Administration and Leadership, Exclusives, Training

What’s in a Title? Why Credentialing EMS Leaders Matters

Brian LaCroix is the president of the National EMS Management Association (NEMSMA), an organization for leaders representing all service models. Brian recently retired from his role as president and EMS chief for Allina Health EMS, a hospital-based system with headquarters in St. Paul, Minnesota, serving more than 100 communities with more than 600 employees. It was named career service of the year by the NAEMT in 2017. Brian began his career in 1983 and has worked as a volunteer firefighter, EMT, paramedic, educator, author, peer counselor, manager and executive officer.

Q: Why is supporting and credentialing leaders in the field of paramedicine such a focus for NEMSMA as an organization?

A: NEMSMA is all about education and support of leadership, and not only existing leaders but aspiring leaders. We have an interest providing leaders with real, practical, and meaningful information, a solid and best practice base of knowledge, and the support needed in order to make sure that we are providing the highest level of care to the communities we serve.

Historically it’s been said that we have a history in our career field of picking either high performers or well-liked employees and giving them a hearty handshake and a shiny badge and promoting them to leadership roles with little or no background, education or information support. Several years ago, NEMSMA came up with the idea to create leadership competencies to support the training of our current and future leaders. Those competencies are based around seven pillars, which are things like finance, human relations. 

We also took the additional step of creating three levels of leadership, because as a profession we don’t have one title for leaders either. In some organizations, there are chiefs, in some they’re presidents, in some they’re CEOs. But for the NEMSMA credentialing program, the first level is supervising paramedic officer then managing paramedic officer and then executive officer. We worked with an outside agency to help create the credentialing testing. Now each level of officer credentialing has a different process that one has to go through to demonstrate competency.

Q: Why do you view leadership credentialing as important for the EMS industry?

A: It’s a good question, why does this matter? And why should people consider credentialing? Let me go back to an example of an aspiring leader. If I’m a middle manager or even a field paramedic who says, “Hey, this leadership thing interests me. How do I become chief one day?” Historically, there’s been no roadmap to do that. Laying out these competencies and setting up this credentialing program provides the roadmap for an individual to take if they have an interest in becoming a leader in the career field of paramedicine.

And the other thing that it does is allows someone to demonstrate proficiency. So as an employer, if I want to hire a new leader and that new leader comes to me with a credential from NEMSMA in whatever level of leadership they function at, I can have confidence that they’ve had to go through a pretty disciplined and rigorous education program and evaluation program to demonstrate competency. 

Q: What do you think about the national discussion going on about what EMS clinicians should be called?

A: Several years ago, the National EMS Advisory Council put out a statement that cited no less than 37 names being used to describe professionals in the EMS field of healthcare. We call ourselves EMT, basic, intermediate, level one, ALS, and the list goes on. We grumble when we’re referred to by the general public as ambulance drivers, lamenting the fact that we believe, oftentimes, people don’t understand the work that we do and the level of sophistication that we bring to the out-of-hospital environment. Yet, we’ve still hung on to this sort of bewildering list of names. That has not helped our cause.

We know from the experience of our colleagues in Canada, the United Kingdom, Australia, other English-speaking countries that have adopted the nomenclature “paramedicine,” that it’s been helpful in shifting the understanding of the work that we do with the general public and with legislators, who often have oversight of the economic environment that we live within.

So two years ago, NEMSMA issued a position paper, which took the point of view that practitioners of paramedicine should be referred to as paramedics, regardless of the level of care: BLS, ALS, critical care. The reason behind this is to elevate the profession. It would help lawmakers, the media and insurance providers if we eliminate some of the confusion. It would help differentiate our career field from first responders in other fields such as law enforcement and the fire service.

The upsides to the change in nomenclature we believe are big and significant, and the downsides have to do with what I call “inside baseball.” Canada has tackled this one by simply having three levels of paramedics. There’s a primary care paramedic, an advanced care paramedic and a critical care paramedic. And something like that could effectively describe all 37 of the labels we currently have and sort of cut that heap of confusion.

Q: How does the nomenclature and specialization within other professions offer a model for the future of the paramedicine profession?

A: Paramedicine has had one foot in public safety and one foot in healthcare since its creation. In healthcare, we have doctors and nurses, but we also have pediatricians and cardiologists and neurologists. There are all kinds of specialists but they are also all doctors. The same can be said for nurses. We have cardiac nurses, nurse practitioners and different specialties and different levels of training. That’s not difficult for people to wrap their head around. So some argue that it would confuse the public to move to the nomenclature of paramedic but I think it’s actually just the opposite.

In public safety it is similar. We have firefighters who are also rope technicians. We have hazmat specialists. We’ve got confined space experts. They all function within the discipline of the fire service. You can say the same thing about law enforcement: There’s SWAT officers, school liaison officers, but they’re all cops and people can understand that. I think the disciplines of other professions offer experiences we can look to as roadmaps in developing our nomenclature for the profession of paramedicine.

Q: So you’re retiring from Allina Health EMS next month after 36 years of service in the field of paramedicine. What are you most proud of in all those years of work?

A: There are a lot of things I have contributed to at Allina Health EMS that I’m proud of, but my real answer is the people. When I came here this organization wasn’t really known as a place that had a lot of deliberate focus on employee engagement or experience or well-being. It wasn’t that we were terrible; we just weren’t known for it. In the time I’ve been here, I’ve been able to work with a lot of really good people on the leadership team, on our labor union team, and with our direct staff and create an organization that I think has been acknowledged as an organization that cares about its people.

We really try to keep good people, because at the end of the day it’s not about sitting in an office and thinking good thoughts. It’s about taking a step out of an ambulance and laying your hands on a patient and having an interaction. To do that, we knew we had to cultivate a culture that cares for the people that work here. That has been the most gratifying thing for me.