The Importance of Education in EMS

As the Spring issue of Fire Rescue Journal goes to press we have just wrapped up a very successful 2018 SC EMS Symposium. The weather was quite the hodge podge; from 35 and flurries at the beginning of the week to 75 and sunny, and back to the 50s by weeks end. As the dates of the conference inch more towards the warmer months we should experience even “beachier” climates in years to come. The SC EMS Network puts on an outstanding symposium every year, and this year was no exception. I didn’t see an empty vendor slot in the entire exhibit hall this year, and there were plenty of new vehicles to crawl around on in the outdoor tent as well. If you missed this year, you missed many announcements and innovations coming to South Carolina EMS. We always ensure we deliver news from the bureau, exciting innovations, and new projects for the coming year. This year was no exception. We issued more than 250 new Forever EMT ID cards this year, the Medical Control Physicians and EMS Advisory saw presentations to remove the Community Paramedic program from pilot after more than five years, and it looks like after all the votes were counted the EMS community is ready to design and release new uniform patches. If you miss symposium, you miss a lot. Hope to see you there next year as we work to push attendance even higher. This year’s reported numbers were closing in on 500 and we’d like to see 600 next year. Make no mistake about it, decisions are made every year at the symposium state-wide meetings that affect you and how EMS business gets done in South Carolina. If you miss out, your opinions won’t be heard on some of these vital issues. Last, but not least, the awards dinner on Saturday night never fails to amaze us and make me proud to be party of South Carolina EMS. Hearing tales of heroism, selfless dedication to duty, and the projects that individuals and agencies take on as the awards are read is incredible.


Why is Education Important?

The mention of the symposium brings us to the topic of this column; the importance of education. To be clear, although our continuing education is very important, and we should strive to actually accumulate more than the required hours of ConEd. This column concentrates more on advanced, college level education. This debate has raged on over the years and numerous views have been presented both for and against advanced schooling for the fire and EMS professions. Whichever side you come down on, I certainly respect them, but let’s take a moment and think about some items you may not have considered.

Did you notice I left out our brothers and sisters in law enforcement from the list above? Have you seen that when this topic comes up that they are not on one side or the other? That’s because as a profession, they have learned in order to advance in their careers, and in many cases even apply for a job, they need to possess an Associates or usually a Bachelors degree. There is no moving up in most law enforcement agencies without a degree of some sort. Why then do we shy away from it in our profession?

The debate about the minimum education requirements for paramedics has been going on for decades. Many in our state continue to argue vociferously that the possession of a degree is unnecessary and poses a threat to the viability of the profession in South Carolina. I disagree equally as vociferously and say we’ll never be a “profession” but merely a “job” if we don’t encourage advanced education. There are those among us that are arguing even now that our basic education models for training paramedics is too long, cumbersome and has too much “fluff.”

Of course, we are all frustrated with our shortages, overtime, forced shifts and large turnover rates; but shortening or lessening the courses that provide us the knowledge, skills and abilities to become even beginner level providers? How can this be good, other than to simply push the numbers up and fill rosters? If filling a roster with anyone that has a paramedic ticket is your goal, you should rethink where your agency is headed, because ultimately it could mean disaster for your agency or your patients. So now that that’s out of the way, let’s talk about having an Associate’s Degree as a MINIMUM level for paramedics in the field.

Are We Technicians or Clinicians?

The argument that higher education is unnecessary is shortsighted and continues to hinder our industry from expanding its role in health care. Secretly, most senior EMS administrators will tell you that they believe advanced education provides them with better providers; publicly, this stands in stark contrast to the reality of minimum job requirements. I could not find one entry level provider job on the South Carolina Municipal Association website, the Association of Counties website, or the South Carolina EMS portal job postings that indicated anything more than a high school diploma is required to be hired and practice in any agency in South Carolina.

I’ll make a stand here and say this: 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 to practice.

Higher Education Equals A Better-Prepared Paramedic

In order to earn a degree, a student must complete a basic series of English classes. Having command of English fundamentals is critical to paramedic students. Most 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’s much more difficult for students with lower grade-level reading skills.

Unfortunately, that is the case with many students graduating high school today. In medicine we continue to communicate almost exclusively in written forms in textbooks, journals or research papers. Paramedics must not only be able to comprehend the content but also analyze it, question it and integrate it into their practices. College English classes can provide the tools necessary for true understanding and comprehension of the language.

Paramedics must be able to communicate quickly, succinctly and accurately; both verbally and in writing. Most institutions require a public speaking course as part of the associate’s degree track. Students learn how to choose words wisely, to debate points of view with details and defend opinions with well constructed arguments. If you haven’t done so lately sit down and read through some of your agencies run reports. We at the bureau do, and too often it is during an investigation and again all too often, the person sitting at the table tells us, “No one ever really told me how to write a PCR,” or “I always write a good report, I don’t know HOW this one slipped through.”

It’s key to understand advanced level writing and thought processes in order to write a PCR that the next level of provider can interpret and continue the care of the patient you’ve given them. Forget it being “defensible” in court, we should NEVER write a report for this reason. Your reports should be written so that a clear picture of your call is presented: what you saw, what you did, what happened after you did it, and what you then had to do differently and why — if that was the case. If you’re writing a report to those standards every time, you won’t have to worry about a lawyer reading them.

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.

Paramedicine Has Become More Complex

EMS old-timers will tell you just how much the industry has changed — boy will they ever! 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. In South Carolina a paramedic has access to nearly 70 medications in the field, provided their Medical Control Physician allows it. Technologies such as video laryngoscopy, multi-lead ECGs, waveform capnography, in-field labs, lactate monitoring and ultrasound require greater proficiency in using and interpreting the data.

Research is driving EMS, you should know this by now and if you don’t accept this as fact, you’re hurting your agency and your patients. Destination decisions are forms of treatment and are being scrutinized as such by the bureau, as they are by the Legislature, as they should be by your agency. We didn’t write the laws telling us to take patients to specialized service hospitals for treatment, but we do have to enforce them.

Do you think they were written without clear research and facts to back them up? 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 advanced practice brings forth a paramedic who manages patients beyond the reach of well-meaning but often simplistic protocols.

Many EMS systems depend mostly, if not entirely, on private health insurance and Medicaid/Medicare reimbursement. The EMS industry has been taken to the financial woodpile over the past decade and has had to take some severe “whoopings.” Why? We have not been able to demonstrate our value to patients, public health and the payers.

The rise of community paramedicine and MIH programs works not only from a financial standpoint, but also from the viewpoint of clinical outcomes. Future paramedics have to be as well versed in public health concepts, chronic care and non-urgent clinical issues as they are in emergency medicine. Don’t think so? Think again folks.

That translates to more studies to better understand and incorporate these new and expanding scopes of practice. Courses taught by subject matter experts contribute to the greater world 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 developing areas of health care. Gone are the days of just knowing how to do something, but now a good clinician needs to understand WHY.

Believe it or not, most people feel an associate’s degree should be required for paramedics to practice. This doesn’t mean it will be so; it just means we know where we NEED to be, just not how to get there. The fact that most employers and DHEC doesn’t require a degree for licensing paramedics should not deter us from what must happen.

Our industry has done an admirable job in adapting to the evolving world of EMS but it’s not sustainable without a strong foundation of well-prepared clinicians; clinicians with undergrad and graduate degrees.

Moreover, with more responsibilities and greater autonomy nearly always come with greater recognition and 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. Need an answer to your recruitment and retention issues? There it is. There are so many things we cannot change or have little control over such as reimbursement models or other Federal oversights; education expectations though, is something that you as leaders CAN can change.

You Will Be Missed

As this article was written we lost an icon in South Carolina EMS. It is with a heavy heart that we sent our brother to his eternal rest after a short bout with cancer. H. Dean Douglas was taken from us quickly and unexpectedly and myself, along with hundreds of providers from several states attended his service at Furman University, nearly the only facility available that could handle a crowd of people large enough whose lives Dean touched. Please keep his family in your prayers as they transition through this time in their lives and watch this column for a tribute to Mr. H. Dean Douglas in the future. #clandouglas #noonefigthsalone

Rob Wronski is the South Carolina Department of Health and Environmental Control (SC DHEC) Bureau Chief of EMS. He has served in many roles since becoming a firefighter paramedic in 1991, culminating with his selection as Chief of EMS for the state where he has served for nearly three years. He has held several executive positions including Assistant Chief of the St. Andrews Fire Department in Charleston, Medical Officer of the Mt. Pleasant Fire Department, and a Shift Commander in the Beach Park (IL) Fire Department. His experience includes working in fire-based EMS, including ALS and BLS first response as well as fire based and county based ALS transport.

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