Jan 7, 2019)

DrParasite said:


> My degree is in information management and technology.  I also double majored in History.  my graduate degree will be an MBA, and I am going to try to get a Grad certificate in cyber security management too.  None of that helped me get an EMS job.  none of it helped me get a fire job. the only thing that matter was that I had the certs,decent interview skills, and above average networking skills.  it did help me get an IT job though.
> 
> Please explain how your degree helped you get the job more than having your paramedic certificate.  Other than maybe filling out a checkbox for HR for "has bachelors degree."
> While the major might not have mattered. the coursework likely did.  If your degree is is in engineering, and mine is in underwater basket-weaving, and we are both new grads applying to work in an engineering firm, who would you think has the upper hand?
> ...


My BA certainly helped me get my new (fire) job. The hiring committee circled back to it several times when speaking about critical thinking and communication. I didn't bring it up, but they were pleased to see it. It helped me get my last (3rd service job too), I was a new grad and was actually asked to bring my thesis with me on my first day so the boss and community paramedic coordinator could read it just to see what sort of thoughts I had on community college. Maybe I'm just lucky?

Some people are great writers, I wasn't until I went to college and studied...Political Science of all things. I brought over a million dollars in grant revenue in the last few years using those skills. Certainly doesn't hurt my ability to write reports either. I wasn't much for public speaking in high school, college helped me out there too. Such a skill is part of many, many aspects of EMS and made me a better educator. There are many other ways to learn these skills besides my silly liberal arts degree and I respect that wholeheartedly. I think those with long EMS careers and less formal education probably have no problem learning these things as they go along. I can't imagine forcing current paramedics to go back to school for an AAS, it doesn't seem feasible and the return on it is probably not that great. 

Where it does benefit is with giving new folks a better foundation to learn on. We need to give paramedics a more well rounded education to help them excel in their roles. The amount of time we spend teaching pharm math and report writing at the medic program I'm an adjunct at is significant. We want our grads to be good when they get out of school, and part of that is knowing those two things. Yet it can take weeks to effectively teach it, which is probably made worse by many of the paramedic instructors not having much ability to really teach these non-technical subjects. I would like to think that a semester of math and semester of english comp would go along away to leaving more time for paramedic specific education. 

It's also far from impractical timewise, at least in Colorado. For most programs, two semesters of AP is required, with a 100 level bio class prereq. To receive the AAS, you need to add a math, one to two english courses, and a computer science course. It's a relatively small investment that many of our local medics already do, and I can't imagine we're much different than the rest of the world.

We probably can't measure M&M outcomes between AAS and certificate paramedics. I don't think that invalidates the degree argument. There are countless benefits that are perhaps less tangible.

And as much as I hate to say it, it's important to get a seat at the adult's table. Healthcare will use our lack of degree requirements against us forever, fair or not.


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## mgr22 (Jan 7, 2019)

DrParasite said:


> Please explain how your degree helped you get the job more than having your paramedic certificate.  Other than maybe filling out a checkbox for HR for "has bachelors degree."



DrParasite, you should re-read my post. I didn't say my degree helped me get an EMS job more than my paramedic certificate did. I said my degree helped me get an EMS job. You ask how I know? Mostly by the job description that listed a college degree as a prerequisite. Oh, and then there was the interviewer -- my eventual employer -- who said something like, "We're looking for someone with a degree."


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## mgr22 (Jan 7, 2019)

DrParasite said:


> While the major might not have mattered. the coursework likely did.  If your degree is is in engineering, and mine is in underwater basket-weaving, and we are both new grads applying to work in an engineering firm, who would you think has the upper hand?



Yes, you're right about some majors carrying more weight than others. However, getting a degree in something -- even basket-weaving -- would be better than not getting a degree at all, in my opinion. Earning a degree is evidence of achievement and scholarship, two attractive qualities that not all non-degreed job candidates can promote as easily.


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## TXmed (Jan 7, 2019)

Just throwing my 2 cents in. I obtained my paramedic certification THEN went on to get my associates in EMS and should graduate with my BS in may. 

Working towards my degree has made me a better clinician and caregiver. Formal science classes taught me things that I either never knew or took me years to learn. Classes in statistics, psychology, English, and speech have made me a better professional. My classes surrounding culture, healthcare, administration, and project planning have helped me see a bigger picture. 

I never would have known the value of my degree, if i never have pursued it. 

Pre-hospital healthcare delivery needs to be a career choice. Not a certification you get with a fire department.


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## DrParasite (Jan 8, 2019)

mgr22 said:


> Oh, and then there was the interviewer -- my eventual employer -- who said something like, "We're looking for someone with a degree."


So any generic degree?  The content wasn't important, as long as they can fill out the checkbox for "has a degree"?  I've seen jobs that required a degree too.  And seen a lot of super qualified people get passed over because they had 20 years of work experience, but never got their degree.



TXmed said:


> Just throwing my 2 cents in. I obtained my paramedic certification THEN went on to get my associates in EMS and should graduate with my BS in may.


Out of curiosity, at which point did you start working as a paramedic?  after you obtained your certification or your degree?

Your educational progression is exactly how I think it should be.  complete the basics for the cert, get the job, obtain some experience, than further your education in EMS with the AAS, and then continue to get a BS.  That would impress me a lot more than a new hire applying for a job with a medic certs, an AAS, and a BS, with 0 experience.  I would start the cert medic and the BS medic at the exact same level.


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## mgr22 (Jan 8, 2019)

DrParasite said:


> So any generic degree?  The content wasn't important, as long as they can fill out the checkbox for "has a degree"?  I've seen jobs that required a degree too.  And seen a lot of super qualified people get passed over because they had 20 years of work experience, but never got their degree.



Well, he didn't share all his thoughts with me but...yeah...the content didn't seem important, to the extent that he didn't ask what my degree was in. I may have told him anyway.

Not sure where you're heading with this, DrParasite. You seem to be challenging my answers to your questions about my personal experiences. What's the point?

Regarding super-qualified, experienced people without degrees getting passed over, yes, that happens and I agree that those are sometimes bad decisions. I could tell you stories about how I've occasionally been the only person in the room who advocated for capable people without college degrees. No doubt others on this forum have done the same.

As unfair as hiring decisions may be, they get made. Our colleagues without degrees will be better prepared if they understand that. Some of them may choose to seek degrees not because they want to learn stuff, but because they want to have more options. Not a problem for me -- that's why I got a degree.


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## cruiseforever (Jan 8, 2019)

How long have colleges been offering a degree for paramedic?  I got my cert. 30 years ago and I cannot think of a college that offered a degree in EMS.


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## Tigger (Jan 8, 2019)

DrParasite said:


> So any generic degree?  The content wasn't important, as long as they can fill out the checkbox for "has a degree"?  I've seen jobs that required a degree too.  And seen a lot of super qualified people get passed over because they had 20 years of work experience, but never got their degree.


Any degree helps teach critical thinking and shows some degree of dedication to study. Perhaps employers see value in that more than they do with job specific skills?


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## RocketMedic (Jan 8, 2019)

Having a degree is an investment in yourself. It’s like packing the bolt cutters along on a patrol or bringing a spare Mewtwo to the Elite 4- you don’t necessarily need it, but it’s awesome to have when you find an opportunity that might need it. Also gives you lateral entry into teaching, government and a host of other roles.


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## SpecialK (Jan 9, 2019)

You blokes are still arguing about needing a two-year qualification for paramedics? australia was doing that in the 70s and a bit of searching said we needed that in 1996.

I guess you need to quickly decide if you want to come up to par with other first world countries or not then eh ....


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## VentMonkey (Jan 14, 2019)

I don't believe I've ever doubted the importance of a degree, nor what it is that a degree brings to this field in general. I was asking as more of a broadly generalized question for others similar to myself. Not to say that I wouldn't obtain, or have completely ruled out obtaining my degree altogether; I have not.

I agree that we need to take a page from other first world countries with regards to prehospital education and its fundamental platforms, but again this horse has been beaten to a pulp. Ultimately my goals remain very much in line with many on this forum. True education-based, clinically-driven decisions are hard to make without formal education and training in _any_ discipline.

I didn't feel @DrParasite was picking on me, but merely helping to illustrate the value of my questions in general (as did @mgr22). I absolutely think all things aside, we as a profession have no dog in "progression of the field" fight without education from the bottom up. Restructuring may take decades, however, perhaps the minute EMS (in The States) rids itself of traditional mantras the lines in the sand will begin to dissipate.

With all that, the problem to me remains that much of what we focus on in this country when discussing prehospital medicine, and/ or its education is of little value to both personal, and professional long-term growth.


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## aquabear (Jan 15, 2019)

If the IAFF is against a degree requirement for paramedics, I am for it.


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## Eir (Jan 16, 2019)

SpecialK said:


> You blokes are still arguing about needing a two-year qualification for paramedics? australia was doing that in the 70s and a bit of searching said we needed that in 1996.
> 
> I guess you need to quickly decide if you want to come up to par with other first world countries or not then eh ....



The U.S. seems to have lost interest in trying to be a first world country.

I'm working on my two-year paramedic degree now, though I'm 35 and ten years out of my first, unrelated, college experience. Maybe it's just my program, but there seems to be a disconnect between the academic and practical aspects of the program that makes me wonder what a four-year degree in EMS would look like beyond requiring an additional fee for the certification soup that passes for advanced training now to also come with college credits. It seems like the demand for such programs really needs to come first.

I feel like fire is a big piece of what is holding us back. Newly certified Basics are nowhere near ready to start working in the field, but fit perfectly into a too-many-Basics-on-an-engine response that fire departments seem to favor. I don't see other first world countries making this same mistake.


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## Carlos Danger (Jan 16, 2019)

SpecialK said:


> I guess you need to quickly decide if you want to come up to par with other first world countries or not





Eir said:


> The U.S. seems to have lost interest in trying to be a first world country.



Yes, because the initial education requirements for paramedics is definitely what defines whether or not a nation is "first world". 

I certainly support better initial education for paramedics, but if we're being honest, part of the reason it hasn't happened is because there're really no objective, demonstrable need. There's no research out there that I'm aware of that indicates that paramedics with a college degree have better outcomes than those without.


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## DrParasite (Jan 17, 2019)

Remi said:


> I certainly support better initial education for paramedics, but if we're being honest, part of the reason it hasn't happened is because there're really no objective, demonstrable need. There's no research out there that I'm aware of that indicates that paramedics with a college degree have better outcomes than those without.


I couldn't have said it better myself.


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## akflightmedic (Jan 17, 2019)

Remi said:


> part of the reason it hasn't happened is because there're really no objective, demonstrable need. There's no research out there that I'm aware of that indicates that paramedics with a college degree have better outcomes than those without.



So no research = no better outcomes? So do not conduct the study because we know it is pointless anyways, right?

Not calling you out in particular, just rephrasing for the follow on set up...

Nursing. There ARE many studies that demonstrate a BSN produces more favorable outcomes and better care versus ADN. As much as I dislike comparing nursing to paramedicine, in the same breath they got their **** together, lobbied for higher education and created a demand for themselves which in turn created a shortage and higher wages. After many years of making a degree entry the standard, they then went a level higher and are now making the BSN the standard. And they have studies to support their claim.

Having said that, couldn't we try to make a degree for entry the requirement for starters, over several years it will thin the heard appropriately and raise demand and wages for degreed paramedics. There are studies which show too many medics on scene is less beneficial so this is a step in right direction. Once we have thinned and made degree entry standard, then we actually have a demographic to conduct studies on and evaluate whether or not the care is better. The tricky part is studies like that would need to be evaluated across the entire continuum of care to determine whether treatment started earlier on moved through the system appropriately and ended with favorable/better outcome. 

One of the issues in general is our short life spans as medics career wise. This is an unsupported statement by me, however it seems not enough of the "good ones" stay in the field long enough to effect change in the right direction. Maybe, just maybe they would IF we made getting in the industry a degree requirement and raising wages, they would stay.

Chicken and Egg...repeatedly.


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## mgr22 (Jan 17, 2019)

Just to build on Akflightmedic's remarks, I think there's danger in concluding something isn't true just because there's no research that supports it. It's ok to learn from the experiences of others, even if skepticism is part of that process. The problem, in my opinion, is when unresolved cognitive dissonance -- e.g., I don't have a degree, so I don't need a degree -- affects quality-of-life decisions and limits career-related opportunities.

Or something like that.


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## DrParasite (Jan 17, 2019)

akflightmedic said:


> So no research = no better outcomes? So do not conduct the study because we know it is pointless anyways, right?


That isn't what he said at all... he said there was no research to support the claim that more education leads to better outcomes.  If anything, he said that research has not been conducted to either support or disprove the claim.





akflightmedic said:


> Having said that, couldn't we try to make a degree for entry the requirement for starters, over several years it will thin the heard appropriately and raise demand and wages for degreed paramedics. There are studies which show too many medics on scene is less beneficial so this is a step in right direction. Once we have thinned and made degree entry standard, then we actually have a demographic to conduct studies on and evaluate whether or not the care is better.


so in a time when their are many EMS agencies that are desperate for paramedics, you want to thin the heard of available cattle?  Most EMS agencies I am aware of have paramedic jobs posted; very few are overstaffed with experienced paramedics.  If you look at career fire departments, many will put you on the short list to get hired if you are already a paramedic, because they are that desperate.  And how many agencies do you know that are constantly paying paramedics OT to staff trucks?  And even these agencies that are desperate, how many are still paying their medics **** wages?

We can argue that we have a paramedic allocation issue, not an actual shortage, but that's a different issue.


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## Carlos Danger (Jan 17, 2019)

My original reply to this thread was specifically in response to the implication that EMS care in the US was somehow woefully behind that of the Commonwealth nations.  From a systems and educational standpoint, I know that's true. But from a clinical outcomes standpoint - which is really what matters, right? - I don't think there's any evidence to support that idea.

As I wrote in that reply, and as a perusal of my old posts on this site would demonstrate, I am a strong advocate for better training for paramedics. I've been making that argument since long before many members of this site were even involved in EMS.




akflightmedic said:


> So no research = no better outcomes? So do not conduct the study because we know it is pointless anyways, right?



I didn't say either of those things, I just said it hadn't been demonstrated by research. However, remember that, "what can be asserted without proof can be dismissed without proof".

Outcomes research in EMS is notoriously challenging because there is so much variation in protocols, drugs, response times, experience levels, etc. from state to state, county to county, even agency to agency, not to mention the hospital care that follows. That said, if you could find a way to do such a study with all those variables controlled for, then sure it should be conducted. Why not?



akflightmedic said:


> Nursing. There ARE many studies that demonstrate a BSN produces more favorable outcomes and better care versus ADN.



I had to endure having that absurdity shoved down my throat during my BSN program. Those studies are all done by the nursing educational industry in an effort to convince nurses and hospitals that they need to buy more of what the nursing educational industry is selling. As such, they lack rigor and objectivity. Most are based simply on outcome differences between hospitals that have a higher % of BSN holders vs. those that have lower percentages, but do not even attempt (not that you really can, anyway) to control for the many other factors that affect outcomes. Also, most of the outcomes that they are looking at when they make these claims aren't even the types of outcomes that we typically think of as important in healthcare in 2019. They are looking mostly at things that relate to patient satisfaction, not length of stay, 30-day readmission rates, cost, or anything like that.

It's like saying King County has it's excellent survival rates from out-of-hospital cardiac arrest BECAUSE all of their paramedics are trained at Harborview, and completely discounting their extremely high rates of bystander CPR, rapid first response, high-performance, evidence-based resuscitation protocols, state-of the art hospital care, and all the other things that clearly impact survival but have nothing at all to do with where the paramedics are trained.

The BSN is good for individual nurses and good for nursing overall, but it has very little, if any effect on direct patient care.



akflightmedic said:


> Having said that, couldn't we try to make a degree for entry the requirement for starters, over several years it will thin the heard appropriately and raise demand and wages for degreed paramedics. There are studies which show too many medics on scene is less beneficial so this is a step in right direction. Once we have thinned and made degree entry standard, then we actually have a demographic to conduct studies on and evaluate whether or not the care is better. The tricky part is studies like that would need to be evaluated across the entire continuum of care to determine whether treatment started earlier on moved through the system appropriately and ended with favorable/better outcome.



Considering that a two-year degree doesn't take much longer to complete than the current length of many paramedic programs, it doesn't seem like much of a leap. I'm not sure it would do much to thin the herd, or if that should even be the goal, but I think there should be a strong push for it, for sure.

Nursing didn't require (_essentially, _it still isn't mandatory anywhere) a BSN until BSN programs had existed for a long time and had already become pretty popular. It seems like the best way for EMS to move to a degree requirement is for paramedic programs to voluntarily become two-year programs first. It's already happening in some places.


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## akflightmedic (Jan 17, 2019)

akflightmedic said:


> Not calling you out in particular, just rephrasing for the follow on set up...



Come on....both of ya are smart enough to not miss this sentence which I deliberately inserted to clarify the issue I was framing...and not implying it was your position. But kudos to both for grabbing that ball and running with it...(Remi and Parasite)

As for the other comments, we agree. However, THEIR actions and the path they took (RNs), shows that higher wages and demand will follow higher level entry. It is marketing, business and lobbying...I get that. In my desire to see longevity of paramedics, yes you absolutely need to think the herd, cut the chaff, whatever analogy you want to use, because once we have a higher standard, do away with medic mills which are a plenty, we can then start to change our profession for the better. When the IAFF is one of the biggest funders AGAINST this, that alone should tell you it is the right move. 

And yes, I know one of my favorite quotes, and I do realize many studies start out with a hypothesis they will prove come hell or high water....my point was how they banded together and shored up the profession as a whole and get to reap the benefits of such actions. What other course of action can we take? None I can think of other than an entry level degree in order to add validity to your claim that you deserve more. Yes, I agree a lot of the course work in pursuit of a degree does NOT make one a better paramedic. Overall, the image of everyone having a degree and then arguing for more or better conditions will be taken more seriously by those who control the purse strings and the general public.

Like it or not, this is a marketing/PR move I am suggesting for now....and once that foundation is done (which requires Medics to have degrees) then we can start doing the really cool stuff of being involved, respected and considered on a serious/scholarly level of impacting patient outcomes, improving early care and participating in studies which stretch across the entire team with many of the variables you mention and I alluded to in my first post...THEN we can have studies done, make changes, increase wages, working conditions, etc.

It is time for a top down overhaul.

Or we can say no, no no and chicken egg this until ironically we get degrees in other fields and move on, leaving the battle to the next gen.


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## akflightmedic (Jan 17, 2019)

DrParasite said:


> very few are overstaffed with experienced paramedics.



Exactly! And why are there so few experienced paramedics hanging around...?


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## Tigger (Jan 17, 2019)

Aside from pretty middling cost of going from a certificate program (~80% of an AAS), what are the disadvantages of getting an AAS in paramedic studies? Legitimate question.


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## DrParasite (Jan 18, 2019)

Cost is probably the big disadvantage; AAS programs are typically longer than certificate courses.  

the certificate program I was in was 12 months from start to finish, from January to December.  The degree program is 5 semesters, so about a year and a half.  Scheduling was also difficult; my program was monday and wednesday from 6pm to 10pm, with the occasional saturday.  other schools run monday/thursday or monday/friday, from 9am to 5pm, on alternating weeks, to accommodate the shift workers.  The degree program is usually during the day, on set days, which means it's hard to attend if you work a full time job.

Of course, the other legitimate question is why get a degree when all you need is a certificate to get the job.


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## cruiseforever (Jan 18, 2019)

I worked for a place that started to require an AAS.  The requirement was dropped after a couple of years when they failed to get enough medics or hired.  There is even a problem getting good emts.  Our area offers what I feel is a good starting wage and it keeps increasing.  For some reason people are not interested in going into the emergency fields any more.  This includes fire and police.  The colleges have cut way back on the classes they offer due to lack of interest by the public.


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## mgr22 (Jan 18, 2019)

DrParasite said:


> Of course, the other legitimate question is why get a degree when all you need is a certificate to get the job.



Because striving for more than the minimum can be a gratifying experience. If everything we did were based on cost-benefit analyses, we'd live in dormitories, drive scooters, and shower once a week.


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## DrParasite (Jan 18, 2019)

mgr22 said:


> Because striving for more than the minimum can be a gratifying experience. If everything we did were based on cost-benefit analyses, we'd live in dormitories, drive scooters, and shower once a week.


No one is saying you shouldn't strive for more than the minimum; If you want to get your AAS in EMS (and I do encourage all paramedics to complete theirs, particularly if they want to do something in EMS aside from being on an ambulance), than absolutely go for it, especially once you have a job in EMS and have some experience under your belt.  And I will also agree that earning your degree can be a gratifying experience.

But that's a lot different than mandating a degree when many the industry doesn't require it, and mandating a degree where there is 0 evidence that a degree will have any actual impact on the provider's ability to do their job.


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## mgr22 (Jan 18, 2019)

DrParasite said:


> No one is saying you shouldn't strive for more than the minimum...



Did you not just ask the question I answered? Wait, let me check...yup, there it is: "Why get a degree when all you need is a certificate to get the job?" Asked and answered. As for your comment about lack of evidence for mandating a degree, we've been through all of that. I get it: You don't think EMS providers need degrees.


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## DrParasite (Jan 18, 2019)

mgr22 said:


> I get it: You don't think EMS providers need degrees.


You obviously don't get it, because I said no such thing; you are are putting words in my mouth, words that are incorrect.

What I said was EMS providers do not need degrees to obtain entry level positions to work on an ambulance (or fire truck) as a field provider.  And there is no evidence to say contrary, and because there is no mandate for current providers to obtain degrees, I question how much the degree is really needed.  If an EMS provider wants to do more than be an entry level provider, they absolutely should further their education.  Because experience + additional education beyond the entry level standard = person likely to be promoted.

If you want to get your PhD for the gratifying experience, go for it.  I'm sure it will be very gratifying. 

If you want to get your PhD, and all you do is ride around on the ambulance as a paramedic, than you are one super educated provider, but your going to be treated the same as a paramedic who completed a certificate course.  Spending the extra money and time in class that you won't get back because the degree isn't required, and the time you were not working.... sure graduating is gratifying, but was it worth it?


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## mgr22 (Jan 18, 2019)

Me: "I get it: You don't think EMS providers need degrees."

DrParasite: "You obviously don't get it, because I said no such thing; you are are putting words in my mouth, words that are incorrect."

Ok, so you DO think EMS providers need degrees?


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## PotatoMedic (Jan 19, 2019)

I've been watching this and thinking.  My personal opinion is that the entry requirements into a paramedic program are too low.  And to bring them up a paramedic should be an AA degree.  We need a real anatomy and physiology series, we need a communications class, an ethics class would not be bad, statistics would be great because ems is getting more and more into research and the basic field provider NEEDS to be able to understand those if they want to be competent providers.  Just those classes alone on top of English 101 and 201(or maybe a technical writing class instead of 201), math, psychology, and your token elective or two, and you have an AA degree.  

Now to explain myself.  My a&p for my paramedic program helped to explain diseases just enough as my classmates did pass and understand the materials.  But I felt like it was easy as I had done a full a&p series with lab.  Statistics is as explained above.  Psychology, we deal with a lot of psych patients so having a basic understanding of psychology and how it works I think would help.  A communications class would be good as we do a lot of communicating, reports to nurses, public events, talking to medical dirrctors to modify protocols.  Ethics can be good but also know depending on the teachers viewpoint it is very subjective (in my opinion).  

I just feel the more education would bring us up as as providers with a better foundation to learn paramedicine, which I believe will improve competency.

I also will note the BSN push is because hospitals get a higher reimbursement rate if they say they have x% of their nursing staff with BSN's.  So maybe we could force an increase in education by tying reimbursement from Medicare to having associates degree paramedics.


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## Eir (Jan 19, 2019)

The psychology BS program I was in included a required stats class, a required junior-level research methods class, and a required writing-intensive senior capstone class. If we want paramedics doing research in and advancing our field, we should train them to do it. 

My paramedic program requires a full A&P series with lab, a communications course, a psych course, an English class, and a few electives on top of the paramedic core courses. I don't understand how people can claim that paramedics should be allied health professionals but have any less education than that.


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## FNGperpetual (Feb 7, 2019)

Following  this..


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## DrParasite (Feb 7, 2019)

Eir said:


> I don't understand how people can claim that paramedics should be allied health professionals but have any less education than that.


Because paramedics didn't need it for decades prior, and they did the job pretty damn well?  And current paramedics who don't have that education are still allowed to be paramedics?

Unless you're saying every paramedic who doesn't have that education is grossly incompetent, and it was just by dumb luck that their aren't bodies lining up on the sidewalks of people they have killed because they were operating without such a basic fundamental education.....


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## DrParasite (Feb 7, 2019)

mgr22 said:


> Ok, so you DO think EMS providers need degrees?


That's a simple question, with a complicated answer, primarily because the definition of EMS providers can vary.

Should anyone who wants to be a "community paramedic" has at least an associates in EMS?  absolutely.  If you are going to be a critical care paramedics, should you have a degree in EMS?  absolutely.  And if you are going to be an EMS supervisor, you should definitely has an associates degree in EMS, with a bachelors in some type of management.... not just years as a field provider for that agency. 

If you are a paramedic on a first responding engine, should you have a degree?  well, considering I am against ALS engines on general principle, I would say maybe; while it would make it harder to be a paramedic on an engine (which I think is needed), I ask the same question: what has changed over the past 20 years that makes the existing education no longer sufficient for that particular role?  Where is the evidence that it is needed, that it will help created better paramedics, or that it will do anything other than make the degree cost more, while not giving a positive return on investment?

If you are going to be an ambulance paramedic, should a degree be mandatory?  no, because the job hasn't changed much in the past 20 years.  

How much voodoo have we done in the past, that the smart people said was in the best interests of the patient, and everyone else agreed?  backboards, everyone gets a NRB at 15 LPM, giving oxygen to a COPD patient who is having respiratory distress will make them stop breathing, lights and sirens for all calls save lives, because response times matter, giving ACLS drugs down the tube will save a life if you can't get a line, etc.  As we switch to evidence based medicine, and are realizing that a lot of the voodoo isn't really help, we want to see evidence before we do something that it is beneficial.  Shouldn't we hold our proposed educational minimums to the same standards?

Now, if you want to make the National Registry exams harder, where they have a 60% failure rate, and when reviewing the data, you find that out of the 40% who did pass, 80% were from degree programs, while only 20 % were certificate only, and of the 60% that failed, 80% were from the certificate only, and 20% were from the degree, than I would absolutely say that it's time to get rid of the certificate only programs, because it's obvious that the current non-degree requirements are no longer meeting the new testing standards.

Do I think all paramedics should have at least an associates in EMS?  Well, maybe.  If the entire industry say that degrees are good, and says that in 6 years, if a paramedic does not have a degree in EMS, their certification is revoked,than I will support it.  I think it's wrong for all these experienced paramedics to say that we need to have degrees in EMS for all new paramedics, when they don't have degrees in EMS.  It's a combination of do what I say, not what I do, and I already got mine, so I'm good, but all you new guys needs to jump through a bunch of hoops to get yours.  If you are going to raise standards, those standards should apply to EVERYONE, not just new people.

Do I think a generic associates should be a valid substitute?  absolutely not.  Do I think a bachelors degree in an unrelated field should be a valid substitute?  absolutely not.  Does the EMT need a degree?  nah, and they are still EMS providers.


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## dutemplar (Mar 1, 2019)

Most of the programs I'm familiar with required a full year A&P course, and college level algebra (or tested equivalent).  Granted, that was a few decades ago.  Amusingly, there was no degree track most places then.  Unless as a paramedic you took a 2 year program in EMS management, in which case the NREMT-P was worth 18 whole credits.

What we need more than revamping paramedics to degrees, is revamping colleges and degrees.  With the exception of a few technical programs (18D comes to mind), the pre-reqs, actual paramedic program, should be merged into a neat 2 year program.  When I was browsing before, two paramedic "associates" degrees were 3 years in length, well in excess of the "equivalent" allied health 2 year associate tracks.

But colleges are in business to sell seats, not to effectively educate.  That said, the very best medics I've ever seen or worked with were technical and not degreed ones.  

On an irrelevant side note, my Psychology 101 class was taught by a non-PhD person.  I loved, loved, loved the biology of psychology portion.  I had just completed Neurobiology 401, and had that professor actually accompany me to the hippy tree-hugger's class after she yelled at me for explaining how very very wrong she was on a few parts.  Then he explained how wrong she was that lecture.  Good times.


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## MackTheKnife (Jun 15, 2019)

The degree "thing" is a never-ending conundrum. Nurses and paramedics have this debate all of the time. Since I'm both, here's what I think: For medics, if there was a medic-specific degree (AS, AA) that would lead to a Bachelor's, that would be great. AAS degrees can't be used for a Bachelor's I believe? Other than that, I would say no.
In nursing, BSNs are a minimum entry requirement requirement at a majority of hospitals, my hospital being an exception. They hire new grad RNs with an ASN and no further requirement for a BSN. And if a hospital wants to apply for Magnet status, a minimum of 80% of RNs must have their BSNs.
Having said that, nurses with ASNs can have a career as a floor nurse. But if they ever want to become "more" than a floor nurse, they need that BSN or MSN. To be an nursing school instructor, the majority of schools require an MSN. Which has led to a large percentage of wanna-be nursing students getting denied entry into school due to a lack of instructors. A great Catch-22. I've got my BSN and do not plan to go any further.
There's no right answer.


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## Bishop2047 (Jun 15, 2019)

In Canada there is increasing pressure to make the Advanced Care paramedic program require a bachelor's. The ACP schooling already takes three years and there are bachelors programs in place to top up to a degree post diploma (No associate's degrees of any kind in canada). some examples of these...

https://www.mhc.ab.ca/programsandcourses/academic programs/programs of study/paramedic 

http://www.upei.ca/programsandcourses/paramedicine 

https://www.utsc.utoronto.ca/jtprogs/ 

I did some of my clinical time in the states, and wish that the degree ( AAS or AS ) was mandatory for new Paramedics. It would go a long way to making the profession more respected. Medicine is very academically driving and we should never shy away from something that would give ourselves more clout.


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## FiremanMike (Jun 16, 2019)

I’m curious..

What is the practice environment for those of you who are vehemently in the “all medics should have degrees” camp?

In my neck of the woods, everyone and their sister is a paramedic, and the majority of the work they do is BLS transport.  I am in the “medics in leadership and instructor positions need to be working on degrees, but street medics do not” camp, and that is likely influenced by my practice environment..


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## Carlos Danger (Jun 16, 2019)

FiremanMike said:


> I’m curious..
> 
> What is the practice environment for those of you who are vehemently in the “all medics should have degrees” camp?
> 
> In my neck of the woods, everyone and their sister is a paramedic, and the majority of the work they do is BLS transport.  I am in the “medics in leadership and instructor positions need to be working on degrees, but street medics do not” camp, and that is likely influenced by my practice environment..



As you know, many people excitedly get into EMS and are quickly disappointed with the mundane work, relatively low pay, limited career options, and a perceived lack of respect from the rest of the healthcare industry. I think what happens is that then, when they begin to consider what might be done to improve things, they come to think that for some reason all that will change if more education is required.


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## MackTheKnife (Jun 16, 2019)

FiremanMike said:


> I’m curious..
> 
> What is the practice environment for those of you who are vehemently in the “all medics should have degrees” camp?
> 
> In my neck of the woods, everyone and their sister is a paramedic, and the majority of the work they do is BLS transport.  I am in the “medics in leadership and instructor positions need to be working on degrees, but street medics do not” camp, and that is likely influenced by my practice environment..


Good post. I think you are stating what is probably the only good reason, for now, where a degree would be necessary-leadership. EMS can't be compared to hospitals because there's no similarity. Everyone in hospitals have degrees for the most part, excluding CNAs, etc. Our physical therapists, occupational therapists, have Master Degrees! Nurses at a minimum have an Associate's. This is due to license requirements, not so with EMTs or medics. This debate will continue on, as we all know. If a degree does  become mandatory for medics, it should be an Associate's with progression to a Bachelor's possible.


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## Tigger (Jun 16, 2019)

MackTheKnife said:


> The degree "thing" is a never-ending conundrum. Nurses and paramedics have this debate all of the time. Since I'm both, here's what I think: For medics, if there was a medic-specific degree (AS, AA) that would lead to a Bachelor's, that would be great. AAS degrees can't be used for a Bachelor's I believe?


If there is a credit transfer agreement from the college conferring the degree it should not matter. Even if you never got a degree, many institutions will let you transfer at least some credits earned at another institution. 


FiremanMike said:


> I’m curious..
> 
> What is the practice environment for those of you who are vehemently in the “all medics should have degrees” camp?
> 
> In my neck of the woods, everyone and their sister is a paramedic, and the majority of the work they do is BLS transport.  I am in the “medics in leadership and instructor positions need to be working on degrees, but street medics do not” camp, and that is likely influenced by my practice environment..


We have far from a paramedic shortage here, but there aren't five paramedics on every call here either. It's common to have two paramedics on a call, rare to see many more. While the paramedics might be present every call, there isn't such a glut that half of them are stuck doing "mundane" things. Usually one will lead the call and the other will provide the skills the EMT-IVs can't. Given the frequency in which an individual leads a call here, I think some adding a degree requirement to get some more exposure to critical thinking would go a long way here.


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## mgr22 (Jun 16, 2019)

Most of the debates I've seen about degrees for paramedics have focused on EMS-related curricula. I urge those of you considering the pros and cons of higher education to be flexible about your major. I've seen many management openings in EMS that required AS or BS degrees without specifying the field. Also, if you had to leave EMS at some point due to injury, finances, or burnout -- a more common occurrence than you might think -- an EMS-specific degree probably wouldn't give you an edge.

There aren't usually any guarantees of higher net earnings with degrees, but there are possibilities -- good, long-term possibilities. If you have the flexibility to spend lots of discretionary money on either a degree or something else, consider the former.


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## DrParasite (Jun 20, 2019)

FiremanMike said:


> In my neck of the woods, everyone and their sister is a paramedic, and the majority of the work they do is BLS transport.


It's been a while since I looked at the numbers when I was in NJ, but IIRC, ~80% of the EMS calls handled by my agency were handled by BLS only (ALS was either never dispatched (most common), cancelled by BLS crew on scene prior to arrival (second most common), or triaged to the BLS crew after an ALS assessment (smallest occurrence).  ALS was a separate regional entity, with BLS 911 being municipally organized, with no FD role in EMS at all.

Now that I'm in NC, every ambulance in the region has a paramedic on it, and the FD first responders are BLS only (City of Durham FD is ILS, and there are some volunteer departments and one career department that doesn't go on EMS calls at all).  My rough guess is 50%  of the calls could be handled by BLS only.  If you include those calls where only VOMIT is done, that number jumps to 75%.

I've worked in urban areas, suburban, and now quasi rural, all for non-FD based EMS systems.  never saw the need for a paramedic degree, and worked with some great providers.  But is someone shows actual evidence as to why it is needed to be an entry level provider, I will gladly reevaluate my position.





FiremanMike said:


> I am in the “medics in leadership and instructor positions need to be working on degrees, but street medics do not” camp, and that is likely influenced by my practice environment.


Respectfully disagree.  I do think that paramedics should get degrees to progress in their career, however the entry level street medic doesn't need one (hasn't needed one in the past 20 years, and there is no evidence that it is needed currently).

If you just want to be a street medic, on the ambulance, no degree is needed.  but if you want to progress at all (special operations, FTO, supervisor, community paramedic, training division, administrative roles, QA, doing anything other than simply being an ambulance rider), you should be mandated to get a degree.  or even better, you can get the job with just the cert, with the understanding that the EMS degree must be completed within 4 years (after you have some real-world experience, so you can expand your clinical knowledge).


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## rescue1 (Jun 20, 2019)

DrParasite said:


> It's been a while since I looked at the numbers when I was in NJ, but IIRC, ~80% of the EMS calls handled by my agency were handled by BLS only (ALS was either never dispatched (most common), cancelled by BLS crew on scene prior to arrival (second most common), or triaged to the BLS crew after an ALS assessment (smallest occurrence).  ALS was a separate regional entity, with BLS 911 being municipally organized, with no FD role in EMS at all.
> 
> Now that I'm in NC, every ambulance in the region has a paramedic on it, and the FD first responders are BLS only (City of Durham FD is ILS, and there are some volunteer departments and one career department that doesn't go on EMS calls at all).  My rough guess is 50%  of the calls could be handled by BLS only.  If you include those calls where only VOMIT is done, that number jumps to 75%.
> 
> I've worked in urban areas, suburban, and now quasi rural, all for non-FD based EMS systems.  never saw the need for a paramedic degree, and worked with some great providers.  But is someone shows actual evidence as to why it is needed to be an entry level provider, I will gladly reevaluate my position.



I think you make a good point about the general huge overuse of ALS in situations where it is not beneficial (in my personal opinion, due to the pathetic standards of BLS education), but I think that's a separate issue from the degree argument.


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## FiremanMike (Jun 20, 2019)

DrParasite said:


> Respectfully disagree.  I do think that paramedics should get degrees to progress in their career, however the entry level street medic doesn't need one (hasn't needed one in the past 20 years, and there is no evidence that it is needed currently).



We actually agree on that point, sorry sometimes I get a bit wordy and my responses can be unclear because of it..


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## ExpatMedic0 (Jul 9, 2019)

Any type of advocacy for paramedics not having at least an AA/AAS cracks me up....  Fire department and old people love the idea though! ;-)


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## DesertMedic66 (Jul 9, 2019)

ExpatMedic0 said:


> Any type of advocacy for paramedics not having at least an AA/AAS cracks me up....  Fire department and old people love the idea though! ;-)


The same fire departments that require at least an AS/AA to be in any kind of leadership position...


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## DrParasite (Jul 9, 2019)

DesertMedic66 said:


> The same fire departments that require at least an AS/AA to be in any kind of leadership position...


yes, the same fire departments that requires a degree to be a supervisor, not to be a backstep/rear facing/hose pulling entry level firefighter........


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## SandpitMedic (Jul 9, 2019)

ExpatMedic0 said:


> Any type of advocacy for paramedics not having at least an AA/AAS cracks me up....  Fire department and old people love the idea though! ;-)


This.

Evolve or die (or at least sit stagnantly complaining about low pay/respect/opportunity/etc).

Why bother to notice all other allied health and clinical professions have increased their educational requirements over time to increase their standing, compensation, quality of applicants, and foundational education?


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## PotatoMedic (Jul 9, 2019)

Here was an interesting read I saw on Facebook.  https://www.yumpu.com/en/document/read/62721460/educator-update-summer-2019/7


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## SandpitMedic (Jul 10, 2019)

PotatoMedic said:


> Here was an interesting read I saw on Facebook.  https://www.yumpu.com/en/document/read/62721460/educator-update-summer-2019/7


That’s a great read.
Cited a lot of opinion and nomenclature vs data, but still a good argument for upping the ante.


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## MackTheKnife (Jul 10, 2019)

SandpitMedic said:


> That’s a great read.
> Cited a lot of opinion and nomenclature vs data, but still a good argument for upping the ante.


Umm, did you see all of the references?


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## MackTheKnife (Jul 10, 2019)

Has anyone done the Bachelor's in EMS Administration from Columbia Southern U.?


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## MackTheKnife (Jul 10, 2019)

PotatoMedic said:


> Here was an interesting read I saw on Facebook. https://www.yumpu.com/en/document/read/62721460/educator-update-summer-2019/7


Read the article on my phone- it was difficult! But one thing mentioned was EBP. I don't know if EBP is taught in medic school, but it is taught in nursing school (BSN). Perhaps a selling point for degrees?


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## DrParasite (Jul 10, 2019)

MackTheKnife said:


> Umm, did you see all of the references?


Did you actually look at what the references said?  And did you note that out of all the references (removing the NHTSA ones), 3 deal with people leaving EMS or keeping people in EMS, one is a joint position statement, and 3 are actually EMS related sources, with the rest involving taking assumptions from other groups and saying it should apply to EMS?  And two references are from the 90s.....

the article also states many assumptions (with increased education will result in increased salaries, and with increased pre-requisite classes will make the paramedic certification (since it's the state issued cert that lets you practice, and you need to maintain not the degree) more valuable, completely ignoring the question of where is the additional funding going to come from, as well as saying that providing degrees will make it easier for paramedics to leave the field to pursue other venues.

And of course, it ignores the critical question: if EMS degrees are needed, and important to the profession, and would make everything better, including better pay and better patient outcomes, why are we not mandating an EMS degree (not a generic AAS or BS, an associates degree in EMS) for all existing providers (which NYS did with their nurses and BSNs, and if they don't get them in X number of years, their nursing licenses are suspended until they do), and only forcing this increased cost and training length on new members of the profession?

Did you also consider the author's biases when you evaluated the content of this article, which was written in NAEMSE newsletter?  The author is an educated individual; She obtained her bachelors in Biomedical sicneces 15 years before she became a paramedic; her masters is in Fire and EM administration.  However, her primarily role has been that of an educator, a role she has had a role she has held since 2001, after being a paramedic for 5 years (she has continued to work as a flight medic until 2009 and recently went back to it part time).  She is also a faculty member and program director at the local community college teaching EMS, so she has a financial interest (at a professional level) in transitioning from a shorter certificate program to a longer degree program.  So the bulk of her experience isn't from that of an ambulance paramedic, but that of an educator (which I will 100% should require at least an associates, if not a bachelors degree for full time faculty, with a preference to a masters) and a flight medic.  And she doesn't had a degree in EMS at any level.....

BTW, I have my bachelors degree, and am working on my masters.... and I know some people who have bachelors and masters degrees (and one PhD) who work as paramedics who make the same amount as a certificate-only paramedic working on the same ambulance.


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## KingCountyMedic (Jul 10, 2019)

I'm old and have a high school diploma, EMT card, Paramedic card, and I think a blockbuster video rental card. I'm not anti education by any means but I think the education should be relevant to the job you're doing. We have a lot of newer, young folks with degrees, some bachelors, some masters, and some PhD's and many of them want more money because they have a degree even though that degree in no way shape or form is related to pre hospital EMS or even medicine in general. Just doesn't make sense to this simple minded high school graduate.


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## akflightmedic (Jul 10, 2019)

While I see the point the non-degree supporters are making....I can only think of the Nursing Profession as a model to better wages and better conditions.

They tossed diploma nurses and many states have phased out even LPN nurses. Does having a degree make one a better nurse? I do not think so, however there are studies which argues that it does. Aside from that tangent, I circle back to....how can we argue for better pay, better conditions, peer respect/support within the medical community, when "we" are unwilling to elevate our entry level education? Even if it does not contribute significantly to the paramedic work itself...


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## PotatoMedic (Jul 10, 2019)

One thing nursing did well was tie reimbursement to degrees.  Hospitals that want higher reimbursement rates need to have 80% or more of nursing staff with a BSN.  That has been the reason for the big push for degrees in nursing recently.

I honestly think paramedics should be at minimum an associate degree.  I believe general education such as psychology, writing classes, stats are both part of the core education of any degree but very useful for a paramedic.  Add in more robust prerequisite such as full a&p with a lab, microbio, biology, chem, round it out with paramedic school and you have yourself an AA degree.  Yes not all programs will be able to adapt... Harborviews program will have to change, but I believe we will have better providers.


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## KingCountyMedic (Jul 10, 2019)

PotatoMedic said:


> One thing nursing did well was tie reimbursement to degrees.  Hospitals that want higher reimbursement rates need to have 80% or more of nursing staff with a BSN.  That has been the reason for the big push for degrees in nursing recently.
> 
> I honestly think paramedics should be at minimum an associate degree.  I believe general education such as psychology, writing classes, stats are both part of the core education of any degree but very useful for a paramedic.  Add in more robust prerequisite such as full a&p with a lab, microbio, biology, chem, round it out with paramedic school and you have yourself an AA degree.  Yes not all programs will be able to adapt... Harborviews program will have to change, but I believe we will have better providers.




I think Harborview has an agreement with some other program now for those that want to get the AA Degree. It wasn't around when I went through. They do a full A&P course now prior to start of Training.


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## DrParasite (Jul 10, 2019)

Because your making several assumptions based on a different field with a completely different funding model. 

Increasing education does not always correlate to more money: if it did, social workers (who must have a bachelors degree, and most have a MSW) wouldn't be starting in the lower 33k. 

And if't not just nurses who have raised their education requirements: PAs have also raised their educational standards, It used to be associates degree program, and then they faded way and BS took their place... now almost all the programs are masters degree level programs, but they all take the PA-C exam to be called a physician assistant. 

I'm not against raising the educational standards: in fact, I think the current ones are pretty embarrassing, especially when you discuss A&P with a paramedic certificate student and they have no clue what the lymphatic system is.  But do we need to raise the standards?  And by that I mean, where is the Evidence Based stuff that shows that a degreed paramedic is better than a non-degreed medic?  Are the graduation rates on the NREMT-P exams much higher degree vs non-degree?  Are the non-degree medics failing to meet the standard that is currently set for them?  If the education isn't sufficient, than our current standard for certification (the NRP practical and written exams) should validate that claim, and provide definitive proof that the education is lacking, needs to be raised so more people pass the entry level paramedic exams.

Nurses were able to tie reimbursement rates to education level (which was organization specific, not provider specific, so I do question it's validity, but I digress): do you think EMS will get more money for having providers with degrees?  And if not, where will the money come from?  Do you think AMR will cut into their profits just because you have a degree, and are doing the same job you did for the past 10 years?

If CMS comes out tomorrow and tells every agency that their ALS 1 and 2 bill will be automatically rejected if the paramedic writing the chart does not have a degree in EMS, than we have a good reason for everyone to get that degree.  

And why should those degree requirements only be applied to new paramedics?  if the industry wants it, because it makes the profession better, and increases standards across the board, then EVERYONE should have to get an AAS in EMS (not a generic associates, or a bachelors degree in an unrelated field).  If the education is needed, than everyone should get it.   If the state regulatory body says "in 10 years, if you don't have an AAS in EMS , than your paramedic certification is suspended, than we have a good reason for everyone to get degrees.  If you want to continue to be a paramedic, you have plenty of time to complete the requirement to help the industry: if not, than maybe your not as dedicated to the field as you claim.

for the TLR crowd, there is no evidence that a degree paramedic is any better than a certified one (remember, we are going away from unproven dogma "which obviously must be correct" and transitioning to EBM).  However, if it's better for everyone, than everyone should be mandated to have a 2 year EMS degree or their paramedic certification is suspended, no exceptions.

BTW, there is a county EMS agency in NC that recently started their own paramedic program.  The county college runs a 2 year AAS program that is  CAAHEP-accredited ; the county EMS agency's isn't, so they won't be able to take the NR exam, but as long as they finish and take the state exam, they don't care, because they will be paramedics.


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## PotatoMedic (Jul 10, 2019)

You are correct that their is no evidence, absolutely zero, that shows degrees paramedics provide better care.  Their is a lot of evidence that shows degrees nurses provider better care and prevent hospital acquired infections.  All we can do immediately is extrapolate from allied professions till we are able to do our own research as a profession.


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## MackTheKnife (Jul 10, 2019)

DrParasite said:


> Did you actually look at what the references said? And did you note that out of all the references (removing the NHTSA ones), 3 deal with people leaving EMS or keeping people in EMS, one is a joint position statement, and 3 are actually EMS related sources, with the rest involving taking assumptions from other groups and saying it should apply to EMS? And two references are from the 90s.....
> 
> the article also states many assumptions (with increased education will result in increased salaries, and with increased pre-requisite classes will make the paramedic certification (since it's the state issued cert that lets you practice, and you need to maintain not the degree) more valuable, completely ignoring the question of where is the additional funding going to come from, as well as saying that providing degrees will make it easier for paramedics to leave the field to pursue other venues.
> 
> ...


My head is bowed! As stated, I read it quickly on my phone. You obviously took more time than I did. Kudos.


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## DrParasite (Jul 10, 2019)

PotatoMedic said:


> All we can do immediately is extrapolate from allied professions till we are able to do our own research as a profession.


how about before we push for a major major change to our professional, we complete the research to validate our thinking?  It's not like there isn't a large enough pool of both degreed and certified paramedics out there....

After all, for how many years did we strap everyone's curved spine to a hard flat piece of wood (and later plastic), because we (or some super smart people) _knew_ that was the best way to prevent a spinal injury from getting worse?  And even if they were in a minor fender bender, or a fall from standing height, we _knew _that it was in the patient's best interest to strap them to a LSB, just in case?  or how high flow oxygen was indicated for everything?  how long did we know that was the correct way to do things?  30 years?  40 years?


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## PotatoMedic (Jul 10, 2019)

DrParasite said:


> how about before we push for a major major change to our professional, we complete the research to validate our thinking?  It's not like there isn't a large enough pool of both degreed and certified paramedics out there....


By that logic we should NOT be using CPAP in the prehospital setting as there is NO research that shows that CPAP is beneficial in the prehospital setting (least there was none when King County Medic One came out with their statement on why they do not use CPAP and that was the reason given (about 4 years ago now)).

Yes we need to do changes that are sound and make sense I agree there.  I just happen to believe that we can use other allied health professions research to show that their might be benefits to use doing the same.  Kind of like EMS using hospital research that showed benefits to patients who go CPAP and extrapolating it to the EMS world.


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## SandpitMedic (Jul 10, 2019)

Dr. Parasite, I think you're going full apples to oranges here. I'm sure you are highly intelligent, and you've got all your ducks in a row however, I have to ask. Why are you so staunchly opposed to raising the bar for paramedics, and why do you find it necessary to for an outside entity, such as a reimbursement organization or insurer, to come out and say "you need this degree for this amount of reimbursement?" Why does CMS or the state have to come out and say, "ya'll need degrees by X date?" Should we not be entitled to police ourselves in this regard and to voice our opinion _as paramedics and prehospital EMS professionals _about the direction of our own field? Should we base our probable outcomes on those who have done what we are arguing to do and whom are closest to us on the professional medical spectrum (RN, RT, PA, MD), or should we go based on what the social workers have accomplished with their degree requirements? Apples to oranges, in my opinion.

You're rallying from the rooftops about why we shouldn't push for higher education, barriers to entry, and a better overall professional outlook by providing antiquated and barely comparable analogies.  Also, by your own measurement, a paramedic who doesn't understand what the lymphatic system is, yet has a patch and a p-card, is indeed embarrassing. Why not push for a degree program that includes a true one-year A&P course to be the standard as part of an AAS in EMS and certification for the NREMT? Wouldn't getting away from the dogma of the backboard be the equivalent of getting away from the dogma that a paramedic should take a one year certification class to get out there on the ambulance and practice clinical medicine?

Why do we need an evidence based _medicine_ study to look into our educational standards as a profession? Did the nurses or the PAs do a medical study about increasing their barriers to entry and educational requirements for degrees/certifications/licensure ? Is there a randomized controlled trial for that? Was that required? Did it work for them with/without a "study"? Taking a look around (as many of us have stated) would lead one to believe it has been of great benefit and reward for professions who have upped the ante in recent history. Meanwhile, we sit here debating the practices of reimbursement bodies and allow the nurses to live rent free in our heads.

We have to wake up and do whats good for us. What is the worst that can happen - we get better educated and qualified individuals (who know what the lymphatic system is) working on the ground and in the air as prehospital clinicians? No, the worst that can happen is we continue the status quo, and we continue our ubiquitous griping and grabassing while we sit on our phones and computers typing here on EMTlife in our downtime instead of plugging away at some college classes.

Your mileage may vary, as always. (Also, there's nothing wrong with grabassing on EMTlife on occasion)


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## DrParasite (Jul 11, 2019)

PotatoMedic said:


> By that logic we should NOT be using CPAP in the prehospital setting as there is NO research that shows that CPAP is beneficial in the prehospital setting (least there was none when King County Medic One came out with their statement on why they do not use CPAP and that was the reason given (about 4 years ago now)).


no research at all?  what about https://www.emsworld.com/article/10323777/prehospital-use-cpap which is from 2005, or Kosowsky J, Stephanides S, et al. Prehospital use of continuous positive airway pressure (CPAP) for presumed pulmonary edema: A preliminary case series. Prehosp Emerg Care 5:190–196, which was published in 2001?  Looks like there is plenty of research, if you chose to look for it.





PotatoMedic said:


> I just happen to believe that we can use other allied health professions research to show that their might be benefits to use doing the same.


your entitled to your opinion, just as I am to mine.  But I think EMS should be doing our own research, not taking the research of others and hoping we can duplicate it in a  different environment with several different variables.  I will agree, there might be benefits; but before we go all in and half cocked again based on questionable ideas that "in theory" make sense, (remember, every patient needs 15 LPM via NRB, and only gets a NC if they can't tolerate the NRB), lets do the research.  Instead of increasing the time that every new paramedic needs to spend in class, and drastically increasing the cost for a paramedic certification (because that's the current bar, not the degree), lets demonstrate why the current system is insufficient, using scientifically validated research.



PotatoMedic said:


> Kind of like EMS using hospital research that showed benefits to patients who go CPAP and extrapolating it to the EMS world.


The human body responds the same whether in hospital and outside of the hospital.  Clinical trials (of meds and equipment) can be applied in hospitals, doctors offices, ambulances, and prison medical units, because regardless of the location, the human body should respond the same way.  

Education requirements and patient outcomes are not the same as a patient treatment.  You're comparing oranges and watermelons.


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## DrParasite (Jul 11, 2019)

SandpitMedic said:


> Dr. Parasite, I think you're going full apples to oranges here. I'm sure you are highly intelligent, and you've got all your ducks in a row however,


finally, someone sees it!!


SandpitMedic said:


> I have to ask. Why are you so staunchly opposed to raising the bar for paramedics, and why do you find it necessary to for an outside entity, such as a reimbursement organization or insurer, to come out and say "you need this degree for this amount of reimbursement?" Why does CMS or the state have to come out and say, "ya'll need degrees by X date?" Should we not be entitled to police ourselves in this regard and to voice our opinion _as paramedics and prehospital EMS professionals _about the direction of our own field?


I'm not opposed to raising the bar; I'm opposed to the way this change is supposed to be implemented, which requires raising the bar only for new people.  I'm not opposed to raising the bar, provided raising the bar will be be beneficial to everyone, and not just more costly for future generations or paramedics. I'm not opposed to increased educational requirements in the area of business and management, especially for supervisors, educators, and administrative positions; in fact, I think it's long past due, but I think if we are going to change the entry level standards, we should have some validatable data justifying the push from within EMS, not taking research from others and applying it to EMS and hoping it works for us as it did for them.  Sidenote: you don't need to be a paramedic to do research, but having an MS or PhD does help, esp when dealing with all the statistics and other data analysis that makes my head hurt.

Think of it this way: lets raise the bar to an AAS for every paramedic; nah, lets make it a BS instead.  But the wage increase we were hoping for didn't happen, as no additional funding was provided to EMS agencies.  retroactive studies showed no statistical difference in patient moralities between the every paramedic has a BS in EMS and 20 years ago.   But we have fewer paramedics in the system because the course is longer, those new paramedics are now more heavily in student loan debt (on top of low wages), and every EMS system is short on paramedics, because they can't fill the spots they have open currently.  Oh, and that director of your agency?  He has a bachelors degree in underwater basket weaving, and his NRP, and has been with the agency with 20 years, the last 8 as director.  But he's pushing for every paramedic to have their BS in EMS, but he has no plans of going back to school to get his.



SandpitMedic said:


> Should we base our probable outcomes on those who have done what we are arguing to do and whom are closest to us on the professional medical spectrum (RN, RT, PA, MD), or should we go based on what the social workers have accomplished with their degree requirements? Apples to oranges, in my opinion.


The argument made was higher education = rising wages.  The example of social workers, who work in hospitals too, demonstrates that is not always the case.  Similarly. you can't compare the wages of an MD or PA to that of a medic; apples and orange.  RN and RT might be more applicable, if they are both in a hospital based system, especially if they are funded out of the hospital general budge and not just what money they make on ambulance transports... what about the fire service (I know, dirty word, but you can't ignore the largest employer of EMS personnel in the US), or in the private for profit EMS world?  



SandpitMedic said:


> You're rallying from the rooftops about why we shouldn't push for higher education, barriers to entry, and a better overall professional outlook by providing antiquated and barely comparable analogies.  Also, by your own measurement, a paramedic who doesn't understand what the lymphatic system is, yet has a patch and a p-card, is indeed embarrassing. Why not push for a degree program that includes a true one-year A&P course to be the standard as part of an AAS in EMS and certification for the NREMT? Wouldn't getting away from the dogma of the backboard be the equivalent of getting away from the dogma that a paramedic should take a one year certification class to get out there on the ambulance and practice clinical medicine?


you misunderstood... I'm not against any of that; however I am against implementing it the way many people want to implement it (for the new people only, not the current paramedics), as well as arbitrarily raising the standards without showing a prehospital need for the standard to be done.  Maybe I was wrong, and there is no need for a paramedic to know anything about the lymphatic system, so expecting them to be familiar with it is both unnecessary and unreasonable.  I don't know, but if they can pass the NRP exam not knowing about it, and paramedics for the last 20 years haven't needed it, how important is it?



SandpitMedic said:


> Why do we need an evidence based _medicine_ study to look into our educational standards as a profession? Did the nurses or the PAs do a medical study about increasing their barriers to entry and educational requirements for degrees/certifications/licensure ? Is there a randomized controlled trial for that? Was that required? Did it work for them with/without a "study"? Taking a look around (as many of us have stated) would lead one to believe it has been of great benefit and reward for professions who have upped the ante in recent history. Meanwhile, we sit here debating the practices of reimbursement bodies and allow the nurses to live rent free in our heads.


nurses absolutely did research, which was how they got the 80% BSN rule tied to reimbursement rates.  Also, that's a BSN, not a BS and RN cert; that's a key difference, one many in EMS are failing to see.  Nurses have a completely different funding model, lobbying group, and, quite simply, don't have to worry about becoming too expensive, and then getting outsourced to a lower bidder (which has happened to several well paying municipal EMS agencies in NJ).

We can follow the lead of others..... but what if the causation does not result in coloration?  meaning, what if we do raise the standards, and nothing changes, except it puts us in a worse position, with fewer new medics more in debt, and older medics retiring?  You are saying if we do what others did, the same thing will happen.... but there is no guarantee of that, and there are increased costs to future generations, costs that you, as someone who supports this change, don't have to pay.


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## DrParasite (Jul 11, 2019)

SandpitMedic said:


> We have to wake up and do whats good for us. What is the worst that can happen - we get better educated and qualified individuals (who know what the lymphatic system is) working on the ground and in the air as prehospital clinicians? No, the worst that can happen is we continue the status quo, and we continue our ubiquitous griping and grabassing while we sit on our phones and computers typing here on EMTlife in our downtime instead of plugging away at some college classes.
> 
> Your mileage may vary, as always. (Also, there's nothing wrong with grabassing on EMTlife on occasion)


You keep saying *We *have to wake up do what's good for *us*.....






But the costs are burdened on the next generation, not the current one.  We (the existing generation) are telling the new guys they need to get educated, but we don't need to get educated.  So which is it?  do educational standards need to be raised, because if that's the case, than everyone should need an AAS in EMS, and I would support that 100%, especially if everyone in the industry wanted it (and even if the FD didn't, well, if it gets them out of the ALS first response and that funding gets reallocated to put more paramedics on the ambulance even better), or are we good with just our NRP cert, but those new guys are too dumb and need to get more educated?  

The are some much needed benefits to the degree (well, the education obtained during the degree process anyway), but it's naive to say there are no drawbacks, especially to the individual who has a family, or is the breadwinner, and now needs to take off 2 years of their life to go to school, and have 0 income, vs taking a certificate program while working FT, getting a job in EMS as a medic, and continuing to support their family while they completed the EMS bridge program. Also, that degree is great, but experience + degree is even better.

I'll go one step further: how many EMS agencies are pushing for their personnel to obtain EMS degrees?  how many are paying for their staff to attend those classes?  is every EMS agency reimbursing the cost for all the fees and textbooks at the local CC?   How many EMS agencies have hired a person who is an NRP and told them they have 5 years to get their AAS in EMS, and if they don't, they are terminated?  So while many individuals are advocating for it, are their agencies actually investing in the push, or just taking advantage of it if it happens?

If we need a degree, why stop at a AAS? why not require a BS?  or an MS?  heck, we could make it a PhD, so we could really get some EMS research done!!! ok, hyperbole aside, the level of education should correlate to the job.  And yes, there should be different educational requirements for ambulance paramedics, ambulance supervisors, flight paramedics, EMS educators, EMS director, FTOs, EMS administrative officers, etc, all of which should have increasing level of educational requirements before you are even considered for the position.  

Remember, I am only talking about the requirements for the entry level ambulance position; everything else should require progressively more formal education, and more experience.


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## mgr22 (Jul 11, 2019)

Every time this topic comes up, as it does several times a year, I have to remind myself we're not talking about whether to get a degree, but whether degrees should be required industry-wide.

How would that happen? We can't even mandate safe lifting or mental health among our members. I don't see degree requirements going beyond the agency level.

That's not to say degrees aren't useful. And there's a big difference between saying lots of good paramedics don't have degrees (true) and there's no good reason for paramedics to have degrees (false). But those are issues for another thread.


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## akflightmedic (Jul 11, 2019)

I skimmed due to time crunch, however I did see raising bar creating a shortage....hmmmm, sounds like old familiar tactic. A shortage would lead to low supply, high demand, which means better wages or negotiating ability for those who did seek the degree. And the only way a service can get paid for ALS calls is if they provide ALS service....now wages are tied into reimbursement. Sweet!

Also, a shortage is ok, because as most of you are aware, many studies have shown fewer medics on scene is more ideal overall.


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## DrParasite (Jul 11, 2019)

akflightmedic said:


> I skimmed due to time crunch, however I did see raising bar creating a shortage....hmmmm, sounds like old familiar tactic. A shortage would lead to low supply, high demand, which means better wages or negotiating ability for those who did seek the degree.


only if 1) a degree was a requirements to hold a paramedic certificate and 2) if you look at the thread to see who is fully staffed, you will find there is already a shortage in many areas, yet wages haven't gone up.... but yes, that is the theory about how supply and demand works... My suspicious is with all the OT lovers and people willing to work 60 and 80 hour weeks on a regular basis, as well as work for multiple services, we are out own worst enemy when it comes to that





akflightmedic said:


> And the only way a service can get paid for ALS calls is if they provide ALS service....now wages are tied into reimbursement. Sweet!


If the only way you can paid for ALS services is having a provider with a paramedic degree treat the patient, I would agree with you.  But that isn't what is being proposed by various parties.





akflightmedic said:


> Also, a shortage is ok, because as most of you are aware, many studies have shown fewer medics on scene is more ideal overall.


So do we have too many paramedics, or not enough?  Can't have it both ways.....


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## SandpitMedic (Jul 11, 2019)

You wrote a lot, so I will hit what I thought were the high notes.

I wasn’t comparing wages, I was comparing educational mandates and the progression of the most similar professions in medicine. AKA the RT, RN, PA, NP, and physicians. Educational foundations and building blocks that progress onto each other, you know the old adage - Rome wasn’t built in a day. The RNs are phasing out the ADN and transitioning to all BSN while giving current ADNs time to get their BSN. The PAs are transitioning to MS but still allow practice for anyone grandfathered in at a lower degree level, including certificate holders, AS, BS - With no plans to force any existing provider to get an MS, while all incoming will be forced to complete an MS program.

Two different routes but generally the same result. The argument is made that having a degree vs a certificate does not make a good provider better or a MS provider better than a BS provider better, yet whether we like it or not that is how medical education is trending.

I’m not advocating basket weaving BS. In my experience, formal education is not a requirement for any level of paramedic, and generally speaking time in service is the only parameter utilized for a majority of EMS supervisors, FTO’s, educators, and  CCT/FP-C (although additional specific technical training is required for CCT/FP-C),

I’m advocating an AAS in EMS from an accredited community college (which obviously includes the DOT paramedic curriculum/internship) being _*THE BASE*_ requirement for a NREMT Paramedic card.

Yes, it starts for entry level medics, the new guys, where current NREMT P card holders are grandfathered in. Obviously there will be a timeline for them to get their AAS as well. Judging by how long EMS takes to do anything I’d say it would probably take within 2-4 cycles before being mandatory for all those recertifying has to have it. (That’s off the cuff, I’d like to see 2 at most but that’s just me; four years seems like plenty of time to get that done IMO).

Rome wasn’t built in a day. This initiative will take time.

There are so many things I’d like to say, but these posts are just getting too long.

BUT. One more thing... AKFlightmedic hit the nail that is supply and demand. The wages WILL increase. And volunteer PM should not be a thing, but I digress.
AND- stop comparing us to social workers. That’s not even the same playing field. Might as well argue that a lot of teachers have MS degrees and make crap wages. I’m not arguing wages with my comparison to RN, RT, PA, etc. I’m arguing educational requirements and foundation for _CLINICAL medical providers and professionals. _

Edit: damn, okay one more thing. Re: cost.
The cost of an AS/AAS paramedic program is often several thousand dollars less than a private paramedic program. At least on the western half of the US.


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## PotatoMedic (Jul 12, 2019)

DrParasite said:


> no research at all?  what about https://www.emsworld.com/article/10323777/prehospital-use-cpap which is from 2005, or Kosowsky J, Stephanides S, et al. Prehospital use of continuous positive airway pressure (CPAP) for presumed pulmonary edema: A preliminary case series. Prehosp Emerg Care 5:190–196, which was published in 2001?  Looks like there is plenty of research, if you chose to look for it.your entitled to your opinion, just as I am to mine.
> 
> ...


I stand corrected.  You are correct I did not look for the research as, at that time, all I went off was the memo released by KCM1.


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## DrParasite (Jul 12, 2019)

SandpitMedic said:


> You wrote a lot, so I will hit what I thought were the high notes.


I know... I try to be thorough and complete





SandpitMedic said:


> Yes, it starts for entry level medics, the new guys, where current NREMT P card holders are grandfathered in. Obviously there will be a timeline for them to get their AAS as well. Judging by how long EMS takes to do anything I’d say it would probably take within 2-4 cycles before being mandatory for all those recertifying has to have it. (That’s off the cuff, I’d like to see 2 at most but that’s just me; four years seems like plenty of time to get that done IMO).


You just did what I call "assuming facts not in evidence."  I have seen 0 calls for any timeline mandating that existing providers get AAS in EMS.  you say it's obvious; you're making an assumption, one that makes logical sense to me, but I could just as easily see the old guard fighting it.  But including that AAS in a 2 cycle period would go a long way to showing that the entire industry supports this change, and is willing to put forth the effort to raise the bar, vs simply forcing this on the next generation.


SandpitMedic said:


> BUT. One more thing... AKFlightmedic hit the nail that is supply and demand. The wages WILL increase. And volunteer PM should not be a thing, but I digress.


volunteer PM aside, considering we are currently in a paramedic shortage, with everyone having open spots, have wages risen yet? in theory that should happen, but there are still plenty of agencies who are paying crappy wages.





SandpitMedic said:


> AND- stop comparing us to social workers. That’s not even the same playing field. Might as well argue that a lot of teachers have MS degrees and make crap wages. I’m not arguing wages with my comparison to RN, RT, PA, etc. I’m arguing educational requirements and foundation for _CLINICAL medical providers and professionals._


Well, teachers are not hospital employees, but you missed what I was trying to say:  with increased education doesn't always correlate to higher wages.  even restricting to clinical medical providers and professionals, you can probably make that argument for in hospital providers; do you think private company paramedics will do the same?  what about fire based, where 80% of their budget goes to the suppression side?  When the pool of available money doesn't increase, where will the funding come from?

QUOTE="SandpitMedic, post: 679225, member: 20958"]The cost of an AS/AAS paramedic program is often several thousand dollars less than a private paramedic program. At least on the western half of the US[/QUOTE]Seriously?  can you provide some examples?  

The reason I ask is around me, most of the paramedic programs are ran by the CC system, through their paramedic program through their continuing education department.   Privates don't exist (except for when an agency runs their own paramedic class).  And from my conversations with some directors, they tell me moving from the con ed side to the cirruculum side makes the college more money because they charge more.


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## SandpitMedic (Jul 12, 2019)

They don’t have private medic schools where you are? That’s fantastic. Throughout the west there are numerous private EMS educators. I would like to see private EMS education for PM go away and see the paramedic level only offered at the CC level. (To be overly optimistic, I’d like to see private EMS ALS services go away too nationwide and be replaced by govt or hospital based services, but that’ll never happen).

We must remember that if we view this from a self centered perspective we won’t understand each other. Things are different in different parts of the country. By pushing for an EMS AAS degree as the basic entry level requirement, you are pushing for the domino effect that will be better for the entire industry. If it was NREMT mandated then states would have to comply or rewrite their legislation to drop the NREMT. They most likely won’t drop it (didn’t drop the nursing, PA, RT, and medical boards) which means it would have an effect on most states and therefore more of the industry. Yes, it is an assumption because none of us have a crystal ball. 

I did a little research and found there are only a handful of states that do not recognize the NREMT-P (now NR-P) level. Somewhere on the order of 3-5 states as the data is inconsistent in a few states. That means somewhere on the order of 90-94% of EMS has some NREMT-P requirement for initial paramedic certification.  Already in Oregon, if you became a paramedic after 1999, an AAS degree is required for certification. Texas also has an AAS degree requirement of some sort for paramedic licensure. 

All of the benefits have been opined and espoused too many times to repeat.

With the current shortage I have seen some pretty hefty bonuses offered in the private world upwards of $10,000... again maybe different in your neck of the woods.


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## SandpitMedic (Jul 12, 2019)

Usually at the college level it is a credit based system in which you pay per credit.

I’ll tell you my timeline and costs.

In 2008 I went to a community college (CC) and took my EMT Basic course for about $300.

In 2012 I was searching for a paramedic school and the private school (NCTI) was charging $10,000 just for the didactic year(not including an internship/books/additional fees) and $13000 all told in Riverside, CA. I did some shopping for a one year medic cert course. In Las Vegas the same NCTI school (under a different name at the time) was only $6000 all inclusive of books, equipment and internship, and thus I moved to Las Vegas. However, if I would have done the 2 year Paramedic AAS option it would have only been about $3000 at the time. (Side note, I only paid $3000 up front anyway for my PM school, and halfway through I got hired by an agency that covered the rest and gave me a paid internship in exchange for a 2 year contract- lucky).

In today’s numbers with tuition costs soaring, the most recent NCTI folks in Vegas are either sponsored by AMR or they can pay the $13000 for the paramedic course. Meanwhile at the CC, you can get an AAS in Paramedicine for about $7000. 

That’s roughly half the price for a degree program. Also, at the CC level you can use GI bills, get financing/FAFSA, or get a sponsoring agency to pay for you. With a private school they are harder to finance and most don’t qualify for the GI bill to cover costs of tuition.


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## Carlos Danger (Jul 12, 2019)

I took my EMT-B while on active duty in the Army and when I got out, I used my GI bill to pay for my initial paramedic program (a 10 month certificate) that I finished in 1997, and I've been involved in pretty much this same discussion almost constantly since then. 

In the interim, I earned a AS-science with the intention of going to school to become a PA (which I never did), an AAS-EMS in 2000, AS-Nursing in 2002, BSN in 2008, and MS-Nurse Anesthesiology in 2015. My first EMS job was in a busy urban 911 service, and I quickly transitioned to working FT in HEMS and part-time in various 911, ALS intercept (QRV), and ground CCT roles while also working in level 1 trauma center ED's and high acuity ICU's. I took CCEMTP while it was still a fairly new program (1999, I think?) and was one of the first few dozen CFP's (in 2000?) -now called FP-C)  for whatever that matters (this was back in the day when the only study resource was ICU nursing textbooks). I taught large portions of the CCEMTP as adjunct faculty for several years and have been a clinical coordinator and clinical instructor for student nurse anesthesiologists, medical students, residents of various flavors, and paramedics since 2016. I have not practiced in field EMS since 2013, but when I did, I worked with as many excellent clinicians who had little formal education as ones who had bachelors degrees and higher.

None of that is laid out as an attempt to brag, or to position my opinions as more valuable than anyone else's. I mention it all merely to illustrate the background that underlies my thoughts, which are outlined below:


Every paramedic should have a strong, working understanding of the basics of A&P and pharmacology, as well as the ability to reason logically and communicate effectively via both the written and spoken word. All this in addition, of course, to mastering the fundamental skills of paramedicine. 


Paramedics are not mini-ED physicians or intensivists. They are also not PA's or NP's or ICU nurses or anesthesia providers. Too much focus on trying to make them appear as such has been harmful, IMO.  


"Education for the sake of education / more education is always worth it" is a blatant lie. There are far too many people working for $15/hr and struggling to pay off huge student loan debts for anyone to believe that more education is always worth the cost, either in terms of dollars or the time that it requires. You only live once, and your time and money should be spent conservatively.   


Supply and demand is always probably the most important factor in determining wages, but it isn't the only thing that matters. In the healthcare industry, there are many things (aside form the value of the work performed by the frontline providers) that influence the payroll budget of any given agency. The fact that a majority of paramedics now have degrees has no bearing on reimbursement, or on the cost of fleet maintenance, for instance.  Obtaining a degree doesn't automatically make you more valuable to your employer. 


There have been several references in this thread to the push for a BSN for nurses. The reality is that there is no increased reimbursement for hospitals that have 80% BSN's. There is also no evidence that a nurse with a BSN provides better clinical care than one with a ASN. People often quote "facts" such as this, but those ideas are promoted primarily by the ANCC, which is effectively a trade origination for nursing educational programs and has no ability to back its claims up with any credible research, or even with any decent reasoning. A BSN can be a useful credential for the nurse that holds it, but there's very little (if any) evidence that education beyond a basic nursing program benefits patients or systems. 


I think EMS education needs to evolve, but I also agree with  @DrParasite that sweeping changes should be based on some sort of solid rationale (not necessarily a large, multi-center, double-blind study). The proposed increases in minimum education are a big, expensive deal.   


I may have more to say later, but I'm done for now.


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## SandpitMedic (Jul 12, 2019)

Remi said:


> I took my EMT-B while on active duty in the Army and when I got out, I used my GI bill to pay for my initial paramedic program (a 10 month certificate) that I finished in 1997, and I've been involved in pretty much this same discussion almost constantly since then.
> 
> In the interim, I earned a AS-science with the intention of going to school to become a PA (which I never did), an AAS-EMS in 2000, AS-Nursing in 2002, BSN in 2008, and MS-Nurse Anesthesiology in 2015. My first EMS job was in a busy urban 911 service, and I quickly transitioned to working FT in HEMS and part-time in various 911, ALS intercept (QRV), and ground CCT roles while also working in level 1 trauma center ED's and high acuity ICU's. I took CCEMTP while it was still a fairly new program (1999, I think?) and was one of the first few dozen CFP's (in 2000?) -now called FP-C)  for whatever that matters (this was back in the day when the only study resource was ICU nursing textbooks). I taught large portions of the CCEMTP as adjunct faculty for several years and have been a clinical coordinator and clinical instructor for student nurse anesthesiologists, medical students, residents of various flavors, and paramedics since 2016. I have not practiced in field EMS since 2013, but when I did, I worked with as many excellent clinicians who had little formal education as ones who had bachelors degrees and higher.
> 
> ...


Interesting perspective, although, I’m unclear whether you’re for a degree or not? You seem to lay out both sides of that coin. I presume at the end there, you seemed to ultimately support it with some kind of study first... 

I would say that the majority of paramedics nationwide do not hold an AAS in EMS. I would also say that an EMS AAS would not sink someone into a huge debt at a price point of $5k-$10k. 

Also, I’ve not seen anyone say that paramedics are equivalent to mini-ER physicians or intensivists. I think the reference was made to illustrate the educational paths the most similar medical professions to EMS have taken as they have grown. 

My path is a very, very similar one to yours, however you’ve got some years on me. Likewise, when I take my position on being pro-degree it stems from my own educational and professional experience. As I stated earlier, what’s the worst that can happen from mandating an AAS to be a paramedic? Better educated EMS providers who are better suited for their own future with a degree and some college credits, and better suited to master the skills and understanding of paramedicine.


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## SandpitMedic (Jul 12, 2019)

I’m going to bump this up a notch. Wages are not the only reason to mandate degrees and evolve EMS education. 

One reason, to be blunt, is if it prevented some people from becoming a paramedic. In my opinion and experience, barriers to entry eliminate some (not all) people who shouldn’t be paramedics in the first place. Whether due to emotional immaturity, lack of common sense, failure to strive, or just being flat out too lazy to accomplish the requirements it will prevent some undesirables to reach such a level.

EMS should not be the catch-all _career_ for those who want to play with lights and sirens or couldn’t pass a civil service exam or background check. You all know the salty lazy muckity mucks I’m talking about, you see them in the ER bay and around the ready room with their feet on the ****ing table. As it stands, anyone can just go to paramedic school and get a P card, and with staff shortages, the private schools just pump them through. They get retests on exams and it practically takes an act of Congress to fail someone on an internship these days. Then they just get recycled. If anything the educational standards are falling.

To be respected as professionals and to evolve as a profession we cannot allow a process like that to continue.


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## MackTheKnife (Jul 12, 2019)

Remi said:


> Every paramedic should have a strong, working understanding of the basics of A&P and pharmacology, as well as the ability to reason logically and communicate effectively via both the written and spoken word. All this in addition, of course, to mastering the fundamental skills of paramedicine._ Couldn't agree more! I've seen so many medics break down a 12-lead EKG to a "gnat's a$$" but not have a grasp on A&P, and pharmacology._
> There have been several references in this thread to the push for a BSN for nurses. The reality is that there is no increased reimbursement for hospitals that have 80% BSN's. There is also no evidence that a nurse with a BSN provides better clinical care than one with a ASN. People often quote "facts" such as this, but those ideas are promoted primarily by the ANCC, which is effectively a trade origination for nursing educational programs and has no ability to back its claims up with any credible research, or even with any decent reasoning. A BSN can be a useful credential for the nurse that holds it, but there's very little (if any) evidence that education beyond a basic nursing program benefits patients or systems.  _As for 80% BSNs, that speaks to hospitals achieving or maintaining Magnet status. As Remi said, having BSNs doesn't affect reimbursement. Remi is also correct about BSNs do NOT provide better clinical care than ASN/ADN nurses. Some nurse (Aikens) did a study, which is often quoted, stating than patient outcomes were better with BSNs. I read the study and it was specific to a surgical floor with some iffy correlation and no causation. Don't believe everything you read!_
> 
> 
> ...


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## Carlos Danger (Jul 13, 2019)

SandpitMedic said:


> Interesting perspective, although, I’m unclear whether you’re for a degree or not? You seem to lay out both sides of that coin. I presume at the end there, you seemed to ultimately support it with some kind of study first...



I do support moving to a AAS degree for paramedics, with the program centered around one or two semesters of A&P and a semester of pharmacology, as well as a basic clinical statistics / research course and writing courses. I don't think this is much of a leap, since most paramedic courses are already at least two semesters. There's no reason to do any sort of study first - the ones that the pro-BSN crowd talks about are useless - other than perhaps trying to estimate the economic and related impacts on the whole emergency services field. 

While I think this is probably a good idea and I don't really see any downsides either, I also don't think I see any real advantage or necessity for the profession. I guess that's where I diverge from the rest of the "pro degree" caucus; I think it would probably be generally positive, but I just don't see it really having much impact overall on the industry level. So I'm a bit agnostic about it. Partly because I'm a little cynical about the value of higher education in general.

For_ individuals_…..heck yes. Every damn one of us should seriously consider whether earning a degree would have value to us. For anyone who plans on making a career in EMS and possibly eventually move on to something else in healthcare, I'd say it's definitely worth it. 

But for _the profession as a whole_? Again, I think the idea probably has more positives than negatives, but I'm not personally convinced that it really needs to be done.

I feel the same exact way about a BSN requirement for RN's. 




SandpitMedic said:


> One reason, to be blunt, is if it prevented some people from becoming a paramedic. In my opinion and experience, barriers to entry eliminate some (not all) people who shouldn’t be paramedics in the first place. Whether due to emotional immaturity, lack of common sense, failure to strive, or just being flat out too lazy to accomplish the requirements it will prevent some undesirables to reach such a level.
> 
> To be respected as professionals and to evolve as a profession we cannot allow a process like that to continue.



I agree. A requirement for a AAS degree almost certainly would weed out _some _of the less motivated candidates. It also might put some upward pressure on compensation, at least in some areas. And it might help improve the perception that the rest of healthcare industry has of paramedics. But I also think adding two semesters to what is already required  might not be enough of a barrier to have too much of an effect in these areas.


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## MackTheKnife (Jul 13, 2019)

If I'm correct, an AAS doesn't allow for progression to a BS degree, correct? So, entry-level degree should be an AS.


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## OceanBossMan263 (Jul 13, 2019)

Conversion of the current EMT-P programs to an AS seems like a logical starting point. The added classes are things that would actually be useful (as stated many times before, A&P, pharm, some basic chem, math, etc). 

Municipal service could be the place to really see the increased entry requirements in play. It's easier to change civil service regulations for a more desirable job than convince private companies they need to cut out their pool of applicants. In NY, most of the PD and FD jobs require 60 college credits anyway, which would be perfectly aligned with AS.


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## ExpatMedic0 (Jul 13, 2019)

A lot of replies here from people who USE to work in EMS, got degree's and changed career fields. Nursing and PA school are defiantly the classics. I have lost so many good co-workers and partners over the years, especially to PA school. What I find interesting is many of you still clearly care about EMS or at the very least are still interested in it and staying active on this forum and likely other sources, maybe via literature and networking, or volunteering or even working part-time in EMS. I think this kind of builds on the discussion at hand. You likely left for a reason, whatever that reason was... your new career, which requires a degree, is probably better in terms of pay, working conditions, professionalism, ect ect. I'm coming up on my late 30's, I have a masters degree (completed on campus) from a QA world ranked top 50 university, but here I am, still hanging around in EMS qualifying for low-income assistance with housing and working full-time. I don't think it should have to be this way and in my personal opinion, one of the ways forward for the entire profession is getting our paramedics degrees, treating and not transporting, along with restructuring some of the financial and reimbursement issues with our industry.


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## Carlos Danger (Jul 13, 2019)

MackTheKnife said:


> If I'm correct, an AAS doesn't allow for progression to a BS degree, correct? So, entry-level degree should be an AS.


An associate's degree (AA, AS, AAS, ASN, etc.) is typically about 60 or so credits and takes four semesters (traditionally two years), which is half of what a bachelors degree (BA, BS, BSN) requires, which is 120 or so credits typically taken over 8 semesters and 4 years.

An AA or AS is usually intended for transfer to a bachelor's program. As such, you take all the same major and general education and elective courses that you would take during the first two years of a bachelor's program, so that when you transfer to the 4 year program, you are in pretty much the same place that you would be had you started out in the bachelors program to begin with.

An AAS degree, on the other hand, is usually intended to prepare you for a specific field that doesn't require additional college education. So you take fewer electives and gen eds and more "applied" courses that are intended to prepare you to go right to work in the field you are studying.

Look at two year engineering degrees, for instance. The AS in electrical engineering is a transfer degree where you take all the math and science and humanities and what not that the bachelors degree requires during the first two years, and there's not much you can do with it if you end up not transferring. The AAS in electrical engineering technology requires fewer math and science courses and fewer electives, since you aren't going to transfer into a 4 year program. Instead, you spend that time learning hands-on technical skills so that you can go right to work as an electrical engineering technician as soon as you graduate. Similar degree names, same length of time, very different results.

For paramedicine, the AS degree won't won't work because you have to spend so much time taking the paramedic-specific courses that you simply don't have time to take all the general education courses that a AS would require.

All that said, much of a AAS will still transfer. My AAS-Paramedicine included I think 40 credits in "paramedic theory" and "field practicum", and the rest of the credits were the gen eds. When I started my BSN program, they took all my gen eds and also gave me like 30 elective credits for the paramedic courses. So it wasn't a seamless transfer the way a AS—>BS transfer is intended to be, but I still got a lot of credit for my paramedic education.

There's probably no way to create a two-year degree that includes all the normal paramedic program education and clinical, as well as all the courses that would be required to transfer as a junior into a 4-year program. Just not enough hours in the day.


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## SandpitMedic (Jul 13, 2019)

My AAS in EMS also transferred most of my gen ed and elective credits towards my PA degree, as well as satisfied some of the prerequisites to apply for PA programs. 

There’s no downside from my lens.


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## DrParasite (Jul 13, 2019)

MackTheKnife said:


> If I'm correct, an AAS doesn't allow for progression to a BS degree, correct? So, entry-level degree should be an AS.


OK, What Remi said was correct, but I can make it even simpler: for every degree you complete, you need to complete it's requirements.  

so if you get an AS, AA, ASN, whatever, you need to complete the requirements for THAT degree.  Now, if you want to earn your BS, you need to complete the requirements for the BS.  Maybe the classes from your associates will qualify; maybe not. So if I get an ASN, or an AAS, AS in Nursing, and decide to get my BS in engineering, some classes from my associates may qualify for my bachelors, but I will still need to complete all the classes for the program that my bachelors will be in.

I'm currently completing my MBA; my adviser was able to take some of my undergrad classes (5xx level classes) and apply them to the MBA program, so I didn't have to retake those classes.  But it's all program and degree specific.


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## RocketMedic (Jul 14, 2019)

ExpatMedic0 said:


> A lot of replies here from people who USE to work in EMS, got degree's and changed career fields. Nursing and PA school are defiantly the classics. I have lost so many good co-workers and partners over the years, especially to PA school. What I find interesting is many of you still clearly care about EMS or at the very least are still interested in it and staying active on this forum and likely other sources, maybe via literature and networking, or volunteering or even working part-time in EMS. I think this kind of builds on the discussion at hand. You likely left for a reason, whatever that reason was... your new career, which requires a degree, is probably better in terms of pay, working conditions, professionalism, ect ect. I'm coming up on my late 30's, I have a masters degree (completed on campus) from a QA world ranked top 50 university, but here I am, still hanging around in EMS qualifying for low-income assistance with housing and working full-time. I don't think it should have to be this way and in my personal opinion, one of the ways forward for the entire profession is getting our paramedics degrees, treating and not transporting, along with restructuring some of the financial and reimbursement issues with our industry.


Hi, boat buddy!


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## MackTheKnife (Jul 15, 2019)

Just got my _Prehospital Emergency Care _journal for July/August 2019. Check out the article in the _Position Statements _section on pgs 593-595: National Association of EMS Educator's Position on the Critical Care Paramedic. Speaks specifically about going to a Baccalaureate for the CCP.
DOI: 10.1080/10903127.2018.1536772


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## MackTheKnife (Jul 15, 2019)

ExpatMedic0 said:


> A lot of replies here from people who USE to work in EMS, got degree's and changed career fields. Nursing and PA school are defiantly the classics. I have lost so many good co-workers and partners over the years, especially to PA school. What I find interesting is many of you still clearly care about EMS or at the very least are still interested in it and staying active on this forum and likely other sources, maybe via literature and networking, or volunteering or even working part-time in EMS. I think this kind of builds on the discussion at hand. You likely left for a reason, whatever that reason was... your new career, which requires a degree, is probably better in terms of pay, working conditions, professionalism, ect ect. I'm coming up on my late 30's, I have a masters degree (completed on campus) from a QA world ranked top 50 university, but here I am, still hanging around in EMS qualifying for low-income assistance with housing and working full-time. I don't think it should have to be this way and in my personal opinion, one of the ways forward for the entire profession is getting our paramedics degrees, treating and not transporting, along with restructuring some of the financial and reimbursement issues with our industry.


"I used to work in EMS" sounds like what someone would say in a 12 Step support group!  Seriously, I used to work in EMS many years ago, and after starting my third career in 2016 (RN), I ran into a newly retired FF/PM at our ACLS class. As we were going through heart rhythms, he said I was pretty good for a brand new nurse. I told him I had been in the medical arena since the 1970's and was a medic during the mid-80's. He told me I should challenge the medic exam (Florida). He told me how. So I took my NREMT certification that I had always maintained, got a reciprocal FL EMT license, and then challenged the test. It was an easy test as it was the FL State test. I had found out that FL had been using NRP, but was experiencing a less than 40% pass rate, and switched back to their own exam.
Why do I write this? Because my first love is, and always will be, EMS. I wish that their was some way to get back in, but around here, it's nearly impossible, especially at my age (61). 
I frequently get into the "medic-RN" questions with some of the nurses. It's hard to explain the mindset of a medic, even at times to an ED nurse, let alone a floor nurse. They don't understand the abilities and autonomy of a medic.  I'm a Charge Nurse and I live for the codes and support team calls. My nurses, and my Nurse Manager, think I'm, nuts!


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## VentMonkey (Jul 16, 2019)

MackTheKnife said:


> Just got my _Prehospital Emergency Care _journal for July/August 2019. Check out the article in the _Position Statements _section on pgs 593-595: National Association of EMS Educator's Position on the Critical Care Paramedic. Speaks specifically about going to a Baccalaureate for the CCP.
> DOI: 10.1080/10903127.2018.1536772


Are you able to post the link?


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## DrParasite (Jul 17, 2019)

MackTheKnife said:


> Just got my _Prehospital Emergency Care _journal for July/August 2019. Check out the article in the _Position Statements _section on pgs 593-595: National Association of EMS Educator's Position on the Critical Care Paramedic. Speaks specifically about going to a Baccalaureate for the CCP. DOI: 10.1080/10903127.2018.1536772


the NAEEP has a vested interest in increasing the education requirements, just like many authors who advocate for the increased education for others, but not themselves. But that doesn't mean they are wrong, only that their biases needed to be considered when evaluating the validity of their position paper.  It's no different than evaluating the biases in the IAFC and IAFF's position paper.

That being said, I've read the paper, and it's sound reasoning.  We don't use CCP in the systems I used to work at, but based on what I have heard and seen, having that educational level on par with a nurse seems appropriate.  One thing I would remind you is the CCP isn't an entry level position; providers usually need a year or two of experience before they will be considered for a critical care position (or so I am told).

When you start doing stuff that is beyond the entry level provider, common sense dictates that additional education will be needed.  Esp if that stuff is beyond what the original field paramedic was supposed to do (CCP, community paramedic, etc)


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## MackTheKnife (Jul 17, 2019)

VentMonkey said:


> Are you able to post the link?


I included the DOI. I get the print copy only.


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## DrParasite (Jul 17, 2019)

VentMonkey said:


> Are you able to post the link?


No, but I can do this.......


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