Definitively the Ultimate Pre-hospital Advancement (DUPA)


For years US EMS has struggled to come to terms with the realization that EMS outside of the US, rather than a bunch of vocational laborers paid to drive people around in trucks for minimal pay, are educated and professional providers of out of hospital care which has a measurable impact on the lives and health of their patients.

In many nations this takes on the form of a degree, by which policy makers and the general public gauge the economic and social value of its members.

In contrast US EMS providers and their various bodies, such as their testing organization, NREMT, their (permit me to be generous) “professional” organization NAEMT, and even educational curriculum designers, and numerous other organizations have not only resisted requiring university level education, but actively take steps to make sure attaining professional status is inhibited all the while making money making providers feel like they have obtained some level of demonstrable knowledge. They even celebrate this abbreviated education and knowledge by handing out cards demonstrating capability.

We all know the cards, BLS, ACLS, PALS, ITLS, PHTLS, NRP, AMLS, BBLS, ABLS, BDLS, and on and on.

The government not wanting to mandate education concurrent with the responsibilities of EMS providers as well as the sensibilities of other first responders such as fire fighters even develops their own “training” in the form of NIMS, et. al., also choosing “add on” certification classes composing of mere weeks or even hours of “education.”

Most of this “education” is at a level so basic it is almost intuitive. At the very least it could be done in far fewer hours than is being allocated and advertised. But it all has 1 thing in common. It does not confer a degree. You know, those things that come with a couple of letters that society values. That policy makers respect. That little piece of paper that forces employers to pay more when everyone is required to have it. It comes with letters like MD, DO, RN, BSN, RRT, PA, BS, BA, MA, MS, PhD, DsC. etc.

The hours of many if not all of these classes are not even transferable towards this elusive piece of paper. It reminds me of the scene in the Wizard of Oz, where the wizard is giving out his promised payment for the broomstick of the wicked witch. When he is tasked with giving the scarecrow his brains, he announces, that the scarecrow has no fewer brains than other great thinkers, but lacks a diploma. If you are involved with US EMS, that scene pretty much describes the root of all of your struggles.

But you can go to any social networking site, online publication, print publication, etc. and listen to providers get insulted over being called “ambulance drivers.” You can see them preach about how they are “professionals”, “educated”, “responsible”, and all manner of adjectives and accolades demonstrating their value and importance. As my 5 year old would say “blah, blah, blah…”

The aforementioned courses are not only accepted by providers, they are celebrated. Most of them require you to fork over some money to “stay current”, despite most of them adding nothing new, or so little, that practice is often changed before their guidelines are.

They must be great for people who have ADHD, a few days of utterly disconcerted information that gets you a little gold sticker, er…I mean card, certification, whatever. But I wonder, is the knowledge and or skill really perishable? If it is and requires recert so often, it must mean those certified are not using the information. Logically, if you constantly perform a skill, it should not deteriorate. In fact, it should get better!

Proponents of such “education” are quick to point out that this information, no matter how basic and required for even basic job performance, are effectively disseminated. That’s nice; I could send it out in an email and reach more people more effectively. These proponents are effectively “tricking” people into believing they received some form of useful or even valuable education.

A great example is AMLS. “Advanced Medical Life Support.” As a Physician I was never required to take such a class. However, it took years of both classroom study and practical education in order to provide medical care and life support. But after a quick 2 day course, I could have gotten a basic outline, show everyone my card, and advertise myself as an “advanced medical life support” provider. Of course any knowledgeable professional like a Doctor would instantly dismiss my credential as at best ignorant and at worst with malice. After all, what could you possibly learn in 2 days with no base of knowledge it is expanding on?

Some claim these classes are often “the best education” or classes they have ever had. Compared to what? Similar courses? Initial training? Sitting around with your coworkers and friends drinking beer and talking shop?

But as the old saying goes “if you can’t beat’em, join ‘em.” So I will be developing a class. It will be “taught” over 2 days. In a bar, casino, or strip club. We will drink and engage in a group discussion (we’ll call it collaborative adult education in order make it sound legitimate) about studies, basic science such as anatomy, our experiences, and opinions. We’ll ask a few philosophical questions, eat, joke around, and go back to our respective hotels for “private” study time. At the end of the 2 days, we will officially hand out DUPA cards. This card will be good for 2 years and unlike course completion cards, will officially certify you as meeting all the requirements of being a complete DUPA. I assure you, it will be one of the best classes you ever take, but unfortunately it will not confer a degree just like all the other ones and you will probably look forward to doing it again after your card expires in order to stay current in your knowledge. Instructor courses will also be available for an extra fee. Make sure to put that at the top of your resume, LinkedIn, etc.. In fact, use it as pre or post nominals. Show off your new knowledge and skill by making sure it is on your name badge in giant letters.

For those who do not speak Polish, under no circumstance are you to put this title in google translate.


5 thoughts on “Definitively the Ultimate Pre-hospital Advancement (DUPA)

  1. Remi

    I have made this argument many times, though never with such eloquence or wit. Perfectly stated.

    The “alphabet soup” has gotten much worse in recent years. There are seemingly more “Critical Care Paramedics” (a large majority of whom have never even been in an ICU) around these days than there are ICU nurses and RRT’s and intensivist physicians combined.

    “Primary Care Paramedic” is next…..

  2. Micheal H. McCabe

    Sign me up, I need a few more letters to overload the local “credentialing” process.

    You bet your DUPA!

    Micheal H. McCabe, BA, MS, EMT-P, AFA, CPR, ACLS, DPMA, FACAG (I made up the last one… “Fellow – American College of Amateur Gynecology.”)

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