There is no question that paramedic practice is changing every day in the United States and all over the world.

Specifically in the United States there is more emphasis on furthering education and training than in the past.  The United States has a history of regarding paramedic practice as a mostly technical profession. Thus, most programs have been offered from community colleges which award candidates a certificate at the end of the course. This is certainly a different approach than our UK, Australian, and Irish counterparts. In most countries, becoming a paramedic requires much more of a clinical approach to things, including a four-year degree. This leads us to the topic of paramedic education in the United States.

The current climate is a mix of paramedics who want more education and those who want to see the profession remain a technical profession. For over forty years, we have regarded paramedic practice as a technical profession in the United States. To this day it is still listed as a technical profession. However, in recent years the overall thought process and approach has changed. Paramedics are asked to do more, interpret more data, and keep up on more information than ever before. With this change in climate, the attitude about continuing education has changed substantially. More paramedics are obtaining baccalaureates and masters than at any point in the history of the profession. Some are even getting doctorate degrees!

Pay remains an issue

In the United States there is a loss of incentive to obtain more education. The incentive to obtain more education is lost because becoming a paramedic is a certification and there may not be much increase in pay with advanced education. The route that increases a paramedic’s pay in the US is to become a part of the administration team. Not all paramedics aspire to administration, so they end up leaving the profession for other healthcare professions or leaving healthcare altogether. Most programs at this point are a two-year associate degree program which is a technical degree. There are a few baccalaureate programs in the US but obtaining a baccalaureate degree in EMS does little for pay or progression in the career. The main incentive for obtaining more education for paramedics is to try to move up the clinical ladder and into administration or training in their service.

The nursing counterparts in the United States of America have several incentives to continue their education and obtain multiple certifications. Nurses do not simply top out in an administrative role. There are several areas in which nurses can move up and excel. Nurses can move into education, training, become a Nurse Practitioner or even move into anesthesia. Nurses have the ability to improve their skills in several areas and receive higher compensation for doing so. This is what is missing in the area of Emergency Medical Services within the United States. There may be paramedics with higher-level education practicing in the streets, but there is little or no increase in pay to accompany the increased education and training.

Moving paramedicine forward in the United States

The EMS profession is still in its infancy here in the United States. Paramedicine has yet to figure out where it belongs. Does it belong in public safety? Does it belong in health care? While practices sort this out we remain at a crossroads. Trying to figure out where we are in the evolution and development of paramedicine and where we want to go. One thing is for certain; we are light-years ahead of where we were ten years ago. The paramedic practice of the future will be much more involved than we ever could have thought possible.

Overall the climate is changing here in the United States. Mostly because of the FOAMed movement. There is a notable need for change and fellow EMS professionals are working together in collaboration with other EMS professionals worldwide to change the culture in the US. It is an exciting time to be in EMS in the United States with all of the changes that we expect to come over the next five to ten years.  More medical directors are treating their paramedics like equals and teaching them to be more clinicians instead of technicians, which is a great start. More involvement of medical directors with their field providers, more education and training, and finally changing from a certification to a license will change everything in the United States. One step at a time, one day at a time, one tweet at a time will get us where we want to go.