Controlling our destiny: how paramedics can ensure the future of EMS

Certification standards, research and degree requirements are necessary to support a career pathway for paramedics

This article originally appeared in the July 25, 2019, issue of the Paramedic Chief Leadership Briefing, EMS degree pathway | Progressive cardiac protocols | EMS readiness. Read the full briefing and add the Paramedic Chief eNewsletter to your subscriptions

I recently had the pleasure of presenting two educational sessions in London. The first, for the UK College of Paramedics, focused on opportunities for EMS personnel to reduce risks, the second, for the UK Association of Ambulance Chief Executives (AACE), National Education Network for Ambulance Services, focused on occupational risks from the perspectives of educators and administrators. In both sessions, there was a great deal of interaction that focused not only on the immediate risks but also on the future of EMS services.

During the AACE presentation, we discussed how thousands of UK paramedics are leaving ambulance service to work in private physician’s offices. It is an exciting time for the paramedic profession to have so many career opportunities. It is also a potentially critical time for the EMS industry to be proactive about imagining and developing the system of the future that will:

  • Support multiple career pathways
  • Plan for workforce needs on multiple levels
  • Create a way for paramedics working in alternate careers to be immediately remobilized in the event of a disaster
Gary Strong, National CPD Lead for the UK College of Paramedics; Prof. Brian Maguire; and Prof. Andy Newton; at a College of Paramedics presentation in London.
Gary Strong, National CPD Lead for the UK College of Paramedics; Prof. Brian Maguire; and Prof. Andy Newton; at a College of Paramedics presentation in London. (Photo/Courtesy of Brian Maguire)

The discussion also highlighted the fact that the UK paramedic system is, in many ways, far ahead of the U.S. on multiple levels including education and career opportunities for EMS personnel. Some groups in the U.S. are attempting to foster improvements in the U.S. system. One of the most recent proposals is the Paramedic Manifesto.

Establishing a degree requirement for EMS

I applaud the authors of the Manifesto and congratulate them for producing a thoughtful document that will contribute to a strong foundation for the paramedic profession. As the Manifesto describes, there are some critical next steps that are necessary for the further development of the paramedic profession in the U.S.

One of the most important next steps is the establishment of an academic requirement for entry into the profession. There is no pathway to full professionalism that does not include an academic requirement. As the Manifesto notes, paramedics in many other countries have already established that a bachelor’s degree is the minimum entry level for all their new paramedics. The proposal to establish an associate degree as a short-term goal and a bachelor’s degree as a longer-term goal is a reasonable approach for American paramedics. Beyond entry-level requirements, we should strive to develop graduate-level requirements for advanced clinicians, senior leaders, educators and researchers.

Although an academic requirement is an absolutely necessary step, it is not the only step necessary. Paramedics must also take on the responsibilities of leadership by establishing:

  • Certification standards
  • Self-regulation
  • Professional priorities
Professor Brian Maguire presenting to UK Association of Ambulance Chief Executives in London.
Professor Brian Maguire presenting to UK Association of Ambulance Chief Executives in London. (Photo/Courtesy of Brian Maguire)

One professional priority that requires nurturing is research (including the establishment of a contemporary research agenda and mechanisms to support research). There is a slowly growing body of research but much more is needed [1]. The long list of research questions that must be addressed include:

  • How do we best meet the changing needs of our communities?
  • How can we protect our providers from harm?
  • What are best practices for operations including deployment, community health and disaster response?

Paramedic educator Gene Iannuzzi recently noted that we have to do a much better job of educating the public about who we are and what we do. We can learn from Australia where, for 10 consecutive years, paramedics were voted the No. 1 most trusted profession. In the U.S., we must take every opportunity to educate our politicians, our communities and our colleagues in other professions about what we do and why. No politician should ever wonder if it would be better to hand over ambulance services to Uber.

The future is in our hands. We can abrogate our responsibilities and allow others to control our destiny or, we can accept the responsibility to work together to control our own destiny.


Maguire BJ. Contemplations on the Future of EMS. EMS Insider. 1998; 25(8): 6 -7.

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