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EMS, We Have Some Work to Do

As if fire-based EMS doesn’t have enough issues with its name brand of service delivery, I want to tell you about two new challenges.

First, there are some in the American EMS community trying to convince us that a change is needed, that we need to call everyone paramedics. No more EMRs, EMTs or AEMTs—just use the term paramedic for everyone, regardless of actual certification level.

The reason given is that in the United Kingdom, Canada and Australia, all EMS providers are called paramedics. While this single nomenclature may work in these and other countries, it should not be adopted in the United States.

The term paramedicine came up in the discussion when the educational standards were being drafted, and it was determined that we still had work to do for that term to be applied consistently when talking about EMS. With the increasing push for community paramedicine, the use of the term appears to be on the agenda again, and there is even talk to take it another step by changing the level of providers to a single nomenclature.

The verdict is still out on whether mobile integrated health (MIH) or community paramedicine (CP) will replace EMS as we know it today. With the pending changes in the Patient Protection and Affordable Care Act and a right turn that could derail the plan for value-based purchasing, the future is even cloudier.

I oppose any idea to even consider the single use of the term paramedics for all EMS personnel. In the past nine years, the United States has continued to not fully adopt the four levels of EMS providers found in the Model Scope of Practice document. There was considerable work done to evaluate and adopt these levels, not to mention the work done on the educational standards developed for each level. What impact would there be in the scope of practice if the names changed?

While I am somewhat confident that a movement like this will fall flat in the United States, it is better to debunk it than allow it to pollute the minds of those just beginning their EMS careers. One of the largest challenges to adoption of a single nomenclature in the United States will be the language in every state statute that requires a person to be an EMT before they can advance to AEMT or paramedic training.

Knowing what it actually takes to change the laws of each and every state should be one of the first considerations when proposing such an idea. I encourage everyone to weigh-in on this proposal should you get the opportunity to voice an opinion.

The second area of concern to me comes from a recent article in The Economist, The World in 2017, by Tom Standage called “Apply Within.” In this article, Standage identifies the hottest new jobs in 2017. With the aging of the population, it can’t really be a surprise that much of the increase is found in the medical field. The source of the statistics listed in the article comes from the U.S. Bureau of Labor Statistics.

The new job that caught my eye was “Ambulance Driver.” Have you heard this was going to be one of the hottest new jobs in 2017, with a projected 33% forecasted growth?

If you’re like me, you’re shaking your head, wondering how this happened. I know EMS has only existed in the United States for about 50 some-odd years, but for this term to still be used makes you wonder what the general public thinks when they see an ambulance.

Do they think EMTs and paramedics or ambulance drivers?

We clearly have an image problem if one of the hottest new jobs is “Ambulance Driver.” I don’t think it even matters if you’re driving a fire department ambulance—there’s a lack of understanding of the kind of personnel coming to an emergency. In most cases, the public still wonders why firefighters, who arrive on an engine or ladder truck, are coming to the medical emergency.

EMS is often not as engaged with some of the federal bureaucracy as it needs to be. It doesn’t matter what name is on your patch; EMS needs to be recognized with professions that are clearly identified.

Fire-based EMS providers are certainly more than ambulance drivers. We need to work on our brand and make sure we educate the public on not just our titles, but also on what’s involved in reaching those levels and the importance of each title when the public calls 911.

Hopefully with the new work this year to revise the Agenda for the Future and the Model Scope of Practice, the term ambulance driver and the single use of paramedic is not in the plan.

EMS, we have some work to do. 

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