Over a Captain Chair Confessions the old Captain asks Where To Start? One part of his post suggests that we need a national certification process as a first step and points to the National Registry of EMTs as the starting point for that. Which of course we old timers know was what the NREMT was supposed to be way back when it started. While many states use the NREMT as it’s certification foundation, many don’t. It was a good idea back then, but I’m not so sure it is now.
My state doesn’t use the NREMT for EMT and paramedic certification, although it did back when I was first a paramedic. Which is why I still maintain a NREMT-P certification, otherwise I’d probably never have gotten it. Besides, if I ever move and want to become a paramedic in my new state, the NREMT might help.
The NREMT might be the place to start if it’s standards weren’t mired in a 1980s (or ’70s) paradigm. Because it is, using the NREMT for advancing the idea of EMS professionalism is a non starter for several reason.
First the name National Registry of Emergency Medical Technicians is all wrong. Technicians aren’t professionals, they are technicians.
Here is the definition of technician,
1. a person skilled in mechanical or industrial techniques or in a particular technical field
2. a person employed in a laboratory, technical college, or scientific establishment to do practical work
3. a person having specific artistic or mechanical skill, esp if lacking original flair or genius
#3 is the killer. Now, we can argue if paramedics are technicians by definition or are really professionals because what we do does require some original flair or genius in the real world. Unfortunately, that flair or genius comes not from our training (versus education), but from our experience.
For comparison, here is the definition of professional,
a. Of, relating to, engaged in, or suitable for a profession: lawyers, doctors, and other professional people.
b. Conforming to the standards of a profession: professional behavior.
2. Engaging in a given activity as a source of livelihood or as a career: a professional writer.
3. Performed by persons receiving pay: professional football.
4. Having or showing great skill; expert: a professional repair job.
1. A person following a profession, especially a learned profession.
2. One who earns a living in a given or implied occupation: hired a professional to decorate the house.
3. A skilled practitioner; an expert.
This definition is broad enough that there is room to put paramedics in there. Except for the fact that we are Emergency Medical Technician – Paramedics. There’s the rub.
So, are we tradesmen (or tradespeople if that sort of thing hangs you up)?
Closer, but not perfect. Notice that it says skilled worker, not profession or professional.
The problem is that tradesmen often limit who can practice their trade by licensing or even guilds. So, even if you were say a non union plumber, you’d have to have a license issued by the state permitting you to work as a plumber. Said license would limit you to plumbing and gas fitting. You could not work as an electrician because that’s another license all together.
We don’t do that in EMS. Firefighters can be paramedics, EMTs can be police officers (and vice versa). About the only restriction that some states have is that you have to be an EMT or paramedic to work on an ambulance. So, for some specialty care areas (think pediatrics) or specialized transport modes (think helicopters) we have RN/paramedics or RN/EMTs. Note that EMT or paramedic comes last, just as with FF/paramedics. Have you ever met anyone who says that they are a “paramedic/fire fighter”? If you have, you’re a rarity. That doesn’t cover the people who are Security Guards/EMTs or Accountant/EMTS.
Get it? EMT or paramedic is a skill set, not a trade, not a profession.
So, if the people who make up EMS workers are not professionals, can EMS as a whole be a profession?
Which brings us back to the NREMT. Which, if you are wondering is not the main focus of my criticism. It’s just the most visible target right now.
Why do I think that they are part of the problem?
Because of their recertification process. It’s main virtue is that it’s cheap. Which might also be part of the problem.
Every two years, holders of NREMT cards have to recertify. Said process includes a refresher course and a number of hours of Continuing Education Courses. Which are also mostly rehashes of what we were taught in EMT or paramedic school. OK, once and a while we need to recover some of the territory that we originally learned, but every two years? The NREMT also offers “Recertification by Examination” option. Where you can pay $110.00 to take essentially the same test you took to get your original card. Do doctors or nurses have to retake their boards every two years? Or at any point in their careers? I don’t know the answer for sure, but I’ve never heard of it. They are required to attend and document that they attended X number of Continuing Education course pertinent to what they do, but they don’t have to re attend medical or nursing school every Y number of years.
That’s the firsts part of the process, then comes the paperwork. For the NREMT, it’s about a four page form for recertification. I have to document that I took a DOT approved refresher course and 24 additional hours of Continuing Education in a variety of subject. OK, that’s not too onerous. Boring maybe, depending on the class, but not too tough.
Then I have to prove I have a copy of my ACLS card. And a CPR card. Oh, and two or three signatures. My medical director must sign that she’s seen me do the same skills that I’ve been doing since she was in high school, my training director has to sign that I have a CPR card, and someone from management has to sign that I actually work there. So much for being a professional, it’s more like I’m in high school and need to get my report card signed by my parents.
Oh, the last. you have to work for an ambulance service. You can apply for “inactive” status for one recertification cycle, but after that you’re screwed. So, if you or I suffer a career ending injury, as they say in sports, and can’t work on an ambulance, we can become inactive. If we go to work, say teaching EMS related courses at a local Community College or even an independent EMS school, we can’t maintain our NREMT certification for more than two years.
And we’re supposed to be professionals? Sure we are.
I know a man who was an Oral Surgeon for almost 50 years. He retired a few years ago, but kept his license up. He now is a visiting professor at a pretty big name School of Dentistry. I don’t know if he has to maintain his license to teach, but I suspect he does because part of what he does is supervise dental students who are working on live patients. He doesn’t practice, he doesn’t get paid by the school to do procedures, he supervises people learning to be dentists. Yet the board that licenses him doesn’t tell him he can’t have a license any longer because he doesn’t go to his officer every day and charge people for fillings.
So, if we are going to have the NREMT as the basis of our soi disant profession, it had better start treating us like professionals and not school children.
On the other hand, we had better start treating ourselves like professionals and not school children.
If we want to be professionals then the first step is that we have to be self policing. That is the people that oversee certification, re certification, quality assurance, and discipline need to be actively registered and engaged in the EMS field. Not doctors, not nurses, and goodness forbid career bureaucrats. Who if they weren’t regulating EMS would be regulations hair dressers or plumbers.
I haven’t even touched in the issue of whether we need a federal agency to oversee and coordinate EMS across the nation. We don’t because it would likely be as effective as the federal agency we have to oversee and coordinate disaster relief across the nation. Different subject for a different day.
As is whether or not we should require some sort of college degree to be an EMT or paramedic. The only virtue of that, if you want to call it a virtue, is that that the increased cost would keep some people from becoming EMTs or paramedics. Frankly, I’d rather see paramedic be a two year course with things like Anatomy and Physiology built in. As well as writing and math classes or at least an option to test out. If you’ve seen some of the PCRs I have over the years, you’d know what I mean. All too many of us can’t spell, can’t put a coherent sentence together, and don’t know how to construct a narrative that won’t make the doctors and nurses reading them snort soft drink products out their noses as the try to figure out what we’re saying.
Well, that’s my rant for today. Feel free to comment and tell me how wrong I am.
I’ll have fun with those comments too.
And yes, I’ll make fun of your spelling.
I don’t know about you, but I feel better.