September 29, 2019
In 2017, the National EMS Advisory Council (NAEMSAC) released an advisory recommending fundamental changes to the nomenclature used in emergency medical services (EMS). Following this advisory, the federal government convened a series of national meetings to discuss this topic. Last week, they released a white paper draft summarizing the results of these meetings. Here’s our breakdown on this important issue.
At a high level, nomenclature change aligns with ongoing efforts to increase professionalism in EMS — something advocates identify as crucial to the evolving industry. However, it also works to perform simple housecleaning in a field plagued with acronyms and a myriad of titles. US standards currently recognize four prehospital provider levels: emergency medical responder (EMR), emergency medical technician (EMT), advanced emergency medical technician (EMT-A), and paramedic (formerly EMT-P). Further confusing the landscape is the overarching term of emergency medical services (EMS).
“This is ____. She is an EMT,” says the layperson. “I’m actually a paramedic,” replies the proud clinician. Cue a confused look from the layperson and anyone in earshot. Complicating the issue further is any attempt at describing the activities performed by EMTs and paramedics. Are they practicing EMS, or do they work in an EMS system, or both? Do EMTs and paramedics perform the same work? What about prehospital nurses? Are they nursing or EMSing? And down the rabbit hole, we go.
Advocates argue ‘paramedic’ and ‘paramedicine’ are more straightforward and professional. If this initiative comes to pass, almost all providers would be paramedics, and they would practice paramedicine despite their environment. Practically speaking the levels would become something like emergency medical responder (EMR), basic care paramedic (formerly EMT), primary care paramedic (currently paramedic), and advanced care paramedic (flight, critical care, and community paramedics).
The white paper does highlight concerns voiced during the meetings regarding the removal of EMS, rescue, and other descriptors from local operations. However, it is crucial to note that renaming clinicians and their work does not mandate changing the names of departments or services — no need to repaint the ambulance or engine just yet.
EMS systems, fire rescue departments, mobile integrated health teams, and so on, are names designed to clarify the environment in which the paramedic works. However, the care rendered in each situation can be best described simply as paramedicine. “I am a paramedic. I practice paramedicine. I work in my local EMS system.”
This change mirrors other healthcare professions, such as nursing and medicine. A cath lab nurse, an ER nurse, and a family practice nurse are all nurses practicing nursing. Similarly, physicians across all specialties are practicing medicine. We call their departments, health systems, and teams various things. But the actors themselves are distinct and clear.
While the proposal has many supporters, both the International Association of Fire Fighters (IAFF) and the International Association of Fire Chiefs (IAFC) stand in opposition. They state that each provider level is distinct and warrants a separate name and that there is little evidence justifying the change. However, it is unclear what kind of evidence would be needed to support the move other than a desire by the industry itself and a clear rationale.
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