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A step in the wrong direction: Reducing EMS certification levels

Crumbling volunteer EMS infrastructure requires radical thinking and strategies to provide quality emergency care


Earlier this week, legislators in New York state began a painful discussion on whether to allow EMS services to reduce the level of certification in its ambulances. This action is in response to the dwindling number of volunteers who respond to calls. Certified first responders would be used instead of requiring a minimum EMT level.

This is a major step in the wrong direction.

Over the past 50 years, EMS has been evolving. Many services began as a second function for funeral services; others were simple rescue squads staffed by community volunteers who had first aid training. Treatment was often based in the speed of which an ambulance could be driven to a hospital. For the public, it was reasonable to expect that if you died while in the field, you stayed dead. Resuscitation care was only found at the hospital.

The real issue is not the certification. It's the worsening shortage of volunteers who can no longer spend the time and money to work a job for free. (Courtesy photo)
The real issue is not the certification. It's the worsening shortage of volunteers who can no longer spend the time and money to work a job for free. (Courtesy photo)

Over the subsequent decades, education for the field care provider expanded to include a wide range of services, from first responder to critical care paramedic. As the role of field medicine in health care evolved, so did the public's expectation of the providers. Television shows such as "Emergency!," "Rescue 911" and a myriad of reality shows reflect what society thinks of its EMS providers.

As a long-term field care provider, I often marvel at what we do today compared to when I started in the early 1980s. To be sure, the equipment has become increasingly sophisticated and ambulances today are rolling mini emergency departments.

EMS relies on education and training to execute appropriate treatment plans

More importantly though, is the level of education and training it requires to use all of that gear effectively and efficiently. It's of no small significance that the paramedic's ability to differentiate among a countless number of potential diagnoses to prepare and execute an appropriate treatment plan is based on a high level of knowledge, skills and professional ability.

EMTs have also increased in their training requirements, as tasks and responsibilities have increased. Moreover, EMT education is grounded in the transport mode. There is an assumption that a certified EMT is the minimum staffing level required to provide adequate care during transport. The EMS Education Agenda predicates its structure on that point.

Emergency medical responders are not trained with that assumption in mind. The emergency medical responder curriculum provides information on what to do for the first few minutes of patient contact. The information is effective, but with about a third to half the number of required hours of training for an EMT, it does not provide a foundation for the ongoing assessment and care of the patient.

The real issue is not the certification. It's the worsening shortage of volunteers who can no longer spend the time and money to work a job for free. That era went away a long time ago. Unbeknownst to most citizens, EMS and emergency medical transport are not assumptions to be made in life.

Crumbling volunteer infrastructure requires radical thinking and a new way of providing emergency care. Regionalize services. Fund career EMS. Work with health care systems and hospitals to provide a wider range of field care services beyond emergency response.

Being a volunteer is noble, worthy of respect for the work that is done in good faith. Being a volunteer is not an excuse for less than standard care. It shouldn't be used as a reason for a failing EMS system. We ought to be moving forward, not backwards to the stone age. 

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