Have you ever considered a career in healthcare? Like many in the age of pandemics, aging populations, addictions, and violence – you’ve probably thought about how you can do your part. \But the healthcare industry can be cloaked in mystery when you are trying to start that career – especially if you’re considering a career in emergency medical services.
In this article, you’ll learn how to become a paramedic in Massachusetts successfully, from early level education to paramedic certification and finding a job.
Entry Level Training
Regardless of your motivation, a career in pre-hospital healthcare can be very challenging but also very rewarding. Your career will begin with obtaining a certification in basic life support, cardiopulmonary resuscitation that is, which is typically offered through the American Heart Association or the American Red Cross. The CPR course typically takes 4 to 8 hours to complete.
With your CPR card in hand, you must then attend another course to earn an emergency medical technician certification. This is the entry-level licensure for all emergency medical services professionals and is regulated by the Office of Emergency Medical Services. (Pro Tip: It isn’t called the same thing in every state, but each state does have its own licensing body that provides authorization to practice for emergency medical responders, emergency medical technicians, and paramedics.)
In order to obtain certification as an emergency medical technician, candidates must complete 160-200 hours of instructor led training culminating in a written and psychomotor examination conducted by the National Registry of Emergency Medical Technicians.
The course of instruction covers preparatory topics including medical ethics, legal consideration, and communications systems in public safety as well as clinical topics including basic anatomy and a wide variety of medical and traumatic emergencies and the non-invasive therapies EMTs may use to treat those ailments. Some states and programs also require EMT students to complete 24 to 48 hours of clinical time working in an emergency room and/or ambulance under the supervision of a certified EMT, paramedic, or registered nurse.
There are currently five states that do not require certification by the National Registry of EMT’s for initial licensure: Florida, Illinois, Montana, New York and North Carolina. Whether or not your state requires you to obtain NREMT certification, it’s highly recommended as it offers the best chance at easily obtaining certification in other states by a process called reciprocity.
Paramedic Training in Massachusetts
So you’ve obtained your certification as an emergency medical technician? That’s great—but this article is about paramedics, right?
Indeed, it is.
Once you have earned your license as an emergency medical technician, you can begin to plan for your professional future. Most paramedic educators will recommend, at a minimum, you gain some experience as an EMT prior to attempting the paramedic curriculum. This is because of the gap between EMT education and EMT practice which is a prerequisite for paramedic education.
Paramedic education can be obtained through a few different avenues. Some ambulance agencies provide paramedic training in house. One such company is Transformative Healthcare based out of Woburn, MA. Another option is to complete your training through a private school that specializes in initial training for EMS providers. These schools include the National Medical Education and Training Center. Finally, and most commonly, paramedic students are educated through community colleges and even some universities with the added benefit of graduating with an Associates of Applied Science in Paramedic Technology. These schools include Dean College and Quinsigamond Community College.
Regardless of the type of school you attend, however, it is imperative that they be accredited by the Committee on Accreditation of Educational Programs for the EMS Profession (CoAEMSP). A graduate of a paramedic program that is not accredited, or under a letter of review, from the committee will be unable to sit for the written or psychomotor examination with the National Registry of EMT’s. Schools may have other accreditations, but for examination eligibility the program must have CoAEMSP accreditation. (Pro Tip: Check your chosen school’s CoAEMSP data for attrition, graduation, and NREMT pass rates. This will provide valuable insight into your school of choice.)
Paramedic pre-licensure education is not for the faint of heart. It will challenge you academically, emotionally, and is arguably the most rigorous vocational training available today. During the academic preparation to become a paramedic in Massachusetts, students will study anatomy and physiology, cardiology, pharmacology, and advanced pathophysiology in depth. While the depth of the information learned is not equivalent to a physician, many students often refer to the experience as, “drinking water from a fire hose”. Persistence, and perseverance, are key in the didactic phase of training which typically lasts from twelve to eighteen months.
Following, or in tandem with, the didactic study is a clinical component. During the clinical component, students are given opportunities to demonstrate the skills they’ve been taught under the direct supervision of physicians, nurses, and paramedics duly licensed in their state. Students must complete a minimum of 250 hours of clinical experience in the hospital setting including the emergency room, operating room, and labor and delivery. This is followed by 250 hours of clinical externship, also called “ride time”, on an ambulance under the supervision of a licensed paramedic.
Paramedic School Tips
As previously stated, paramedic school is challenging. According to a 2013 study conducted by CoAEMSP, paramedic school attrition hovers between 30%-40%. There is an immense amount of information packed into the didactic phase of the program. Because of that, students that enter paramedic programs with limited field experience are at a disadvantage in assimilating the information completely.
The best advice for future paramedic students is to gain experience as emergency medical technicians prior to attempting paramedic school. The industry average recommendation is two years of experience – in fact, it used to be a program requirement for most paramedic programs up until the early 2010’s. The reason for the recommendation is that the paramedic curriculum builds upon the student’s previous knowledge, but even more the lessons learned through experience and guidance from other providers while practicing the trade.
All isn’t lost, however – even if you’re a rookie, you can still complete paramedic school and go on to have a successful career. Here’s a few tips to help you get over the finish line:
It is imperative that you get enough sleep! It is just as important as an adult learner as it was as an elementary school student.
If you don’t understand the material – ask for clarification! Too often, students will wait until weeks after a lecture to ask a question about it. Meanwhile, material has been presented that built upon the lecture in question and threatens the student’s understanding of the entire module.
Skills are equally as important as the knowledge. It’s not enough just to know when a particular skill is indicated nor is it enough to just know how to successfully perform an intervention. Don’t skimp on practicing your psychomotor skills when you have the chance. And make sure you’re practicing them correctly!
Students have particular trouble understanding concepts like anatomy and physiology, acid/base balance, and the biochemistry that is taught during paramedic school. Khan Academy has excellent videos on YouTube that many students find helpful. If that’s not quite your learning style, reach out to your instructor(s). Few, if any, will not set aside the time to tutor and coach you toward academic growth.
Inevitably, you’re going to get discouraged at some point. For when that happens, write yourself a note outlining your motivation for paramedic school. Do this on the first day of class. Then set it aside in a safe but accessible place. When you feel discouraged during the process, go back and read it to remind yourself why you started this journey to begin with.
Paramedic Certification in Massachusetts
So, after everything we’ve covered thus far, are there really additional steps on how to become a paramedic in Massachusetts? Indeed there are, as the next step you have to take revolves around certification.
All EMS providers in the Commonwealth of Massachusetts are licensed by the Office of Emergency Medical Services. There are two pathways to obtaining Massachusetts licensure: initial education and reciprocity. Given that Massachusetts is known as a “National Registry” state, both pathways are fairly simple.
After successful completion of a CoAEMSP accredited and Massachusetts approved Paramedic Initial Education program, the student has two years to complete both the NREMT written examination and the NREMT psychomotor examination. After successful completion of both exams, the student will receive notice from the NREMT of their certification. With that certification, newly certified paramedics must apply online via the Office of EMS website for licensure to practice. This process can take one to several weeks.
For paramedics already licensed in another state, the Massachusetts Office of Emergency Medical Services accepts applications for reciprocity. The provider must hold, at a minimum, an active certification from the National Registry of Emergency Medical Technicians at the level they are applying for licensure in Massachusetts. The provider must also provide license verifications from every state the applicant provider has ever been licensed in as an EMS professional. OEMS will not issue the provider’s license without such verification and failure to provide such documentation will delay the process or cause your application to be rejected.
Regardless of the pathway to obtaining licensure, Massachusetts requires paramedics to maintain certification with the National Registry of EMT’s as a condition of ongoing licensure. There are two avenues for recertification. The NCCP continuing education model, which mandates 60 hours of continuing education every two years; 30 hours must meet certain curricula and the remaining 30 are regionally and locally mandated – often left to the individual provider’s interests. Alternatively, providers may elect to recertify by challenging and successfully passing the NREMT certification examination.
International Board of Specialty Certification
Ambitious paramedic providers that seek to specialize in a particular specialty of emergency medical services can seek to obtain certification through the International Board of Specialty Certification (IBSC). Currently, the IBSC recognizes the specialty knowledge of aviation medicine (Flight Paramedic or FP-C), critical care medicine (Critical Care Paramedic or CCP-C), mobile integrated healthcare (Community Paramedic or CP-C), and tactical medicine (Tactical Paramedic or TP-C).
While not typically required outside of the air ambulance industry, certifications from the IBSC are considered prestigious due to the depth and scope of knowledge needed to successfully complete the written examination. Within the air ambulance industry, flight paramedics are typically expected to posses the FP-C certification or obtain it within their first year flying as a condition of employment.
Career Outlook for Paramedics
According to the Bureau of Labor Statistics, the EMS profession will grow 11% between 2020 and 2030 with 261,300 EMT and paramedic jobs and a median pay of $17.62 per hour in 2020. However, that growth in amidst an industry shortage of personnel with most ambulance agencies staffed well below minimal operating capacity which is causing stress on the workforce.
Emergency medical services is an essential profession, despite the lack of legislative mandate to that effect. The job is challenging and sometimes frustrating but also married with a significant sense of accomplishment when you can see the discernible difference you’ve made in someone’s life. And many use emergency medical services as a pathway to advancing in the healthcare industry into nursing professions, other allied health professions, and even to medical school.
While I’d love to offer you a rose-colored lens with which to view the profession, I regret that I cannot do so. This job is certainly important to the community and we make a meaningful impact. However, very few if any ambulance agencies in the United States have adequate staffing translating into significant hours of overtime, provider burnout, and overall substandard pay. Albeit, due to the general workforce shortage in the country today, especially in healthcare, following the worst of the coronavirus pandemic – there may be light at the end of the finance tunnel.
Paramedics don’t only work on ambulances though, as paramedics are finding themselves useful in a wide array of healthcare settings including emergency rooms, urgent care centers, cardiology offices, and can even be found on cruise ships and oil rigs at sea. Not only is the type of care and the setting grossly different than that of an ambulance provider but the pay is also remarkably better and offers a better work/life balance than traditional paramedic positions.
Unlike our firefighter and law enforcement brethren, emergency medical services do not have the robust advancement process as an industry that we see, especially, in the fire service. There is a traditional “ladder” that ambitious providers can climb, but the playbook for climbing that ladder changes from agency to agency as there are no leadership development programs accepted industry wide to prepare for upward growth.
The first rung in the EMS leadership ladder is a field training officer, or FTO. FTO’s are clinically competent providers with a firm understanding of the agency’s operation that indoctrinate new employees and precept students during their clinical ride time. FTO’s in some agencies are offered more leadership experience as “officers in charge” to fill in during the absence of appointed supervisors and, come promotions, are the ones promoted to supervision. Providers considered for FTO are confident, competent providers that have held their license to practice for at least two years and have been with their agency for at least one year, but usually longer.
The second rung has a few different names depending on where you go: shift supervisor, lieutenant, even sergeant in some places. The hallmark of this grade of leadership is that it is the first-line of supervision. That is, these folks are responsible for directly overseeing EMS operations. These providers have varying experience from a year of experience at their practice level to decades with indeterminate tenure with their agency. A strong recommendation for providers eyeing a promotion to this level that have never served in any management position before is to attend any of the leadership development programs recognized by the National EMS Management Association for credentialing.
The third rung is, as you would imagine, middle management. Again, with multiple titles including captain, manager, or field supervisor – these leaders are responsible for overseeing a bigger piece of the puzzle. While still engaged in the daily operations, they are more likely to be found in an office than out on the road even though they are usually required to maintain their licensure at the paramedic level. All EMS leaders at this level, and beyond, should seriously consider attending the Ambulance Service Manager program sponsored by Fitch & Associates.
The fourth rung includes a desk, a salary, and the luxury of business casual attire in many agencies. These managers lead entire departments and hold ranks or titles like director, deputy chief, district chief, or major. For these leaders, the primary focus isn’t necessarily on patient care itself but the different strategies employed to deliver care. If you’re ambitious and like the sound of this position, a bachelor’s degree will be very helpful. Additionally, five to ten years of experience in the ambulance industry with at least four years of supervisory experience will be important to get your resume considered for an interview.
Aside from earning a medical degree and being a medical director for an ambulance service, the fifth and final rung of the leadership ladder is the director or executive staff role. These directors, chiefs, deputy chiefs, and chief (insert title) officers have an impressive tenure in the industry with at least a decade of management experience and hold a master’s degree. They are the ones responsible for the entire “kit and kaboodle.” These managers plan the strategy of the agency, create partnerships with other agencies including governmental entities and healthcare organizations, and ensure compliance with the slew of local, state, and federal statutory mandates placed on ambulance companies.
The world of emergency medical services is a unique world seldom understood by outsiders. So, it makes sense when candidates with an interest in becoming EMTs and paramedics become confused about the process, what it takes, and the sacrifices made to be successful in the industry. It’s overwhelming for many and, frankly, most humans were not built to endure the stressors that emergency medical services providers are faced with on a daily basis – there is no shame that a person is not suited for emergency services.
Emergency medical services isn’t a career suited for everyone. It entails long hours, hours of monotony broken up intermittent, brief, moments of adrenaline and sometimes terror to return to the mundane all over again. The job is unpredictable and no shift is ever the same day twice, which is exciting but also exhausting. That coupled with increasing demands, exposure to communicable disease, and historically low wages has yielded an exodus of providers from the profession.
This profession, though, is also an honor and a privilege to be a part of. EMS providers across the country provide an important lifeline for hundred of thousands of Americans who have no other hope of survival in the event of a medical emergency. For those that can embrace the downsides to the career, we get to assist in the delivery of babies as and witness the beginning of life. And we provide care and compassion as we witness the end of life, sometimes giving the good fight and others as an usher to help the patient great death like an old friend. This profession can often be considered the best and the worst at the same time.
If you’re still interested in knowing more about how to become a paramedic in Massachusetts, you can reach out to your local community college. If they do not offer the EMT and/or paramedic initial education program, they can point you in the right direction. If you have any questions about the process to licensure, you can reach out to the MA Office of Emergency Medical Services or your local EMS Council.
If you’re still interested in becoming a paramedic outside of the Commonwealth of Massachusetts, you can reach out to your local community college for guidance on locating an initial education program. If you have questions about the licensing process, requirements, course accreditation, or eligibility for licensure – reach out to your state’s EMS licensing authority and/or the National Registry of Emergency Medical Technicians for additional support.
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