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Readers' Questions on EMS State Education Regulations


Dear Paul,

I have been an EMT instructor for 10 years. I have also been a career EMT for about 15 years. Recently, my state regulators have been discussing a proposition that if you are going to teach EMT or paramedic courses you must work as an EMT or paramedic in a paid or volunteer capacity. Here is the issue: I have recently become disabled and can no longer work in EMS. What is your opinion of this situation?

Best regards;




First of all, I am sorry that your medical condition will not permit you to continue in this line of work. Like you, I would be very upset if this happened to me.

My state, too, requires instructors to be active field providers. I believe that this is in the best interest of the students. It allows instructor to bring "real world" and up-to-date knowledge into the EMS classroom. Clearly, you can be a terrible instructor with or without field experience, but in most professions (PA, nursing, physical therapy, medicine), the instructors are all working clinicians. If EMS is to mature as a profession, we must accept the responsibilities that come with being a profession. That cannot happen if our corps of instructors is not up to the task. Part of the responsibility is having instructors who perform the job and see patients on a regular basis.


Dear Paul,

My state gives its own examinations for EMT, EMT-I and Paramedic. It will recognize the NREMT, but mandates that EMS providers who work in the state take and pass the state exam. Do you believe that all states should use the NREMT as a credentialing exam? If so, why?

Best Regards,



Well, Chuck, I'm sure I am going to get some angry letters, but I believe that the NREMT written and practical exams should be the standard for EMS practitioners no matter what the state or level of provider. (For the purposes of total disclosure, I function as a NREMT representative for the practical exams.) In my opinion, state exams are not subjected to the same level of scrutiny and validation process as those of the registry.

In addition, I believe that most states' EMS bureaus have a vested interest in certifying as many providers as possible. They worry that the NREMT exam "fails" too many people. Properly educated students will have no problem in passing the NREMT written exam, with the operative term being "properly educated." The failure rate on the NREMT exam is a function of the quality of the training programs, not of the exam. Perhaps our training programs need to step up to the plate and do a better job.

The world of 2007 will bring new challenges to EMS, challenges that could not have been anticipated in 1970. These new realities demand better educated EMS personnel, which will require commitment, money and a new vision for what we want our EMS personnel and systems to be able to accomplish. I guess it is easier just to complain about hard exams.


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