The Portable Paramedic

In preparation for my quest for the disco patch, I started looking at reciprocity requirements throughout the country and I came to one conclusion: being a paramedic and trying to move is very frustrating.  For the life of me though I cannot figure out why this is.

When I went through paramedic school so many years ago, we had a mix of people in my class: there were two of us from New Jersey, many from Massachusetts, one of New Hampshire, and a few from Connecticut.  We went through our Massachusetts approved paramedic class, but not all of us tested in Massachusetts.  A few of my classmates decided to go directly down to Connecticut and test there, as they had no intention of working in an EMS system in the great Commonwealth.

Here is how it went: the classmate that I sat right next to who got the same training as I did, took the same tests, did the same amount of field and clinical time drove across a boarder that was less than twenty miles to the south a took a test that was not identical to mine but similar.  Both of us passed.  She worked for a service south of that boarder, and I worked for one to the north of it.  Despite the fact that our training was identical, in order for us to work in each other’s states we each would have more hoops to jump through to again prove our worth as a paramedic.

Now, expand that out to a more national scale.  Some states accept certifications from other states as being just as good as certs from their own.  Others only accept National Registry.  Still others feel that National Registry is not even good enough and they require you to come in and take their state’s test.  Still another state on the west coast requires National Registry, a state certification, and then clearance within the specific county you choose to work in if you want to care for their sick and injured.

Then there are Oregon and Texas.  Add on to that a minimum of an Associate’s Degree.  While I feel that these two states are right on point and just may be the only two that are actually getting it right, the gross disparities from state to state create quite a hardship for any paramedic that wants to go someplace else.

It is time for us to get out of our respective sandboxes and head for the beach.  The sand there is just as easy to play with, and it is a lot easier to play with others.  States, like those kids in the sandboxes, need to learn how to share their paramedics better with others.  It is time to do away with the variety of different means of certifications and decide on one.  This is the one thing that I hope the field EMS Bill (HR 3144 if you haven’t heard of it) will give us: standardization.

While the saying might always be true that “when you’ve seen one EMS system you’ve seen one EMS system” the same does not go for paramedics.  Each and every one of us receives similar training.  Not identical training but similar training.  If states want to maintain their own standards that’s fine but they should be loose enough to allow in experienced providers from different systems.

It should not be such a challenge for me to gain experience and knowledge from different systems.  Realistically, it should be a piece of cake, and until we realize that, we are going to continue to have paramedic shortages, and people who are unhappy in their current situations with no way out.  Unhappiness feeds burnout.  Burnout destroys quality patient care, and when that quality patient care goes away, our patients suffer, and outcomes suffer.


  1. Tamiscript /

    Maybe I’m reading that paragraph wrong, but Texas does not require an Associate’s Degree for Paramedics…yet.

  2. The one thing I learned after going to EMS Today is just how far behind a lot of services and States are. When I hear silly things like checking a blood glucose level is an ALS Skill, I get to wondering if standardization is just going to bring us further down!

    At some point we’re going to have to hurt some feelings and put the bar where it should be and “demote” everybody who doesn’t meet it.

  3. Skip Kirkwood /

    In other health professions, you take the national boards – ONCE! Then, you apply for a license in whatever state that you want to work in. That makes sense – the state is responsible for regulating all professions.

    Until the rest of EMS folks get their heads out of their orofices, buck up, and get behind the national registry, the mess that is described will continue. On one hand, we want to be like other professions. On the other hand, we keep acting like patients change configuration and physiology at state lines. Guess what – they don’t!!! But as long as we develop curriculum to teach “my state’s scope of practice and nothing more” then the next state over will have to make you take their test, blah blah blah.

    We own this thing, ladies and gentlemen. Only by joining your associations and pushing for change will we eliminate messes like this.

    • Fern the Fire-Rescue newbie /

      Here’s the tough question though. We’ve got a tough enough time lobbying at any level of government. How do we convince the states that no, their standard for EMS professionals is not the gold standard?

      I agree with you wholeheartedly. A friend and fellow Fire EMS blogger (well, she’s EMS only – but that’s beside the point) asked me how to get her cert. in my state (she’s in one of those better states to the north of me) and the answer that I found from the Mass OEMS is that she has to take her written again, along with a practical if they feel her state’s standard is not up to par. That’s quite honestly stupid. I find it ridiculous that besides the transfer of certs, protocols swing wildly. We don’t use the Cincinnati Stroke Scale; we use the Massachusetts Stroke Scale, which is the SAME DAMN THING. States do not need to reinvent the wheel.

      Here’s another question we should ask ourselves: Maybe we should just go national with our protocol and be done with it?

      • Skip Kirkwood /

        It’s really not that hard. What it takes is time, money, and numbers. If every EMT in each state belonged to a state EMS association, paid $50 dues per year, the association could afford to hire a lobbyist that could get it done. Bang! Right past the state EMS office, to the guys who make the statutes. The state EMS office gets little to no vote in the matter if you get a few influential senators or representatives involved on your side – and that’s what good lobbyists do.

        But, as best I am starting to see, the majority of EMS folks are very good at whining and complaining, but not very good at stepping up and putting their money, and their efforts, where their mouths are. Want to know why the fire and police services do so much better? They get together, pound lawn signs, and elect people friendly to their cause. End of story.

        Join, pay, and play – or stop whining and waiting for somebody else to make things better for you. It’s not gonna happen that way.

  4. While I agree that a national exam followed by state application would not only ease many of the issues we’re talking about here, I believe it would be extremely difficult to make any significant moves towards federal authority and away from state authority. Of course, this is the idea that the National Registry wishes to promote. The problem, in my estimation is not so much getting EMS PROVIDERS to agree, but rather to get EMS REGULATORS to agree. As we know, the regulators don’t necessarily do what is right or what is best, but rather what is promoted by their loudest and most influential constituents.

    • Skip Kirkwood /

      There is no move toward federal authority. There is no provision for federal licensure of professionals in the constitution, and no precedent in any other profession. There is no truth that the national registry espouses federal involvement, they are very well acquainted with how professional regulation works.

      Regulators will respond to the loudest and most influential constituents. The problem is that in most states, medics are not loud or influential. Look at who shows up at state EMS council meetings – physicians, nurses, hospital administrators, regulators, educators – everybody except medics! If medics would participate in the process, they could outweigh the few members of other professions who now carry the day.

      The fault is all ours, ladies and gentlemen!

  5. Wes Ogilvie /

    And there’s at least one state in the west that requires you to have a job offer in hand before getting your state or county certification.

    The reality is that National Registry as it currently exists is little more than a testing mechanism for the states to use in lieu of developing their own tests. We don’t truly have a national certification. But then again, most professions don’t either.

    I’m also a licensed attorney in Texas and the hodgepodge of bar admission rules between the states is incredible.

    So, no, it’s not just EMS.

    • Skip Kirkwood /

      At least the state bar differences make sense. The law changes, sometimes radically, at the state line. Patients, and medical science, on the other hand, do not. Don’t get me started on what the Multi-State Bar Exam does and doesn’t do…..

  6. Anonymous /

    I think what it comes down to is the care that can be provided. I find it alarming that if something happened to me where I live right now, I would get one standard of care, one set of protocols. . . but if I drive fifteen minutes south into another state, I could potentially get a different standard of care from someone who is as equally trained as each and every paramedic in my system.

    Skip’s right: Patients don’t change. Equipment does not change. For the most part, training does not change. . . why should the standards change?

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