Alphabet Soup


ACLS, ACLS-EP, PALS, BTLS, PHTLS, AMLS, NALS, EPC, ABLS, NRP, PEPP. How many of you have heard of some or all of these courses? Everyone one of them is available to paramedics, and most of them are available to EMTs as well. Many people refer to them as “merit badge” courses, since so many people collect the “successful completion” cards for these classes in the same manner other people collect stamps or Quarters for all fifty states. With about the same relevance to work for that matter.

All of these classes share one common trait. They are meant to fill “holes” in BLS and ALS education. Why, you may ask, do these holes exist?

Is it because the subject matter is so intense and intricate that it’s beyond what a new EMT or paramedic student should know?


Is it because they are updated more frequently than the EMT and paramedic programs?

Partially, although I contend that a well constructed refresher should to that.

Is it because both ALS and BLS training programs are too short and cover only the bare minimum of what EMS education should? Is it because compared to other English speaking nations our EMS education is too short and inadequate?

DING, DING, DING! No more phone calls, please, we have a winner.

There is a lot of discussion in the various EMS forums about “professionalizing” EMS. Some people think that trade unions are the answer, others champion degrees along the lines of what nursing has done. While both have merit, I think the real road to professional respect is to revamp the educational foundation of the field.

This would certainly raise the bar and that would certainly provoke a back lash from some.

Remember, the volunteer community insisted upon and got no real increase in the length of the basic EMT course. The 1994 revision took all of the theoretical underpinnings (aka medical knowledge) out of the basic EMT program. Many paramedic programs didn’t and still don’t have a lot of theory in them. They concentrate on skills and protocols, not understanding.

Lengthening both ALS and BLS classes (especially BLS) is not going to be popular in many quarters. Volunteer services have a hard enough time recruiting and retaining people now. Make it more difficult and their task will be much harder. Fire departments have a hard enough time getting new people to take EMT, let alone paramedic training. Not to mention the expense. Non fire employers, both private and public, won’t like the idea because it means that they will not have an inexpensive pool of “trained” and “certified” people to pick from.

I’d guess some, if not many, instructors won’t like it because longer classes are going to mean more work and expense. Not to mention income out of some people’s pockets. That’s the money they make offering and teaching add on courses.

The NAEMT, AHA, and other organizations that offer, and make a lot of money from, these courses also aren’t likely to think much of my idea either.

Still, if there is ever any hope for this thing some of us have taken to calling EMS 2.0 to work, we have to start over from scratch.

EMT courses have to include basic Anatomy and Physiology, trauma care, better burn care education, more detailed medical care education, more pediatrics, and more educatoin and training on elderly and infant specific illnesses and treatments.

Let me be a bit more specific. These changes are not only not likely to be too popular, they are not likely to be implemented. The argument will be not only cost, but the “Most EMTs don’t do emergencies so they don’t need this education.” line of reasoning.

Which brings us to another problem. Not all EMTs do the same work, although we all tend to be lumped in to one group. Not only by the ill informed public, but by hospital staff, doctors, employers, and everyone else. Maybe it’s time to look at that part of the industry too. Maybe we need more than one level of EMT Basic and more than one level of EMT Paramedic.

Something else to think about.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.


  1. Great post. I'm 41 (tomorrow), have recently joined our local VFD and am in the process of becoming an EMT. Perhaps i'm a bit out of the normal range, but I want deeper training including all of what you've written about. I have a deep hunger and thirst to know the "whole picture" instead of remember steps in order and being a robot.Perhaps i'll be one of the newer people that can help push better standards in the future as I gain experience in the field and take a part in the 2.0 talks on a local and larger level.Thanks for the excellent post. It really has me thinking a LOT today about issues like why so many people are content in this country to just 'earn their sticker, grade, pat on the back, etc.' instead of WORKING FOR IT AND GAINING REAL KNOWLEDGE. It's odd how things seem to have become an accepted norm when just in my short lifetime it used to be different.

  2. I was a vollie firefighter/emt for 10 years. Also, an emergency nurse for 10 years.Y'all don't need to know the deeper meaning of things….y'all just need to drive faster to the hospital!!!Now that I've got your attention; I think that anybody that wants to be a nurse or a doctor should spend 2 years on an ambulance first.The process to get your RN or MD should start with A&P, microbiology, etc along with 2 years of service on an ambulance.That way you wont be gettin' some 4 year nurse that doesn't know how to take a BP or a dick doctor that is arrogant.EMT(-B,I,P or whatever alpha soup there is nowadays) should be the first step on the stairway to RN or MD.Steve

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