Thanks to all who took the time to respond to last week’s item “Paramedicine is not Fire Suppression: a response to Chief Ludwig,” Let’s look at the major issues.
WHAT IS PROPOSED
A future issue of PreHospital Emergency Care will have a “Joint Position Statement on Degree Requirements for Paramedics.” The National EMS Management Association (NEMSMA), the National Association of EMS Educators (NAEMSE) and the International Association of Flight and Critical Care Paramedics (IAFCCP) formulated this position:
A two-year associate degree is the appropriate entry level of education for practitioners at the current paramedic level.
Paramedics involved in 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.
That means 13 years from now a new caregiver completing an initial paramedic program that is Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredited must also have an associate degree.
POSITION PAPERS DO NOT UNILATERALLY CHANGE POLICY OR PRACTICE
Three organizations involved in Emergency Medical Services have collaborated to issue a joint position paper. That means “We think this change should be made and we will explain why in this paper.” In practice, policy position papers need to achieve two objectives:
- They need to communicate, clearly and concisely, the position taken by the organizations in relation to a specified policy area, which could be quite narrow or fairly broad.
- They need to influence policymakers, ideally so that they act in accordance with the organization’s wishes, but otherwise, so that they adopt a position that is close to the organization’s position.
The organizations that regulate EMS: state agencies, National Registry of Emergency Medical Technicians, NHTSA, and physician medical directors will consider the Joint Position Statement. They may support it, ignore it or oppose it.
The same options are true for major EMS employers; membership organizations representing ambulance service owners; fire-based ems leaders; union organizations representing EMS caregivers; national/regional organizations representing volunteers and community ambulance services.
CHICKEN VERSUS EGG
Many responded that the industry needs to raise the pay before they will invest in additional education. That is not the model used by emergency medicine physicians, nurses, physician assistants or coders to improve their pay, prestige and working conditions.
Some pointed out the restrictions in ambulance reimbursement as the driving force to keep ems caregivers in many communities at near poverty wages. The current healthcare reimbursement system is undergoing a dramatic change and ems caregivers are not in the position to quickly move from the lowest paid “supplier” to the professional pay of a medical service “provider.”
ANGST
There are significant issues that need to be addressed when implementing an associate degree requirement for initial paramedic training. Sharp readers pointed out the concerns of adverse impact and blunting the efforts of high-school based fire/ems academies to develop and include more members of the community into emergency services.
Some readers were offended at last week’s article, they felt that adding the degree requirement implied that they were not good enough. That is not the message. Others thought that this meant that they would have to get an associate degree after 5-30 years as a caregiver. That also is not true.
What is true that ems caregivers have experienced the smallest improvement in wages and work conditions compared to all of the other caregivers involved in emergency medicine since 1966.
Those working in large, often unionized, third service and fire service organizations have done well. Everyone else has not. We cannot continue to do the same things and expect a different result.
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Postma, Mark and Asbel Montes (2018 January 17) “AETNA/CVS Deal May Finally Change Ambulance Industry.” EMS Insider Accessed September 16, 2018, from https://www.jems.com/ems-insider/articles/2018/january/aetna-cvs-deal-may-finally-change-ambulance-industry.html
Hodge, James G., Daniel Orenstein and Kim Weidmann (2014) Expanding the Roles of Emergency Medical Service Providers: A Legal Analysis. Arlington, VA: Association of State and Territorial Health Officials.
National Fallen Firefighters Foundation (2017) High School Fire & EMS Programs and Academies: Opportunities and Changes. Report of the National Fallen Firefighters Foundation High School Technical Curriculum Online Workshop. October 25-26, 2016. Crofton, MD: National Fallen Firefighters Foundation.
Position Papers by organization:
National Association of EMS Educators (NAEMSE) Click under “National EMS Resources” and go to menue item “Position Papers” – 11 position papers.
International Association of Flight and Critical Care Paramedics (IAFCCP) Click under “Library” – 9 position papers
National EMS Management Association (NEMSMA) click under the NEWS tab – 5 position papers
National Association of EMS Physicians (NAEMSP) – click under the “Resources” tab – over 100
International Association of Fire Chiefs – click “Position Statements” under the “About IAFC” menu item. Including Oppose Proposed Degree Requirements for Accredited Paramedic Programs