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Does EMS Need a New Name?

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.

For more info: 

https://www.ems.gov/projects/nomenclature.html

https://www.ems.gov/pdf/nemsac/NEMSAC_Final_Advisory_Changing_Nomenclature_EMS.pdf

 

Working Group members present at the meeting:

EMS for Children Innovation & Improvement Center: Samuel Vance

International Association of Flight & Critical Care Paramedics: Aaron W. Byrd, DHSc, MPA, NRP, FP-C

National Association of EMS Physicians: Alexander Isakov, MD

Association of Air Medical Services (AAMS): Elena Sierra (AAMS Membership Director)

National Association of County & City Health Officials: Christopher Hoff

Academy of International Mobile Health Integration (AIMHI): Douglas Hooten

National Registry of Emergency Medical Technicians (NREMT): Kevin Mackey MD, FAEMS

National Association of Emergency Medical Technicians (NAEMT): Dennis Rowe

International Association of Fire Chiefs (IAFC): David Becker

Commission on Accreditation of Medical Transport Systems (CAMTS): Eileen Frazer

Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP): George W. Hatch Jr., EdD, LP, EMT-P

National Fire Protection Association (NFPA): John Montes

American Ambulance Association (AAA): Joe Robinson

National Association of State EMS Officials (NASEMSO): Kyle L. Thornton, EMT-P, M.S.

American College of Surgeons Committee on Trauma: Mark Gestring, MD, FACS

National EMS Management Association (NEMSMA): Mike Touchstone

National Volunteer Fire Council (NVFC): Ed Mund

Association of Critical Care Transport (ACCT): Roxanne Shanks

Commission on Accreditation of Ambulance Services (CAAS): Sarah McEntee

International Association of Fire Fighters (IAFF): Robert McClintock

National Association of EMS Educators (NAEMSE): Bill Robertson

American Academy of Pediatrics (AAP): Caleb Ward, MD, MB BChir, FAAP

American College of Emergency Physicians (ACEP): Allen Yee, MD, FACEP

International Association of EMS Chiefs (IAEMSC): Peter I. Dworsky

Emergency Nurses Association (ENA): Robert Kramer

Comments

Submitted byflairmedk on 03/08/2019

So continues the debate and growth of EMS as it is currently know. Another one of our stumbling blocks to being a peer respected part of healthcare. I continue to see that we stand at nothing and continue to either change as a fractured group or allow our peers to determine who we are / or named. I do not take a patient to the ambulance or EMS receiving building. Why because a long time ago it was named a hospital and from there it determined what people who worked there may be called. Yes some titles may change over time but some are set in stone and do not change. Why is that? Because people became educated by that profession on what to call that person i.e. doctor. In our young professional we have allowed socioeconomics to drive the type of care that may be provided in a particular location. Therefore, many people only know what they have become accustomed to. If a city, county, etc. cannot afford to have paramedic level response they have whatever level it is for that area. So maybe those areas do not market EMS. Maybe they market the Ambulance Service, Corp or whatever it is they call it. That is a failure of the profession as a whole to market appropriately. We need to market the industry as a whole everywhere. To explain people that go to urgent care do not say that they are going to the mini-hospital. Likewise they don't say I am going to the big urgent care. Why is this? Because of many factors but money spent on advertising are a few examples. As far as what each provider is named in the system, well it almost is a mute point. They are what the industry determines is an appropriate name. Then just as before you market that name that is attached to the larger industry name of our profession. Explaining that role in the big picture. If we could all get on the same page with a set of standards and market that as what and who we are, then problem solved. Stop changing it to fit what other industries think we are, or should be named. We should determine that and educate them and the public. Not saying I'm right. Just my humble observations of 27 years in EMS. Thanks for reading.

Submitted byRschleg2 on 04/11/2019

That is not the origin of the title Paramedic. The apocryphal story used in the article is an unfortunate misconception that when you think about it doesn’t make any sense for why it was used to create the name.

Paramedic is combined from two Latin words, “para” which means beside and medicus which means “physician/doctor”. When you think about what we do the actual origin of what we do makes a lot more sense. If we’re talking about changes titles and nomenclature, I think Paramedic is one that we keep.

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