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EMS is Not Nursing!

As the debate over requiring a degree for paramedic education heats up, I want to clarify one thing: EMS is not the same as nursing, or respiratory therapy, medical assisting, radiography or any of the other dozens of allied health fields.

Please stop trying to compare emergency medical services to any other form of medicine. Many argue that if we look to nursing to see the importance of degrees, we can compare that to EMS. Just so we are clear, registered nurses with a BSN and associate-educated, entry-level paramedics are not the same thing. My premise is that they are two completely different fields of medicine.

First consider that each perform in different arenas. The primary role of an (entry-level) paramedic is to work on an ambulance in the prehospital environment. As employers, both the fire service and other EMS providers, are not looking for field supervisors or managers during their first few years on the job. Employers need entry-level competent paramedics to work on emergency vehicles and provide out-of-hospital care.

The RN with a BSN works in a hospital or nursing home, and even they need additional on-the-job training; the decision-making processes and healthcare provided are different. Licensure is different. There are certainly variations in these roles, but for the most part, that sets the stage for this discussion.

One major reason EMS is not nursing is that the reimbursement model is completely different for hospitals from the prehospital reimbursement, which is only provided for the transport of patients. The care delivered to each of these different patients is not the same, which results in different reimbursement models. The system that provides funding for different types of services is not based on the level of education but rather on the kind of service provided.

Another point made is that requiring a degree will increase salaries for EMS providers. You cannot assume that a degree in EMS (for entry-level) providers will provide a higher salary. In some fire-service agencies, the certificate-trained paramedic makes more annually than some masters-degreed professionals.

I have heard the argument that if you limit the pool of EMS providers and the supply is low, salaries will go up – a completely flawed economic idea. Depending on where you are in the country, there are many employers struggling to get candidates now. Making fewer (entry-level) paramedics is not going to help raise salaries in any arena. More likely, fewer paramedics will drive the level of care from ALS to advanced EMT or even BLS.

How many volunteer nurses do you see in the hospitals or nursing homes? The impact on the volunteer fire and EMS agencies will not be an improvement to those communities but will probably force them to go from providing ALS to BLS services. Seventy percent of American fire-service delivery comes from volunteer or combination departments; many of these agencies provide ALS service. Making it harder to receive a paramedic education and a license will not increase the number of providers.

Since when is having a college degree evidence of being a professional?

All the chatter about this subject is just background noise. All those writing articles or talking about mandating an associate’s degree for every paramedic program knows that neither they nor anyone can make this happening.

I would like for someone to explain how this major change in EMS education could actually occur realistically and not just hypothetically. Provide all the required steps, including the changes in state statutes in 48 of the 50 states.

Limiting the education programs of entry-level paramedics to only those who have graduate with an associate’s degree would affect a high number of employers because of the decrease in the total number of paramedic programs. Currently, every paramedic student in every paramedic program has a pathway to get a college degree in one way or another. Either their program offers a degree option (if it is a college or university) or it is required to have either an articulation agreement or memorandum of understanding with a college or university should the paramedic graduate student wish to enroll and finish all the general education courses to meet a degree requirement.

All the hype and rhetoric are just people beating their own drums for recognition.

The fire service is the largest provider of emergency medical services in the United States, and so radical changes like this have direct impacts on the workforce and service to every community. While this debate is just getting started, it takes everyone to speak up and be engaged in the debate. Stay tuned for more updates.


The IAFC has released a toolkit on this topic, Opposing EMS Degree Requirements, which includes the IAFC’s position statement and an FAQ report along with other materials.


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