Paramedics and Higher Education

Paramedics and Higher Education

Oct 14, 2014

Once again, the topic of “should we strive for higher education?” has come up, and once again I need to come out in support of this. And it has nothing to do with the fact that I currently possess a degree. Many wonder what it will do for our bank accounts. They ask for evidence of how increasing education will result in increased income at the street level. To me, it is the simple concept of supply and demand.

Currently, it is so easy to get a job in EMS. Look at larger companies like AMR, which almost have a revolving door of providers. We used to put on big recruiting class and would usually retain about 60% of our hires six months out. There never seemed to be a shortage of EMTs to staff trucks. Increasing the knowledge base of providers means that not everyone will want to invest the time into the field, and will result in the people getting into the field being the people who want to make a career out of the field. Fewer providers will be available at that level, so their skills will be more coveted. As a result, departments will pay more for their ability.

In my eyes, there are three places that we need to increase our education. The first two have nothing to do with actually providing care but everything to do with understanding how our care affects our patient. We need more education in anatomy and physiology, and pathophysiology. Most paramedic programs that I have encountered do a barely adequate job with these topics. While most paramedics understand how diseases and conditions affect the body, we need more. Right now, most education revolves around that immediate emergency, as it should, but we could be well served with some additional knowledge about the body outside of our encounters with these patients. As we establish that stronger base, then we can expand the care that we provide, which is where my third topic comes in.

With the growth and expansion of community paramedicine, paramedics need more education in after care. We need to understand what level of care goes into our patients after we intubate them. We need to understand what sort of rehab a post-CABG patient will experience prior to being discharged home. That way, when we deal with these repeat customers who are the ones who actually need us we can better care for them. Furthermore, understanding after care will allow us to provide that at home care that many community paramedicine programs revolve around.

Whenever the debate of whether or not we should be able to decide whether or not to leave patients at home versus the “always transport” mentality that most EMS systems in the United States have, what people fail to remember is that we are notoriously bad at deciding who does not have to go to the hospital. Studies have proven it. Better understanding how our patients react after we provide them care will make system designs that include the treat and release of patients on scene more viable.

So where does this leave the existing paramedics? Where does it leave the folks who have not received the level of training consistent with what I am talking about? You can’t expect someone to carry a full time job, and go back to school, right? Personally, I think the first thing that we need to do is establish another level of care. Create that higher level of paramedic that includes the additional training, and then push systems to require those medics on trucks. Then, the gradual phase out of the existing paramedic curriculum could occur, much like what has been done with the intermediate level in many services. I would, however, leave the EMT curriculum for the most part untouched. This would give people an entry-level position into the field.  Making a full on commitment to this field is a difficult thing to do.  It’s not for everyone.

Of course though, this entire concept puts a lot of faith in our industry that they would be ready to support people as this change is made, and then be willing to pay them after the transition occurs. The general public and stakeholders in many systems do not fully understand paramedicine and its capabilities. They have been brainwashed into thinking that good care revolves around timely response and not high quality providers. That is the biggest sell, and of course guaranteeing that better education would reduce supply and increase demand thereby increasing pay for providers is based solely on opinion and not substantiated fact.

The bottom line though is we need to find a way to stop people from seeing high quality EMS as being expendable. We need to find a way to keep it from being a branch of public safety that any service can get in to. We know what we are capable of, yet we still allow this “you call we haul” mentality to dominate the industry. Change is needed. We just need to figure out where it starts.