Guest Editorial: If I Were the Zeus of Prehospital Care

As a prehospital healthcare professional, I sometimes wonder if we are not our own worst enemies. 

We say we want to be recognized as professionals and paid appropriately, but we argue vehemently about requiring a college degree for entry into the profession. 

We demand to be recognized as equals by our healthcare colleagues, yet we insist on clinging to a public-safety operational model rather than embracing one of public health. 

We embrace specialty certifications—community paramedic, critical care paramedic, flight paramedic, tactical paramedic—yet we whine about the need for and importance of lifelong learning and continuing education requirements to maintain our licenses and certifications.

Over my 42 years as a prehospital healthcare professional, I have been an active and sometimes even obnoxious proponent of the need for a process for the professionalism of prehospital healthcare providers. 

If I were the Zeus of prehospital healthcare, I would decree that process to be:

1) An associate degree as a minimum requirement to sit for the National Registry paramedic exam. 

2) Passage and maintenance of certification as a nationally registered paramedic to obtain and maintain state licensure.

3) A bachelor’s degree as the required pathway to advanced clinical certifications (community paramedic, critical care paramedic, flight paramedic, tactical paramedic, etc.).

4) A bachelor’s degree as the required pathway for all supervisory, education/training, and administrative certifications.

5) A bachelor’s degree as a minimum for all supervisory, education/training, and administrative positions. 

6) A national standardized lifelong learning and continuing education requirements program for the maintenance of national paramedic certification and state licensure across all U.S. states, territories, and the military. 

7) The implementation of a public-health model for providing prehospital healthcare and its full integration as a component of the healthcare continuum. 

8) Implementation of standardized national health, wellness, and safety standards for prehospital healthcare providers.

9) The implementation of 8–12-hour work shifts with restrictions on back-to-back shifts (mandatory holdover and call-in).

10) The implementation of a salary scale compensatory with the education, certification, licensure, and competencies of prehospital healthcare professionals.

11) The elimination of all ridiculous and demeaning EMS t-shirt slogans, e.g., I Race the Reaper for a Living; As a Paramedic My Job Is to Save Your Ass, Not Kiss It; and Drive Safe or I Get to See You Naked. 

I know what you’re thinking: This is all well and good, but we have a national paramedic shortage, and these education and operational changes will make it worse. People will die! 

Really? People will die if we require degrees? Enough with the fearmongering! People will not die, because as a profession we will establish a plan that will provide an appropriate, controlled, step-by-step process to enact a Zeus plan. 

Years of inaction while wringing our hands and whining about being the redheaded stepchild, getting no respect, and infighting has gotten us nowhere. I am close to retirement, and I want to know—check that, I need to know—that the sweat, blood, tears, and vomit I’ve endured as a prehospital healthcare professional have not been in vain. 

As Norman Vincent Peale said, “Action is a great restorer and builder of confidence. Inaction is not only the result, but the cause of fear. Perhaps the action you take will be successful; perhaps different action or adjustments will have to follow. But any action is better than no action at all.” 

I am asking the young guns, the true mavericks of prehospital healthcare (you know who you are), to stand up, take action, and continue the positive progress of the prehospital healthcare profession.

John Todaro, BA, NRP, RN, TNS, NCEE, is assistant director in the College of Nursing at the University of South Florida in Tampa. He is a member of the EMS World editorial advisory board.