When there is a fire it is very labor intensive, yes today there are more EMS calls than fire, but a fire takes longer than an EMS run and requires a lot more people to put it out.
What would happen if the NREMT required a degree?
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When there is a fire it is very labor intensive, yes today there are more EMS calls than fire, but a fire takes longer than an EMS run and requires a lot more people to put it out.
We have countless medics and emts with associates, bachelors, and masters degrees...this makes them neither better or worse providers.
I think an associates program would be a good minimum, simply because most of the classes required for a bachelors, are completely unrelated to EMS...
At most community colleges, all you need is general ed type stuff to get an associates in EMS, after taking all of the required courses for medic school, so an AS wouldnt really be a stretch, just a handful of other classes you would need.
Requiring a degree for an entry level position like EMT is a pipe dream.
The biggest benefit i would see from requiring a degree, is potentially higher pay and hopefully elevation of the profession as a whole.
I think an associates program would be a good minimum, simply because most of the classes required for a bachelors, are completely unrelated to EMS...
At most community colleges, all you need is general ed type stuff to get an associates in EMS, after taking all of the required courses for medic school, so an AS wouldnt really be a stretch, just a handful of other classes you would need.
Requiring a degree for an entry level position like EMT is a pipe dream.
The biggest benefit i would see from requiring a degree, is potentially higher pay and hopefully elevation of the profession as a whole.
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I completely agree and this is my point. One of two things needs to happen for EMS to be a viable progressive field.
We can either
1. Go back to really only treating emergencies and get progressive about dropping people off at urgent cares or outright refusing to transport non emergencies.
Or
2. We can progress to "MHS" or mobile health services and be dispatched as "mobile health units" to take care of all variety of medical complaints that are emergent or non emergent in a much more economical and sensible fashion.
The way we are right now is a really poor combination of the two. We see WAY more social work and non emergent stuff than emergent stuff as you have rightly pointed out. However we try and treat it all as emergent. We do EKG's in a 5 minute ride to the hospital and establish an IV and give asprin for patients who have been having chest pain for 2 weeks. If this same patient showed up at their family doctor they would be managed quite differently. We use expensive resources on routine transports because we have "emergency" on the side of our vehicle.
We either need to get back to only really treating and transporting "emergencies"
Or
we need to get away from the emergency title and adapt the whole field to "mobile healthcare services" and then train accordingly. If the majority of our time will be spent with non emergent patients who could benefit vastly from proper referals correct facility placement then our training must reflect that.
I agree with what your saying here but the problem is the whole though process is wrong. You may need a degree to be viewed as a professional by the rest of the world but it doesn't (or wouldn't) make EMS any more professional or provide higher quality providers. It might provide higher salaries and more rights and privileges and let us be taken more seriously but in the end the actual training from achieving a degree does nothing to make you a better medical provider from a basic treatment standpoint (based on current American ems systems).
Requiring everyone to have a degree will just cause the "price" of EMS To go through the roof to pay for the training and the higher salaries. The government will have to fund it by paying better rates for medicare and medicaid. private insurance will get slightly more expensive to cover the higher EMS bills, and all of that for care that likely will not improve outcomes at all for the vast majority of patients.
As far as more professional and higher quality providers...I think you're off base. Even if all that was required is an Associate's Degree, the cost of getting it will cause some people to not go for that particular cert. This obviously isn't a complete fix, but it will require more time, effort and money than the current setup, which I think would weed out the people who don't really want to be a paramedic.
Oregon has required a degree for quite awhile (in terms of EMS anyway), and while there are still plenty of less than desirable paramedics, and people who only do it to help with getting a job as a firefighter, it seems that the average quality of paramedics here is higher than elsewhere.
It would depend on how the degree was structured, but the extra time and credits required very well could make for a better provider; to be eligible to even get into a paramedic class you have to take a full year of Anatomy and Physiology. Believe it or not, that pays all sorts of dividends. There are some non-degree programs that require this, but that's just one example of something that could easily be added and would be a benefit.
I do agree that simply requiring a degree is not the perfect panacea though; it won't magically fix all problems. But it will help, be a great start, and make many of those problems easier to fix.
Wayfaring Man...seriously, you need to learn not only about EMS, but about the entire medical profession.
Some keep mentioning "cost". I don't see how a community college degree is any more expensive than the $3000 some pay for a simple EMT course and up to $20,000 some pay a medic mill for a 600 - 1200 hour certification with no college level courses. Then, you have people who pay well over $1000 plus hotel for a simplified overview of critical care; CCEMTP course. There are also medic mills cashing in on the CP course which is another 2 - 4 week cert which they can charge a few thousand dollars for and no college courses or prerequisites are needed. I fail to see this cost logic when people are in debt for $20,000 for a quick cert and no credits to transfer to a college.
An Associates degree with college level courses for A&P and pharmacology would be a benefit rather than the overview courses which some certificate programs are offering even in the colleges. And, the degree should be in EMS/Paramedic. Just having a random degree might make you more literate but the focus should be on the medical part. Very few Associates degrees for allied health have time for all those courses some believe to be a waste of time like the humanities and math. What few there are should improve your communication skills and help with drug calculations or reasoning skills.
Right now it appears there are only about 20% of those holding an active certification in EMS who have a degree. Chances are there are many of this percentage who hold a degree in something else like nursing or some totally unrelated field. This also includes the volunteers who might have another very different profession which requires a degree such as school teachers and accountants.
Even the percentage for the instructors holding degrees is very, very low since the Paramedic courses are considered tech school and no degree is required to teach in that classification. This means there are very few mentors to push for education. The change must start here first. Instructors must raise their standards first. They also must raise their education levels so they can take charge of the EMS programs in the colleges. Right now nursing administration still plays a large role in the education portion since few are willing to move up the ladder and accept the overall responsibility.
Until more do take advantage of the many community college EMS degrees, nothing will change. The degrees are there but it seems too many offer arguments against them.
It also takes decades to get a degree established for licensing. It took over 15 years for the current "certification" changes to come into effect. Basically all that did was change the titles and not much else. Essentially EMS has the same education requirements it had in 1980 without much more for forward planning for degrees. There will just be more certs with each state again doing its own thing as we now see with the CP program and the CCT courses. More fragmentation and no direction can only be the endgame again.
The state of Oregon also makes several exceptions to obtaining the degree so it is really hard to use it as an example.
An Associates degree with college level courses for A&P and pharmacology would be a benefit rather than the overview courses which some certificate programs are offering even in the colleges. And, the degree should be in EMS/Paramedic. Just having a random degree might make you more literate but the focus should be on the medical part. Very few Associates degrees for allied health have time for all those courses some believe to be a waste of time like the humanities and math. What few there are should improve your communication skills and help with drug calculations or reasoning skills.
Right now it appears there are only about 20% of those holding an active certification in EMS who have a degree. Chances are there are many of this percentage who hold a degree in something else like nursing or some totally unrelated field. This also includes the volunteers who might have another very different profession which requires a degree such as school teachers and accountants.
Even the percentage for the instructors holding degrees is very, very low since the Paramedic courses are considered tech school and no degree is required to teach in that classification. This means there are very few mentors to push for education. The change must start here first. Instructors must raise their standards first. They also must raise their education levels so they can take charge of the EMS programs in the colleges. Right now nursing administration still plays a large role in the education portion since few are willing to move up the ladder and accept the overall responsibility.
Until more do take advantage of the many community college EMS degrees, nothing will change. The degrees are there but it seems too many offer arguments against them.
It also takes decades to get a degree established for licensing. It took over 15 years for the current "certification" changes to come into effect. Basically all that did was change the titles and not much else. Essentially EMS has the same education requirements it had in 1980 without much more for forward planning for degrees. There will just be more certs with each state again doing its own thing as we now see with the CP program and the CCT courses. More fragmentation and no direction can only be the endgame again.
The state of Oregon also makes several exceptions to obtaining the degree so it is really hard to use it as an example.
I don't see what you mean by devil's advocate. Anyone who works in a profession which is based on billing and reimbursement should be aware of CMS and its definitions in health care.
To petition CMS to be classified as a health care professional by showing education and providing the data you make a difference in patient care. This does not mean how many "saves" you did last year but what you have done to make a difference to the community and health care with its effects on the economic status for CMS.
Every health care profession which is reimbursement dependent has had to do this in order to survive as a profession. This has to be done as a profession nationally. It also does not stop there but support must be continued in order to keep the money coming.
Just because EMS was created to respond to emergencies doesn't mean that's all we're going to face. Shouldn't we adapt and learn about what we deal with on a regular basis as well? We have to look at the reality of what we face, not just fixate on our original purpose.
A degree requirement will weed out the people who don't place value on education; the ones that others in this thread have mentioned who stay in field for 10 years vs those who go on higher career paths. EMS needs to retain a few higher educated members to make progress in politics, conduct research, etc.
I guess clinically and for our scope of practice it will not make a difference. It would be the same way an ASN is no different from an BSN, yet the BSN looks better on paper. Awesome thread OP!
We absolutely should adapt. We have to lead the charge by not treating every "emergency" call as an emergency. Our protocols are laid out to treat emergencies, our systems are laid out for emergency response, everything we do screams emergency. If we want to be progressive about adapting to our actual call breakdown we need protocol to refuse to transport the "back pain X 3 months" to the ER, we let him know it's not what we consider an emergent condition and leave him or her with a reference sheet of orthopedics and chiropracters. As long as we continue to transport everything to emergency rooms, then we continue to treat every condition regardless of severity, as an emergency. This has to change if we are going to adapt. That is what I was saying with the Mobile Healthcare Services side of things
As to the education portion, I agree. It would raise intelligence minimally by weeding out those who don't like minimal education. But it really wouldn't improve clinical skills or scope of practice or anything at all. I guess my point with requiring a degree is I don't think it would make one spec of difference in patient outcomes at all.
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For the small town surrounded by other small towns, the chance of there being two major structure fires at once is minimal -- mutual aid can make up the rest.
For the big city, you don't need to rely on mutual aid, assuming you've staffed appropriately.
You can model the risk of fire and staff to the expected number of fires plus some additional margin. Heck, you could staff to the 95% CI, if you wanted to.
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These aren't mutually exclusive. We could certainly have the "MHS" model -- fly-car advanced practice paramedics, and then regular BLS and ALS 911 units that can triage to urgent cares as needed (or call for non-emergency transportation -- a taxi, say -- once they've assessed the situation).
The problem is there is barely enough fire fighters for one fire. When you have a 2 or 3 man engine company and 2 ff on the ambulance then you don't have to wait for the second due engine company to start a search and follow 2 in 2 out
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On the margin, I doubt it's worth it. We have to be rational about this kind of thing: just because it's better doesn't mean it's worth the added cost. The NIST study of NFPA 1710 (the 4-man recommendation) says that a 4 man engine company makes a difference, sure, but, for example, the improvement of a 4-man company over a 3-man company in terms of the number 1 duty of firefighters (other than self-preservation), conducting a primary search, is only 6%. On the margin, I don't see that as worthwhile, considering what a firefighter costs.
This is probably tangential. I am, broadly, making the point that cost effectiveness matters, it's not just about what's best, it's about what's best at a desired cost.
Problem with that study is that it is operating under the assumption that there are other engine or ladder companies at the scene, it is OSHA requirement that you cannot go into a building with only 3 FF on scene. You need an IRIC to start anything interior
Bluntly put firefighters save thousands more lives per year by doing first response medical well with quality CPR then they do by pulling people out of structure fires. There are departments that will go 10 years at a time without having a viable entrapment.
False. 2 in 2 outdoes not apply in life threats.
FURTHER..how may small or for that matter large FDs regularly make grabs? How many successful RIT operations do you hear about? The insistence on interior firefighting inside modern day (since the late 60s to early 70s) construction is why we continue to kill firefighters in the same manner at a rate of 100 a year.
The problem with number one is that its not how disease works. Advances in healthcare will quite literally put us out of a job eventually.
Number two is the only way to be viable. That requires a significantly higher level of background education to understand the factors involved. Hence degree requirements.
I'm all for this. I just see more people wanting higher education requirements so we can titrate pressors more effectively or RSI better. We really need to get away from "emergency" education. Our mindset when treating most calls ought to be the same as if the patient just walked in their family practice office.
OP
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A lot of interesting points. One reason I made this thread was because in my opinion, I don't believe you should have join the fire service or change heath care provider titles, to have a fulfilling, stable, and rewarding career in EMS. This includes being treated and compensated like a professional.
As a whole, our nation is not close to this yet. I think we have a lot to learn from the other 1st world countries and in my opinion we cannot progress any further without mandating a degree in some way. I will say I am excited to see the national healthcare changes currently and the explosion of mobile inter-graded healthcare programs EMS is initiated around the country. These could develop into something...
As a whole, our nation is not close to this yet. I think we have a lot to learn from the other 1st world countries and in my opinion we cannot progress any further without mandating a degree in some way. I will say I am excited to see the national healthcare changes currently and the explosion of mobile inter-graded healthcare programs EMS is initiated around the country. These could develop into something...