your opinion on a manditory 2 year degree for paramedic

[fire911medic]

I think that two year degrees would be a good thing if it produced a significant increase in pay and recognition. However, it does not do this right now even for those who do have it. You receive the same basic medical training either way, you just have to put up with all the other crap classes to be able to do it, though some states do require you have college level math and english in order to start a paramedic class (great ideas). Despite this one growing problem I am seeing with university based programs as opposed to fire programs is the lack of clinical experience which is obtained. This seems to be greatly lacking for two reasons. One in a two year degree, most go straight through emt into medic class with little to no time on a truck. They have excellent book knowledge and understanding of diseases, and know what to do, but lack the confidence in doing it, whereas in my experience, department trained medics or those with significant experience on a truck fare much better. A medic is simply nothing more than a basic with a bag of tricks. If all your fancy drugs and equipment fail, you have to rely on good basic skills, and university schooled medics seem to have tunnel vision on the advanced procedures, and lose track when forced to rely on basics. University based programs rely on financial aid, are much more expensive, and there is a push to get students through quickly. Though one plus for them is the financial assistance and usually better labs to learn in and larger budget to purchase needed supplies. Also, it is more difficult to attend classes on a 24-48 schedule. Truthfully, unless they have dual classes and allow you to attend either day as your shift allows, it is truly almost impossible to work and go. If it were a perfect world and EMS was how I would like, everyone would have two years in a high volume service as a basic before even considering going to paramedic school. 1 year minimum before intermediate or emt-advanced. That ensures the needed experience. The college level math and english to allow for drug calculations and well written reports, and finally the actual class time would take 2 years to complete. These accelerated courses leave much out, or barely glazed over. I have been on both sides, taking my basic through a university, then choosing to take 2 years off went to work for a department who paid for me to obtain my medic and they put me through, but it took two years to complete the entire program and was not an associate's degree. My next obstacle to tackle will be obtaining my critical care endorsement, but that has a two year experience requirement which I think is great. If these modifications were put in place, I think we would see a tremendous improvement in the quality of care given to our patients and respect gained from the community.

[Ridryder 911]

We need to keep the education to elementary level. Lets have our EMT textbook written at a 6'th grade level. Also, no entry requirements, hell anyone can be an ambulance driver. Why should we require psychology classes & anatomy & physiology& all that fancy stuff. Who needs all that reading, writing & math stuff...All EMT's do is drive an ambulance anyway. How much training do you need for that?

Maybe if they want to advance themselves they could go to a trade school later & finish a 500 hr course, with one 11'th grade textbook, this is next door to the cosmetology program.. (although they go for a full year). But, unfortunately they will probably want to get paid if they do that & then they will quit volunteering....(geez there goes the swimming pool & golf course budget.)

Oh yeah, who knows the next thing they will want to be medically licensed .. .huh ... don't they already have a license to drive an ambulance ? Its not like there educated anyway ?

Yeah, lets just keep it the way it is .... it just fine!

[Tibby]

Canada's EMS certification system is completely different from the U.S. Comparing them is apples and oranges. If becoming an EMT or Medic in the U.S. suddenly required a 2 or 4 year degree, the recruitment pool would evaporate.

I don't think so. In my school where a Degree is optional, most of the class is going for the degree. Including those going into fire and nursing and other similar careers.

Remember that 80% of the US is made up of rural communities.

80% in rural areas? Are you talking about in land mass or population? That number is WAY too high for population. Every stat that I google comes up with 74-80% of the population living in Urban areas. But even so, what does this have to do with the subject at hand?

[Guest]

I think that two year degrees would be a good thing if it produced a significant increase in pay and recognition. However, it does not do this right now even for those who do have it.

Around here is DOES make a difference. LPs are paid more than NREMT-P because of their higher level of education. They get offered better jobs and more promotions. And it works. I know a few going back to school to get their Associates because it will increase their pay and opportunities. The problem is the state will help pay for an ECA/EMT/volunteer to take the cert. classes, but you can't usually get funding for the degree programs. That's why most people pass them up. Let's face it, we don't make much and have families to support. We're going to take the classes that someone else will help pay for.

[zippyRN]

UK situation is interesting and probably the one most pertinent to the debate

until a few years a go paramedics i n the UK were 'certified' in that the only way to be a paramedic officially was to be employed by an NHS Ambulance service and follow their training programme.

Then we had 'proper' Registration for paramedics ( with the Health Professions Council) and a good number of people were able to be grandfathered into Registration through non NHS routes. We are now facing a situation where the NHS in house route will no longer be acceptable for New registrants with the move to Foundation Degree / DipHE ( basically 2/3rds of a Honours degree) entry.

Ambulance technicians have remained unregistered and controlled by employers ....

A move to Higher Education preparation for practice doesn't necessary bode poorly for EMS - what bodes poorly for EMS in the rural USA is the fact that the US population is so greedy and so unwilling to accept the need for anything other than the most basic of healthcare be provided by the government .

[SA_Medic]

We have had a four year system for some time now, and yes the guys that has gone through the four year program does pay more.

Here is how our EMS education system works,

You can follow the traditional route, Do a Four week course and qualify Basic Ambulance Assistant (EMT- work 1000 hours patient care (documented) and write and entry exam for Ambulance Emergency Assistant (EMT-I).

If you pass the entry, and you are selected to attend the class (space is limited) you study 3 months and do clinical rotations in between classes. Work another 1000 documented hours patient care, and write entry for Critical Care Assistant (EMT-P).

If pass that and you are yet again selected for the class, you do a 10 month course with clinical rotations in between classes.

The other way to do it, is as follow:

Finish high school, apply to the technician to do your National Diploma.

This takes four years of full time study, no clinical rotations (unless it has been changed since I last heard). On completion of your N-Dip you are a Paramedic / Rescue technician.

You can then if you want continue your studies and get a Bachelor's degree in EMS in 12 months.

If feel like stying some more, anther year will give you your Masters and yet another year will give you your Doctorate.

The draw back I have experienced with this system (N-Dip) is that you get Paramedics, fresh out of tech and now highest qualified on the scene. They have no clinical/practical experience, trying to tell an EMT-I with 9 or more years experience how to do things.

It leads to high strung emotions. Had a MET-I and a N-Dip physically attack each other on a MVA.

So, as with everything in life, it has it's good and bad points.

[THE_DITCH_DOCTOR]

Since nursing was brought up, why do you think nurses get paid so much? Because they have to go through so much crap to get their nursing credential, that a lot of people are weeded out, there is a greater demand than supply and therefore they create a situation where they are needed and can demand what they want.

Without the degree, nurses would be getting paid just like EMS is currently. And as for the "volunteer" problem, you know what? Perhaps rural communities should just remain as BLS operations- no one demands that there be volunteer paramedics (Need I remind you all that in many cases ALS has been proved to be little or no benefit?).

[emt_hound]

Tibby... I was speaking of land. 80% of the US is rural. Yes, the pop. is smaller and way more spread out....but that's the point.

The system that has developed throughout the majority of the continental US to deal with emergencies relies on volunteers as its backbone. Only urban areas can afford to field full-time, paid paramedics and emergency responders. Getting volunteers that are trained and certified to respond to emergencies is hard enough without requiring a 2 or 4 degree training route.

Let me sample our squad for a second: 8 full time employees. 4 medics, 4 EMT-I's. 6 more per diem medics that work for other services and come in to fill gaps. 25 volunteers, all EMT-B's and EMT-I's. Some are highly educated with degrees in engineering or law. Others have associates degrees in architecture. We've got a high school English teacher, a Concierge for one of the ski resorts, a butcher, an LNA, a fellow that works at the plastic's plant, and another that works at the local ironworks. We've got a softwear programmer, a mechanic, and an electrician. This is just a sample.

Simply requiring a 2 or 4 year degree program removes all of these volunteers from our roster. Do they have the time or money to go through a program like that? No. Do we have the money to pay to replace them with degree'd medics? No. Hell, there isn't a single paramedic program, certification, associate, or bachelor's, in this entire freakin' state.

Am I happy about this? No. Am I endorsing the current status quo? No. I want highly trained EMTs. I want paramedics with B.S.'s in paramedicine...but recruiting for rural medicine is hard enough now without requiring a degree. Make the degree financially attractive and things will change.

Right now, EMT's get paid $8 an hour in our service area. Medics are lucky to be pulling in $12 an hour. How do you entice the sort of highly educated individuals you want, when they can make three times as much money working in just about any other career field?

I don't know how it works in urban services where the need for volunteers is (I'm assuming) less. I have heard that Seattle is paying medics something like $50k...basically, an attractive wage. All my experience is in rural ems. Things are different out here, and unfortunately, out here is the majority of the country.

[vs-eh?]

A couple of things...

In 1997 (I believe), Ontario introduced the so-called "Symptom relief" drug package for BLS. This was a province wide addition that all PCP's (they weren't called PCP's then) had to have. It added ventolin, ASA, NTG, EPI 1:1000, and glucagon to the skill set. All current EMS employee's had to have a CME (I assume) and brought up to par with this new addition. Prior to that BLS could basically do BOB for the patient and take them to the hospital.

Prior to 2000, PCP education was a 1 year gig. They added the second year for whatever reason. To spread to out a little more, to add some breadth requirements, to allow more extensive education in pharm and A&P, to add an introduction (and with some schools, mine in particular more like 3/4 of the course) to the ALS skill set and advanced assessment.

Did the addition of the drug package in '97 or the addition of an entire year full time education (with corresponding tuition) cause a drop in people wanting to enter paramedicine? No. In fact it probably increased the demand. People saw the increased skill set, advanced assessment, and increased education as a benefit, not a burden. Paramedicine is more popular then ever in Ontario.

Do we get paid better than our American counterparts? Generally, yes even at the BLS level. Does the increased education and skill set play a hand in that. Certainly. Again this is only for Ontario, the rest of Canada I can't speak for, but I'm pretty sure pay is less (at least for BLS) in other provinces. Education, I am certain, plays a role in that.

The whole "rural" arguement I don't quite understand. This is Canada emt_hound, remember I have to battle polar bears, wear snow shoe's, and deal with eskimo's on a daily basis. Canada is equally "rural" and a generally harsher environment. As a city boy born and raised I don't know any different. To me "rural" is cottage country an hour outside Toronto. I have never had to deal with volenteer's nor have I ever worked outside the city. However the majority of the province is ONLY covered by PCP/BLS. That is why air ambulance is such a big industry in the north of the province. Critical care choppers and fixed wing is all they have out there. The same PCP working in Timmins graduating today must have the 2 year program, generally the same education, and generally the same skill set. Probably are paid $5+ less an hour than me, but still. They certainly have volenteers out there, but to my knowledge there are no "volenteer" PCP's. Ontario requires that at minimum there must be at least 1 PCP on a 911 ambulance in the province. Again I don't know how it works in the majority of the province, I'm spoiled in the city. All ALS, tiered response, paramedic response cars, on Delta/Echo responses initial response by one of fire(usually)/police/EMS is under 4 mins. Everyone in the allied services is full time, career basically.

Heh, I guess my point is that things change, people have to adapt. We constantly are learning on this job, be it first day or your 5000th day. ALS medics who have less education, less clinical/field experience, less knowledge than I do as BLS is scary. ERDoc said 50-75% of the medics in his area wouldn't know what angiotensin II is or does? Scary. 10 hours of ER time and you're on an ambulance? Scary. EMT's who have 100 hours of training, and is some cases are transporting my loved one and "assisting" with drugs that they have zero clue what they actually do, is scary.

A change is needed.

EDIT - I am actually quite frequently asked by patients how long I went to school for to do this. I am older than I look, so people may see me as straight outta high school. Also the general public here has zero clue that there are different levels of paramedic in the city. We all wear the same uniform, we all drive the same ambulances, we all are called paramedics. I would be embarrassed to say the least if I told them I had only about 3 weeks full time education and I am caring for you. That I never really had any clinical or preceptorship, but "Hey, so how are ya feeling..."

[emt_hound]

Well, that's my point. Career medics around here are the rarity. The great majority are volunteer EMT-B's and EMT-I's working for small, single-ambulance towns. Most only get paid when they're actually out on a call and some towns simply don't pay at all.

If there was money in it...and God, I wish there was, there would be demand...and if there was demand then there would be insistence on higher education standards.

But the reality for us is there is very little money...so very little demand...and we have trouble recruiting and retaining the volunteers with the certification requirements we have in place, as minimal as they are.