Why a Degree Requirement has Nothing to Do with Old School Medics and Everything To Do with the Future of Out-Of-Hospital Care

A position paper advocating a degree requirement for paramedics was published in Prehospital Emergency Care about a year ago. Most of us writing about this issue are “old-school” paramedics. There are significant increases in the breadth and depth of clinical preparation in the current paramedic curriculum. There may even have been an “OK boomer“ response from recent paramedic graduates.

The position paper made this recommendation:

A two-year associate degree is the appropriate entry-level of education for practitioners at the current paramedic level.

Paramedics involved in the specialized practice, such as flight paramedics and community paramedics, etc., should be required to complete upper-level undergraduate coursework up to and including a bachelor’s degree as a prerequisite to specialty certification.

These requirements should apply to paramedics entering our profession and we recommend the EMS community within the United States enact such requirements by 2025.

Most 2014 or later Paramedic Program Graduates Have an Associate Degree

Adoption of the 2009 National EMS Educational Standards required significant changes to the 375 community college programs that offered a Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredited paramedic program.

The clinical preparation included adding a course in Anatomy and Physiology. There was heavy lifting from hundreds of dedicated educators, regulators, professional organizations, caregivers, and employers to force-fit the 2009 paramedic curriculum into a two year technical or applied associate degree while meeting the CAAHEP accreditation requirements by the 2014 deadline.

The 171 accredited paramedic certification programs not directly affiliated with an academic institution or teaching medical center had to update their consortium agreement to allow academic transfer credit for successful credentialed paramedics. For many of these students, they will need to complete about 20 hours of general education courses to get an associate degree from the consortium educational partner.

The private university where I was a program director for a now-defunct EMS degree program required these lower-division courses to be transferred in:

• 6 hours of English Composition
• 3 hours of College Algebra
• 3 hours of Statistics
• 3 hours of Humanities
• 4 hours of a Physical or Natural Science with lab

Paramedics Need to Be Part of the Healthcare Industry

All of our healthcare colleagues who were part of street medicine in the early 1970s – emergency medicine physicians, nurses, “accident room” technicians and hospital managers – have increased income, prestige, and organizational power. Paramedics remain the lowest compensated caregivers, many still restricted to the role of a low-cost provider of stretcher transportation to an emergency department.

To be included in the healthcare industry, we need to have the same level of professional preparation. I worked with regional hospitals while I was with a consulting firm. We would be hired to move an ambulance-paramedic-medical transportation operation from Point A to Point B. The last task was to recruit a new EMS director. The EMS director reports to the Chief Operating Officer.  For a suburban hospital system, the position would pay $125,000 or higher.

This was a difficult position to fill. All of the direct reports to the Chief Operating Officer possessed clinical competence and a graduate degree. The master’s degree would either be in their clinical area (pharmacy, physical therapy, nursing, behavioral health, etc.) or healthcare administration. At this level, they were expected to be effective leaders of their department and help the executives run the hospital system.

We could find excellent paramedics with management experience, a bulging portfolio of technical certifications, and the equivalent of a dozen semester hours of academic credit. The hospital executive would not accept the candidate.

They would select a healthcare manager with a graduate degree that may also have an emergency medicine-related skill. Or they would restructure the EMS director job, demote the position out of the senior staff level and significantly cut the salary. In one example, the EMS boss reported to the director of physical plant operations and was paid about half of the originally proposed salary.

If we do not change, then we can look to another 50 years of low paying careers with little mobility as other healthcare professionals perform the out-of-hospital clinical tasks we are best suited for. This month, Los Angeles County Fire Department placed its first Advanced Provider Response Unit in service. A Captain/paramedic is partnering with a nurse practitioner to see patients. This position could have been an Advanced Practice Paramedic.

What would Firefighter/paramedic Roy DeSoto, the fictional advocate for the Los Angeles County Fire Department paramedic service, think about this development?

Emergency Medical Services Turns 50 (2019 August 29) LACoFire Museum 12:47

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Caffrey, S.M., L. C. Barnes & D. J. Olvera. 2019. Joint Position Statement on Degree Requirements for Paramedics. Prehospital Emergency Care (23)3. 434-437

Featured Image: Los Angeles County Fire Department Advanced Provider 11.  (November 18, 2019, press release) Today, the LACoFD launched the Advanced Provider Response Unit (APRU) pilot project in Battalion 11 (Lancaster). AP-11 is in service from 0800-1800 hours Monday through Thursday.

AP-11 will assess minor patients in the field, perform simple interventions, and re-direct patients to appropriate levels of care without the need for ambulance transport or an ER visit. AP-11 is staffed with a Nurse Practitioner and Fire Captain. The LACoFD is thankful to the many stakeholders who made this launch possible! #LACoFD #APRU #EMS #Caring #Community #Innovation