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We Don't Need No Stinkin' Badges!

Like all of us in EMS and emergency medicine, I m an overachiever. When I did my Eagle Scout work, I earned 23 merit badges instead of the required 21. We also have merit badges in EMS, such as Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS) and many, many more. The idea of a merit badge course was first proposed by the American Red Cross, and the courses were called Basic First Aid and Advanced First Aid. The American Heart Association (AHA) joined the fray with myriad courses. These courses have been good in that they ve made education available to the masses and standardized the material presented. Initially, the AHA certified graduates of the respective course. Now, for fear of litigation, they simply say you completed the course.

I think, in the overall scheme of things, that there s nothing wrong with merit badge courses, per se. What I do have a problem with is making such courses a requirement. There are several reasons for this. First, the developers of these courses are not held to any recognized standards in regard to testing or evaluation. For example, the various written examinations provided by the AHA have been notoriously poor. Thus, how can an employer dismiss an employee or how can a state not certify a paramedic based on an evaluation system over which they have no control or whose validity is suspect? Second, if you re a licensed (or certified or nationally registered) paramedic, you ve passed an evaluation that s of a much higher level than those associated with merit badge courses. So if you re a licensed paramedic you ve mastered material much higher than that in an ACLS or PALS course.

We re facing the same thing in emergency medicine. Even though I m board-certified in emergency medicine by a nationally recognized certifying board, my hospital still requires me to maintain ACLS and Advanced Trauma Life Support (ATLS) certifications. This requirement is ludicrous because the certifying exam for my boards was exponentially more difficult and comprehensive than an ACLS or ATLS exam.

So let merit badge courses serve their primary focus being a nationally accredited course in a given area. Also, provide a card or certificate to indicate that someone has completed the course, and allow it to count for the appropriate continuing education credits needed for accrediting bodies. But never make it mandatory. Let the individual decide which course to take.

This brings me to another pet peeve. Why do so many people feel the need to put all of their various abbreviations after their names? Is it not enough to be an EMT, Intermediate, Paramedic, Nurse or Physician? I recently saw an article in a popular EMS magazine written by a nurse. His RN was followed by nine (I counted them) various abbreviations. It was as if he was saying, I am embarrassed to be a nurse and must impress you with these other abbreviations. Being a registered nurse, like being a paramedic, is quite an accomplishment and that, in and of itself, speaks volumes about your dedication and education. Typically, in publishing, most journals will publish only your highest earned degree, and others will publish fellowship status for physicians to describe board certification in a medical specialty. And that is it.

Another pet peeve is those who put candidate in respect to a degree they have not yet earned, e.g., PhD (c) or MA(c). Why do people do this? By definition, everybody who has registered in a college can say they re an AAS candidate or even a PhD or MD candidate. Again, this shouts insecurity and is unnecessary. Once you have earned the degree, use the abbreviation. Otherwise, wait. Be proud of what you are, and once you obtain your degree, display it proudly but not until you actually get the paper in hand.

Bryan E. Bledsoe, DO, FACEP

Or I could write:

Bryan Edward Bledsoe, BS, DO, FACEP, FAAEM, EMT, EMT-SS, EMT-P, EMT-PI, BCLS, ACLS, ATLS, APLS, PALS, NALS, PHTLS, BTLS, BSEI (Breast Self-Exam Instructor), Eagle Scout, Basic First Aid, Advanced First Aid, Advanced Water Life Saving, salt water and freshwater angler, Member, Sons of the Sacred Shrimp, AOA, Phi Beta Pi, licensed to drive in the state of Texas, licensed to be married, all dogs vaccinated, D. Div. (c). Gee, I feel better about myself.

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