Administration and Leadership

National Registry Evolution Builds Momentum


NREMT Executive Director Bill Seifarth.
Since its founding in 1970, the National Registry of EMTs (NREMT) has offered the nation assurance that the men and women providing emergency treatment in the out-of-hospital setting are capable of providing the care that patients and their loved ones deserve. Following the interim direction of Drew Dawson, the NREMT named Bill Seifarth as its new executive director in August 2018. An EMS industry veteran, Seifarth brings more than 20 years of experience to the position, including leadership at both the state and federal levels, along with a background of managing several comprehensive certification programs.

Additionally, Seifarth spent 13 years with the Maryland Institute for Emergency Medical Services Systems where he had statewide oversight of the education and licensing of EMS personnel in Maryland, as well as supported the Atlantic EMS Council in developing education and certification resources.

Seifarth holds both a Master of Science and Bachelor of Science degree in Emergency Health Services from the University of Maryland, Baltimore County.

Q: You’re taking over the reins of an organization that’s been around for nearly 50 years. What’s your vision for the next half-century of the NREMT?

A: First, it is an honor and a privilege to be named the Executive Director of the National Registry. This is an amazing opportunity with awesome responsibilities. I am energized about what the future holds for the Registry and the EMS profession.

We are first and foremost a certification organization. Our primary mission is to protect the public by certifying that EMS personnel are competent not only on entry but throughout his or her career. So that we can more precisely measure competency throughout an EMS professional’s career, the Registry embraces innovation, best practices and the latest scientific advances.

Collaboration is also important to our organization and our mission. We’ll forge new partnerships while strengthening existing ones, working hand-in-hand with state officials, national EMS organizations, EMS educators, EMS training officers, EMS operational programs, medical directors, employers, elected officials and many others.

Finally, I want to elevate our customer service to a new level. Responsiveness to questions, concerns and feedback is paramount for organizations such as ours. This includes continuing to build examinations that reflect today’s EMS practice, strengthening our internal operations to handle the needs of our constituents quickly and effectively, and building value to the EMS profession through national certification.

Q: How do you see the Registry adopting to new technology?

A: As the next generation of EMTs and paramedics enter the profession, we recognize that the traditional mechanisms we’ve used to communicate—email, websites optimized for computers, and phone calls—need to evolve. The Generation Z workforce, and their millennial predecessors, prefer to access information on mobile devices vs. computers, and they communicate by text messaging vs. email. Earlier this year, the National Registry released our first iOS mobile application, and 40,000 registrants are already using it. We are planning to release our first Android application soon.

Our commitment to technology goes beyond mobile applications. The National Registry recently started a multiyear project to improve and modernize our comprehensive technology platform. For example, registrants can now directly import CAPCE course records into their National Registry transcript and recertification application. In the fall, we implemented a new customer service system that allows our team to better respond to emails and phone calls.

Q: How does having nationally certified clinicians benefit EMS services and communities?

A: Over the past five decades, the National Registry has protected the public by ensuring that EMS personnel are competent. EMS services and communities in every state and territory depend on the National Registry, benefitting from the psychometrically sound and legally defensible approach to assessing competency. Today, over 400,000 EMS personnel are currently certified by the National Registry.

Research is another service provided by the National Registry. The Registry has contributed to EMS for many years by researching and publishing on a broad range of topics. The benefit to EMS services and communities is that this research helps to advance our profession. Working in partnership with state EMS officials, EMS educators, medical directors, and others in the EMS profession, we provide tools that ensure the public is protected, and we provide EMS-related research to advance and benefit EMS services and communities. 

Q: Generally, it’s state governments that regulate the licensing of EMS personnel. What is the role of national certification?

A: State EMS offices have the legal responsibility and authority for issuing a license to practice in their state, and they are ultimately responsible for protecting the public. However, the National Registry partners with states, helping them carry out their duties by certifying and determining competency of EMS professionals. We have more than 50 staff and experts in the assessment and certification industry. Hand in hand, we protect the public and advance the standards of the EMS profession.

Independent national certification is a common model for health care professionals, including physicians and nurses. The certification organization provides an important part of the profession, in partnership with state licensing agencies.

Q: After two decades in EMS, you spent the last several years at an organization that credentials healthcare professionals in ultrasound. What can EMS learn from its healthcare colleagues about certification and continuing education?

A: It’s always wise to learn from others and to institute best practices. The National Registry can learn from other certification organizations just as fellow certification organizations can learn from us.

One exciting thing to explore is how we can more fully embrace technology and innovation. Both of those lead to thinking outside the conventional box, especially as it pertains to the measure of competency. One of my favorite examples of innovation is with simulation. Specifically, computer-based simulation offers an effective method to assess critical decision-making abilities. A potential example for EMS involves the use of computer-based simulation in which the EMS professional or student can interact on the screen and make decisions as to scene safety, assessment, treatment and transport.

Other cutting-edge technology currently used by other certification organizations allow for the assessment of isolated skills using an interactive console. For EMS, this could translate to a computerized monitor and defibrillator that can be used to assess dynamic cardiology skills. Such options could allow for “fun,” yet precise, assessment without the common challenges of subjectivity and inter-rater reliability. Taking into consideration the advancements and best practices of other certification organizations will allow the National Registry to progressively offer relevant assessments and ultimately better achieve our mission of protecting the public. Of course, any change or introduction of new methods of assessment will not take place until there is a buy-in from stakeholders and approval by the National Registry Board of Directors.

Q: Why do the exams seem so difficult?

A: It’s common to hear from folks that our tests are the hardest exams they’ve ever taken in their lives or career. And, in some respects, it is intended to be just that because we measure competency to the individual’s capabilities. Using an exam that adapts to the individual to test to the limits of the candidate’s abilities is more efficient and allows a much shorter test while also being more accurate.

If a candidate takes a question [item] and they get it correct, the computer algorithm serves them more difficult items until they answer an item incorrectly; then it gives the candidate easier questions. The National Registry—for our EMR, EMT and paramedic cognitive examinations—is testing the individual to his or her ability using computer adaptive testing (CAT).

The CAT exam asks questions in the various domains and continues to ask questions until there is a confident determination of competence or not. The CAT process tests to an individual’s abilities, hence the common notion that the National Registry is one of the hardest exams a person will ever take. The National Registry uses this format to minimize the amount of time needed to test each candidate and to reduce test administration costs.

Q: How are the exams actually created?

A: National Registry brings together subject matter experts, including EMRs, EMTs, AEMTs, paramedics, medical directors, educators, and state EMS officials to write and review questions. We have procedures to review, pilot test and analyze the test questions before they become part of an exam.

The examinations are written by EMS professionals for EMS professionals. Passing scores and standards are determined by EMS professionals, not by the National Registry staff. The EMS professionals writing and reviewing items, as well as setting the passing standards for exams come from a variety of backgrounds and programs. We strive to ensure that all groups of subject matter experts are representative of the EMS profession we serve.

Finally, we invite everyone to become part of that process. It is valuable to see how test development works, but it is equally valuable to say that you had a role in developing the exams. Please visit volunteer.nremt.org to sign-up and help us write the future together.