In January, NHTSA posted new National EMS Education Standards and new instructional guides for the four new provider levels: Emergency Medical Responder (EMR), EMT, Advanced EMT (AEMT) and Paramedic. (Download them atwww.ems.gov.) And even if you finished your EMT or paramedic courses years ago, this evolution in EMS education will bring changes to your continuing education and your workplace.
"The standards, which represent our transition away from the National Standard EMS Curricula, are part of the EMS Education Agenda for the Future, but the guidelines are only a tool to help get instructors up to speed," says NHTSA EMS Chief Drew Dawson.
The National Association of EMS Educators developed the standards and enlisted 78 volunteers to write the instructor guidelines, says Project Director Deb Cason, RN, MS, EMT-P, director of emergency medical education at the University of Texas Southwestern Medical Center in Dallas. She and the team developed several drafts of the standards, revising them based on feedback from the EMS community.
"The final draft is lots different from the first draft," Cason says. For one thing, the first draft estimated an EMT course would take 180Ï220 hours. By the final draft, that was cut to 150Ï190 hours due to concerns about its impact on volunteers.
"Our next step is building a transition toolkit to convert an [existing] first responder, EMT-basic, EMT-intermediate or paramedic to a new EMR, EMT, AEMT or paramedic," says Vermont EMS Director Dan Manz, leader of the Education Agenda Implementation team, which is representing state directors, training coordinators, medical directors, educators and the National Registry of EMTs (NREMT). The transition challenges are "quite complicated," he says.
"One piece is to get old guys trained as new guys Ú and tell the old guys what the new guys are learning," Manz says. He predicts continuing education and/or refresher courses will address this need.
"The other piece is to get old educators trained to teach the new guys," he says. "Our educators have various degrees of education, so we need various tools to equip them to teach the new standards."
State EMS offices also need tools to transition providers from their current scopes of practice to new scopes of practice, and NREMT "needs answers about how to integrate transition requirements with registration cycles," Manz says. (Cason stresses that the standards represent the "floor" for skills at each provider level, so states and local jurisdictions can add skills. However, the NREMT will test only on skills outlined in the standards.)
Manz said transition deadlines are "fuzzy," but he predicts textbook publishers won_t release resources based on the new standards until mid-2011 so they can also incorporate revised American Heart Association guidelines for CPR and emergency cardiac care, which come out in late 2010.ƒMannie Garza
For more about the new provider levels, read "From Fragmentation to Unity" from September JEMS atjems.com/jems
In 2008, 29 people died in 13 U.S. air-ambulance crashesƒthe most ever in one yearƒprompting the National Transportation Safety Board (NTSB) to hold a four-day public hearing in February on helicopter EMS operations. Air-ambulance services and organizations and public officials presented the NTSB with testimony and documents. (Listen to recordings of the hearingswww.ntsb.gov/Events/Hearing-HEMS/default.htm .)
Three years ago, the NTSB gave the Federal Aviation Administration (FAA) four air-ambulance safety recommendations, stating, "Many of the 55 EMS-related aviation accidents (fatal and non-fatal) that occurred between January 2002 and January 2005 could have been prevented with simple corrective actions, including oversight, flight-risk evaluations, improved dispatch procedures and the incorporation of available technologies."
In response, the FAA promotedvoluntary safety measures. In February, an FAA representative testified that services had voluntarily outfitted 40% of the helicopters with collision-avoidance systems, but only 11% carry flight-data recorders.
As part of the hearings, the Association of Air Medical Services (AAMS), Helicopter Association International and the Air Medical Operator_s Association submitted recommendations that include having the FAA work with provider associations to set timelines for services to provide night-vision goggles or other enhanced vision systems or use instrument flight rules, establish and monitor implementation of "formalized enhanced operational control systems," set standards for flight operation quality assurance programs, and address issues related to "helicopter shopping."
But some people question whether such initiatives go far enough.
"Everyone says they_re for more safety, but many operators want it to be done by self-regulation, which isn_t working," says Gary Wingrove, director of government affairs and strategic planning for the Mayo Clinic_s Gold Cross Ambulance Service (which operates three helicopters). He contends the FAA and the air ambulance industry "have not universally adopted" a single safety recommendation by AAMS or federal agencies, and he supports a bill now in Congress that would allow more state regulation of air ambulances.
"I think most [air ambulance] services are advocates for safety, but when it comes to money, they talk out of both sides of their mouths," says Kathy Robinson, RN, EMT-P, a program advisor with the National Association of State EMS Officials (NASEMSO). A former president of the Emergency Nurses Association, she is married to a flight nurse and has many friends on flight crews. "I_m concerned about their complacency, by their assumption that the risk is just part of the job," Robinson says.
The NTSB will now develop new recommendations for the FAA.ƒMG
Farm rescue EMS training directory atftp://ftp.hrsa.gov/ruralhealth/FarmRescueEMSDirectory.pdf
Names in the News
The National Association of EMS Physicians gave its 2009 Ronald D. Stewart Award toWilliam "Bill" Jermyn, DO, Missouri_s EMS medical director at the time of his death in mid-2008. The NAEMT Keith Neely Outstanding contribution to EMS Award went to former NAEMT PresidentRobert E. O_Connor, MD, MPH, and the Friend of EMS Award went to NHTSA EMS SpecialistSusan McHenry, MS, who was Virginia_s first EMS director. ÚJerry Overton, one of the nation_s best-known EMS leaders, announced Feb. 17 that he would leave his post as chief executive officer of the Richmond (Va.) Ambulance Authority to become president and CEO of Road Safety Inc., maker of the SafeForce system, which provides driver monitoring and feedback to improve ambulance safety.
Paper Ranks Regional DeathRates from Natural Hazards
Susan Cutter, PhD, director of the Hazards and Vulnerability Research Institute at the University of South Carolina, and researcher Kevin Borden have published a paper examining geographic patterns of natural hazard mortality in the U.S. from 1970 to 2004. Some of the findings, such as "greater risk of death along the hurricane coasts," seem intuitive. Other findings are less obvious, most notably that the deadliest natural hazard is heat.
During the study period, only 1.5% of all natural hazard deaths were the result of hurricanes or tropical storms; 19.6% resulted from heat or drought. What the researchers categorize as severe weather (fog, hail, wind, severe storms and thunderstorms) accounted for 18.8% of these deaths. The next largest category is winter weather with 18.1%. Hurricanes make headlines, but EMS is more apt to encounter patients suffering from the effects of heat or cold.
The authors of "Spatial patterns of natural hazards mortality in the United States" say they see their research as a foundation for future studies on disasters in specific areas. "It enables research and emergency management practitioners to examine hazard deaths through a geographic lens," says Cutter.
Ultimately, emergency management professionals could use the specific information for their areas to plan for and be better prepared for the disasters statistically more likely to occur.
The full report appeared on p. 64 of Volume 7 of theInternational Journal of Health Geographics in 2008. It_s available atwww.ij-healthgeographics.com.For more on deadly weather, read "When Lightning Strikes" on p. 36 of this issue of JEMS.ƒAnn-Marie Lindstrom
Training video on Emergency Response Guidebook athttp://phmsa.dot.gov/hazmat/library/erg
In Breif: Sudden Cardiac Arrest Foundation (www.sca-aware.org)begins "You Can Save a Life at School" campaign