In the 1995 film Crimson Tide, the following exchange concerns between an old school nuclear submarine captain and his new, highly educated executive officer:
Capt. Ramsey: [chuckles] Be careful there, Mr. Hunter. It’s all I’ve got to rely on, being a simple-minded son of a bitch. Rickover gave me my command, a checklist, a target and a button to push. All I gotta know is how to push it, they tell me when. They seem to want you to know why.
Hunter: I would hope they’d want us all to know why, sir.
As a paramedic since 1986,I feel like Capt. Ramsey, in that I was given a set of protocols and drugs to push, and all I had to know was how to push them; the ER physician would tell me when to give them. We expect today’s paramedic to not only know how to push the drugs, but why and when to give them, with very little supervision. This is an awesome responsibility with no room for error.
Most of us are familiar with the traditional paramedic program that leads to a license or certification from the state EMS office. The training model traditionally has been hospital based or occasionally housed in a local community college. When the successful paramedic student adds up all the time spent in class, labs, hospital rotations and field time, they easily have put in more hours than the average associate degree requires. In fact, some programs result in the awarding of an associate degree. When we add the time they spent working in the field in order to be accepted to paramedic school, they may be closer to a bachelor’s degree in time invested.
If we compare the evolution of nursing education, we would find a similar arc. First, it was hospital based, then it moved to a college-based program resulting in an associate degree, and now we have the Bachelor of Nursing Science (BSN). In 1996, the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration (HRSA) published the national consensus document titled EMS Agenda for the Future. The purpose was to establish a system of EMS education that more closely parallels that of other allied healthcare professions.
Today we are close to seeing this vision come to fruition with paramedic programs working to achieve accreditation through the Commission on Accreditation of Allied Health Education Programs (CAAHEP). In collaboration with the Committees on Accreditation, The CAAHEP reviews and accredits more than 2,000 educational programs in 20 allied health-science occupations. While it is possible for a paramedic program to become accredited without affiliation with a higher-education institution, most will seek a relationship with a college in order to achieve accreditation.
There will be a strong push for accreditation this year because the National Registry of EMTs (NREMT) has added accreditation as an eligibility requirement for paramedic testing, effective at the end of this year. This will create an opportunity for higher education institutions to establish both associate’s and bachelor’s degrees in paramedicine. Given that there currently is a shortage of paramedics, the first thought might be that this only will worsen the situation. But this might actually be the solution to this problem, in that much of our paramedic shortage is the result of an unfocused path to becoming a paramedic.
A young high-school graduate may spend two to three years just working toward acceptance into a paramedic program. A formal path for the brightest and best academically gifted high school students to attend four years of college to receive a bachelor’s degree in paramedicine, with a minor in fire science, may increase dramatically the qualified labor pool for the fire service. Because most fire departments respond to 80% medical and 20% fire and service-related incidents, it sounds like the correct degree.
Imagine using colleges to recruit a diverse student population of young high school graduates who represent true diversity for the fire service. Then we just might have enough qualified candidates for our future work force. Imagine a fire chief interviewing new firefighter/paramedic candidates whose credentials include National Registry Paramedic, a bachelor’s degree, and Firefighter I with four years intern experience in the field.
If we can train qualified nurses, physician assistants and dental hygienists in an allied health model, then why not paramedics?
Peter Struble is chief of the Wallingford (Conn.) Fire Department.
