Q&A: Kevin Mackey shares the impetus behind NREMT Resolution 22-13
The NREMT Chair gives a behind-the-scenes look at the comment period and talks transparency
It’s been the subject on the tip of the EMS tongue for the last two months and has been an issue that drove many to their keyboards, generating comments and an explosion of social media. At its June meeting, NREMT proposed a resolution to explore the potential for expanding the eligibility requirements for certification. The resolution would update the eligibility criteria for all levels (EMR, EMT, AEMT and paramedic) to include successful completion of an EMS education program that meets or exceeds the National Emergency Medical Services Education Standards and has been awarded CAAHEP accreditation, or been issued a CoAEMSP "Letter of Review," or has received state EMS office approval. In the eyes of many, this lit the blue touch paper and ignited an explosion of comments.
At the conclusion of the 60-day comment period and receipt of a record, setting perspectives, questions and concerns, the National Registry Board of Directors, at its special meeting on August 17, voted to rescind the resolution.
With the ink still wet on the NREMT announcement of Resolution 22-13, I joined my Prodigy EMS coworker, Hilary Gates, in recording an important edition of our EMS Educator Podcast with the National Registry of EMTs Chairperson, Kevin Mackey, MD, FACEP; Executive Director, Bill Seifarth; and Prodigy Medical Director and brand new NREMT Board Member, Maia Dorsett, MD.
Together, we addressed the events of the past 90 days. Here, find more on the discussion with Kevin Mackey. The full broadcast can be accessed here.
Q: What was the impetus for this proposal?
Kevin Mackey, MD, FACEP: “Toward the end of 2021, the board became aware of an escalation of conversations at many different levels – most of them at states, some of them with leadership though other organizations that were being met with challenges – and some of those conversations were around accreditation and the challenges of accreditation. I think a lot of folks who saw this resolution come through thought it was about the workforce and then there were also some organizations and some states who were challenged with the exam. They say sometimes our exam is too hard and we create a barrier for people to enter into the workforce. So those were where the conversations started toward the end of 2021, and then they became a little bit more focused as we came into the spring of this year, with, several states that were having active legislation being considered to remove the requirement for national certification from their states and they were getting a lot of pressure put on them by well-meaning legislators, who were thinking that this was the right path forward.
“That pressure continued to climb through the end of the spring and the conversation became much more about accreditation, and so our (NREMT) executive committee met face-to-face with the executive committee of CoAEMSP and had conversations about the challenges with accreditation and challenges we were having because the two organizations are tightly aligned. So as we left that meeting at the beginning of May, we knew that we would need to do more fact finding and ask more questions, and the plan was to take it through the summer and into the fall and have more collaborative conversations with our partner organizations. That's the way the National Registry's operated since I've been on the board and that's a good path forward – collaboration and discussion is very important, especially when we're going make a decision that can impact the entire nation.
“Fast forward a couple of weeks into the beginning of June, and legislation had successfully passed in at least one state, and the important thing about this is there was also money, real money behind it to remove the requirement for a national certification and that stepped up the conversation to a very feverish pace.
“In our board room in June, we had a two-day conversation. We talked about this one topic for two days, which took up 90% of our board meeting that we had slated. We felt like the pace was too rapid and we didn't have the luxury to wait to have the collaborative conversations, which we normally would have; that we needed to act.
“What the resolution was designed to do was to put a stop-gap measure for a state to use that would ensure the safety of the citizens that they serve, because if you sit for a non-validated, non-scientifically backed examination, you really don't know what you are getting when you call 911 – you get a paramedic that took an examination that may or may not have been scientifically validated and is not reliable and scientifically defensible.
“So, we felt that this resolution would provide a stop-gap measure for those states, kind of an emergency state. It needed to be decided now, but we also knew that we have a 60-day public comment period. That is what that 60-day public comment is for, for us to listen to our stakeholders and the folks who we work with and alongside for the betterment of EMS in our country, and we were dependent on that 60-day period for them to voice to us, how does this create challenges, who supports it, who doesn't support it. And the messages came through loud and clear.
“That's a very long answer to a very short question, but that tells the nation how we got there, why did the National Registry not do their normal collaborative process, what was the emergency that we weren't seeing – and if you're not in that boardroom, it looks like we acted really haphazard and totally irresponsible, but I hope after hearing that explanation, they understand that we were actually acting on behalf of those EMS providers.”
Q: What did you take away from the comment period?
Mackey: “Well, the loud and clear message was the value that our country and our EMS community places on accreditation and on a standard for a person who graduates from a paramedic program. That is the loudest message that came through and the big ‘ah-ha’ moment was accreditation is important and our country feels that way.
“There were a thousand comments, and it was not unanimous, however, the interesting and most telling thing is that save for one national organization, all other national organizations were entirely against this. They said that this is not safe (the resolution as proposed) and this is not the right direction for EMS for the future.”
Q: What about accreditation and competency?
Mackey: “This is a message to just, not only the educators, but also the employers out there. We've been talking a lot about minimum entry level competency, but we've thrown the word competency around a lot, and I think that employers equate competency to ‘I'm going to throw you the keys to the ambulance and go out and run a bunch of calls,’ and, and there's nothing that could be further from the truth.
“When a person graduates from a paramedic program, as educators know, they take our examination and they pass our examination, now they're nationally certified: there's still work to be done to introduce that person to the role of EMS – you can't just throw that person in an ambulance with a less experienced EMT and say, good luck – because the product that you get may not be what you'd hope for. Competency does mean that you pass an examination, that you have the knowledge, skills and abilities to perform the job, but there's still work to be done.”
Q: Do we have enough paramedics?
Mackey: “We are administering record levels of examinations, so it's not like the numbers of people taking the examination, that are eligible, are suddenly dropping off. They are at record numbers, numbers we've never seen before. So, as you've heard from members of our board, the workforce issue is more of a distribution problem. It's not so much a numbers problem.”
Q: One of our national organizations put out a resolution to challenge you to be more transparent – a big statement – how have you addressed that?
Mackey: “As the chair of the NREMT Governance Committee, I'm convening a meeting in early September to discuss this specific resolution and to look for opportunities for us to increase transparency. I already have a couple of ideas about bringing the national community into the conversation earlier. We have board members who represent organizations who are nominated by organizations, and then we also have liaisons who are invited to all our meetings.
“But how can we get even further ahead of decisions that the board is about to make? And so that we can get input earlier and they can see what's coming from the National Registry earlier. And so we can work on processes to make things happen, that will be easier for everyone.”
Q: As the Chair of the National Registry, what would you like to communicate?
Mackey: “I would like to thank the nation's EMS community for speaking up, for engaging with us in the 60-day public comment period in a respectful way. That gave the board the background, feeling, emotion and the knowledge to make the decision that we needed to make. That was for the betterment of the EMS community. We heard you; we heard you loud. And the great thing that came out of this is a national conversation, a national statement, and we now have a collaborative workforce made of the nation's largest EMS organizations that are fully engaged and are going to begin to work together through not just this issue, but many more.”
Collaborative, collegiate conversation
This summary represents the tip of the conversational iceberg had with not only Kevin Mackey, but also Bill Seifarth and Maia Dorsett, MD. I don’t think the aforementioned iceberg, will in this case sink the ship, but represents a cool way to begin a collaborative, collegiate conversation in which all parties have now laid their cards on the table. We now know, very clearly, who is thinking what and that presents us with an opportunity to move forward. In the words of Kevin Mackey in the NREMT press release, “This resolution started conversations that many have signaled were needed. We are excited to continue that discussion and pursue solutions that best serve the needs of the local to national EMS communities.”
As Churchill said, “This isn’t the beginning of the end, but the end of the beginning.”
Opinion: The NREMT proposal is a step backward for EMS education
“The EMS profession could withstand a weakened CoAEMSP far easier than it could a weakened NREMT accepted by fewer states”