July 25, 2019 | View as webpage

The 2019 EMS Trend Report, sponsored by Pulsara, debuted this week at the Pinnacle leadership forum. In this fourth iteration of the report, leaders question whether the pace of change in EMS is enough to advance the industry.

In this briefing, Dr. Brian Maguire posits controlling our destiny in EMS will require accepting responsibility through certification standards, self-regulation and educational requirements. Also, Training Officer John Pethel shares an example of how research, and collaboration between front-line staff and agency leadership allowed Jackson County EMS to improve cardiac arrest outcomes through progressive protocols.

I encourage you to read the report for yourself, as well as these articles on fostering progress, and to share them with your colleagues to begin the conversation about the steps you can take at your agency to further engage your workforce in the future of EMS.

In addition, find ongoing news, takeaways and more in our coverage from Orlando as leaders share research, strategies and inspiration at Pinnacle.

Greg Friese, MS, NRP
Editor-in-Chief, EMS1

Controlling our destiny: how paramedics can ensure the future of EMS
By Dr. Brian J. Maguire

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

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

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.

About the author

Dr. Brian Maguire began his career as a New York City paramedic. He went on to achieve a doctoral degree in public health and was one of the first paramedics in the world to be appointed as a university professor. As a Senior Fulbright Scholar and an adjunct professor at Central Queensland University in Australia, Brian has been one of the most published paramedics in the world in the area of paramedic safety. He now works as an epidemiologist for Leidos in Connecticut, where his work is focused on improving occupational safety for the U.S. military.

See what the experts have to say about EMS degree requirements:
Progressive cardiac protocol improves neurologically-intact discharge rates
By John Pethel

Jackson County (Georgia) EMS works closely with Northeast Georgia Medical Center to track outcomes of STEMI and out-of-hospital cardiac arrest patients. We receive real-time feedback on each individual patient, as well as regular reports to better understand how our protocols and treatment are working, to identify trends to better make decisions for the people of Jackson County.

Jackson County EMS operates seven 24-hour ambulances and we have double paramedic trucks. We run approximately 9,000 calls a year. We formed a research committee in an attempt to improve our cardiac arrest success rates. Our goal was not only to increase our ROSC rates, but also to increase our post-arrest neurologically-intact discharge rates.

After quite a bit of research and collecting data from all over the country, we developed our protocols. Our committee worked very hard on this, we trained extensively and our paramedics really embraced these changes. Aside from standard ACLS, here are the changes we implemented to improve cardiac arrest success:

  • Immediate LUCAS CPR
  • Elevation of the head to decrease ICP and increase cerebral blood flow
  • Impedance threshold device (The decrease of intrathoracic pressure has shown to increase the pre-load and increase perfusion)
  • Passive oxygenation with a nasal cannula at 15 LPM to combat hypoxia by allowing the alveoli to take up oxygen during CPR without lung expansion
  • Immediate administration of norepinephrine bitartrate when indicated upon ROSC

Prior to implementing the new protocols, we had a ROSC rate of 31%, and a neurologically-intact post-arrest discharge rate of less than 5%. We implemented these protocols late in 2018, and our success was remarkable. In 2019, we started keeping data from all of our arrests, including trauma cases. Keeping all-inclusive numbers did impact our ROSC rates, but we wanted a true measure of what we were doing. So far in 2019, we have a ROSC rate of 43.5%, with a neurologically-intact post-arrest discharge rate of 29%. Some arrests from multi- system trauma were unsurvivable, but were aggressively resuscitated for the possibility of organ donation.

We are very proud of our 43.5% ROSC rate, especially since we are keeping all-inclusive stats. However, our neurologically-intact post arrest discharge rate is our ultimate goal. Our success has not gone unnoticed. Several surrounding agencies have expressed interest in our protocol and some have even attended our training. The architects of our protocol were invited to speak to a group of cardiac interventionalists on the topic.

An unconventional STEMI protocol

Our chest pain/STEMI protocols are somewhat unconventional for our area as well. Keeping in mind that time is muscle, we ty to be as efficient with the clock as possible. Aside from the standard umbrella treatment of acute coronary syndrome, here are the steps in our specific STEMI protocol:

Our goal is to not only treat the STEMI in the field, but also to save precious time in the ED. More often than not, we are able to bypass the ED and go straight to the cath lab.

Jason Grady, STEMI coordinator, Northeast Georgia Medical Center, noted, “Jackson County EMS was an early adopter of the most progressive STEMI protocol in the United States and became a leader in the Northeast Georgia STEMI system, setting an example of how leadership and front-line crews can come together to save lives.”

As pre-hospital medicine changes, we are committed to change and adapt with it. Our success has been a collaborative effort starting from the top. A progressive medical director and EMS director, an aggressive group of educators, proactive paramedics and wonderful support from the surrounding hospitals have put us in a position to better serve our citizens.

About the author

John Pethel is training officer, Jackson County EMS. He has been a paramedic for 25 years.

Learn more about cardiac arrest protocols and STEMI systems of care:
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