Look, this forum in particular has been a hotbed of progressive EMS ideas and advocacy since I joined it in 2004. Many of the conversations go in circles because change comes slowly. There are many multipage threads over the years talking about this. Many are worth reading and they involve US and non US EMS, Fire, PAs, MDs, RNs, etc... the full breadth of the membership of this place.
If you look at what makes EMS progressive and a long career in other nations, it generally functions as a government third service and requires vastly higher education requirements, typically 2, 3, or 4 year degrees to be ILS with additional university education yielding higher responsibility, scope, and pay to include BS or MS degrees including pathways into additional fields. Look at Canada, NZ, Australia, and parts of Europe (many of which may also incorporate RNs and MDs into EMS).
Pinning EMS to Fire guarantees that EMS will be considered a secondary function of FD, a stepping stone within FD. Yes there are a handful of departments that are EMS Fire instead of Fire EMS, but most do not think EMS first and never will. Increasing education requirements will not be permitted to occur because Fire doesn't want that. Fire wants degrees to be in Fire when people go for officer after they do their requisite **** duty on the bus. Pushing Fire as EMS's savior means making EMS just a higher paid version of what it already is for most: a temp job in career that is not ultimately EMS.
Volunteer EMS creates a similar issue, specifically East Coast volly depts in areas that could absolutely support professional departments. Low entry requirements and people doing the job for free will keep anyone from raising the bar for entry and education which drives scope and role which drives pay.
EMS is a small, fractured, and isolated component of healthcare and has an identity crisis frequently confusing itself with public safety (Fire/PD). For EMS to progress it has to identify with its actual field of focus, and that is MEDICAL services in the prehospital environment. We ought to rename EMS to PHS: Prehospital Healthcare Services.
EMS gains career paths when people stay in it. Career paths open when EMS providers are educated professionals rather than stone steppers and interchangeable cogs. Some pathways are dead ends: hospital work is silly because the hospital is full of niches that are already filled! Advocating for cheaper and less educated paramedics to be interchangeable with higher educated higher paid healthcare workers inside the walls of a hospital actually works against EMS progression because it confirms the idea that EMS is exactly those things that are holding it back: technician level, lower education, cheap. Community paramedicine is one of those pathways of true progression but it truly should be the role of an educated professional rather than another 40 hours cert course. More broad education makes it far easier for medics to transition. it is why RNs can jump specialties far easier. They start as generalists. EMS are specialists from the start. Broad education is found in degrees.
Things have gotten better, and they could get better still. Change has been incremental because all the education reform is always pared back by intrasigent interests working against ultimate EMS progression. Eyes on the prize! Associate Degree in Paramedicine as the minimum to become a medic, no exceptions, grandfathered if you have 5 years of medic experience, otherwise you have 5 years to get it or you get dropped to AEMT. Intermediates get 5 years to transition and EMT-Cardiac and the like all go the way of the dodo. Do that modest thing, and changes start.
