Why EMS degree could be the standard come 2025

[PotatoMedic]

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

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

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

 

[FiremanMike]

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

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

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

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

 

[PotatoMedic]

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

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

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

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

 

[SandpitMedic]

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

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

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

The evolution will follow, as @Summit stated.

 

[Summit]

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

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

 

[FiremanMike]

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

We should strive to not make EMS degrees like that.

 

[DrParasite]

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

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

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

As I said earlier:

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

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

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

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

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

plus, they unionized......

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

sad by true.

Follow the nursing model and the paradigm shifts.

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

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

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

 

[SandpitMedic]

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

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

 

[DrParasite]

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

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

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

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

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

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

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

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

 

[DrParasite]

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

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

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

 

[Summit]

plus, they unionized......

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

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

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

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

 

[SandpitMedic]

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

After all, if a new provider earns their paramedic cert today, they can have a 30 year career with only a HS education and a cert. Lets aggressively raise the standards for the entire industry, because all the smart people say more education is needed. If that is where the industry is moving to, let's do it for everyone. don't the patients we treat deserve the best? I'm an EBM guy; what evidence shows that an AAS/AS would make a better street medic? higher written scores on the NR-P exam? lower 1st time failure rates on the NR-P exam? better cardiac arrest save rates when the lead paramedic has an AAS vs a cert only?

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

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

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

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

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

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

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

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

 

[Carlos Danger]

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

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

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

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

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

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

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

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

 

[Tigger]

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

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

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

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

 

[SandpitMedic]

So the consensus is we should implement degrees.

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

 

[DrParasite]

So the consensus is we should implement degrees.

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

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

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

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

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

 

[mgr22]

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

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

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

 

[VentMonkey]

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

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

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

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

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

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

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

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

 

[SandpitMedic]

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

 

[mgr22]

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

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

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