The Future of Paramedicine

[CWATT]

I recently came to learn one of my regional regulators has set 2025 as the target for a singular-scope Bachelor's of Paramedicine. I for one am a supporter. I view it as the professional standard long deserved by Paramedics (EMT-P) and the necessary shift to accurately position ourselves within the health professions community, especially in contrast to the other health diciplines that have made the transition in recent years.

In waxing philosophic about another one of my regional regulators (whose population majority is rural and current EMS system is municipally supported services with limited tax pools), they expressed opposition citing funding concerns. As it is, part-time casual / on-call is the norm, so adopting a singular scope would put additional financial pressure on those municipalities. How much, I'm not sure, but I do wonder if we would see a reemergence of 'Ambulance Attendents' to offeset the cost (versus an EMT/EMT-P combo).

There's also a second aspect to consider; the role and scope of what Paramedics will be. Many people maintain a Bachenor's of Nursing to be a better career pursuit because it offers a 'Paramedic' bridge and are already used alongside Paramedics in critical care settings. Moreover, the role of nurseing continues to adopt increasing autonomy which makes me question how exactly Paramedics will differentiate themselves.


I'm curious to hear from the community, especially the grizzled veterans who have been longing for this.


- C

 

[mgr22]

Are you saying medics have been longing for a B.S. in paramedicine? I'm not so sure of that. I don't get the feeling that having an occupation-specific curriculum is much of an issue at all. There are those who favor two-year or four-year degrees for medics, but I haven't heard many colleagues insist on a particular major -- not that I see it as a problem either way. Maybe I'm just not "grizzled" enough

 

[EpiEMS]

regional regulators has set 2025 as the target for a singular-scope Bachelor's of Paramedicine

What body is this, if you don't mind my asking?

How much, I'm not sure, but I do wonder if we would see a reemergence of 'Ambulance Attendents' to offeset the cost (versus an EMT/EMT-P combo).

Well, EMTs are pretty inexpensive - and abundant - at least near me. But in a rural area, you might have some problems - so perhaps an EMR (or non-certed) drivers plus an EMT attendant for IFT would suffice?

 

[CWATT]

Are you saying medics have been longing for a B.S. in paramedicine?

I've met a number of paramedics who echo a common theme expressed in the thread "why are we looked down upon so much as a profession"; the lack of a Bachelor's degree. I imagine you'd be hard-pressed to find an EMT-P that doesn't feel their job is comparable in scope to a RN (supported by bridge opportunities), but the professinoal recognition indicated by the discrepancy in pay reflects a certificate not a degree.

@EpiEMS - I'm reluctant to say for two reasons. First, like many, I enjoy a degree of anonymity here. I would like to continue to engage with the community without worry that it may cast doubt or have reprocussions on my professional practice. Second, I came to learn this information by hear-say and I'm not sure if it has yet been made public. My suggestion would be to speak to your regulator to see if this applies to you.

 

[EpiEMS]

@CWATT Totally understood.

So, I have yet to hear about anything like this in the U.S., but I do know that it is the target for Canada. Perhaps we in the US will be surprised when the EMS Agenda for 2050 or the new national scope doc come out?

 

[Carlos Danger]

In the US we are easily much more than 8 years away from being able to require a BS degree of paramedics. I think we only have one state out of 50 that even requires a two-year degree (Oregon?) now, and many paramedic programs (if not a majority) are still 10-month vocational programs that don't require any college-level courses at all, though that does seem to be changing slowly. Politics and economics both make it hard to advance paramedic education here: politically, large FD unions and professional organizations tend to have influence and generally oppose the idea of requiring more education, and economically, paramedics in some areas make far too little money (not to mention the many rural areas that still utilize volunteers) to justify spending the time and capital needed to earn a 4-year degree, so such a requirement would likely result in large shortages.

Lastly, I'm not convinced that a majority of EMS professionals really want to complete a BS degree, either. You see plenty of enthusiasm on this and other online forums for the idea, but I think these forums are not representative of EMS folks as a whole.

EMS in the US is still very fragmented, with very little leadership at the national level to pull something like this off. That's a big part of the reason why EMS has changed so slowly here.

In Canada, paramedics already have a lot more education than we do here, and my understanding is that much of it is university-based. Also, we are probably talking about much smaller numbers of people to have to educate to the level, too. So it is probably a lot more feasible an idea there.

 

[Summit]

I recently came to learn one of my regional regulators has set 2025 as the target for a singular-scope Bachelor's of Paramedicine.

I am unsure what that means?

What is a "regional regulator"?
What does a "2025 Target" actually imply?
What is a "singular-scope Bachelors"?

 

[Summit]

I think we only have one state out of 50 that even requires a two-year degree (Oregon?)

Oregon and Kansas kinda sorta require it eventually maybe unless you work your way around the requirements (and the associates degree doesn't have to be in paramedicine).

And everything else you said is spot on and saved me from typing a longer response!

 

[mgr22]

I've met a number of paramedics who echo a common theme expressed in the thread "why are we looked down upon so much as a profession"; the lack of a Bachelor's degree. I imagine you'd be hard-pressed to find an EMT-P that doesn't feel their job is comparable in scope to a RN (supported by bridge opportunities), but the professinoal recognition indicated by the discrepancy in pay reflects a certificate not a degree.

Ok, but I think the issue has more to do with a degree than the major. For example, my B.S. is in Industrial Engineering. I think it's carried as much weight as a medical-specific degree. I'm not saying I think medics with degrees are necessarily better; I'm just saying there have been opportunities I've taken advantage of where the degree mattered but the major didn't.

 

[Summit]

If you want to follow the role of nursing, start modestly. Aim for an Associates for all new medics. Make 2025 a requirement that all newly certifying medics have an AS in Paramedicine. Agencies will start doing what hospitals did: they'll require any newly hired medic get their associates within 3 years of hire (most hospitals require nurses to get a BSN within 5 years if they don't have it). In a decade 75% of paramedics will have at least an associates degree, those without it will either be very senior people or dancing between transport services). Many will be in bachelors programs to be more competitive.

The only thing that will stop us is ourselves (and the IAFF).

 

[WolfmanHarris]

Well unless I've missed news from the US this is almost certainly Canada. By way of background, the Canadian Medical Association (CMA) which previously accredited various non-physician education programs including Paramedic programs announced that they would no longer do so in the future. As a result, the Paramedic Association of Canada (PAC) which already publishes the National Occupational Competency Profiles (NOCP) is preparing to take a more direct role in accreditation and the follow-on document for the NOCP will be calling for a 4 year BS as entry to practice.

While accreditation does not necessarily lead to the provincial governments immediately changing their requirements, the various colleges tend to seek accreditation for the purposes of labour mobility. For instance none of the current NOCP's are reflected in the regulations or legislation for my province (Ontario) but an accredited program has been the de facto requirement for years. It gets even more complicated once you get into the Association of Paramedic Regulators which in some provinces include a professional college and in others are directly regulated by the Ministry of Health and other stakeholder organizations but, I think this is a reasonably accurate depiction of how it works.

What this will actually look like when implemented and how long it will take to become the norm countrywide isn't public as yet. I'm looking forward to attending PAC's conference in Quebec City this summer though where I assume we'll get a big update.

 

[Summit]

Well unless I've missed news from the US this is almost certainly Canada.

Only if they started using EMTP instead of ACP etc

 

[SpecialK]

Broadly, and briefly, the future will be expanding clinical telephone advice, non-response, referral options and non-transport.

Essentially, call the ambulance service and something will be done for you; whether it's telephone advice, referral or a physical response to assess you and point you in the right direction. This will be expanded as further embedding into the health system is undertaken. The single, national electronic health record will go a good way to helping with this and national pathways such as falls, asthma and COPD.

This is already being done but the future will be doing more of it. I have also heard it is being investigated whether Control can ditch AMPDS and move towards something better and more towards Healthline/primary care focussed.

I don't see education changing much; it's already firmly established a Bachelors degree is the minimum standard for Paramedic and Postgraduate qualification about this for ICPs. Whether any other Postgraduate specialisations emerge I can't say but perhaps specialisation into the primary care space.

 

[CWATT]

Only if they started using EMTP instead of ACP etc

This is Canada, yes. I wasn't explicit about this because I didn't want the thread to turn into a gossip column but rather an opportunity to discuss where we see and would like to see paramedicine go as a profession.

A side note, not all jurisdictions use PCP/ACP. Some use or until recently used EMT/EMT-P

 

[FLMedic311]

What I would really like to see happen here in the US is instead of just a national training model is to have an actual accepted Minimum Standard of Care. Of course more education is better and I get that a lot of people would frown on the idea of having to have more education to become a paramedic, but how could our profession as a whole not benefit from that??

 

[SpecialK]

What I would really like to see happen here in the US is instead of just a national training model is to have an actual accepted Minimum Standard of Care.

What do you mean by this? I imagine most places are fairly similar no? or do you mean more like a single consensus set of clinical guidelines published by an authoritative professional body which everybody agrees is the minimum?

 

[FLMedic311]

What do you mean by this? I imagine most places are fairly similar no? or do you mean more like a single consensus set of clinical guidelines published by an authoritative professional body which everybody agrees is the minimum?

Exactly, I think there need to be a national consensus to a minimum standard.

 

[EpiEMS]

Exactly, I think there need to be a national consensus to a minimum standard.

I mean we have the national EMS education & scope guidelines, but they don't have any teeth, I think?

 

[FLMedic311]

Agreed, and not only that but it's only purpose is to set an educational standard. Not saying that's a bad thing, I would just also like to see something "with Teeth" that would hold all States and it's MPD's accountable to provide EMS to a minimum standard. We have all seen and maybe even currently work in a system that is simply put, not providing a great product. Some places claim budget, other say training and on occasion you get the one's who are either lagging behind the times/stuck in their old ways. These are not good reasons to be providing what I believe most forefront EMS providers would believe to be a sub-standard care. Granted I know the elephant in the room is who/how would we determine these "standards" admittedly I don't have a good immediate answer, but I imagine it would have to be by committee.

 

[EpiEMS]

Granted I know the elephant in the room is who/how would we determine these "standards" admittedly I don't have a good immediate answer, but I imagine it would have to be by committee.

I'm guessing that the teeth might come through Medicare/Medicaid reimbursements.

As far as who should determine standards, it should be EMS providers - I think - in a self-regulatory body like the UK has.