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Beyond EMT-B?

This column, called Ask the Educator, is a new feature on the JEMS.com site. Its purpose is to address the issues and questions that come up in EMS specifically about education.

By way of introduction, I am the director of the paramedic program at Stony Brook University in New York and have two academic appointments there. I have 31 years' EMS experience and continue to work as a per diem paramedic. I also authored the Case of the Month column solo for JEMS for about eight years and now continue to contribute several times per year.

In my experience as an educator and conference speaker, people are always asking me why a course was set up a certain way or why they can't do a particular skill. This column will give you the opportunity to ask those questions as they come to mind, rather than waiting to catch me at conference. Although I can't promise that you'll agree with my opinions, it's my hope that your questions and my discussions will stimulate dialog and, thus, progress.

For my debut column, I want to discuss a letter I recently received via JEMS.com.


"I have 13 years' experience as an EMT-B, a bachelor's degree in biology, six years' experience as an ER tech, eight years' experience in EMS education, five years working for a regional medical direction office, [credit as an] AHA Instructor Trainer-and the list goes on. But I'm not allowed to be considered for nearly every EMS management position posted locally because I don't have a little "P" after my certification. Is this just a local thing? I doubt it."


First, your lack of a paramedic credential doesn't seem to have affected your success in EMS. You've worked as an ER tech for six years (which requires a medic ticket in many venues), in EMS education and in other, impressive roles as listed.

But to begin to answer your question, I'd like to point out that nursing managers are nurses and that directors of emergency medicine departments are physicians. Further, in the military, commanding officers of aircraft carriers are required to be naval aviators. In many fields, it's just understood that to supervise credentialed or licensed employees, the supervisor must possess-at minimum-the license/credential that the supervised employees are required to have. One reason for this standard is that a successful manager must have the respect of their employees. The fact that the manager has been in the trenches and jumped through the same hoops goes a long way toward removing at least one area of employee/manager friction.

In EMS, operational reasons also mandate the paramedic credential for management positions. In many services, if a paramedic is sick or on vacation, the supervisor/manager may have to work the vehicle. Paramedics can staff BLS and ALS vehicles, whereas an EMT manager couldn't fill a temporary hole in their ALS staff.

Twenty years ago, a bachelor's degree set you apart in the workforce. But now, many jobs now require master's degrees. You have a bachelor's degree in biology, so let's imagine that you work in a biology-related position and are considering an advancement that requires a master's degree, say into a teaching position. Would you complain that it required a master's and set out to change that requirement? I don't think so. You would either step up and complete the additional schooling or look for another job with qualifications you already possess. Why should EMS be any different?

Other comments in the remainder of your letter-about witnessing providers getting positions for which they're clearly unqualified and about not wanting to be a paramedic but also not wanting to continue "pushing a stretcher and saying 'Yes, sir' to [your] paramedic 'partner' who is an undeclared superior" -are concerning to me on many levels.

With all due respect, I think you're painting with a very broad brush. The paramedics I've worked with always had a collegial relationship with EMTs. The EMTs knew their jobs as well or sometimes better than their paramedic colleagues. As for your comments that you're not a "typical EMT and there are few in [your] shoes," aren't you exhibiting the same elitism and entitlement that you accuse other medics of? What is a "typical EMT," according to your definition? Inexperienced? Uneducated?

In addition, the second half of your note takes a decidedly negative turn. Perhaps your cynicism (and not your lack of a paramedic certification) is the most significant hindrance in your career advancement, if it's noticed by current or prospective employers. Instead of expressing such cynicism, why not take productive measures to get beyond it? You state that you don't want to be a paramedic but realize that to be considered for certain jobs you must possess that credential. My simple question is: Why not take an accredited paramedic course if it will help meet your career objectives?

We must all do things that are perhaps difficult in the short term in order to reap the benefits in the long term. We always have a choice-to either take the hard road or to wait and wish for changes that many never occur. As my wife says, "If wishes were horses, we would all be riding."

However, it doesn't seem that your reason for not wanting to be a paramedic is because you're waiting for a horse. You've obviously labored in the past to obtain the positions and successes that you described. So perhaps the best question to ask is: What is the real root of your choice not to be a paramedic? Is your fight against the standard just a fight for fight's sake, or is it a just cause for the good of the profession? Those are questions only you can answer.

If you have a question about EMS education, send it to me at paul.werfel@stonybrook.edu. Until we meet again.


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