Guest Editorial: Keep Our Profession Professional

Editor's note: On August 18 the National Registry of Emergency Medical Technicians announced its draft resolution 22-Resolution-13 had been rescinded. Read more here. 

All professions require a certain amount of self-regulation. This generally includes defining minimum standards for the certification and licensure of new professionals. To create and maintain these, paramedicine has an established national certification body, the National Registry of Emergency Medical Technicians (NREMT), which is the pathway in many states to practice as a paramedical professional.

Just as important as the licensing process itself is setting guidelines to establish eligibility to seek certification and licensure. In paramedicine we’ve defined the important requirement of graduation from a health care education program nationally accredited through the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) or Commission on Accreditation of Allied Health Education Programs (CAAHEP). 

In June the NREMT floated the idea of allowing state EMS offices to approve paramedic education programs that don’t meet CoAEMSP or CAAHEP criteria. The Registry “recognizes that alternatives to delivering and independently ensuring quality EMS education exist and are worthy of exploration,” it said in a resolution. 

The idea to remove accreditation requirements from paramedic education is not only absurd but dangerous and destructive. The ultimate effect of dismantling this requirement is to allow less-qualified, inadequately run, cheaper pseudoeducational programs to rapidly crank out minimally qualified paramedics to fill job slots, with no regard for the quality of the care they would provide. 

The NREMT took a bold step toward building paramedicine as a profession by requiring graduation from an accredited paramedic program to qualify for the certification exam process. This helped improve paramedic education and advance the profession. So why would the NREMT now decide to remove this requirement? Why would it denigrate this essential step of paramedicine professionalism? Why would we allow this to occur?

As a profession, paramedicine has numerous organizations that purport to represent us: the National Association of Emergency Medical Technicians (NAEMT), American Paramedic Association (APA), International Association of EMS Chiefs (IAEMSC), and others. They have been conspicuous by their silence. Why are they not screaming from the rooftops that this degradation of the certification process would be a dangerous detriment to the profession and provision of quality care? Why are they not fighting to keep our profession professional? 

I suspect the bottom line is fear—fear from those who provide paramedicine as their second- or third-tier responsibility that they may have to meet a higher, more professional standard. Fear from those providers that they might have to pay more to obtain and maintain higher-qualified paramedic professionals. Fear that their fiefdoms could be upset and their budgets affected. Fear that the public will recognize paramedicine is an integral part of health care and that it should be an essential service.

No matter your delivery platform, that is not the issue. I assert that paramedicine as a profession requires fully accredited paramedic education programs that feed into a national certification process supporting state licensure. I also support establishing a baseline degree requirement to obtain paramedic certification and licensure. 

The real issue is, will we as professionals stand up and demand the establishment and maintenance of high-quality accredited paramedic education programs, a national certification process in support of state licensure, and the provision of the highest-quality out-of-hospital health care possible through professional education, development, and evolution? 

Please make your voice heard, push the cause of professionalism, and stand for what is right for EMS. We must demand that paramedicine be recognized and managed as a health care profession, with all those rights and responsibilities.  

John Todaro, BA, NRP, RN, TNS, NCEE, CHSE, CHSOS, is the director/principal consultant at Eagle Emergency Education Consultants in Land O' Lakes, Florida and a member of the EMS World editorial advisory board.