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Here, in the Republic of Texas, there are five levels of EMS providers: Emergency Care Attendant (ECA), Emergency Medical Technician (EMT), Emergency Medical Technician-Intermediate (EMT-I), Emergency Medical Technician-Paramedic (EMT-P), and Licensed Paramedic (LP). The ECA is the same as a first responder in most states. The LP is something unique to Texas. Let me digress.
In Texas, as in most states, EMS personnel are not truly licensed like physicians, nurses, plumbers, barbers and so on. There is no state statute that defines the profession and details licensing requirements. Instead, EMS personnel are “registered” with the Texas Department of State Health Services (TDSHS). Several years ago there was a push for licensure. Licensure, in Texas, would require that a new law be established by our legislature, which only meets biannually. EMS has never been on the legislature’s radar screen and the bill never went anywhere.
In a gesture of good will, TDSHS established a provider level called “licensed paramedic.” To become an LP, you needed either a two- or four-year degree in any field. While the intentions were good, I considered this to be a step backwards.
From a functional and legal standpoint, there is absolutely no difference between an LP and an EMT-P. Some systems will pay a little more for LPs as an incentive — some don’t. While the LP level does recognize those with a degree — and I don’t mean to downplay education — it does not really benefit the profession. LPs are not truly licensed and are not allowed to perform any additional skills or have any responsibilities above an EMT-P, despite their increased education. That is wrong. Instead of having a higher level that providers would actually want to strive to reach, an LP is simply an empty moniker that serves to bolster our vanity.
But, as has been the history of EMS, the slogan, “Give them a patch and they will shut up,” seems to have worked again.
If the state does not give you a patch, you can simply make your own. I have recently seen Texas EMS patches for “Tactical EMT” and “Tactical Paramedic” (whatever the hell that is). Recently, I saw one that read “Dive Medical Technician.” These patches are simply knock-offs of bona fide EMS patches and create an adverse effect on the industry’s image. The motivation to make these and wear these is beyond me.
Another vanity favorite in EMS is the self-assigned title of CCEMT-P, which is the acronym for Critical Care EMT-Paramedic. Most people self-assign this title after completing a CCEMT-P course or a similar course. And while some states have started to recognize this level (i.e. Tennessee, Louisiana, West Virginia), most have not. This became a point of contention in a legal case not too long ago where I was an expert witness. The paramedics called themselves CCEMT-Ps, yet there was no evidence they passed any sort of certification examination. The plaintiff’s attorneys had a field day with that and the paramedics looked foolish.
 If the state does not give you a patch, you can simply make your own. I have recently seen Texas EMS patches for “Tactical EMT” and “Tactical Paramedic.” These patches are simply knock-offs of bona fide EMS patches and create an adverse effect on the industry’s image  | ||
| — Bryan Bledsoe | ||
In many countries, critical care certification is available for EMS. Generally, you need four to six years of field experience and a year of critical care education — similar to nursing. Then you take an amazingly difficult certification exam. That is quite different than in the United States, where people take a 120-hour EMT class, go immediately to an 800-hour EMT-P class, then take the 80-hour CCEMT-P class – after which they feel really competent to take care of complicated ICU cases. We are only fooling ourselves here. I am very pro critical care paramedic; I wrote a textbook on the subject (heavily based upon the Canadian, nursing and flight nursing curricula). You cannot master 1,160 pages of complex material in two weeks or 80 hours! Imagine if we all used the initials from each class we took (e.g. Bryan Bledsoe, TCHGC, CTOP [Texas Concealed Hand Gun Course, Case Tractor Owners Program]).
And finally, there is mental health care. Virtually anybody can call themselves a “mental health care provider” in the United States and this term can be found sprinkled throughout EMS. There is a significant discrepancy in education in mental health care. Psychiatrists are physicians (MD or DO) who complete a four-year residency after medical school and take certification examinations in psychiatry. Overall, they have 12 or more years of education beyond high school.
Clinical psychologists are health care providers who hold a Doctor of Philosophy degree or Master’s degree in Clinical Psychology and have passed a certification examination in clinical psychology. They often have eight to 12 years of education beyond high school. A PhD in psychology does not automatically make one a psychologist.
Social workers — usually with a bachelor’s or master’s degree — do a great deal of counseling. Then, there are marriage counselors, substance abuse counselors, music therapy counselors, and on and on. Then, there are pastoral counselors — priests, rabbis, ministers — who also provide counseling. Some have received counseling education in their seminary — some have not.
While the standards for psychiatrists, psychologists, social workers and other professional counselors appear standardized, many of the other providers are not. This has given rise to various certifications in mental health care. You can become certified in such areas as Thought Field Therapy (TFT) or Eye Movement Desensitization and Reprocessing (EMDR). With TFT, you repeatedly thump the patient in the head which unblocks Qi (energy flow) and heals various problems. The founder of TFT even reported success at using this method to treat atrial fibrillation. Advanced practitioners can even treat people over the phone using only their voice — no tapping needed. EMDR is similar.
If interested, you can obtain “board certification” in a mental health field. For instance, the American Academy of Experts in Traumatic Stress (AAETS), based in New York, offers “certification” in various mental health disciplines. You can become certified in:
- Board Certified Expert in Traumatic Stress
- Board Certification in Forensic Traumatology
- Board Certification in Emergency Crisis Response
- Board Certification in Motor Vehicle Trauma
- Board Certification in Disability Trauma
- Board Certification in Pain Management
- Board Certification in Illness Trauma
- Board Certification in Bereavement Trauma
- Board Certification in Domestic Violence
- Board Certification in Sexual Abuse
- Board Certification in Rape Trauma
- Board Certification in Stress Management
- Board Certification in School Crisis Response
- Board Certification in University Crisis Response
Later, if you have the time and money, you can obtain a Certificate in Traumatic Stress Management or a Fellowship in the American Association of Experts in Traumatic Stress (FAAETS). I called the following organizations to determine whether AAETS was recognized as a certification body:
- American Medical Association
- American Osteopathic Association
- American Psychiatric Association
- American Psychological Association
- National Association of Social Workers
Of these organizations, only one had ever heard of AAETS. None recognized their board certification scheme. The term “Board Certified Expert in Traumatic Stress (BCETS)” comes up a lot in EMS, especially related to CISM. Interestingly, you do not even need a college degree in psychology to become a “board-certified expert.” Amazing.
This discussion came to light because I recently had to re-certify my emergency medicine board certification (required every 10 years). The examination was quite intense with both written and oral sections. I bought several books, took a review course, and then turned off the phone for more than a week to study. I flew to Philadelphia and completed the exam. It cost well over $4,000 overall, but it was worth it.
To people who don’t know me, board certification by a nationally-recognized body assures the public that I have met certain national standards. The term NREMT or NREMT-P means the same. You can’t say the same thing for LP, CCEMT-P or BCETS. While these monikers may make us feel important, they actually dilute and degrade our profession.
