Entering phase 2 of EMS

2019 was a paradigm-shifting year for the EMS industry and profession – one that will set the pace for the next decade’s worth of ambition and work


2019; EMS hasn’t been this exciting since the White Paper was introduced in the 1960s. 

Sure, there have been a number of milestones within our industry along the way – and they certainly haven’t gone unnoticed. They were all an integral part of “phase 1” of our industry. And despite some of the conspiracy theories, gripes toward generational changes, and a change in the guard of EMS leadership amongst our many organizations, we’re by no means heading toward the beginning of the end ... we’re simply at the end of the beginning. 

Phase 1 of EMS – roughly the past half-century of its existence – has brought our infant field from funeral home operations, white shirt and pant “ambulance drivers,” and minimally competent field technicians toward our present status – an industry. We have regulating bodies, national credentials, multiple forms of service models, lobbying support groups, and are even a career choice for many individuals. By all means, we still have a lot of work ahead of us (defining our identity, as one of those challenges), but we’re absolutely an industry that is arguably becoming one of its own. We’re at the end of the beginning of phase 1 of our existence. 

A lot has been building-up toward 2019 – and even our transition into 2020 – but four key paradigm-shifting concepts have gained the spotlight just this year alone. (Sheriff Danny Perkins/Garfield County Sheriff's Office via AP)
A lot has been building-up toward 2019 – and even our transition into 2020 – but four key paradigm-shifting concepts have gained the spotlight just this year alone. (Sheriff Danny Perkins/Garfield County Sheriff's Office via AP)

A lot has been building-up toward 2019 – and even our transition into 2020 – but four key paradigm-shifting concepts have gained the spotlight just this year alone. Each one of these is certainly taking course to enter into phase 2 of what will become our industry – our profession – for the decades to come. 

1. Will we all be called paramedics? 

The title of paramedic has certainly been a hot-button item throughout 2019. Should we all be called paramedics? 

Our neighbors in Canada have adopted this nomenclature – along with many European nations and Australia – but what about the U.S.? We still have a fragmented title structure where some of us are EMTs, others paramedics, and many lying somewhere in between. The National Registry has already rolled out its four-level approach toward EMS certification (EMR, EMT, AEMT, paramedic), but not all states have fully followed suit just yet. I’m no stranger to adding an alphabet soup of credentials behind my name, but credentials like EMT-B, EMT-D, EMT-A, EMT-II, EMT-CC and others are simply confusing. Is adopting this four-level approach better? 

Or, should we all be called paramedics, and then differentiate ourselves from there? As a growing profession, does the term “emergency medical technician” (with an emphasis on “technician”) really suit us appropriately? Is it how we want to be defined moving forward? Is a title that aligns more with being aside the physician better suiting, like a clinician? Should we become paramedic-basic, paramedic-advanced, and so forth, instead? 

2. Two-four years (on good behavior) 

As we advance and clarify our professional identity, the question (or debate) comes up regarding whether or not paramedic (ALS) providers should be required to have a degree

A two-year associate degree, or a four-year bachelor’s degree in EMS, paramedicine or some other degree focus are all being discussed both at the state and national level. The intent here is primarily twofold: to express our professional ambitions and beliefs within our field, and to promote an increase in wages through a degreed background. 

The fact still remains, Medicare and Medicaid (CMS) still see our industry as a transport option for sick and injured people. Within that transport timeframe, we occasionally provide some degree of reimbursable care. The argument for having a college degree is that it would better align our services with those of the healthcare industry and, therefore, would make our services more likely to become better reimbursed. This enters into the third paradigm-shifting theme for the year: cost. 

3. What do we cost? 

Cost data collection efforts by the Centers for Medicare and Medicaid Services (CMS) have begun their announcements for the lucky winners of the round 1 (2020) cost data reporting requirements.  

[Were you selected? Read: 5 immediate action steps for Ambulance Cost Data Collection participants]  

This massive data collection project will extend over the next four years and will capture data from every ambulance service in our country. It’s intent: to see how much we cost in order to operate. 

For years, we’ve been complaining that our reimbursement rates are pennies on the dollar compared to what it actually costs to operate. Well, it sounds like CMS is finally asking for proof. This, of course, is not coming without some debate amongst our own ranks. The old adage of, “if you’ve seen one ambulance service, then you’ve seen one ambulance service,” is trying to creep its divisive stigma into the mix. Personally, I think this mantra is a farce. I believe that, if you’ve seen one ambulance service, then you’ve actually seen 1,000 ambulance services. 

I think the cost data collection project will prove that. All-in-all, there are four primary service models for ambulance services within the U.S., but within each of these, there are some variances. Volunteer versus paid, rural versus urban, station-based versus roaming, and a few more similar differences break our four primary service models down a bit more. In the end, they all share the same common hardships, profit margins, strengths and weaknesses within their own models. 

What will the numbers tell us? I think they’ll point toward which service models are most efficient. They’ll show us that our own data is fragmented because of our multiple varieties, and they’ll indicate that we (as an industry) are in a need of some major overhaul across our nation. We need to end phase one, and begin phase two. 

4. Triage, treatment, and transport, but differently 

The announcement of the ET3 project by CMS will also be a game-changing endeavor for our industry as we progress into the next decade. Four or more years of data collection, proof of concept, innovation-seeking and paradigm shifts will help to re-design our industry as we know it. It will help to seek answers toward more viable funding sources, transport options and community service projects

ET3, in my opinion, will force us to embrace our public health and healthcare roots; not solely our public safety and emergency preparedness foundation. Combined with determining how much we actually cost, pushing us toward a degreed profession, and challenging our current nomenclature to better define and identify our industry, we’re certainly in for one heck of a ride as we enter the next decade of EMS. 

So, thank you to all who laid the framework for phase 2 to take speed as we progress forward. We couldn’t have done it without you, and we can’t do it without us going forward. 

[In the 2019 EMS Trend Report, we set out to identify the commonalities in how those who provide EMS services at all levels, and across all sizes and types of organizations, perceive industry trends, opportunities and challenges. Read more.]  

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