FossilMedic says:

He was a thirty-something probationary firefighter and I asked what his first career was. Turns out it was firefighting. He spent over a decade as a career firefighter in a large west coast fire department, rising to the rank of captain. Ailing parents brought him and his wife back to the east, where he spent almost four years getting to this point in his Virginia firefighting career.

He applied for a job at every fire department from Richmond to Baltimore. Over a year went by before he was hired by a moderate sized county fire department, where he spent a dozen weeks in recruit school. He finally was hired by the largest northern Virginia fire department where, two years after graduating from one Virginia recruit school, he is starting a second recruit school … that will lead to the same Virginia certifications he already earned.

Meanwhile, his wife had no problem obtaining immediate employment as a registered nurse at a hospital. It is this staggering lack of career mobility that leads me to label firefighting as a hobby. One of the speakers at last week’s National Association of EMS Educators reminded me of this “recruit.”

The speaker started as a registered nurse from a diploma school in Los Angeles. Hospitals and health departments ran vocational registered nurse training thirty years ago. He also became a National Registry EMT-Paramedic. Because his ambulance agency worked in both Ventura and Los Angeles, he had to maintain paramedic certification from both counties. Moving to another state, he had no problem with his registered nursing credentials, but needed to take a “paramedic refresher course” and sit for a state paramedic exam, even though he already held a national registry EMT-P certification.

Nursing, firefighting and ems have moved forward since the 1960s, but with significantly different outcomes. Since 1996 the vocational registered nursing diploma programs were edged out by community college associate degree programs. Nursing leaders are advocating replacement of the associate degree with the bachelor’s of science as the minimum academic level for a registered nurse. Regardless of how you earned your registered nursing credentials, RNs are able to move throughout the country without needing to re-qualify because of a geographic change. The same is true for most professions.

Since the 1966 Wingspread conference, the fire service has talked a lot about professionalizing the career. Some notable accomplishments are the NFPA 1000 Professional Qualification standards, Degree-at-a-Distance undergraduate program, expansion of the American Council of Education accreditation of selected programs, Chief Fire Officer Designation [http://publicsafetyexcellence.org/ ]and the Fire and Emergency Services Higher Education model curriculums [http://www.usfa.dhs.gov/nfa/higher_ed//feshe_direction.shtm ].

Unfortunately, entry to fire department employment remains restricted to the bottom and top of the organization chart. It is telling that both of the Harvard University three-week summer programs provide no academic credit, either for fire chiefs or union leaders. The $11,000 programs provide an intense and valuable experience for the attendees, taught by Harvard University faculty. The university has not provided a mechanism to award academic credit for these programs.

EMS started as a Department of Transportation vocational training program thirty years ago. By 2009 it will reflect the nursing model, moving into the scope of practice model. We are about two-thirds through this change, with the release of the second draft of the National Emergency Medical Services Scope of Practice Educational Standards draft next month.

There will be four levels of ems provider: Emergency Medical Responder, Emergency Medical Technician, Advanced Emergency Medical Technician and Paramedic. Deb Cason, an EMS program director for the University of Texas Southwest Medical Center, is the project leader. This link takes you to a 13 page, 1.2 Megabyte .pdf handout of a presentation Professor Cason made about the program and process: http://www.dshs.state.tx.us/emstraumasystems/Cason_DevEduStandards.pdf 

The comment period for the second draft will close January 2008. Go to http://www.nemses.org/ to review the standards and provide feedback. There will be a stakeholder’s meeting in February 2008 in Washington DC. The NHTSA contact calls for the submission of the final EMS Scope of Practice by August 2008.

One of the challenges with the incoming EMS educational standards is the requirement that the person in charge of a paramedic training program have a bachelor’s degree. I was surprised to learn that some directors of the 400+ paramedic training programs have yet to achieve an associate degree, much less a bachelor or graduate degree.

The EMS Scope of Practice provides an opportunity for 50,000 practicing paramedics to have the same professional mobility enjoyed by 2.7 million registered nurses. A pity is that the fire service is farther along the professional path, yet may never provide the same type of professional mobility to the 350,000 people who make firefighting their career.

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