While I realize that emergency responders have existed throughout history (Tell Me the Old Stories), I acknowledge that EMS as a formal profession is relatively new. The field is experiencing growing pains—some would even say it’s in crisis. In this new world of capnography, clotting agents, and community paramedics, we are confronted with new challenges and problems.
A wise man once said, ‘there is nothing new under the sun.’ If we feel we are in a new place, we need to pause and look around. EMS personnel often compare themselves with nurses, envying the pay, the work conditions, and the professional development. What we often fail to see is just how similar EMS is with nursing, and how much we can learn from their development.
A wise man once said, ‘there is nothing new under the sun.’ If we feel we are in a new place, we need to pause and look around. EMS personnel often compare themselves with nurses, envying the pay, the work conditions, and the professional development. What we often fail to see is just how similar EMS is with nursing, and how much we can learn from their development.
EARLY DEVELOPMENT
Both nursing and EMS had precursors of willing folks in the community who served those in medical need. Nurses began to organize in the early 1800s, specifically with the formation of the Nurse Society in Philadelphia in 1835. These organizations focused on the needs of providers at the time, primarily those who served women in childbirth and private duty nursing.
EMS also had such a time. By the turn of the 20th century, there had been a smattering of ambulance service, rescue squads, or transport teams, many involved in battlefield casualty removal. Organizations began to focus on developing the area of rapid transport and treatment, and in 1910, the Red Cross First Aid department was formed.
FIRST STEPS
Florence Nightingale’s influence upon early nursing cannot be overstated. Her work in Crimea and elsewhere formed the definitive foundation for modern nursing. As her movement spread, many schools were established. These schools had no accreditation or oversight, and quality varied widely. The War Between the States drove a need for nurses, and this momentum was maintained long after the War. Large hospital-based programs developed, such as Belleview, New Haven, and Massachusetts General.
If Nightingale was the impetus for modern nursing, the White Paper was the initiator of EMS. Just as nursing first began with informal classes, so did EMS. The Korean and Vietnam Wars increased the need for medics and led to advancements. This development continued in the years following the wars with the creation and expansion of large EMS systems.
GOVERNMENT INVOLVEMENT
As nursing grew, the need for regulation became more apparent. The Nurse Registration Act passed in 1903. Professional organizations began to develop, and diploma programs were offered, most, but not all, requiring two years of training.
To continue the parallel, the National EMS Act was passed in 1973. The National Association of EMTs was formed in 1975, and diploma programs for the street-to-paramedic skill level require approximately two years of training.
GROWING PAINS
The two World Wars added much to nursing not only in terms of skill advancement but also in diversification. At the end of the war and on into the 50s, nursing failed to keep up with other fields economically. There were complaints of ‘few financial rewards’ and ‘poor working conditions.’ One of the primary internal debates was over nursing education, specifically whether a diploma or a degree was necessary for an entry-level nurse.
For those of us in EMS, this reflects our present state. Technological advances, both in the military and private sectors, have led to increased skills and diversification, from SWAT medics to community paramedics. Who hasn’t heard someone grouse about the pay, the schedule, or the working conditions? And one of our biggest debates is whether a paramedic should have a degree.
This is where the similarities between EMS and nursing end. EMS is younger; nursing has had more time to grow. Considering the similarities thus far, it would be wise to see how nurses solved their problems. Our solutions may be different, but perhaps we aren’t walking in the dark after all.
NURSING STABILIZES
The education debate stabilized in the latter part of the 20th century—the two-year degree for an entry-level RN became standard. This stabilized income vis a vis other professions and was considered a great success.
Once again, technology advanced further, and more diversification and training was needed. Because the baseline nurse had an accredited, two-year degree, nursing had a stable foundation on which to grow. Bachelor of Science in Nursing degrees became more common, and Clinical Nurse Specialist and Advanced Practice Nursing came into being.
It bears repeating.
Both income improvement and further field development grew from the profession-wide acceptance of a two-year degree entry level baseline.
THE FUTURE OF EMS
As our debate over paramedic education rages, technology and field development presses for our diversification. Just as in nursing, this development cannot occur efficiently without a stable platform. Standardization builds unification. Currently, there is little or no financial incentive to warrant a degree. Requiring a degree, however harsh that may seem, not only creates a significant financial incentive, but provides for easy comparison with other professions. This allows salaries to be balanced by the marketplace. Nursing had to realize this in order to progress, and EMS, too, must recognize this reality. With a two-year degree base, educational funding sources increase, and the trade school stigma is lost, pulling in more academically-prepared students. Two-year degrees can be transferred to four-year institutions which allows for the development of Bachelor-, Master-, and Doctorate-level prehospital education.
POTENTIAL The nursing example can provide a framework for our brainstorming. The positions that have developed in that field can show us the nuts and bolts of how upper-level skill sets can be handled. Prehospital evolutionary niches, if you will.
Just as BSNs provide management skills and serve in supervisory roles in hospitals, doctors' offices, and skilled nursing facilities, BSPs could provide the same for public and private EMS services, transport services, and community health outreach programs. Clinical Nurse Specialists receive additional training in specific areas (critical care, etc.)—EMS already attempts to mirror this with critical care paramedics, biotechnology support specialists, disaster planning, etc. Advanced Practice Nurses are currently being considered for inclusion in some community paramedic services. Why should we look to nursing for advanced practice needs? How much better to have someone come up through the ranks of EMS to fill that role.
CONCLUSION
EMS is at juncture, but there is much to be learned from other professions that are further along in development. We should not be copycats, but we should not reject the growth of others as completely inapplicable. If we can learn from their successes and implement them ourselves, we can advance the field and develop that much more rapidly.
