Master Paramedics? I’m asking you a question

Let me ask YOU a question. What do you think about this:

How do we recognize the best and brightest among us? How would we distinguish the EMTs and Paramedics who have earned the respect and admiration of their peers for being “Really Good” at what they do? I don’t mean just a little bit good, or “pretty” good. I mean masterfully good. The kind of Paramedics that Johnny and/or Roy would have wanted to be had they grown up watching them on Saturday mornings. The kind of people that have worked in the profession for as long as they can remember but that never lost the passion for the job. The kind of people who read everything they can, study everything they can get their hands on, and always seem to have the answers to the most challenging of EMS trivia, as well as the most mundane.

What would we call them?

The old trade guilds used to call their most experienced and skilled members “Master”, as in the term “Master Craftsman”. As their members worked through the years and learned the ropes of the trade, they progressed through the various levels until they reached “Master” status. Some unions still use those terms and honestly, I’m unfamiliar with what all of them are. That’s ok with me because I see Paramedicine as a profession and not as a trade, but I do respect their tradition of honoring those that have earned the title of “Master” by thoroughly mastering their craft.

So what do we EMS people do? How would we recognize a “Master Paramedic” or “Master EMT”?

I’ve been thinking about this for quite a while, honestly. As I progress in the profession and in my career path, I’ve seen the people who were my mentors keep working alongside of me. They’re my colleagues now, and although they still mentor me in some ways, they have been progressing along their own paths just as I have this whole time. Some of them have become true masters of the profession. Some of them have not. Some of them could really be called “Master Paramedics” and I would like to know how we as a profession should recognize those people. I see that these people don’t tend to be treated very well by the profession in general and I think that it’s a crying shame. Think about it, new paramedics walk in the doors to the profession and are allowed to work in the same capacity as our master medics within a relatively short time. Employers tend to not want to keep these people around when budgets get tight because these people tend to be on the upper end of the pay scale. In some agencies there’s a defined career path and upward ladder, but in a lot of (and dare I say most) agencies there is not.

So what if there were a certification, or some way to define a “Master Paramedic” and/or “Master EMT”? What would be the qualifications? What would be the benefits? How would we define those people who have earned (Yes, really EARNED) “Master” status?

This is one of the things I’m asking you to think about. If you would please, put some thought into this and write what you think would make a “Master” paramedic or “Master” EMT in the comments section. No, I don’t think that this is silly. I really want to know what you all think about this.

Here’s what I think:

-          Minimum Years in the Profession: The Master EMT or Paramedic should have more than 10 years of FULL TIME service (15 years if volunteer, depending on call volume)

-          Minimum Experience and Type of Calls:  The master EMT or Paramedic should be experienced in a broad spectrum of the different types of EMS. 911 response within diverse response strategies, Medical Transports, and In-Hospital medical care.

-          Teaching and Precepting Experience:  The Master EMT or Paramedic should have experience teaching EMS classes and in mentoring new providers.

-          Command Experience:   The Master Paramedic of EMT should have experience in being in command of different types of emergency scenes and large scale responses.

-          Knowledge:  The Master Paramedic or EMT should have to pass a complex series of tests that show not only rote memorization, but also complete conceptualization and deep background knowledge of a broad spectrum of EMS and Medical related knowledge.

-          Acknowledgement by Peers:  The Master Paramedic or EMT should have the support and admiration of his colleagues, coworkers, and peers and should be able to get them to vouch for him or her when asked.

Now, I also ask you. If you were to recognize a person that could pass the standards that I’ve set, or that you and others set in the comments below, how should we show our respect to these people for their professional achievements? How should our profession honor and acknowledge our highest achievers?

I’m very curious about this issue. Please feel free to add your thoughts.

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  • http://www.backstepfirefighter.com Bill Carey

    Many cannot get past the term 'ambulance driver' for obvious reasons (reporter's lack of gaining better details for one) without going into a litany of years spent in EMS education to justify the appropriate EMS title. Then the argument decomposes into a debate of the value of EMTs and paramedics towards one another. Use of ''master' would only further the ignorance division. Finally, wouldn't the industry need to have one national body to be organized under?

  • http://www.lifeunderthelights.com Ckemtp

    Hi Bill! Glad to see you out in the blogosphere.

    I agree about the use of that detestable term “Ambulance Driver”, although I think that Kelly uses it quite well. I actually wrote about it here:

    http://lifeunderthelights.com/2009/03/oh-no-you

    However, this would be a distiction that would simply serve as a note to other EMS providers and would not be intended to signify anything to the public. Really, we have plenty of those as it is that don't seem to cause a problem. I mean, does the public know or care that someone has their ACLS, PHTLS, ITLS, PEPP, PALS, NRP, GEMS, TNS, or any other acronyms? Do they care that their local ambulance service is an EMT-I85, EMT-I99, EMT-P, NREMT-P, or anything else? What about CAAS accreditation?

    Those things mean something to EMS providers and others that happen to be in the know. They look good on resume's and whatnot. The public never seems to care, they just want the box with the flashing lights when they fall over and sprain their frenulum. This would serve as a note of distinction for the members of the profession to shoot for, something to actually look forward to achieving as a paramedic… We need some of those things. Otherwise our best, brightest, and most experienced will achieve other distinctions such as RN, PA-C, or Funeral Director like they do now. We need something to keep our elders in the profession to build and maintain our legacy and heritage. Because as a wise person once said “Without a Heritage, ever generation starts over again”

    ANd a national body?? Wow… that's a can of worms. I suppose that I could call LUTL a national body and be almost effective as the ones we call now.

  • http://tooldtowork.blogspot.com/2010/04/when-all-is-said-and-done.html totwtytr

    It's an interesting concept. A guy I used to work with came up with something similar several years ago. In fact, he pretty much paralleled the entire guild system, from Apprentice to Master. Progressive experience and progressive education were integral parts of it. Each EMS system, in addition to having a medical director, would have to employ at least one “Master Paramedic” to oversee day to day operations, supervisor lower levels of paramedic (and EMTs), and so on.

    I don't think it would take a national organization, but it would at least take recognition by the individual states. Not that that would happen either.

    The larger problem is that the general public remains ignorant of what EMS encompasses. Part of that is because I don't think we can agree on what EMS should encompass so it's impossible to convey a message to the public.

  • http://twitter.com/EMT_Tim EMT Tim

    What would the benefit of this “master” title be? Would it advance the profession? Would it provide additional value to an EMS agency? From your description, it would provide recognition for the true experts, which is great, but I'm missing a plethora of additional benefits.

    Right off the bat, a bachelor's degree need be required for any higher level designation. Education will be key to advancing EMS, but it is only one part. There is a lot more to this obviously, but the biggest thing I saw lacking here is an additional formalized education requirement.

    Your stipulations sound similar to Wake Co's APP program, which I'm sure most have heard of. I don't recall if they require a bachelor's degree, but I believe most of the APP's have them already, and some master's degrees. They do require a minimum years of service _in that system_ and additional training. APP's don't oversee administratively to my knowledge, but they do generally have medical command on calls they attend.

    I don't think I answered many questions here, as much as I asked new ones, but hopefully this provides some additional food for thought.

  • http://davidkonig.com Dave Konig

    I have to agree with TOTWTYR in that it is an interesting concept that would need to probably be adopted first on the state level by a majority before being able to put it to a national level. Since we can't even seem to do this sort of thing with certification levels much less protocols, I think it will be challenging to say the least.

    The bigger problem, or the reason not to expend energy on its pursuit, I see is that while titles are nice for recognition (if your into that sort of thing), they really don't mean anything. Ultimately its what you do that counts.

    An EMT and a Paramedic receive that title for going through an objective curriculum and achieving objective goals. In the criteria that you set above, there is quite a bit of subjective achievements. For example, in an urban setting I may consider Command Experience of a large scale scene being 100 or more patients at an event whereas in a more rural setting you may not see more than 100 patients over the course of a month. Does that mean that the rural EMT or Paramedic can't earn the title? Or does it mean that in a rural setting they are indeed considered a “INSERT TITLE”, but as soon as they cross into the suburbs they lose that recognition? That just seems all sorts of wrong.

    I think giving an EMT or a Paramedic an extra title while continuing to do field work as opposed to moving into the management structure will only lead to more dissension, confusion, and ultimately lower morale from within greater than the term “ambulance driver” ever lowered it from the outside. We already see this with the “Paragod” phenomenon so there's no reason to believe this would be any different.

    Of course, I make that judgment based on my own experiences within my own organizations, and there is a great likelihood that someone else has experienced something different… or maybe not.

  • http://davidkonig.com Dave Konig

    Tim, out of curiosity, could you explain to me how, let's say a Bachelor's in Liberal Arts, would be beneficial to an EMS Provider?

  • http://twitter.com/EMT_Tim EMT Tim

    I'd say that going through a formal college education teaches a person a lot about learning and working with others. The specific courses of a BA may not provide real value (other than writing skills, which is fair to say is important) for a healthcare provider, but a bachelor's in general shows an aptitude and capability for learning & self discipline. It is a trademark of nearly every other industry and notably lacking from EMS, especially compared to other medical fields.

    That said, coming more to your point Dave, a bachelor's in EMS or some type of health care management would be much more appropriate. These programs are limited in availability certainly, but associate's programs are a good starting point and would open the door to online EMS/medical bachelor's programs at least.

    I don't know the statistics, but at least some significant portion of the paramedic population received their training from a certificate program, likely a 1 year curriculum. There are indeed great paramedics to come out of these, but in that case it is up to the individual to go above & beyond their coursework. More advanced programs, like those that are associate's or bachelor's, hold students to a higher standard.

    Feel free to take my bias into consideration. I received my EMT training in NC from some great EMTs and paramedics, a number of whom who had higher education and all of whom held themselves to a higher standard than the “minimum.” I've also been exposed to the culture in South FL where many people who want to get into the fire department go to EMT/Medic schools whose only goal is to churn out as many graduates as possible, and these FD applicants only get their medic because they won't be hired without it. They don't want to be clinicians, they want to fight fires. But you can't do one without the other here.

    Again, not all are this way and I'm not knocking integrated Fire/EMS systems. There are pro's and con's with every system, standard and method.

  • http://www.999medic.com Medic999

    We have a similar role already over here in the UK, but unfortunately by the time someone becomes a 'consultant paramedic' they are usually well out of being a hands on medic.

    There are not many of them about, but the ones that are around have more clout due to their educational credentials rather than their filed experience.

    It seems that we already do this informally in all of our services. We all know the medics that we admire and go to for advice or when we just want to know that we did the right thing.

    For that to be financially rewarded would be a nightmare to organise as so much of it is aspects of the paramedics personality as much as their skills and knowledge.

    I like the idea of peer nominated, but then you get to into the realms of 'the big boys club'. I know at least on medic in my service who is particularly well liked as a person but is very respected as a medic.

    An interesting concept Chris, and a thought provoking post.

  • http://twitter.com/seanhfitz Sean Fitz

    Maybe the patch could say “Paragod”? To shut up those medics that THINK they know it all. A good paramedic knows he will never know it all, hence strives for better. One who thinks they already know everything never strives for anything.

  • http://twitter.com/rescue_monkey Rescue Monkey

    Trade guilds are forged in tradition. The beginner starts as an “Apprentice” then advances to “Journeyman” before reaching “Master” status. While I agree that we need some form of advancement and recognition for people who excel in their field.

    EMS is already a trade my many standards (I know I have a blue collar) and I would rather see us move into the professional healthcare provider realm. We need a transition to degree based licenser, just like Nurses, PAs, MDs, NPs. NREMT is making a small effort to encourage educational institutions to become affiliated with a college, but we need mandatory 2 yr degree for Paramedic (4 yr would be better but i'll take what I can get). For a system (EMS) that was popularized in the US, we have fallen behind in the education of our paramedics.

  • http://twitter.com/rescue_monkey Rescue Monkey

    Trade guilds are forged in tradition. The beginner starts as an “Apprentice” then advances to “Journeyman” before reaching “Master” status. While I agree that we need some form of advancement and recognition for people who excel in their field.

    EMS is already a trade my many standards (I know I have a blue collar) and I would rather see us move into the professional healthcare provider realm. We need a transition to degree based licenser, just like Nurses, PAs, MDs, NPs. NREMT is making a small effort to encourage educational institutions to become affiliated with a college, but we need mandatory 2 yr degree for Paramedic (4 yr would be better but i'll take what I can get). For a system (EMS) that was popularized in the US, we have fallen behind in the education of our paramedics.

  • calif medic

    i agree they should be credited for their time and experience definately i have to give some insight though i am going on 21 years as aparamedic i recieved a star of life from the american ambulance association that is an awesome commendation by the way it a huge pat on the back. but alas people do not see us for what we do since they think that the almighty fireman is much much better since they cannot see the commitment that we have because we run EMS calls and the fireman all they want to do is fire fire fire and sashay their ego so we need recognition and public education how do we do that?

  • Rhunic_Carver

    Don't we already have a ranking system for EMS? Hence EMT-B, EMT-I, EMT-P and CCEMT-P. Having a “Master Paramedic” status don't seem like anything but an ego title. Unless it came with a higher pay grade, I don't see it meaning anything. I don't want to be a negative Nancy but all Paramedics are ruled over by their respective SMO's and PPO's, so having a title to say “I'm better then you because, I'm a MASTER Paramedic.” Isn't going to mean anything when you can still only work within the limits of your SMO's, that all Paramedic's in your system are using. You want to be a “Master Paramedic?” Goto med school become a doctor, and then run on the ambulance for medic pay. Some Paramedics are better then other's for sure but a true “Master Paramedic” doesn't need a title to do what he or she does best, they do it because they love the job, and because that's what they were meant to do.

  • http://www.lifeunderthelights.com Ckemtp

    Rhunic:

    I read your comment here on my blackberry while waiting in line for lunch during the back half of my 48hr shift. We're picking up burritos after working a GI bleed.

    Why am I saying this? Well, I wanted some personal back story before I dropped this. When I read your comment I thought: “Here is a guy who just doesn't get it”. I don't necessarily mean that as an insult. I don't mean that you don't get the post, I mean you don't get the whole EMS thing. Sure, you may be an exemplary medic, or EMT, or what have you (although, I'm guessing EMT) but in your comments I read that you think that all paramedics, EMTs, and EMS in general do is play the role of “Cookbook Following Skills Monkey” and that experience and farther-than-base knowledge doesn't do all that much for patient care… And well, respectfully, that means that your perspective is limited by either your own ego or your own lack of experience. It could be a fault of your preceptors or your service… But I could also blame the pervasive attitude among some EMS people to downplay the skills truly required to master the job and downplay those who strive for true mastery.

    That attitude, the belief that this EMS stuff isn't all that important and the belief that “I have a medic patch now!! I'm just as good as THAT guy with the grey hair!” Are dangerous. Time to rethink some things.

    Sorry, I don't usually attack back on my commenters, but you caught me on a 100hr work week with barely any sleep. I'm cranky.

  • Rhunic_Carver

    You got it all wrong. I think everyone who works in EMS should strive for greatness in their profession at all times. Also yes there are people who are “cook book” medic's who never think outside the box for treatment and I would guess don't care about their patients or really care about the outcome of patient care. Should there be a Bachelors in prehospital care? Sure. I would have it right now if it was available. I believe that constant education and re-education are vital to EMS because you never know what the next call will bring you. But having to have a title of “Master Paramedic” makes me angry. To me it just screams EGO TRIP!!! I am a Paramedic and have been for 6 years. In my time around the block I have seen a lot of very bad, and a lot of very good Paramedic's. I normally wouldn't comment but today for some reason that whole “Master Paramedic” thing struck a nerve. If it did exist I would go for it. But not so that I could walk around telling my peers that they need to respect and admire me because I am a “Master Paramedic.” It would be to know that when I am called to duty that I am giving the best care possible. You probably didn't mean it this way but to me when I read your post it just sounds like all you want is another title behind your name for bragging rights. Also on a side note I am sorry about your long week.

  • Rhunic_Carver

    This is the part that pretty much set me to the negative.

    Acknowledgement by Peers: The Master Paramedic or EMT should have the support and admiration of his colleagues, coworkers, and peers and should be able to get them to vouch for him or her when asked.

    Up until then I was on board.

    A person is respected or admired based on their actions. Not their title.

  • Rhunic_Carver

    Don't we already have a ranking system for EMS? Hence EMT-B, EMT-I, EMT-P and CCEMT-P. Having a “Master Paramedic” status don't seem like anything but an ego title. Unless it came with a higher pay grade, I don't see it meaning anything. I don't want to be a negative Nancy but all Paramedics are ruled over by their respective SMO's and PPO's, so having a title to say “I'm better then you because, I'm a MASTER Paramedic.” Isn't going to mean anything when you can still only work within the limits of your SMO's, that all Paramedic's in your system are using. You want to be a “Master Paramedic?” Goto med school become a doctor, and then run on the ambulance for medic pay. Some Paramedics are better then other's for sure but a true “Master Paramedic” doesn't need a title to do what he or she does best, they do it because they love the job, and because that's what they were meant to do.

  • http://www.lifeunderthelights.com Ckemtp

    Rhunic:

    I read your comment here on my blackberry while waiting in line for lunch during the back half of my 48hr shift. We're picking up burritos after working a GI bleed.

    Why am I saying this? Well, I wanted some personal back story before I dropped this. When I read your comment I thought: “Here is a guy who just doesn't get it”. I don't necessarily mean that as an insult. I don't mean that you don't get the post, I mean you don't get the whole EMS thing. Sure, you may be an exemplary medic, or EMT, or what have you (although, I'm guessing EMT) but in your comments I read that you think that all paramedics, EMTs, and EMS in general do is play the role of “Cookbook Following Skills Monkey” and that experience and farther-than-base knowledge doesn't do all that much for patient care… And well, respectfully, that means that your perspective is limited by either your own ego or your own lack of experience. It could be a fault of your preceptors or your service… But I could also blame the pervasive attitude among some EMS people to downplay the skills truly required to master the job and downplay those who strive for true mastery.

    That attitude, the belief that this EMS stuff isn't all that important and the belief that “I have a medic patch now!! I'm just as good as THAT guy with the grey hair!” Are dangerous. Time to rethink some things.

    Sorry, I don't usually attack back on my commenters, but you caught me on a 100hr work week with barely any sleep. I'm cranky.

  • Rhunic_Carver

    You got it all wrong. I think everyone who works in EMS should strive for greatness in their profession at all times. Also yes there are people who are “cook book” medic's who never think outside the box for treatment and I would guess don't care about their patients or really care about the outcome of patient care. Should there be a Bachelors in prehospital care? Sure. I would have it right now if it was available. I believe that constant education and re-education are vital to EMS because you never know what the next call will bring you. But having to have a title of “Master Paramedic” makes me angry. To me it just screams EGO TRIP!!! I am a Paramedic and have been for 6 years. In my time around the block I have seen a lot of very bad, and a lot of very good Paramedic's. I normally wouldn't comment but today for some reason that whole “Master Paramedic” thing struck a nerve. If it did exist I would go for it. But not so that I could walk around telling my peers that they need to respect and admire me because I am a “Master Paramedic.” It would be to know that when I am called to duty that I am giving the best care possible. You probably didn't mean it this way but to me when I read your post it just sounds like all you want is another title behind your name for bragging rights. Also on a side note I am sorry about your long week.

  • Rhunic_Carver

    This is the part that pretty much set me to the negative.

    Acknowledgement by Peers: The Master Paramedic or EMT should have the support and admiration of his colleagues, coworkers, and peers and should be able to get them to vouch for him or her when asked.

    Up until then I was on board.

    A person is respected or admired based on their actions. Not their title.

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  • http://medicandthebeast.blogspot.com/ Orlandomedic1

    Amen

  • FLGangstaFlightMedic

    for all those who think CCEMT-P is above an EMT- P you are sorely mistaken, CCEMT-P is a class, the certification above EMT-P is either CCP-C or one above that FP-C. CICP is equivalent to CCEMT-P and actualy prepares graduates to pass the FP-C witch most consider to be a “Master Paramedic.” My suggestion is to take your Critical Care curriculum, take your FP-C and continue for education, and who knows one day you might just be on the whirrlybird placing chest tubes and other out of the standard scop of practice for an EMT-P

  • GAFlyingmedic

    Interesting question, but at the same time, I believe this to be a moot point. Regardless, I will inject my 2 cents.

    Over my 13 years in EMS, I have collected virtually all of the letters one can, and I am able to put more initials behind my name than are in my name. And I'm German. I have spent over 10 years of post high school education earning them. They include a BS, MPH, NREMT, CCEMT-P, FPC, PNCCT, CICP, RN, BSN, CCRN and some others I am certain that I am forgetting. My certifications do not garner me on ounce of respect, however, as I have been known to miss intubations and blow IVs. And, on that note, were you to be impressed by my certifications and/or title alone, I would be suspect. The bottom line is, there is nothing that the Paramedic who just sewed his patch on his shirt can't do that I can. Period. We all intubate, pump on chests, stick needles in veins and give medications. And yes, we all even drive the ambulance. Our colleagues know who the “Master” medics are. And that's the way it should be. I strive for excellence in care, and deeper knowledge, not your respect or awe.

    The more we bitch and moan about being called “ambulance drivers” and wanting national unions or groups or whatever, the further behind the 8 ball we get. The only way to get ahead in our business is to continually show your colleagues that you are more intelligent than your job requires.

    I feel much better now. Thank you so much.

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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  • Comments
    mr618
    Welcome to the Club
    Well said, Chris. We can't save everybody, but the ones we don't save tend to stick around a lot longer than the ones we do save.
    2014-10-18 14:40:00
    Steel City Medic
    Welcome to the Club
    Particularly appropriate for me this week. Thanks.
    2014-09-23 21:46:00
    DiverMedic
    Welcome to the Club
    Very well done, Chris.
    2014-09-17 22:15:00
    DiverMedic
    My Blogroll
    One of these days you'll figure out where my blog is... :)
    2014-09-17 22:11:00
    emtterri123
    Six Tricks You Can Use Today to Improve Your EMS Narrative Report
    The first and best way to get people reading you to think that you are an idiot is to pepper your writing with spelling and grammatical errors. It makes you look dumb. - Me thinks this should have been restructured as it does not flow and caused me to reread it several times. lol :)
    2014-09-17 08:27:00

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