Over the next two or three years, you and your EMS colleagues will receive new professional names, knowledge, skills and recertification requirements. Change seems to be inevitable in EMS–and medical care in general. But these new changes that will affect you aren’t new. They are, in fact, 11 years in the making.
The 2000 EMS Education Agenda: A Systems Approach, which was published by the National Highway Traffic Safety Administration, identified necessary changes in EMS. Many organizations and individuals participated in the development of the document, which describes a process to change the EMS education system, and therefore, EMS practice.
Like many other health professions, EMS was developed 30 years ago without a “master-plan” to guide its development and evolution. Although many effective components have emerged over the years, those components developed independently and not necessarily with an interrelationship of the pieces. Diverse EMS stakeholders and state and regional needs have led to inconsistent skills and difficulty of reciprocity from state to state.
The national education system described in the 2000 document followed most other health professions and identified three steps to develop educational materials: 1) the National EMS Core Content, 2) the National EMS Scope of Practice Model and 3) the National EMS Education Standards.
The foundation of the new EMS education system is National EMS Certification and National EMS Education Program Accreditation. All steps are identified in Figure 1, p. 67. You can read the EMS Education Agenda at www.nhtsa.gov/people/injury/ems/FinalEducationAgenda.pdf.
The Scope of Practice Model (SOP) has identified new names for EMS personnel. “First responder” is being changed to “emergency medical responder” or “EMR.” The crafters of the SOP felt that EMS and medical responders have a unique focus at the scene of an emergency but have been lumped into a larger category of “first responder” by the press and lay public.
The SOP group dropped the word “basic” from EMT and determined the level should be referred to solely as “EMT.” Hopefully we’ll no longer hear “I’m just a basic.”
The new level between EMT and paramedic will be referred to as “advanced EMT” or “AEMT,” and EMT-Paramedic will be referred to solely as “paramedic.”
The acronym EMT will no longer be generic for all EMS personnel, but it will be used specifically to refer to that distinct level of certification. Instead of using the generic term EMT to refer to everyone, the words “EMS personnel,” “EMS professionals” or “prehospital care providers” can refer to the group when the specific level of certification isn’t known. Hopefully the term “ambulance drivers” will go away completely.
Updated Knowledge & Skills
The SOP project also identified which skills will be in each level of certification based on evidence available at the time of the project’s development. Because each state identifies its own scope of practice, yours may have variations on this national model.
National education standards were developed after the SOP, so the authors of those standards added updated knowledge that providers in each area will need to know to perform any updated skills, as well as other knowledge they should know to effectively assess and treat patients within their particular scope of practice (see Table 1).
Other course considerations for EMT classes include hospital emergency department time for EMT students with patient assessments and field patient contacts. Additionally, at all levels of EMS education, the instructional resources, instructor qualifications, medical oversight, student evaluation on professional behavior and program effectiveness evaluation needed is specified. AEMTs will also have clinical activities and field experience requirements.
To develop course considerations for paramedic programs would be redundant because they were already done by the EMS community for accreditation. So rather than developing them, the Standards and Guidelines for Accreditation are referenced from the Committee on Accreditation of EMS Professions (COAEMSP).
Transition to the New Standards
The new education standards are less prescriptive than their predecessor, the National Standard Curricula (NSC). Accordingly, hours to deliver a particular course will vary. The goal of the new education standards is to focus on outcomes rather than the time spent achieving them.
Consequently, several elements must be in place before instructors and coordinators start teaching from the education standards. This includes that the state has adopted a scope of practice consistent with the SOP, has defined instructor qualifications that must be met prior to implementing the education standards, has identified a transition process for existing EMS personnel and instructors, and has put adequate text and support materials in place for program delivery and certification based on the education standards.
In 2009, the National Association of State EMS Officials (NASEMSO) published the Gap Analysis Template: A comparison of EMS knowledge and skills to assist the transition and implementation of the national EMS education standards (template), which is available at www.nasemso.org/EMSEducationImplementationPlanning/index.asp. Several states have used the template to identify knowledge and skill areas that may require the transition of existing practitioner to the new models.
Suggested instructor qualifications have also been proposed, and several states are in the process of establishing transition policies and procedures. These transition plans are taking a variety of forms depending on the needs of individual states. Some states may provide a prescribed curriculum at specific practitioner levels, some may adopt proprietary courses by EMS publishers and vendors, some may require practitioners to complete a self-evaluation tool, and some may simply publish a range of clinical education offerings.
Most states are currently considering a grandfathering process for first responder to EMR, EMT-B to EMT and EMT-P to paramedic that won’t include cognitive or practical testing. Less certain is the transition process for Intermediate-85s (I-85s) and Intermediate-99s (I-99s), which are intermediate NSC levels that were released in 1985 and 1999, respectively. The transitions of I-85 to AEMT and I-99 to paramedic are still undergoing evaluation and discussion.
Suggested transition templates are now available at www.nasemso.org/EMSEducation
ImplementationPlanning/Toolkit.asp. These templates identify essential content as well as supplemental content.
Although accreditation benefits the institution, this benefit is secondary to accreditation’s role in student and public protection through an independent, external and objective peer review of institutional and programmatic quality as compared with accepted national standards. At present, EMS is one of only a few allied healthcare professions that doesn’t require its educational programs to be accredited.
The Education Agenda calls for all states to adopt National EMS Certification and National EMS Education Program Accreditation. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) issues the national accreditation to paramedic education programs and CAAHEP’s Committee on Accreditation of Educational Programs for the EMS Professions has made significant progress in assisting paramedic education programs to achieve accreditation through their many outreach efforts since 2009.
The National Registry of Emergency Medical Technicians (NREMT) established a target date of 2013 for paramedics applying for National EMS Certification to have graduated from a nationally accredited education program. NASEMSO acknowledges and supports the announcement by the NREMT to add an eligibility requirement for paramedic testing, effective Dec. 31, 2012.
The NREMT move toward programmatic accreditation is in response to the Education Agenda and affects certain candidates who haven’t successfully completed national certification testing by the deadline and those entering paramedic programs after Jan. 1, 2013. It won’t affect currently licensed paramedics and has no effect on recertification of paramedics. Only students who have yet to be trained will be affected by the 2013 NREMT requirement beginning. There’s no coordinated or national attempt to establish entry-level academic requirements for EMS practitioners, although many individuals have voluntarily elected to seek this level of education.
Supporting the Profession
It’s anticipated that National EMS Certification will standardize testing across the country and optimize EMS opportunities for career mobility. It will help ensure entry-level competency, lessen the burden of interstate reciprocity and eliminate legal barriers to EMS practitioners crossing state lines, which has been a source of frustration for providers in these areas for years.
Many locally and state-created certification exams don’t adhere to the American Psychological Association’s Standards for Educational and Psychological Testing, which is used by other allied healthcare professions. So the Education Agenda calls for national EMS certification to be conducted by a single, independent national agency under the leadership of a board of directors with multi-disciplinary representation.
In 2003, the NREMT received accreditation of all five levels of exams from the National Commission for Certifying Agencies, a certification accrediting agency sponsored by the National Organization for Competency Assurance. This is indicative of the NREMT’s commitment to the professional certification process. Currently, 46 state EMS regulatory agencies use one or more of the NREMT examinations. This may include use of a single-level examination or exams for all levels of EMS providers. NREMT exams are developed by a multidisciplinary group of experts with input from various EMS-related organizations. Each level of examination is validated on a continuous basis and many states issue licenses based on the results of NREMT exams.
The Bottom Line
Several references describe the components of a true profession. The most common of these qualities are autonomy, collegiality, commitment, education, service orientation and special skills and knowledge. The majority of states are moving in the direction of implementing the Education Agenda to support a model of professional practice, but they need your support to make it happen.
EMS practitioners and future candidates play a role in this effort. Existing practitioners can volunteer to serve on advisory committees to assist their states in implementation. They can function as ambassadors for quality education and professional practice models by supporting EMS program accreditation and national EMS certification.
Individuals considering a career in EMS should expect nothing less than an environment with adequate resources conducive to learning, competent educators and a curriculum based on national standards. CAAHEP accreditation is one way a program can demonstrate this commitment level. Finally, communities must learn that quality EMS care depends on the support of all citizens and that a high level of public support directly correlates to the number of lives saved. JEMS
This article originally appeared in September 2011 JEMS as “EMS Education Agenda: Changes that will affect you.”
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