EMS has an identity problem. The public is often unsure of our education, roles, and capabilities. In fact, many EMS providers are unsure about who does what in the industry because certification levels often vary from state to state. Is part of the problem in the names we have chosen? As EMS has developed, government leaders and others have chosen the term “emergency medical technician (EMT)” to describe EMS workers. Around the same time, in certain regions of the country (particularly the West coast) the term “paramedic” became the moniker of choice used to describe emergency medical providers.
The term “paramedic” has its roots in the military lexicon. Generally speaking, the terms “EMT” and “paramedic” are used interchangeably but their meanings are often not truly interchangeable. Paramedic Maurice White Jr., a paramedic with the Creek Nation EMS Service who was recently assaulted by an Oklahoma State trooper, was referred to as an EMT on Fox News, CBS News, and the local medical outlets. Perhaps the media’s confusion about EMS provider levels is a factor in the failure of much of the public to accept EMS as a bona fide profession.
Over a year ago, I watched a video produced by Acadian Ambulance where it proposed that all EMS providers be called “medics” based on the history of medics in the military. While I don’t think “medic” is the proper word, perhaps “paramedic” is. The new scope of practice has four recognized levels: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), and Paramedic (EMTP). For simplicity, let’s call the Emergency Medical Responder “First Responder” or “Emergency Medical Responder,” but call everyone else a “paramedic.” This seems to be the model that the public accepts. Nurses are called “nurses” despite the fact that there are two levels of nurses (registered nurses and licensed practical or vocational nurses). Firefighters are called “firefighters” despite varying levels of certification and education. Police officers are called “police officers” (or cops) despite the fact that there are varying levels of certification.
In order for a profession to advance, its different facets must unite, just as EMS should. Medicine conquered the MD/DO issue years ago, just as dentistry did with its DDS/DMD disparities. The nursing arguments (4-year RN, diploma RN, 2-year RN, LPN, LVN) are pretty much a thing of the past, at least as far as the public is concerned. By contrast, however, a look at any EMS social network or website clearly illustrates the juvenile controversy and argument between EMTs and paramedics. To quote noted California punching bag Rodney King, “Can’t we all just get along?” Whether you are an EMT, paramedic, firefighter, or private-based provider, you are still an EMS professional. It makes little difference whether you climbed down from a fire engine or exited an ambulance. You and your colleagues share a common goal and role with other EMS providers — providing quality patient care.
Along the same lines, EMS needs to get away from this idea of Basic Life Support (BLS) versus Advanced Life Support (ALS). Every level of EMS provider primarily provides BLS. Further, Emergency Medical Responders and EMTs provide care that was once considered ALS (e.g., aspirin administration, Epi-Pens, nebulizers). I have had 4-year old patients in the emergency department who could assemble a small volume nebulizer, prepare the medication, and give themselves a treatment. Surely any level of EMS provider can do the same.
Overall, after 30+ years of existence, EMS suffers from issues that other professions of similar ages have outgrown. Among these are an identity crisis and a lack of collegiality. Until these issues are finally remedied, the other issues about which we bitch and complain will neither be addressed nor fixed.
