When you consider EMS education systems across the country, each is different from the next. Institutions that neighbor each other often are as different as night and day.
For the past 30 years, EMS has experienced a tremendous growth and expansion in how EMS education is delivered. For the most part, individuals with a vision and a dream to make the profession an important part of society have brought about these changes. Often, the changes in developing EMS training standards were viewed as controversial and unnecessary. The first 81-hour EMT program was a bold step on the road to the training programs of today.
Many doctors and nurses in the early 1970s were reluctant or slow to embrace the prehospital delivery of ALS. When I started working for a fire agency that provided EMS with ambulance transport in the early 80s, our medical director refused for several years to allow paramedics to intubate patients in the field. At the time, every paramedic was trained in intubation techniques and had performed the skill on patients in the operating room or while working for other services. Many paramedics were ACLS certified, and all were licensed by the state to perform the procedure. Paramedics and their supervisors continued to advocate for the capacity to intubate and worked to overcome any argument or meet any additional training standard the medical director presented, and finally, it became the standard.
Now, more than 20 years later, it s unimaginable to any new paramedic in that area that they wouldn t be allowed to intubate patients who required such intervention. Where would the level of service be today if certain individuals hadn t made an effort on behalf of all paramedics for the right to maximize their skills and deliver the highest level of prehospital care?
With our progressive and hard-earned history in mind, we should be calling for individuals and agencies to continue participating in or creating a permanent revolution in EMS education. We must be committed to improving the level of service provided through quality EMS education and to creating consistency in our big picture of how and where EMS should be in the next 30 years.
For sustained change in EMS education, we should focus on three main areas in which new ideas need to be cultivated.
Training & education in the classroom
New students entering the field today have different educational needs than students of 20 years ago. Thus, training methods and educational materials delivered by older or experienced paramedics must differ from their own education and not simply rely on telling war stories or teaching field shortcuts. Current EMT and paramedic textbooks provide the best and most comprehensive educational material ever seen in EMS programs. The key to success is in how the material is presented to the student by the instructor and if students can transfer that learning to practical procedures.
Students are often unprepared for the learning requirements of EMS programs. Whether they re fresh out of high school or an adult learner, the initial expectation is the time required for their EMT or paramedic certification is only the time they spend in class. They re soon surprised to discover how much out-of-class time is necessary for studying and practicing new procedures. In most cases, two to three times the number of hours spent in each class is needed to master the course material.
Continuing education & merit badge courses
On more than one occasion, extended one- and two-day EMS programs have been referred to as merit badge courses. Like the Scouts, where students earn a badge for a course completion, the number of EMS courses continues to increase each year. Several courses, including ACLS, PHTLS or BTLS, and PALS, are recognized as a standard of care for prehospital providers. But how many different levels of certifications really matter in the ongoing education of EMS personnel? A few paramedics will always think they need to obtain every certification possible and that no extra education is bad, but when does it stop? Is the need for specialized training being driven by an acute need or by financial considerations? As specialized EMS education grows, it needs to grow in the right direction and not just increase in number to sell more programs or course books.
Many members of the EMS community argue that prehospital procedures and standards lack research support. It is true there needs to be more and better research, but it doesn t mean we should stop providing a certain level of service or certain procedures because of one or two research articles. Most of EMS research is based on a review of field medical procedures or medications delivered by paramedics. There is also a need to conduct research on educational methods and consider the outcomes of student learning and overall program success. The best practices of those agencies developing new and innovative training and educational programs need to be shared with other training agencies.
Revolution means bringing about a change. A change for those who follow us and will one day be in charge of EMS education. It means laying the groundwork for future generations. A revolution usually involves people with a passion. If you re passionate about EMS, you should be actively involved in the revolution and either continue or start working to make improvements in a consistency and quality.
EMS education has not yet reached its peak. Join the revolution!