EMS and Paramedicine: At the Crossroads of Change

GROWING UP IS HARD.

As a young industry, EMS had its cute years. We were the baby of the family. Our oldest brother, Police, followed Mom and Dad’s orders to a T. Police was a rule-following perfectionist who aimed to please. Then, there was the middle child, Firefighter. She was similar to her brother, following in his footsteps and enjoying the attention of being the baby of the family ... until we came along. Then, she started taking on a new role – differentiating herself from her older brother while at the same time, nurturing us.

OUR CHILDHOOD

As the baby of the family, we got lost in the shuffle. The family was busy. Mom [Healthcare] and Dad [Public Safety] were way less strict. And, ultimately, we had a lot more freedom to create our destiny. We didn’t always like to play by the rules.

Because of that, junior high was tough. We didn’t fit in. And people didn’t give us the respect we believed we deserved.

THE HIGH SCHOOL YEARS

Now, it’s clear we are each growing differently at our own pace. There are ambulance services that are mature beyond their years. There are those that grew fast and need to catch up with their lanky bodies. There are others who haven’t had their growth spurts yet and are falling behind.

We’re going to graduate soon and have tough decisions to make. These emotional decisions will affect us for the rest of our lives. Doing what we’ve always done is the most convenient and comfortable path. But it may be time for us to enter the next chapter in our EMS life where Paramedics are “Out of Hospital” Clinicians.

What does that look like? Well, we may pursue undergraduate degrees in healthcare. The next 5-10 years will be a challenge. We may have to dig in, study, and stay focused. We may do well in some classes and struggle in others. We might screw up. And, we will definitely have a blast. In many respects, these could be the best years of EMS.

OFF TO COLLEGE

Our healthcare system is broken. The fix is complex and EMS is well-positioned to play a critical role. There is a lot of uncomfortable change ahead if we want to have a seat at the table. That change is going to take grit and perseverance. It’s going to be time consuming. It’s going to be expensive. AND, there are gonna be times when we want to quit. But, the opportunity to define our future is within our reach, we need to stay the course.

THE COURSE LOAD 

PROFESSIONAL MATURITY 101

To be in EMS is to be a Servant Leader, a title that is not easily earned. EMS providers must be prepared to define and stay loyal to their agency and personal values, even in the most trying, complex, and emotional calls. But with the expanded scope of practice, professionalism in EMS also requires providers to be in tune with the community’s needs and to treat even the most mundane calls with a sense of patient advocacy and compassion. 

It’s tough to learn professionalism in EMS without looking to a model. That’s why mentoring is an invaluable staple in EMS. Finding and nurturing relationships with mentors can mean the difference between a life-long career in EMS and one that fizzles. Mentorship is becoming ever more important as the field matures and changes, and providers face new challenges that weren’t covered in the textbook. 

The semester is quickly coming to a close, and with finals around the corner, you’re exhausted, you can’t concentrate, and you don’t even feel like doing the things you once loved. You may be experiencing burnout. Luckily, the EMS community is increasingly shining a light on mental health in EMS, and resources for those struggling with PTSD and burnout are on the rise. As EMS providers continue to find themselves with different types of group projects, it will be paramount for all providers to be educated about how to spot signs of burnout in themselves and in their peers. 

TECHNOLOGICAL MATURITY 101

Have you heard the saying that you’re only as good as the tools you use? So, are you taking notes, studying for exams, and communicating with your lab partners via your sleek new MacBook Pro? Or are you still using paper airplanes, trapper keepers, and your Lisa Frank pencil collection?

Technology today has advanced to allow paramedics the opportunity to be the out-of-hospital clinicians making house calls. We can back up our diagnoses with data, get real-time consultations with specialists, and communicate instantly with the receiving facility.

Medicine has traditionally been slow to adopt anything that changes our processes, even if for the better. But as our field matures, expands, and becomes more sophisticated, it is critical that we embrace the tools available to us.

REGULATORY MATURITY 101

Mobile Integrated Healthcare and Community Paramedicine are not buzzwords. Mobile Integrated Healthcare (MIH) encompasses the concept of meeting the healthcare needs of the community OUTSIDE of the traditional four walls of a hospital. The Community Paramedic (CP) is an expanded-scope, advanced-care clinician who’s positioned to provide that care. 

The Government is starting to support the concept that not all patients need to be transported to the Emergency Department. AND, across the US, states are changing legislation to broaden our scope of practice beyond the loaded word “emergency.”

Instead, regulatory bodies and legislation will more accurately mirror the needs of the community … NOW. Not the needs of the community of 1966.

CLINICAL MATURITY 101

With the new changes in our scope of practice comes new clinical responsibility. This responsibility mandates the need for additional training. An emergent response for Time Sensitive Emergencies (TSE) will always be needed. People will continue to have strokes, heart attacks and trauma.. 

But beyond these emergent cases, there is an unmet need for an expanded role. From the International Board of Specialty Certification — 

Community Paramedicine is an emerging healthcare delivery model that increases access to basic services by utilizing specially trained emergency medical service (EMS) providers in an expanded role.

Over the past decade, local healthcare gaps around the U.S. and internationally have been filled through Community Paramedic programs that use EMS personnel to fill gaps in the healthcare system, particularly in round-the-clock management of non-acute illnesses, mental health issues, and chronic care follow-up needs.

Community Paramedic services will help reduce unnecessary trips to the emergency department, reduce readmission to the hospital, improve the patient's quality of life and decrease overall healthcare costs.

Which leads us to...

OUR FUTURE

Now what? Will we consider “Graduate School?” We’ve been practicing for a few years, but with an expanded scope of practice, comes the need for expanded education. Over the next few years, the expectations of the paramedic will mandate the need for a degree. What level of degree? How will it happen? Will those of us who have been practicing as paramedics since the beginning of EMS also need to get a degree, or will it only apply to those entering the field?

While no one can say for sure at this stage, some of the big names in EMS have issued official statements in favor of expanded education requirements for paramedics. Citing better service in the field as well as a more prestigious reputation for the profession, it seems likely that advocates for such a program will ultimately prevail. 

Regardless of how the expanded education requirements will ultimately look, we need to stand together, arm-in-arm, in a consolidated front. Without unity, we can’t expect to recruit the number of medics necessary to shoulder the burden of the new, ever-expanding, scope of paramedicine.