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The need for higher education in EMS is greater than ever

EMS leaders promote the importance of a degree, but too few agencies require higher education as part of their hiring practices

This feature is part of the premiere edition of the EMS Trend Report, which takes an in-depth look at EMS trends in the United States and sets a foundation for assessing how the EMS profession is changing. Be sure to share this trend report with other EMS leaders and discuss your thoughts on how EMS is changing in the comments.

The debate about the minimum education requirements for paramedics has been going on for decades. Many continue to argue vociferously that the possession of a degree is unnecessary and poses a threat to the viability of the profession.

As a long-term practitioner, professional educator and future recipient of field care services, I will reiterate what I have said for many years: The argument that higher education is unnecessary is shortsighted and continues to hinder our industry from expanding its role in health care and public safety.

Apparently many respondents to the 2016 State of EMS report agree: Nearly two-thirds of agency representatives believe that an associate’s degree is the minimum level of education needed to be a paramedic field provider.

This stands in stark contrast to the reality of minimum job requirements. Nearly three out of four survey participants indicate that only a high school diploma is required to practice.

Given the increasing complexity of field care being delivered in a dynamic and often uncontrolled environment, it’s critical that future paramedics earn a college degree in order to begin practice. Allow me to explain.

1. Higher education equals a better-prepared paramedic

In order to achieve a degree, a student must complete a basic series of English classes. Having command of English fundamentals is critical to paramedic student success. Many Americans read comfortably at the sixth or seventh grade level. Paramedic textbooks are written at the 12th grade or college freshman level. This doesn’t mean that paramedic students won’t be able to read the textbook, but it does make a challenging course of study that much more difficult for students with lower grade-level reading skills.

As an educator, I supplement my classes with narrated slideshows, online videos, interactive activities and the like. But it will never substitute for student self-directed reading and learning.

In medicine — and in society — we continue to communicate deeply through the written word in textbooks, trade journals or research papers. Paramedics need to be able to comprehend the content but also analyze it, question it and integrate it into their practice. College English classes can provide the tools necessary for true understanding of the printed word.

Paramedics must be able to communicate quickly, succinctly and accurately, both verbally and in writing. Many institutions require a communications or public speaking course as part of the associate’s degree track. The student learns how to choose words wisely, to articulate points of view with clarity and defend opinions with thoughtful arguments.

Math and accounting courses train the brain to work logically through difficult problems, making decisions whether to go this way or that way depending on what is known and unknown. Rational decision making is critical for making sound medical judgments without the crutch of protocols. Drug calculations become simpler to understand and execute as a paramedic’s math skills sharpen. Determining destination decisions when time, distance and mode are involved become less biased and more objective.

History and other liberal arts courses also contribute to the ability to think critically and reason logically. Knowing and understanding that what has happened in the past influences what will happen in the future is a key lesson for EMS leaders.

Coursework in philosophy and the arts forces students to think about diversity of opinion, ideas and concepts. The diversity of our patient population demands that paramedics remain open to divergent viewpoints and able to appreciate them rather than pass judgment.

2. Paramedicine has become more complex

EMS old-timers will tell you just how much the industry has changed. Greater understanding of anatomy, physiology and pathophysiology is required. Many systems have increased the number and complexity of the medications paramedics are authorized to administer. Technologies such as multi-lead ECGs, waveform capnography, infield labs, lactate monitoring and ultrasound require greater proficiency in using and interpreting the data.

Research is driving the EMS evolution. Transport mode and destination decisions are forms of treatment and are being scrutinized as such. Deciding when to not perform certain procedures is just as critical as when to do so. Data from well-designed studies, combined with a sound medical education and enriched by reflective practice brings forth a paramedic who manages patients beyond the reach of well-meaning but simplistic protocols.

Most EMS systems depend at least partially, if not entirely, on private health insurance and Medicaid/Medicare reimbursement. The EMS industry has taken a financial beating over the past decade, as it has not been able to demonstrate its concrete value to patients, public health and payors.

The rise of mobile health principles and community paramedicine programs appears to work not only from a financial perspective, but also from the viewpoint of pure clinical outcomes. Future paramedics have to be as well versed in public health concepts, short term and chronic care and non-urgent clinical issues as they are in emergency medicine.

That translates to more studies to better understand and incorporate these knowledge areas. Courses taught by subject matter experts contribute to the greater body of knowledge that the paramedic needs to possess. Independent study or research projects, in the form of a capstone degree project, are an opportunity for paramedic students to broaden or gain knowledge in rapidly developing areas of health care.

3. Eagles or ostriches will drive the future growth of field medicine

As the data from the first year of the State of EMS report shows, most of the respondents believe that an associate’s degree should be required for paramedics to practice. The fact that most employers and regulatory agencies don’t require a degree for licensing paramedics is not a deterrent to what must happen; it’s merely reflective of what is happening today.

The industry has done an admirable job in adapting to the evolving world order of medicine and reimbursement, but it’s not sustainable without a strong foundation of well-prepared practitioners — both clinically and academically — to carry out new missions.

Moreover, with more responsibilities and greater autonomy will likely come greater recognition and better benefits. That, in turn, will allow field providers to grow old in the EMS profession, contributing their expertise and experience rather than fleeing to greener pastures. To soar with eagles is to think like one — otherwise, it’s much easier to be an ostrich and try to ignore what must be done.

Many of the variables in the equation of health care provision and reimbursement are not within the reach of EMS leaders to change. Education, though, is one that leaders can change. Trends report data from next year and subsequent years will be revealing in how quickly the EMS profession increases degree requirements for new paramedics.

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.