A University-Based Degree for Paramedics in Israel

In 1979, after a career in EMS, Dr. Nancy Caroline immigrated to Israel to become medical director at Magen David Adom (MDA), the Israeli national EMS agency.¹ Caroline brought an American paramedic course to Israel, translating her now legendary Emergency Care in the Streets textbook to Hebrew.^2,3

Until 1979, there were no paramedics in Israel, and most of the EMS service was basic life support (BLS) units that had minimal first aid capabilities.^4,5 An exception was a few mobile intensive care units (MICUs), like the one pioneered in Belfast by professor Frank Pantridge, staffed by physicians in the country’s major cities.⁶

The first paramedic course was divided into three main parts: theoretical and practical classes, hospital internship and EMS internship. The paramedics who graduated become the backbone of the Israeli EMS system.

All emergency calls in Israel reach an MDA dispatch center, and ambulances are dispatched from one of 129 stations spread around Israel. MDA has a two-tier (ALS/BLS) system. Since 2015, all the MICUs are staffed by paramedics and EMTs.

Over the years, the training for paramedics in the EMS system has changed considerably. The short, intense course pioneered by Caroline developed into a longer and more sophisticated course, reflecting changes in EMS over the last four decades. Unique to Israel, the training for paramedics in the Israel Defense Forces (IDF) is done by civilian EMS. Paramedics who finish their mandatory military service can work in civilian EMS. The current paramedic course taught by MDA consists of 1,550 hours and is 18 months long.

In 1998, following the work of paramedic Neomi Zvi from the Israeli Paramedics Association, the health sciences faculty at Ben-Gurion University of the Negev established a bachelor’s degree for paramedics. Since its establishment, more than 500 paramedics have graduated from MDA with the degree.

Historically, paramedics have been considered technicians, not independent clinicians, and as such required a more technical training. As EMS systems developed and changed over the years, paramedics were required to diagnose and treat more complicated patients without a physician directly overseeing them. When the program was established in 1998, a university degree for paramedics was not common. Today, the rationale behind a university degree for paramedics is more evident: The changes in EMS require a more comprehensive training framework that can allow paramedics to adapt easily to changes and advance into professions like physician assistants, paramedic practitioners and community paramedics.

The degree is based on three layers: basic medical sciences, clinical courses and internship in hospital, EMS and urgent care centers. While the basic science is taught by researchers and university faculty, the clinical courses are taught by veteran paramedics and physicians in the university’s medical simulation center.

The training for the degree requires five days of studying in the university or in a clinical setting for the entire three years. In total, graduates study for 3,400 hours to earn their degree and paramedic certificate. After graduation, more than a third of the paramedics continue their education with a master’s degree.

Some potential students who enroll into the bachelor’s degree program have no previous experience in EMS. This pre-employment model (as opposed to the traditional post-employment model in EMS, which requires basic EMT experience before becoming paramedics) is challenging. Students with no prior EMS experience need to understand what EMS is about, and what is required from a paramedic in the field beyond academic excellence. Thus, potential students need to go through interviews and an evaluation by a psychologist before being accepted into the emergency medicine program. It is not possible to successfully complete the bachelor’s degree without receiving a paramedic certificate.

As paramedics seek recognition and development of new clinical skills, an academic degree is part of the transition from technicians into mature professionals. Our experience in the last 17 years shows that a combination of academic excellence and early hands-on experience can result in a program that prepares the paramedics for the challenges of the future.

References

1. Baskett P, Safar P. Nancy Caroline—from Mobile Intensive Care to Hospice. Resuscitation, 2003 May; 57(2): 119–122.

2. Caroline NL. Nancy Caroline's Emergency Care in the Streets. Jones & Bartlett Learning, 2010.

3. Caroline N. A tribute to Nancy Caroline, MD, & Emergency Care in the Streets. Interview by Bryan E. Bledsoe and Mick J. Sanders. J Emerg Med Serv, 2002 Jun; 27(6): 127–9.

4. Hadas E, Eisenberg M, Nagel E. Emergency medical services in Israel. American Journal of Emergency Medicine, 1984 Jul; 2(4):366–367.

5. Forster J, Taigman M. "We have no choice". EMS in Israel. Emerg Med Serv, 2002 Jun; 31(6): 39–44.

6. Pantridge JF, Geddes JS. A mobile intensive-care unit in the management of myocardial infarction. Lancet, 1967 Aug 5; 2(7,510): 271–273.

Oren Wacht, Phd, EMT-P, is an instructor in the Department of Emergency Medicine at Ben-Gurion University of the Negev and a paramedic in Magen David Adom.