What are we?

While I’m in the process of forming a new entry, I figured that I would clean up and repost an earlier entry I made for JEMS Connect.

A (re)posting of a sappy “I’M AN AMBULANCE DRIVER” ‘rant’ thingamajig on one of the several forums I frequent (all too often) got me thinking, “Why do people care so much about what we’re called?” This is not to say that what we proclaim our title(s) to be is unimportant, but that the amount of personal offense that some people take to some titles is completely overboard.

So, let’s review the common titles the public uses:

Paramedic: Ok, true, paramedics are a subset of EMS providers, but considering that you can be a paramedic in as little as 300 hours ((thank you Iowa for calling your EMT-I/99s “EMT-Paramedic”) ,[PDF file] and the wide-ranging requirements that go either far beyond the current national curriculum (an honest “thank you” to the State of Washington for requiring at a minimum an associates degree for your paramedics) or far under makes playing the “Mine, not yours!” game really weak.

To throw more wood on the fire you have other countries, most notably Canada where some provinces use the terms “Primary Care Paramedic (PCP),” “Advanced Care Paramedic (ACP),” and “Critical Care Paramedic (CCP)” for the providers on their emergency ambulances. Of course a key difference, though, is where US education is an inverted triangle with each program requiring more hours the higher you go (e.g. EMT-B is 110 hours, EMT-P is suggested to be 900 hours), the requirements for PCPs includes the bulk of the information and scientific background for ACP, with the difference between PCP and ACP far less than the difference between lay provider and PCPs. Now before someone starts posting “Gotcha” replies, yes, I’m ignoring the “Emergency Medical Responder” level. While the level is the most similar to US EMT-Bs, my understanding is that they are used in most places as either a first response or non-emergent patient transport and not for emergency transports (regardless of if coming from a health care facility or not).

Emergency Medical Technician If anything this is currently most correct title to use (albeit more and more states are moving to the new EMT/AEMT/Paramedic nomenclature). Under the NSC (and subsequently used by the NREMT for their levels until 2013 as well as most states), we’re all EMTs. The problem here is that the working use of terms in the field has been to shorten EMT-Basic to simply “EMT” and EMT-Paramedic to “paramedic.” Personally, as with the terms BLS and ALS to determine levels of care (which is a different topic completely), I try my best to not use EMT to refer to EMT-Bs. Yes, I am an EMT-Basic. If anything, that means that I should be called a “basic” and not an “EMT.” Due to the field (mis)use of the term EMT, many paramedics take personal offense when outsiders refer to them as EMTs. It’s understandable to a point, but when your official title or the titles used by the federal government begin your level with “EMT,” then it’s understandable that the public will refer to you as an EMT.

On a side note to the discussion of EMT-Bs, up until July 2010, an EMT-B in California was really an EMT-I (roman numeral 1). However, that just adds an extra layer to the confusion because is an EMT-I an EMT-1 or EMT-Intermediate?

Ambulance Driver/Ambulance Attendant So, since the public can’t refer to EMS providers as “EMTs” or “paramedics” (and we can’t honestly think that they should be aware of and able to recognize the myriad of state specific levels (yes, it’s a Wikipedia reference. It’s a Wikipedia reference with 60 sources) ), they resort to referring to more generic job functions than official titles. Unfortunately this too presents as offensive to many of our more delicate members.

What EMS needs is one overarching title for its members. Just as I’m sure most EMS providers who don’t fly understand pilot ratings (certifications) and thinks that all pilots are the same (i.e. all commercial pilots carry the same certifications, all private pilots hold the same certifications), we can’t expect that those outside of EMS keep up with all of our different certifications. We can draw examples from other fields.

Physicians What title do all physicians, regardless of osteopathic or allopathic education and regardless of specialty have in common? The title of “doctor” and “physician.” Your family physicians, trauma surgeons, anesthesiologists, intensivists, OB/GYNs, ENTs, etc are all doctors. You don’t have one specialist complaining that another specialist is being called a doctor. You don’t see specialists complaining about primary care physicians being called a doctor. You don’t even seriously see battles between DOs and MDs anymore.

Police From patrol to the chief, traffic to detectives, K-9 to SWAT. All police officers. The highway patrol aren’t any less of a police officer than state, county, or local police. Are the police officers who run the department and haven’t seen the inside of a patrol car in a decade somehow unworthy of being called “officer” because of it? Are police officers assigned to jail details now unclean and unworthy of being called a police officer because of where they work? Alternative, can they all rightfully claim to be a “police officer.”

Fire fighters Chief to building inspectors to fire medics to the newest fire fighter. All, in the end, fire fighters. [insert same arguments as above, no need to waste space and time].

If EMS wants to be taken seriously and be given credit when credit is due, then we need to come up with one overarching, public relations friendly title that is, at the least, palatable to all members. As long as we have providers who are serious about playing the “Don’t call me that” game, we will continue to be the red-headed step child in comparison to the other health care or public safety fields (since we can’t decide whether we are health care or public safety). We can’t expect credit, and subsequent public support and funding that comes with it if we can’t even decide on one title to represent all of us.

About Joe Paczkowski

I am an EMT and a second year medical student at Western University of Health Sciences, College of Osteopathic Medicine of the Pacific (COMP).
This entry was posted in EMS Levels and tagged , , , , , , , , , . Bookmark the permalink.

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