On one side of the coin, you have those who say it is time to push the profession forward and obtain the pay and respect which they feel is lacking. Additionally, they feel paramedics need to be more educated, because the demands of the profession are greater. On the flip side of the coin, you have those who are concerned that the new expanded curriculum, along with its associated cost, will make it difficult for individuals wanting to become paramedics or fire departments to run paramedic programs. Based on this theory, the new curriculum will cause a paramedic shortage in an already tight paramedic labor market.
Some fire departments and areas of the country are already experiencing shortages of paramedics. This past summer, a police officer who is the trustee of the Dallas Police Patrolman's Union issued a press release declaring the fire department was short paramedics and a crisis was close at hand. Although the officer's intentions and actions were clearly calculated as part of his strategy to try to raise the pay of his police officers, since there is pay parity between police and fire in Dallas, it still highlighted the issue of a paramedic shortage in Dallas.
Dallas fire officials said the patrolman is wrong since at the time of the officer's press release, the department was ready to graduate a class of 37 new paramedic/firefighters. The Dallas Fire Department operates a 16-month academy that trains personnel to become paramedics and firefighters. Dallas officials are also quick to point out that there is no crisis, since overtime is used to fill any shortages that may occur.
Another large fire department that is experiencing paramedic shortages is the Los Angeles Fire Department. In a story in the Los Angeles Daily News this past July, the LAFD acknowledged that it had to close engine houses daily because of paramedic shortages. However, it pointed out that the closures are done in such a way that no section of the city is without coverage. At the time the newspaper article appeared, the LAFD was short a minimum of 150 paramedics, or approximately 25% of the entire paramedic workforce.
Dallas and Los Angeles, however, are not the only places experiencing paramedic shortages. Reports abound from both coasts as well as from the south and north sections of the country.
With all these paramedic shortages, now comes the new paramedic curriculum. It all started in 1990, when the National Highway Traffic Safety Administration (NHTSA) Consensus Workshop on Emergency Services Training Programs made recommendations for training. As a result of those recommendations, the rollout of the EMT-B curriculum occurred in 1994, the first responder curriculum in 1995 and the EMT-P curriculum in 1998.
Now, many states are poised to develop their own standards based on the new curriculum. In essence, state licensing and training programs will attempt to follow the standard of care established by the new national standard curriculum.
The new paramedic curriculum is broken down into four main components: didactic instruction, skills laboratory, clinical education and field internship.
Within the new curriculum it is assumed that any student entering a paramedic program is competent in English and math. The new standard recommends testing students' English and math competency levels before they enter the program, since those who have traditionally failed paramedic programs were deficient in one or both of these areas. If a student is deficient, the program should provide individual tutoring, thus increasing the course time.
In addition, prerequisites are required for any admission to a paramedic program. A student must be an EMT-Basic (EMT-B) and take a course in anatomy and physiology (A&P) prior to admission to a paramedic training program. The new national standard curriculum will allow for the EMT-B and A&P course to be rolled into the paramedic program.
When it is all said and done, including the competencies and prerequisites, the new national standard curriculum defines minimum subject matter for a new program to average 1,000 to 2,000 instruction hours. Many theorize that it will take two years or more to train a new paramedic.
Some training institutions around the country that are ready to kick off their new paramedic programs have been forced to double tuition, since they must cover their additional instruction expenses. It is predicted by critics of the new national curriculum that the cost of a paramedic program will keep many from entering a school, resulting in fewer paramedics graduating. Others contend that the rigors are stringent for a paramedic to graduate, resulting in a higher failure rate among those who can afford the program.
Then there is the impact on fire departments. No doubt, if a fire department operates an in-house training program, like Dallas, the time in the academy will be much longer, while the attrition rate among personnel in the field will probably remain the same as it was before the new curriculum came about. Still others contend that the impact of the new paramedic curriculum will be felt hardest among volunteer fire departments, where the cost and time to send someone to paramedic school will be prohibitive.
So why even change the paramedic curriculum? Those who favor the change contend the role that a paramedic performs today is quite different from years past. Paramedics today must be more knowledgeable since greater responsibility and burden is placed on them. More sophisticated medical equipment demands a more educated paramedic.
Years ago, a paramedic only had to know how to read a three-lead ECG. With the advent of new 12-lead monitor/defibrillators and thrombolytics, the new curriculum requires a paramedic to be able to interpret a 12-lead ECG and be knowledgeable of thrombolytic pharmacology. Other issues that have changed the perspective of the paramedic profession include expanded scope of practice issues, managed care and injury-prevention programs.
We know the new paramedic curriculum will push the profession forward educationally. The question is whether the new paramedic curriculum will advance the profession as a whole. Much needs to happen, including improved pay, more autonomy and more respect as a career from other medical professions. Only time will tell.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief paramedic for the St. Louis Fire Department and is the vice chairman of the EMS Executive Board for the International Association of Fire Chiefs. He has lectured nationally and internationally on fire-based EMS topics and operates The Ludwig Group, a consulting firm specializing in EMS and fire issues. He can be reached at [email protected].
