Does the average layperson understand the difference between an EMT and a paramedic? Does the term “Emergency Medical Services” describe sufficiently the changing nature of the profession? Does the EMS industry need to explore ways to clarify or redefine its identity?
According to the National EMS Advisory Council (NEMSAC), the nomenclature issue indeed deserves a closer look. After the council sent this advisory to the Department of Transportation (DOT) and to the Federal Interagency Committee on EMS (FICEMS), a stakeholder panel was convened. Numerous organizations were invited to participate, and the first of several meetings was held in Silver Spring, Maryland, on March 5 and 6.
Jon Krohmer, MD, Director of the National Highway Traffic Safety Administration (NHTSA) Office of EMS, encouraged the stakeholder group representatives to fully explore the nomenclature issue over the next 8 months in this and in future meetings.
Krohmer tasked the group to continue the discussion of all issues related to nomenclature of the “EMS” profession and the people who comprise it.
Krohmer added that FICEMS and the DOT are under no obligation to implement recommendations that are put forth by NEMSAC, but stressed that they place a very high value on NEMSAC’s advice.
Facilitator Baxter Larmon, PhD opened the meeting with a high-level review of the history of the industry, asking “What’s in a Name?” Larmon’s long history in EMS gives him a unique view into the changing aspects of the profession, the individual work and the many responsibilities EMS has accepted over the years.
Larmon noted that the 1966 Accidental Death and Disability report didn’t even mention the term “EMT” and that the dictionary definition of the word “technician” includes the phrase “non-professional.” The term “paramedic” came out of an amalgamation of the military word “paratrooper” and the plain term “medic,” according to Larmon. Once it was determined that the new civilian EMS providers would not be jumping out of planes, “para-“ was clarified to mean “beside, beyond, or around.”
Another EMS veteran, Gregg Margolis, PhD, whose 40+ year career in the industry has taken him from volunteer EMT to ski patroller to flight paramedic to program director and professor, among others, emphasized in his presentation to the group the unique role EMS has held over the years.
“What makes us unique?” Margolis asked. “We have a unique relationship with medical direction, we have been physician extenders and we have a big value add: we are 24/7, community-based, mobile, reliable healthcare providers.”
Margolis, who wrote his doctoral dissertation on the topic of requiring bachelor’s degrees for EMS providers, cautioned the group to be careful in discussing the intricacies of what to name the profession, what to call the provider and how to distinguish the various levels of training.
“We need experts in branding, marketing and communications, so that we can be mutually supportive of all of these aspects,” said Margolis.
The group, which consisted of approximately 25 invited stakeholder representatives, had a variety of initial thoughts on the nomenclature issue, including some fear that naming something “paramedicine” will not effectively capture what it is that EMS does.
Marc Gestring, MD, FACS, representing the American College of Surgeons (ACS) Committee on Trauma, wondered about the intention behind the potential name change.
“Are we changing the name to match the profession? Or is the name a new direction for the future of the profession?” he asked.
Other representatives made clear that their organizations had taken stances for or against the renaming of the profession. National EMS Management Association (NEMSMA) representative Mike Touchstone noted that NEMSMA has called for using the term “Paramedicine” to describe the discipline of EMS.
“’Paramedicine’ is the people who are practicing EMS, a name to embody a new practice and an emerging profession,” Touchstone said, emphasizing that the term was not meant to completely replace the use of “EMS.”
The International Association of Fire Chiefs (IAFC) has publicly opposed the name change.
“I don’t think there is a crisis or a huge confusion and how or why it came up, I don’t know,” said IAFC representative David Becker. “I’ve yet to hear a convincing argument that we need to make a broad sweeping change.”
Still others explored the nomenclature regarding specific roles of each provider.
Allen Yee, MD, FACEP, proposed that "'EMS clinicians' include physicians, nurses, paramedics, Advanced EMTs, EMTs, NPs, PAs, and others providing care in the EMS system, while 'paramedicine' is the supervised practice of medicine provided by paramedics, AEMTs, EMTs, EMR."
While no consensus was reached nor expected in the initial meetings, Larmon stressed the importance of taking into account all opinions on the nomenclature issue.
“Your homework is to leave here and contact your groups and organizations to take the temperature and see what they are thinking,” he said.
There will be another in-person meeting in late summer or early fall 2019 as well as a teleconference meeting in June 2019. The matter will also be open for public comment later in the year. Final steps will involve the development of a white paper “that reflects the findings and recommendations resulting from the stakeholder discussions as well as feedback from other members of the EMS community and the public, with the goal of finding common ground,” according to EMS.gov.