Full disclosure: I am in Illinois and Wisconsin licensed EMT-Basic. At the time of this writing, I am three credits short of a bachelors degree in emergency management, with a GPA of 3.6 and I am a member of the national honor society for emergency management, Epsilon Pi Phi.

(h/t Nocturnal Medics on Google+.)

A considered response to:

Why US EMS will never get to sit at the adult table. | the5conflicts

I had to do some thinking about which blog post this on. On one hand, I could put it on this one, which is where I like to keep all my professional work (at least once related to public service and emergency management). On the other hand, I could put it on my personal blog, where I just put my thoughts and feelings on things. I thought that putting this on the professional side was much more useful.First the bad: I disagree with the author’s tone, in that it is generally insulting and dismissive, not to mention condescending. However, this is a personal blog and as such, is the author’s right to be as insulting, dismissive, or condescending as he (I choose the male pronoun for convenience sake) want. As such, it is more interesting and informative to talk about the meat of the author’s argument.

The author makes several suppositions, and several observations, that have general application across the EMS spectrum. The author initially states this as his base argument: “[EMS has] too little education, [does not] understand science, and [is] to simpleminded.” Let’s take these one at a time, shall we?

  • EMS has too little education

This is a tricky one. On one hand, EMS is expected to perform life-saving interventions in a field setting. On the other hand, the current state of EMS education has it such that even a paramedic has roughly the equivalent of a two-year degree has roughly the equivalent of a specialized two-year degree (c.f. the UCLA paramedic program, among others) consisting of somewhere Around 1500 hours (combined) of both classroom and clinical experience time while EMT education consists of less than 200 hours total.

Let me put that another way: the person putting the IV in tear and his arm when she has a heart attack may only have had 1500 hrs. of training. The person performing CPR on the drowned child may have even less. In other words, EMS (EMTs and paramedics) are highly specialized individuals with a very narrow range of education. Most paramedic programs are held through colleges, in conjunction with local hospitals, and last approximately 2 years. The EMT program, also taught under the auspices of local colleges and hospitals, is approximately a six-month course. All of this to perform life-saving actions in the field.

  • EMS does not understand science

As mentioned just previously, the EMS program is very specialized in the United States. Between the didactic and the clinical portions of education in these programs, there is little time for delving into the intricacies of scientific research and clinical reasoning behind some of the applied skill sets. Frankly, the educational program for EMS doesn’t look at the “why” behind the medicine. We are not required to perform research for initial entry into the field, and we are not given guidance on performing clinical research at any point in the career.

Let’s compare EMS to the other public services (police and fire service). The police have the police academy. The fire service has the fire academy. EMS, on the other hand, has professional, state regulated licensure. To my understanding, there is no license to be a police officer nor is there a license to be a fireman. However, if we look at higher education, we see that police and fire both have associated two-year and four-year degree programs, as well as some masters level programs. EMS, on the other hand, has… State regulated licensure. A quick Google search did not uncover more than one or two specific emergency medical services degree programs. There were dozens and dozens of fire and police degree programs, however.

Without access to higher education programs, either associates or bachelors programs, let alone masters programs, is unrealistic to expect the field of EMS to be adequately educated as to various methods of academic investigation. Granted, EMS is relatively young compared to the of the two public services. In the United States, EMS is only been “a thing” since the mid to late 60s, with police and fire are significantly older professions.

  • EMS is too simpleminded

On its face, this is merely a specious argument. It is, frankly, insulting and dismissive of anyone and everyone in the emergency medical service field who wants to advance the field and provide better public service. Stooping to the level of insult is counterproductive, regardless of the level of frustration.

Let’s get a few things straight here. First of all, the medications and procedures that EMTs and paramedics are permitted (not able, PERMITTED) to perform are dictated in the form of protocols by a physician who has chosen to take the role of medical director for the local ambulance companies. In other words, EMS doesn’t get to make up their own policies and procedures on the fly. Anyone functioning in the role of emergency medical technician or paramedic is bound by protocol to only perform certain actions. Anything that does not comply with the stated protocols must be called into the receiving hospital for physicians order. In general, there is a very low level of clinical autonomy in emergency medical services.


None of this should be construed to imply that there are not idiots in EMS. There are idiots who are police officers. There are also boneheads in the fire department. Truth be told, there are proverbial mouth breathers in every sector of the economy and in every job category. EMS is no difference in this regard. However, painting the whole industry with a broad brush does a disservice to even the mediocre providers who are unexceptional in anything other than their dedication to the job.

Now. The author of the original work has an interesting and insightful opinion about the role of research and EMS. Unfortunately, the opinion is less than complimentary. Okay, whom I kidding, it hurt like a bitch. EMS, unlike other aspects of physical medicine, depends largely on what is called “evidence-based medicine.” I’ll be honest: I was unaware of the problems of EBM before I read this article. I was under the impression that evidence-based medicine was, well, based on physical evidence and scientific investigation. While I have not done much digging into it yet, it appears that EBM is primarily based on anecdotal reports and studies. There is a saying in the scientific community that “the plural of anecdote is not data” and that appears to be what EBM is based off of.

I am an idealist. Some would say that I am a fool to hope. However, I am also a realist. I understand and accept that EMS is a growing field and is still struggling even within itself to determine standards to hold itself to. What upsets me, however, is that there are some people outside the field (even those who work in the field previously) who get up on their soapbox and decry the current state of affairs. Instead of lamenting what is, I hope that more people will choose to rise to the occasion and put forth the effort to bring the field of EMS to a professional standard. As it is, we don’t even have a code of ethics of our own.

I don’t know what the answer is. I also know that I am not currently in EMS leadership, and I look to leaders like Dr. Bledsoe to help guide EMS in a better direction that were our past has been.

I continue to hope.

Add: There is a post at EMS Artifact with another salient POV.