Is EMS a Trade or a Profession?

So, you want to be a welder? Here is the national curriculum for welders. So, you want to be a paramedic? Here’s the national curriculum for paramedics. These are the guidelines–all 387 pages–on which paramedic education in the United States is based.

Standardized curricula, such as detailed here, are typical of trades. If you look further, you will see that paramedicine, which is a healthcare profession, is regulated by the National Highway Traffic Safety Administration (NHTSA), which is part of the United States Department of Transportation (USDOT).

So you ask, “Why is a healthcare profession a function of NHTSA?” The answer to this question only makes sense if you don’t think about it. Also, if you will note, the welding curriculum was revised in 2011.

The paramedic curriculum was last revised in 2009. Which trades would you say have had the most changes in the last eight to 10 years? Certainly changes in EMS have occurred much more frequently and are much more significant than those that have occurred in welding.

So why in 2016 is paramedic education still based upon an archaic curriculum administrated by the USDOT? I don’t know.

The best answer I have found is, “We’ve always done it that way.” It doesn’t make sense to me. Furthermore, the current paramedic curriculum took almost two years to develop, so some of the data in it is well over 10 years old.

As a textbook author, we rely very heavily on the material in the DOT curriculum. However, in 2016, we noted that a considerable amount of the information in the DOT curriculum is outdated or incorrect.

Standardized testing (e.g., exams for the National Registry of EMT) is based upon this older DOT curriculum and questions will be asked about information that may or may not be current. Thus, as a textbook author, we have to detail the information in the old paramedic curriculum and explain what has changed and what has not. This is the problem with standardized curricula and one of the major factors that makes EMS a trade and not a profession.

In my other job, I am a medical school professor. My role is to educate medical students and residents in emergency medicine. Guess what? There is not a standardized curriculum that we must follow.

There are not certain textbooks that must be read. Instead, we are given a set of competencies that all graduates must attain prior to graduation. This is common of professions and virtually unheard of in trades.

In emergency medicine there are six general categories of core competencies (osteopathic programs have seven):

  1. Patient care
  2. Medical knowledge
  3. Professionalism
  4. Systems-based practice
  5. Practice-based learning and improvement
  6. Interpersonal and communication skills.

There are various components of each competency that must be mastered. However, it is left up to the individual program to determine the best way to achieve those competencies. Instead of documenting the number of hours in class, or similar checkboxes, residency programs must show evidence of how they use educational outcomes to improve individual resident and overall program performance.

We meet on a regular basis and look at 21 different parameters to determine how the resident is progressing in their emergency medicine education looking almost exclusively at their acquisition of competencies.

Unfortunately, paramedic education looks more at the number of hours in class, the number of hours in the lab, the number of hours in the hospital and the number of hours on the ambulance.

Interestingly, the educational experience in a system like this can vary. Some shifts can be very busy with a great deal of patient exposure and many procedures while some can be so boring that you spend the entire shift in a recliner watching The Jerry Springer Show.

Time for a Paradigm Shift

Instead of using hours as a measure of our education, let’s start looking look at the outcomes. It is time to take a hard and fast look at paramedic education. We have to get away from many of the archaic and dogmatic beliefs and practices that exist. Clock hours, number of intubations, number of IV starts and number of PowerPoint slides seen are not important.

What is important is whether or not the graduating paramedic is competent and ready to assume the important role of prehospital care.

We must also be willing to accept alternative education models. Distributive learning (e.g., online education) is now widespread and it is not necessary for students to sit in a classroom while an instructor flips through a PowerPoint presentation.

Interestingly, when I was in medical school, it was common practice to quit going to class during our second year and simply read the lecture notes and the assigned materials. For many of us, our grades actually went up when we quit going to class. Of course, laboratory sessions were different and essential.

Even today, the NREMT still only allows a maximum of 12 hours of continuing education from distributive learning. The rest must occur from brick-and-mortar type classes. This is very archaic in that many of the distributive learning platforms are quite interactive and quite effective.

Now, in 2016, we have an extraordinary cadre of EMS educators in the U.S. and Canada educating our paramedic students. It was not that long ago when it was virtually unheard of to have a paramedic instructor with a master’s degree or a doctorate. It is now quite common. These are extremely talented educators who are unable to maximize their level of educational expertise because of ridiculous and archaic restraints placed upon them by regulatory agencies and similar entities.

It is time for the national standard curriculum to go away. We must meet and decide what the core competencies of a paramedic will be. We must validate these core competencies through scientific study. Then, we should leave it up to the educators to determine how best to educate their students in these core competencies.

What works in Florida may not work in Texas. What works in Nevada may not work in Massachusetts. We should leave it up to the instructor to assure that their students attain these core competencies by using the educational methods most appropriate.

I can guarantee that the vast majority of paramedic instructors in the U.S. and Canada can better determine how to educate paramedics than the DOT.

As with many things in EMS, we are again bogged down in dogma. Let us take the shackles off of our EMS educators. We need to promote EMS from a trade to a profession. The first step is education. Following that, respect, recognition, and pay will follow.

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