As I travel the country and talk to volunteer organizations, I always try to discuss the EMS Agenda for the Future, including the EMS Scope of Practice, Core Content and Educational Standards. I continue to be amazed by how many organizations, both paid and volunteer, have no clue of what_s coming and how the profession is going to be affected. At a recent conference with 150 attendees,I asked how many people had even heard
of the EMS Educational Standards andfewer than 10 raised their hands. When peoplehave heard of the standards, which have been accepted by NHTSA, there are lots of questions.
Q & A
The first question I get: What are the new levels? The Scope of Practice and Educational Standards lay out four levels: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced-EMT (A-EMT), and Paramedic. Although some are upset with the increased educational requirements, especially at the EMT level, standardizing EMS provider levels in the U.S. is the first step toward a cohesive, professional EMS structure. Unfortunately, volunteer departments may be the most impacted by the loss of multiple EMT-I levels.
The second question people ask: When are these changes going to unfold? Unfortunately, this question is harder to answer. The Educational Standards have been submitted to NHTSA and accepted. Now, it_s up to individual states to take the next step. In speaking with state officials, I think the speed of adoption will most likely range from as soon as possible to as slow as possible. It may be that the National Registry of EMTs (NREMT) will end uppushing this issue. NREMT has already stated that they_ll require accreditation of paramedic programs (another component of the EMS Agenda) as of Dec. 31, 2012, for testing. Even if you_re not currently in a National Registry state, national certification is part of the agenda, and the availability of tests may drive state acceptance. Volunteer departments need to prepare for this.
The third question is a bit difficult: What will be the minimum staffing levels on an ambulance? After doing a bit of researchand talking to some key players, I_m not sure this area has been fully addressed yet. Minimum staffing levels may be up toindividual states, but this would defeat the purpose of having a national infrastructure. It also doesn_t make sense to have each department make up their own rules.
Take hospitals for example. A Level 1 Trauma Center on the East Coast has the same minimum staffing as one in the Midwest, South or on the West Coast. Each facility may have specialties, but a universal minimum standard in training must be met.
The scope of practice of individual EMS providers will be standardized with this agenda, so shouldn_t the requirements for ambulance staffing also be? Right now, some ambulances on the road have two paramedics and others have a "CPR driver" and an EMT. Logic might lead us to believe that all ALS is better than BLS, but where_s the data to show what the nationwide minimum should be? What levels are sustainable across the country, in every state and every community, both paid and volunteer?
The Potential Future
I_m going to go out on a limb and imagine that the minimum staffing level will be one EMR and one EMT for a BLS unit and one EMT and one paramedic for an ALS unit. For some states, it would mean lowering staffing standards, while for others, it would mean raising staffing standards. Volunteer organizations may struggle to make the transition from CPR drivers to EMRs, but it_ll be worth it to finally be unified.
In either case (BLS or ALS), the provider with the highest level of training would be responsible for patient care and, therefore, be in the back of the ambulance. The EMR provider would probably need additional training in emergency vehicle operations, but this wouldn_t be much different than the training CPR drivers currently require. And an EMT on an ALS unit would probably need supplementary training in assisting a paramedic as is often done in the field now.
There will always be regional variations in EMS systems, but we need to all agree to basic standards nationwide. Volunteers need to be held to the same standards as paid departments, and everyone needs to have the same level of service when they call 9-1-1. It_s OK for you to disagree with parts of the system, but once it_s set, we all need to follow it.
Find out more about the agenda atwww.ems.gov.And, if you still have questions, read "From Fragmentation to Unity" in September 2008JEMS at jems.com/journal.
Jason Zigmont,MA, NREMT-P, is an EMS instructor, executive director of the Center for Public Safety Education and the founder ofVolunteerFD.org. He_s also a PhD candidate in adult learning at the University of Connecticut.
Learn more from Jason Zigmont at the EMS Today Conference & Expo, March 2Ï6 in Baltimore.