Should EMS have a degree requirement?*

I don’t know. Neither does anyone else.

I want EMS to have a degree requirement because it should cull the herd a bit, raise the bar and lower the supply of workers ready to do it for next to nothing. This should translate into more money for those that stay in the field, “should” being the key word in this sentence.  A degree will allegedly give us a seat at some metaphorical healthcare table and might change the perception of EMS from being ambulance drivers to some sort of legitimate healthcare providers, perhaps even allowing us to be in charge of our own destiny as an industry (profession?).

A degree is likely a surrogate end point for keeping out the lowest common denominator that is attracted to EMS. Our low barriers to entry coupled with the ability for someone to get a bit of authority, respect and be occasionally viewed as a hero by joining EMS might be an issue.

I have a BA in an unrelated field and honestly, I do not think it helped me learn how to think well or do that much intellectually. What I do think a degree represents is a certain willingness to do more and try to become more educated. A degree may be a surrogate endpoint for a certain type of personality that we should look to attract to our field. A degree might be a rule in, but perhaps lack of one is not a rule out when hiring.

Then again when we look at the general state of college campuses today, at least what I see in the media, it seems open and free exchanges of ideas may be in danger of extinction.

The question regarding a degree needs to be this: will it make EMS better? Well, that depends, better for whom? It would probably make it better for me but should that be the focus of EMS? No. We need to make things better for the patients.

We need to make things better for patients, better for communities and better for healthcare.

Would a degree requirement make things better for patients? Would a degree make patient based outcomes better? Is a degree holding paramedic what is needed in the field by our patients? If a degree does not make tangible outcomes better would it make more intangible things like rapport, patient satisfaction, and public perceptions better? It seems like it should work. Then again there is a long list of things EMS has adopted in the past that seemed like they should work: MAST, therapeutic hypothermia, IV fluid therapy for hypovolemic shock from hemorrhage, backboards, etc.

Maybe we need to think more big-picture and less about us. Maybe wanting to feel like a real health care provider (and I do want to feel that way) should not factor into a needs assessment. Maybe we are trying to turn being a paramedic in to something it might not be? Maybe a paramedic or an EMT is a real clinician, I do not know. Then again, maybe being a pre-hospital clinician is what is needed by patients. Maybe patients need more than an entry level paramedic currently provides. It is hard to say as there in nothing but opinion and speculation regarding this for now.

If we want to invoke a slippery slope argument here we could put a physician on every ambulance in America, but we need to deal with reality. For everything there is a cost to benefit ratio. While adding doctors to ambulances would almost certainly increase outcomes, I suspect the gains would be marginal when we compare cold hard facts with dollars.

What about communities that cannot afford this? While we can argue it is an essential service at some point in rural America there is a finite amount of cash and asking people to choose between an EMS program and some other services is a hard line. An EMS service might be essential but in many places a volunteer BLS ambulance with one EMT meets the criteria. Perhaps a ride to the hospital and some empathy is all that is really needed? Perhaps that is good enough for some areas, or that is the best that they can do.

Perhaps a ride to the hospital and some empathy is all that is really needed? Perhaps that is good enough for some areas, or that is the best that they can do. I like to think we can do better, but it is not up to me.

Until someone has the guts to make a degree requirement in a USA based EMS service and compare outcomes, or do a RCT of some sort, all we have is speculation, opinions, extrapolations, and hunches. Yes, I am aware of the data in other fields like nursing that show some increases in outcomes but those do not necessarily equate to outcomes EMS would use.

On the other hand, the worst case scenario would be a degree requirement with no increase in outcomes and no increase in pay.

While I think a more education is a good thing I also believe the “leaders” of EMS that are calling for this may be unable to see the forest for the trees. Rather than add what I believe to be marginal gains by producing a workforce of well-rounded paramedics, perhaps we should start with a complete overhaul the current EMS education program. If we want to make an EMS specific degree program that adds to our current standards, then I am all for it. But I do not believe that is what many are advocating for.

I would rather have better, more proficient paramedics than a more “well-rounded” paramedic when it comes down to it.

Adding in several hundred medically specific hours to the existing paramedic curriculum seems like what is needed much more than adding in English and math classes at this point.  The benefits gained from a semester of “managing the intubated patient” would far outweigh the benefits of a semester of statistics. Throwing in a 4 credit semester of internship in an ICU of “managing the critically ill patient field internship” would likely bring a larger gain than a semester of studying European literature.

I am in no way anti-education and I believe that a degree requirement is a great idea for anyone looking to embark in EMS management and perhaps it should be the standard. I believe that having an understanding of writing, statistics, scientific methods and research all seem like important things to have a manager to be knowledgeable about.

*For the sake of clarity in this post, I am referring to street level providers here and not managerial/supervisory positions.



  1. Well, yes. I agree about better patient care. And I agree that degreed individuals are self-selected and more professional.

    However, the game, as it’s currently played, is won by those with degrees. RNs and PAs are winning (pay, benefits, and respect). NRP s are losing. But beyond pay and benefits, higher degreed medical professionals also make the rules and set the tone.

    So, I think it’s a little naïve and idealistic to say this is just about patient care. Until we have a seat at that table, we don’t get to help improve patient care from our place.


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