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The Ambulance Driver's Perspective
by Kelly Grayson

How I'd change EMS continuing education

Groundhog Day movie pretty much describes the current state of EMS continuing education

By Kelly Grayson

In the Columbia Pictures movie Groundhog Day, Bill Murray plays a reluctant, self-centered meteorologist sent to Punxatawney, Pa., to cover the Groundhog Day Festival.

Bill wakes at 6:00 am the next day to the soothing strains of Sonny and Cher singing I Got You Babe, only to discover that it is February 2 all over again.

For the rest of the movie, Bill relives every single moment of February 2 — every encounter, every event, every human interaction — stuck in an endless time loop of which only he is aware, until he finally gets the day right, and the loop is broken.

Which, come to think of it, pretty much describes the current state of EMS continuing education.

Every year around this time, EMTs around the country poke their heads out of their burrows, look at the calendar, and subject their training officers to six more weeks of whining, procrastination and flimsy excuses.

And like Bill Murray's character, we've seen and heard it all before.

Article for publication
What brought this reverie to mind was a colleague who submitted a continuing education article for publication in his state's EMS magazine.

The people responsible for the magazine's content are bureaucrats with little or no background in EMS, so they run every submission past an editorial advisory board of experienced paramedics before publication in the magazine.

And these experienced paramedics had what was, for them at least, a damning critique of my colleague's submission: this article has content we've never seen before.

Um, isn't that the point of continuing education? When did broadening and deepening our knowledge bases give way to boring rehashes of outdated material?

Why is it that we forego examination of cutting edge research and techniques in favor of finding new and exciting ways to apply a traction splint?

Does the fact that something is not in current EMS textbooks make it less relevant to patient care? Most textbooks are written on a five year cycle; by the time a new edition appears, the information in it is already five years old, and work is already well under way for the next revision, five years hence.

Some can be mistakes
Those five years may prove some treatments to be well-supported by current practice and evidence-based medicine, while others turn out to be mistakes we are doomed to inflict on our patients for another five years or more, just because they once appeared in the textbook.
Lost in our professional outrage at stories like the Massachusetts EMT training scandal is an ugly truth: EMS refresher and continuing education is about as relevant to current practice as I Love Lucy reruns are to modern culture, and a good deal less entertaining.

As long as mandatory CEU's and refreshers are as tedious as watching paint dry, there will be a market for phantom classes and pencil-whipped training rosters, and there will be a cadre of unscrupulous EMS instructors willing to exploit that market. The temptation is enormous on both sides.

Every year around this time, I get a flood of panicked phone calls from EMTs begging for continuing education hours or a last-chance refresher, willing to pay exorbitant fees for the hours they need to renew their cards for another two years.
And the sad thing is every class has a handful of participants who would have gladly paid even more if they didn't have to attend at all. They don't want the education, they just want the documentation of the education.

I once attended a reception at an EMS conference, where a NREMT official lamented the current state of continuing education.

He explained that CEU's, as originally envisioned, were supposed to be college credits. EMTs would take biology or life sciences courses at universities or their local community colleges.

They'd pursue classes in an allied health curriculum, broadening and deepening the knowledge they gained in EMT school. They'd actively seek to learn new things, rather than listen to yet another instructor repeat old things, ad nauseum. Yet that’s what many of them do.

Who's to blame?
It's a multi-faceted problem, the blame for which can't be laid at the feet of any single entity. For every apathetic EMT that doesn't take continuing education seriously, there's a state EMS agency that mandates refresher content firmly rooted in the 1980s, and an employer that wants to know, "Hey, you're not gonna raise a stink if a few of our people miss a few hours of their refresher here and there, are you? They'll be there for most of it, wink wink."

Which is the most to blame — provider apathy, hidebound regulatory agencies or employers who turn a blind eye to phantom classes — I couldn’t get the NREMT official drunk enough to offer an honest opinion.

To be fair, it's better than it once was. NREMT, and I presume many other state EMS agencies, readily accept college courses for continuing education credit.

The current NREMT refresher guidelines also allow some flexible content, allowing training officers more leeway in class offerings. Mandated content is increasingly based on regular practice surveys. But it still isn't anywhere close to what it should be.

I don’t pretend to have the answers to the problem, but I do have a few suggestions. When my legion of flying monkeys completes my quest for world domination, here's how I'd change EMS continuing education:

  • Do away with refreshers altogether, or make them optional based on call volume. Members of volunteer agencies who run a handful of EMS calls a year would still have to take some type of refresher. Full-time employees in busy EMS systems would not. We're already halfway there with NREMT's options of refreshing though continuing education hours alone or recertifying through examination. No other health care profession mandates a regular refresher course. It's time we stopped doing it as well.
  • Require a percentage of continuing education hours to be above the provider's current scope of practice. No more would it suffice for a practicing EMT to sit in on an EMT course, while offering snarky commentary like it's an episode of Mystery Science Theater 3000. Make it mandatory that 50 percent of EMT continuing education be at the AEMT level or higher, and half the AEMT continuing education hours would have to be at the paramedic level. Paramedics would have to take some of those college science courses mentioned earlier.
  • Fraud would be punished by revocation of licensure and criminal prosecution. Not censure, or suspension, or probation. Take away their livelihood for a minimum of one certification period for a first offense, and lifetime revocation for subsequent offenses. If the fraud was committed by an in-house training program, revoke the license of the EMS provider agency in question and pursue criminal charges. No longer could training officers and administrators afford to wink at falsified training records and profess shock and dismay only when caught.
  • Relax restrictions on distance education and computer-based content. There are paramedic education programs out there that are almost entirely online, with a solid track record of success. So why is it that we limit continuing education to only 10 hours of computer-based content? Relaxing restrictions on non-traditional forms of continuing education would also encourage more of those college courses mentioned earlier. Most universities and community colleges now offer a substantial portion of their curricula online, making it far easier for non-traditional students to attend college.

Anyway, those are my suggestions. If you had to reform the way we do refreshers and continuing education, how would you go about it?

About the author

Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (, or email him at

The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Dave Gammell Dave Gammell Tuesday, July 23, 2013 10:55:10 PM Most EMS training has been the same for the 30 years I have been involved in EMS. Why is it so hard to think outside the box? We are starting to look at research for the care we give, why not the training we provide? Why don't we look at training in other industries and find out what works for them and why it works. Once we have those answers ask if it will work in EMS. If it might work, let's test it, study it and maybe improve on it. It is time to embrace major changes in EMS education. We need to move away from cookie-cutter skill training and work on critical thinking that will transfer into better assessments, treatments and overall improved care of our patients.
Brad Owens Brad Owens Monday, August 19, 2013 11:51:01 AM I'm a paramedic and I do take those science courses like you suggested. It's great education. Albeit, I intend to be a doctor, but I believe every paramedic would benefit from the eye opening experiences I've had in higher education. I also work in a high call volume, and I think there is benefit to refreshers. There are plenty of things we don't see every year, and it's good to blow the dust off of some of our books; AMLS, ACLS, PEPP, etc... But yes EMS needs to be more like the other healthcare professions and stop the lunacy that is our required education system.
Brad McVicker Brad McVicker Tuesday, August 20, 2013 11:46:27 AM I agree and would also like to see standardized INSTRUCTION !..many teach that are NOT taught instructors..teaching is taught.. a learned art ..not all who know can know what I'm talking about.....

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