This debate is presented by the Perspectives Section of the International Journal of Paramedicine (IJOP). The proposition for this debate is that an associate degree should be required for entry level paramedics. The transcript of this debate was published in the Perspective Section of our January-March 2026 (#13) issue, which can be accessed here: https://internationaljournalofparamedicine.com/index.php/ijop/article/view/3543

On the team arguing FOR the proposition: - Sean Caffrey, MBA, FACPE, NRP - Gregg Margolis, PhD - Mike Thomas, DrPH, MHA, EMT-B, FACPE - John Todaro, BA, NRP, RN, TNS, NCEE, CHSE, CHSOS On the team arguing AGAINST the proposition: - Louis Imperatrice, NRP - Edward Bauter, MBA, MHL, FP-C, CCP-C, NRP

The debate was hosted and moderated by Editor-In-Chief, Mic Gunderson, EMT-P (Ret.), FAEMS. The debate was organized by Perspectives' Section Editor, Edward "Ted" Lee, EdD, NRP.

References

The members of the debate team were asked to provide citations for work that that they may have referred to in their presentations as well as other references that would be important to be aware of on this topic. This is a partial list of the references included in the debate article in the Journal.

Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. *Medical Care, 49*(12), 1047–1053. [https://doi.org/10.1097/MLR.0b013e3182330b6e](https://doi.org/10.1097/MLR.0b013e3182330b6e) American Association of Colleges of Nursing. (2025, June 1). *Degree completion programs for registered nurses: RN to master's degree and RN to baccalaureate programs.* [https://www.aacnnursing.org/news-data/fact-sheets/degree-completion-programs-for-rns](https://www.aacnnursing.org/news-data/fact-sheets/degree-completion-programs-for-rns) Aston-Mourney, K., McLeod, J., Rivera, L. R., McNeill, B. A., & Baldi, D. L. (2022). Prior degree and academic performance in medical school: Evidence for prioritising health students and moving away from a biomedical science-focused entry stream. *BMC Medical Education, 22*(1), Article 768. [https://doi.org/10.1186/s12909-022-03768-y](https://doi.org/10.1186/s12909-022-03768-y) Ball, M., Powell, J. R., Gage, C. B., Kapalo, K. A., Kurth, J. D., Collard, L., Miller, M. G., & Panchal, A. R. (2023). Paramedic educational program attrition accounts for significant loss of potential EMS workforce. *Journal of the American College of Emergency Physicians Open, 4*(2), e12917. [https://doi.org/10.1002/emp2.12917](https://doi.org/10.1002/emp2.12917) Ball, M. T., Powell, J. R., Collard, L., York, D. K., & Panchal, A. R. (2022). Administrative and educational characteristics of paramedic programs in the United States. *Prehospital and Disaster Medicine, 37*(2), 1–5. [https://doi.org/10.1017/S1049023X22000115](https://doi.org/10.1017/S1049023X22000115) Bureau of Labor Statistics. (2024, August 29). *EMTs and paramedics.* U.S. Department of Labor. [https://www.bls.gov/ooh/healthcare/emts-and-paramedics.htm](https://www.bls.gov/ooh/healthcare/emts-and-paramedics.htm) Caffrey, S. M., Barnes, L. C., & Olvera, D. J. (2019). Joint position statement on degree requirements for paramedics. *Prehospital Emergency Care, 23*(3), 434–437. [https://doi.org/10.1080/10903127.2018.1519006](https://doi.org/10.1080/10903127.2018.1519006) CAAHEP. (2015). *Standards and guidelines for the accreditation of educational programs in the emergency medical services professions.* [https://emsa.ca.gov/wp-content/uploads/sites/71/2019/07/CAAHEP-Standards-and-Guidelines-for-the-Accreditation-of-Educational-Programs-in-the-Emergency-Medical-Services-Professions-2015.pdf](https://emsa.ca.gov/wp-content/uploads/sites/71/2019/07/CAAHEP-Standards-and-Guidelines-for-the-Accreditation-of-Educational-Programs-in-the-Emergency-Medical-Services-Professions-2015.pdf) Cary, R. R., Geller, J. E., Rallo, M. S., Teichman, A. L., Englert, Z. P., Pierre, P., Murphy, T., Falcon, L., Narayan, M., & Choron, R. L. (2024). Implementation of an education module to improve emergency medical service provider accuracy and confidence in trauma triage. *Journal of Surgical Research, 303*, 241–247. [https://doi.org/10.1016/j.jss.2024.09.014](https://doi.org/10.1016/j.jss.2024.09.014) Questions and Comments You are invited to ask questions and make comments in response to the debate in NEMSMA's online discussion group at: https://groups.google.com/g/nemsma/. Look for the messages with the subject line: [IJOP 3543] DEBATE: An Associate Degree Should be Required for All Entry Level Paramedics. Perspectives Section Editors Edward "Ted" Lee, EdD, NRP – Event Lead Albert Bouwer-Monroy, MS-1, NRP, FP-C Elizabeth Lacy, MPS, BS, Paramedic Christopher Suprun, BS, NRP, FP-C Michael Thomas, DrPH, MHA, EMT-B, FACPE

International Journal of Paramedicine website: https://InternationalJournalOfParamedicine.com

International Journal of Paramedicine's Editor-In-Chief, Mic Gunderson, interviews lead author, Chelsey N. Torgerson, PhD, about the manuscript entitled, "Mental Health Symptoms, Stressors, and Coping: An Exploration of First Responder Experiences Working in Rural, Suburban, and Urban Areas." It appeared in the July-September 2025 (#11) issue. Manuscript Link https://internationaljournalofparamedicine.com/index.php/ijop/article/view/3131 Manuscript Discussion Thread You are invited to ask question and make comments about this paper on the NEMSMA listserv. Access and join the NEMSMA discussion group at: https://groups.google.com/g/nemsma/. Look for the message thread starting with [IJOP 3131] and make your voice as a paramedicine professional heard. Abstract EMS first responders provide essential services to communities in rural, suburban, and urban locations across the United States. While the mental health experiences of first responders have been generalized across all geographic locations, less is known about the mental health differences among rural, suburban, and urban first responders. This study explored mental health symptom profiles, job stressors, coping mechanisms, and mental health resource availability of 118 first responders providing services in rural, suburban, and urban locations throughout Oregon. First responder agencies across Oregon were contacted by researchers and asked to distribute the electronic survey. First responders who received a survey link volunteered to anonymously participate in the study. Findings indicate common challenges as well as unique differences among first responders in different geographic locations. First, mental health profiles of the participants were provided. Symptoms of depression, generalized anxiety, suicidal ideation, PTSD, and bipolar disorder were present in participants. Depression, generalized anxiety, and PTSD was more evident in first responders in urban/suburban areas, while risk of suicide was more prevalent in rural first responders. Second, three primary themes of stressors were identified (along with a fourth "other" category): 1) larger societal stressors impacting first responders; 2) job-related stressors; mental health, relational, and 3) financial stressors from being a first responder. Sub-categories within themes ranged from organizational, patient-related, and position-specific stressors to financial, intrapersonal, and interpersonal stressors. Two themes of stress management were identified: function/ purpose of coping strategies and coping strategies without an identified function/purpose. Suggestions, from respondents and authors, for EMS agencies are provided throughout. Future research is outlined. International Journal of Paramedicine website: https://InternationalJournalOfParamedicine.com

This podcast interviews co-author Siyaphera Makunganya, MSc, about the manuscript entitled, " Strengthening EMS in Malawi: Piloting World Health Organization Basic Emergency Care for Prehospital Providers in Zomba, Malawi." It appeared in the July-September 2025 (#11) issue of the International Journal of Paramedicine (IJOP). The interview was conducted by IJOP's Editor-In-Chief, Mic Gunderson. Manuscript Link: https://internationaljournalofparamedicine.com/index.php/ijop/article/view/3231 Questions and Comments You are invited to ask questions and make comments about this and other papers in NEMSMA's online discussion group at: https://groups.google.com/g/nemsma/. Look for the messages with the [IJOP 3231] header. Abstract Background - Malawi has no country-wide emergency medical services, with prehospital care majorly provided by laypersons, with transport of patients typically provided by private car or taxi and less than 2% of emergency patients receiving transport by ambulance. Zomba Private Ambulances is currently the only private ambulance group operating in south-eastern Malawi. Despite not having formal prehospital provider education in Malawi, Zomba Private Ambulances makes use of mid-level care practitioners, nurses, and first-aid-only providers to provide prehospital care. This study examined the use of an existing emergency training course to educate prehospital providers in Zomba, Malawi. Methodology - This study used a pilot study, consisting of an educational intervention trial conducted in Zomba, Malawi. Prehospital providers from Zomba Private Ambulances underwent training in WHO Basic Emergency Care including lectures and skills workshops led by an emergency medicine registrar. Participants completed a pre- and post-course survey and assessment measuring demographic information and knowledge and confidence of basic emergency skills. Results - 9 total prehospital providers underwent training, consisting of nurses, mid-levels, and providers with first-aid-only. Overall confidence increased significantly after completing the course (83.3 to 96.8% confidence). Knowledge retention varied across participant training levels (post-course scores being: mid-levels 80%, nurses 73%, and first-aid-only 42.6%). Overall, providers displayed increased knowledge post-course, however, post-course knowledge varied amongst domains (e.g., trauma, altered mental status, shock). Barriers to training were identified including lack of transport, other occupational responsibilities, and lack of understanding of course applicability for first-aid-only providers. Conclusion - Using education tools such as WHO BEC assists in the knowledge and confidence of prehospital providers in Malawi. Further studies are required to assess the retention of knowledge and effective use in the field. Additional training should be more easily accessible to improve prehospital triage in Malawi. The expansion of prehospital care in Malawi should utilize contextually relevant training. International Journal of Paramedicine website: https://InternationalJournalOfParamedicine.com

This podcast interviews lead author Raphael Barishansky, DrPH, about the editorial entitled, " Ambulance deserts: A critical challenge for EMS leadership in achieving equitable emergency care access." It appeared in the July-September 2025 (#11) issue of the International Journal of Paramedicine (IJOP). The interview was conducted by IJOP's Editor-In-Chief, Mic Gunderson. Manuscript Link: https://internationaljournalofparamedicine.com/index.php/ijop/article/view/3414 Questions and Comments You are invited to ask questions and make comments about this and other papers in NEMSMA's online discussion group at: https://groups.google.com/g/nemsma/. Look for the messages with the [IJOP 3414] header. Abstract The growing prevalence of ambulance deserts—geographic areas where residents live more than 25 minutes from the nearest ambulance station—poses a critical threat to health equity and public safety in the United States. Rooted in systemic underinvestment, workforce shortages, and fragmented policies, these deserts disproportionately affect rural and underserved communities, where response times can exceed 30 to 60 minutes during life-threatening emergencies. This paper examines the structural determinants of ambulance deserts, including the lack of statutory recognition of EMS as an essential service, outdated reimbursement models, and the absence of coordinated sustainability planning. Drawing on two decades of leadership experience across EMS, public health, and government, the author outlines five strategic actions for EMS leaders: securing essential service designation, advancing statewide sustainability plans, advocating for readiness-based funding, expanding Medicaid reimbursement pathways, and strengthening the EMS workforce. The paper also explores global parallels, offering key lessons for international health and emergency systems. Ultimately, ambulance deserts must be reframed as a public health emergency requiring bold leadership, integrated policy reform, and sustained public investment. EMS leaders are uniquely positioned to drive this transformation—if they act decisively and strategically. International Journal of Paramedicine website: https://InternationalJournalOfParamedicine.com

This podcast interviews lead author Peter O'Meara, PhD about the manuscript entitled, " Integrating community paramedicine topics into degree-level paramedic education programs: a strategic-pragmatic approach " It appeared in the July-September 2025 (#11) issue of the International Journal of Paramedicine (IJOP). The interview was conducted by IJOP's Editor-In-Chief, Mic Gunderson. Manuscript Link: https://internationaljournalofparamedicine.com/index.php/ijop/article/view/3264 Questions and Comments You are invited to ask questions and make comments about this and other papers in NEMSMA's online discussion group at: https://groups.google.com/g/nemsma/. Look for the messages with the [IJOP 3264] header. International Journal of Paramedicine website: https://InternationalJournalOfParamedicine.com

In this podcast, we interview lead author, Zachary Tillett, MD, NRP about the manuscript entitled, "Improving the interfacility transport experience: Development of a mobile delirium/hospice box." It appeared in the July-September 2025 (#11) issue of the International Journal of Paramedicine (IJOP). The interview was conducted by IJOP's Editor-In-Chief, Mic Gunderson. Manuscript Link: https://internationaljournalofparamedicine.com/index.php/ijop/article/view/3290 Questions and Comments You are invited to ask questions and make comments about this and other papers in NEMSMA's online discussion group at: https://groups.google.com/g/nemsma/. Look for the messages with the [IJOP 3290] header. Abstract As the U.S. populace ages, interfacility transport teams face unique challenges in addressing the needs of two rapidly growing patient populations. Both elderly individuals at risk for delirium and those transitioning to comfort-based care, such as hospice are increasingly utilizing interfacility transport resources as the interact with the medical system. Current care modalities for patients are primarily centered on medical stability during transport and do not adequately address aspects such as patient comfort or alignment with goals when a patient is on hospice or at risk for delirum. To address these challenges, a delirium/hospice care box was designed and implemented as part of a high-volume critical care transport program. This box was created to enhance the patient experience by targeting cognitive engagement, comfort, and sensory support. Items included in the box for cognitive engagement consisted of a Bluetooth speaker intended to play music of the patient's choice, fidget toys, sound amplifiers for those who are hard of hearing, and realistic baby dolls for patients with advanced dementia. Comfort and sensory support items included a medical-grade, wipeable weighted blanket, sunglasses, oral care products, essential oils, a clip-on fan, and other items. These were selected based on prior research demonstrating their benefits for this population. The box was funded by a hospital grant and implemented within a busy interfacility transport team at a quaternary care academic center. The goals of the box included enhancing the transport experience, potentially reducing delirium, and aligning the care provided during interfacility transports with the goals of a unique but growing patient population.

This first podcast for the International Journal of Paramedicine features an interview by Rob Lawrence of Mic Gunderson, IJOP Editor-In-Chief. Mic provides the 'backstory' on how he got started in publishing peer-reviewed EMS journals and the origin story for IJOP. Rob then has Mic explain the mechanics of how manuscripts are reviewed and how authors should submit their work to the Journal.

For more information or to read the journal, go to https://internationaljournalofparamedicine.com/index.php/ijop