What’s in a name?

There has never really been a consensus about a general term to call EMS providers

December 02, 2010 10:10 AM

Editor’s note: What do you think of the current generic terms used for individuals in EMS — Responder, EMS Personnel, EMS provider, EMS medic, Medic, Paramedic, EMT, Ambulance Worker, etc.? And if none of those fit, what term should EMS1 — and the industry — adopt? Tell us what you think in the member comments section or by e-mailing us.

By Erin Hicks
EMS1 Associate Editor

If you’ve been in EMS for any length of time, chances are you’ve likely been called a lot of things. And judging by the feedback we’ve gotten, few have been welcome.

Within the fire service, it’s a little simpler — “firefighter” is a safe bet as a broad label. The same applies to the law enforcement world, where titles such as “cop” and “police officer” are universally accepted and embraced.

Within EMS, things get a little trickier due to the emphasis on distinctions — an “EMT” is not a “paramedic” is not an “EMS responder”. So what’s in a name? Quite a lot, judging by recent discussions on several EMS listservs.

The recent debate was prompted by a news article we posted from a TV station’s website about an ambulance crash in Atlanta. The original source used the term “Grady employee” to describe one of the people who were injured. Unsure of what level of education the responder had in the vehicle, we went with the rarely-used but convenient term “EMS worker” in a photo caption.

And so the arguments began. The general consensus reached from discussions on listservs was that “EMS worker” is inappropriate, with one person labeling it “vague” and “somewhat demeaning.”

The arguments were valid, and we agreed both that it was a regrettable usage and something to be avoided in the future. But with no other term that’s universally accepted in this situation, it hinted at larger challenge that trade publications such as ours will always come across.

And if we find it tough, then what’s the general media to do? When different news organizations cover the same story involving someone from EMS about whom there is only vague information, you’re likely to find their label changes from source to source.

So we asked two EMS professionals to give their take on the issue. In their contributions, they offer thoughtful advice on how we can start leading the change both within our industry and beyond. But to reach a true consensus, we need your opinions, too — give us your suggestions in the member comments below or by e-mailing us directly.

How ego can be a barrier

By Skip Kirkwood, M.S., J.D., EMT-P, EFO, CMO President-Elect National EMS Management Association
What should EMS providers be “called” by the media, when individual names are not known? There has never really been a consensus about this, or much else in the EMS community, except for agreement that we don’t like to be called “ambulance drivers.”

Let’s turn to the community

By Margaret A. Keavney, EMS Lawyer and Consultant

The image of the profession in EMS has never been as strong and unified as those of our counterparts in law enforcement or fire, or of fellow health care providers in the hospital or outpatient setting.

We are more like the health-care providers when it comes to training: Everyone wears scrubs: physicians, others nurses, licensed therapists, unlicensed techs, certified nursing assistants (who aren’t nurses) and advanced practice nurses (whose role is more like physician assistants than like RNs or LPNs).

The health care providers have the same problem we do. The place to go to fix this is our own communities. Yes, that will not standardize the names of our positions across the country, but that’s OK. It’s more important that our patients, our legislators, our fundraising and grant-making charities know who and what we are.

It’s OK if an out of state journalist gets it wrong, or (gasp) calls us “emergency workers” in a breaking news piece. When the actual story comes out, the writer should do enough work to understand the training level and role of the individual provider if it is relevant to the story.

The alternative? The National Association of State EMS Officials needs to agree on terminology and promote it in their states. It would be great if the term “medics” meant “all trained EMS responders, regardless of training level or certification of licensure or role in emergencies.” But it doesn’t. Not everywhere.

For example, in New Jersey, where all pre hospital ALS is handled by hospital-based paid paramedics, and half of prehospital based BLS is handled by volunteer, unpaid responders with no minimum standard for training or competency, no one would use the term medic to describe anyone but a certified paramedic.

Some would use the term factually, some with respect, and some with derision. But no one would think it meant the ambulance driver who may actually be only licensed as a driver.

“First aider” is the term worn with pride by volunteers, many of whom are EMTs. Only the state agency for EMS can change the way each state’s clinicians think of themselves, and only gradually. As national organization, NAEMT, NEMSMA, NREMT, and others can propose options, but it has to grow from grassroots.

The modern generation of EMS began in the mid-1960s, when “ambulance drivers” who typically held American Red Cross first aid credentials began to be replaced by new animals — emergency medical technicians or EMTs, and paramedics. A variety of different titles cropped up and were incorporated into state and local legislation, educational documents, etc. My favorite was “Physician-Trained Mobile Intensive Care Paramedic” just because it had the most words.

Over the years, the original EMT and paramedic designators began to morph. Individual therapeutic measures began to append to those certifications so you could have an EMT-D-IV-EOA-MAST (an EMT who had been trained in defibrillation, IV therapy, insertion of an esophageal airway, and application of the Military Anti-Shock Garment).

Why we felt that we had to append each new tool to the level of certification escapes me, but some have suggested that it is a sign of some deep-rooted psychological problems. In some states, the “rockers” attached to the EMT patches could reach the cuff of a long-sleeved shirt. It got pretty silly. After all, have you every seen an MD-CC-VAS-ST? That’s my conjure for a physician who has been trained in cardiac catheterization, vasectomy, and stitches ... silly, yes? The “levels” game continued, with EMT-Intermediate, Advanced EMT, and on and on.

All of this is inside baseball to us EMS folks — but it’s confusing to people who aren’t intimate EMS insiders, and who are simply not going to learn all of our lingo and acronyms. The result is that we have become “EMS workers” or sometimes — ouch — “ambulance drivers” again.

So our media friends have asked me to comment on what I think that they should call us. Given only my humble opinion and some input from some non-EMS friends and neighbors, I think that we should be collectively known as paramedics — or maybe just medics. Why? First, that’s what non-EMS folks call us.

“Call the paramedics!” is what people say when a medical emergency happens. Sometimes they say “call the ambulance” but I think they want the care that we give, not just the truck. Second, it’s a good collective — just like “police” works for municipal police officers, county deputies, state troopers and highway patrolmen, etc., and like “firefighter” works for firefighters, engineers, lieutenants, captains, etc.

Third, our friends to the north adopted the paramedic title for everyone 10 years ago, and it’s working quite well for them. In Canada, everyone who does emergency medical response is a paramedic - what we know as an EMT is a Primary Care Paramedic, what we know as a paramedic or EMT-Paramedic is an Advanced Care Paramedic, and then there are the specialties — critical care paramedic, community paramedic, tactical paramedic, and on and on. See the common theme?

What gets in the way of this simple convention? The only real barrier is ego — “I worked hard to become a paramedic and I don’t want some damn EMT to be called paramedic without earning it.” Get over it — I feel stupid just typing it on the screen. What’s more important — your personal image problem or the collective good of our profession? Yes, I know that in some states it is a crime (!) to call yourself a paramedic when you are not.

Like the Canadians did, I think we should just make the change and let the legislation and rules catch up with us, instead of holding us down.

So what do you think? Tell us about your experiences. What do you think of the current terms used — Responder, EMS Personnel, EMS provider EMS medic, Medic, Paramedic, EMT, Ambulance Worker, etc. What term should EMS1 — and the industry-adopt instead? Tell us in the member comments below or by e-mailing us.

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