Again in this study, similar to the original "Sowing the SEEDS," the percentage of students with college education was a notable finding. Almost 9 of every 10 EMT-P students had at least some higher education. This raises several questions and has immediate implications for EMS educators. Are students leaving college to pursue careers in EMS because they were not previously aware of it as an option, or are students leaving college because it is not a good match for them and their career aspirations? Programs may need to consider recruitment strategies in the high school population in order to give the students career information early on. Also, if the college setting is not working, what should EMS programs be changing to better meet the academic needs of their students?
STUDENTS AND THEIR CLASSES
Although it was not a strong focus of our study, we wanted to ask a couple of questions to try to determine why students were signing up for paramedic classes (Table 2). The vast majority (92%) responding said they had voluntarily enrolled in paramedic school; the other 8% were required by their employers. In our previous study, we addressed a trend in the Loyola system of many students enrolling in EMT-B programs as a requirement for fire department jobs. Our current study is in contrast with our previous findings, as most EMT-P students identified with being a paramedic as opposed to a firefighter.
When assessing current students, it is imperative to realize that 88% of respondents plan on working while in paramedic school. Often paramedic school is a full-time commitment, averaging about a year to complete. Combining the commitments of a paramedic program and a job can be challenging for students. Are coordinators designing their curricula to accommodate students' already overloaded schedules? Should more part-time program options be explored? The goal should be to set up programs to help students succeed, and not set them up for failure with unrealistic expectations. In our current survey results, 10% of students were returning after leaving programs, and 52% of those who left paramedic programs withdrew for personal reasons or time issues, not for academics. Also adding to time-management challenges is that almost one-third of the students were traveling significant distances every day to class (greater than 20 miles). One positive component is that 65% of the students working during paramedic school planned on working in the medical/fire setting, which can enhance their learning and promote better job performance.
EMPLOYMENT GOALS AND EXPECTATIONS
What students will do after successful graduation must be something EMS educators explore with their students. It should be an interactive process that allows for discussion and feedback. We are not doing the field any service by simply graduating students who are unfamiliar with the EMS field or job opportunities available to them. Table 3 summarizes our findings concerning students' employment expectations. Consistent with the EMT-B survey findings, a large number of students planned on pursuing higher education or additional certifications after receiving their EMT-P licenses. The largest percentage of EMT-P students, 68%, planned on obtaining licensure as critical care paramedics. Interestingly, this license is not recognized by many states or the NREMT. Are these students hoping to gain employment in aeromedical programs or with critical transports on the private side? If so, an issue that arises is that these highly specialized jobs are often location-dependent--they can require relocation and prior clinical experience. Do these students plan on working for a time as paramedics, or are they looking at the license as a stepping stone? Or are they attracted to other healthcare jobs for potentially greater incomes and advancement opportunities? Again this underscores the importance of EMS instructors educating students about their profession and gaining greater understanding of their students' perceptions and expectations.
Concerning future employment, 38% of paramedic students planned on working at fire departments where they were currently employed, and 44% planned on waiting until completion of their programs to start looking for paramedic jobs. Only 11% were currently looking for paramedic jobs. A large number (82%) of students hoped to work in the fire service. However, research has shown that most employed EMT-Bs/paramedics are found in the private ambulance industry (40%), followed by local government (30%) and hospitals (20%).3 Employment with a fire service can be quite difficult to come by. If it's not obtained prior to the start of EMT-P class, fire departments may not be hiring immediately after its completion, which can lead to a period of unemployment for students. Finding employment is often location-dependent, and it can be a lengthy and time-consuming process to get on a fire department. As stated in "Sowing the SEEDS," it is likely that a higher percentage of paramedic graduates will ultimately work for private companies for some period of time.