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I Can Do That

First, I m one of the biggest advocates for EMS that you ll encounter. I ve devoted more than 30 years of my life to EMS and its people. But it still concerns me that people believe that this profession can advance without education. When somebody mentions improving educational standards, people start to squeal, I ve been a paramedic for 10 years. I know what I need to do. I don t need any more education. Or they begin to lobby for grandfather clauses that grant them credit or advanced standing. Then, you see posts on various internet lists inquiring about where one can obtain paramedic certification in two months or complete the whole program online. Would you go to a physician who completed just one year of college and did half of it online?

A common phenomenon occurs about two years into work as a paramedic. The paramedic becomes proficient and even excellent at what they do. They go to the ED and see the RNs starting IVs, giving medications, and similar procedures and say, I can do that. Then starts the call for allowing EMS personnel to practice in the ED on parity with the RNs. However, this is when the issue of education really comes to the forefront. Our society has determined that certain educational levels are necessary for a skill or trade. Some levels, because of the unique fund of knowledge, are called professions. Medicine is a profession and has high standards because mistakes can result in injuries or death. That s not the same as the guy who tiles your bath room.

I went from being a paramedic to being a physician, and I see the importance of education. For example, once in the ED, we were discussing the role of paramedics in the ED (of which I am in favor with added education). The conversation basically was that the paramedics could do anything that the nurses could do. About this time, a new graduate nurse brought some lab reports to me and said, His BUN/creatinine ratio is 62. Should I increase his IV rate? I asked the paramedics what they thought. They admitted they didn t know what the GN was talking about. Granted, an experienced motivated paramedic may learn lab data and such, but in the nursing program, this was a part of the initial education. I ve met many self-taught paramedics who were sharper than many nurses (or doctors). But I have met some who self-taught themselves the wrong information and were, in fact, dangerous.

On my shelf here in my study are 15 books from Pearson Education (the main company that owns Brady my textbook publisher). The books include Pearson s package for the two-year associate degree nursing programs, plus books on anatomy and physiology, medical surgical nursing, human development, pharmacology, medical math, psychiatric nursing, pathophysiology, ICU nursing, public health, nutrition, obstetrical nursing and more all to become the lowest level RN!

Paramedic instructors moaned when we found the science behind EMS so massive that we decided it best to be put into five books instead of one (or publish the whole damn thing on Bible paper). Several programs were indignant and changed to the competition a single volume book simply because it was a single volume and cheaper. When this became a problem, we had to counter it with an abridged single-volume book of our own.

Solve this conundrum: How can paramedic education equal the lowest level of registered nursing education when the nursing program requires 15 books and 65 semester hours and the paramedic program requires one book (if that) and 700 clock hours.

There are paramedic programs that rival nursing education. But attending these is hard to justify given the promise of 56-hour work weeks and just $28,000 a year. That s why the National Scope of Practice is such a bad document. The movers and shakers in EMS had the opportunity to move the profession along. But much of EMS in the U.S. is fire-based, and we can t have any EMS education affecting fire suppression activities or education. The fire services complained, and politics prevailed. So the minimum standards for EMS have remained stagnant. As for us, we push the science to the next level with cutting edge books (and I mean books). Some programs will use them, others will not. I surmise we will also publish low-end books with lots of pictures for low-end programs.

So, in answer to the often-asked question as to how EMS can get a seat in the house of medicine, I say education. This is inevitable. Fortunately, a few EMS educational programs throughout the country will continue to push the envelope and enhance the education of EMS providers. Then, the resultant dichotomy among paramedics will force employers to seek those with the better education. In the end, Darwin will be right again evolve or die.


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