In 2000, the National Highway Transportation Safety Administration, in conjunction with a task force representing EMS providers, regulators and educators, released a seminal document, the “EMS Education Agenda for the Future.” The Education Agenda set out a vision for how paramedics, EMTs and first responders should be trained and what skills they should have; it also called for the national certification of responders and national standards for EMS training programs.
Twelve years have passed since the document was published. So on March 28, about 50 stakeholders representing the major EMS organizations and the federal government met in Washington, D.C., for a daylong meeting convened by the National EMS Advisory Council (NEMSAC) to discuss the status of the Education Agenda. How close has EMS come to accomplishing its goals? Is the Agenda still useful, or is it in need of revision?
According to those who attended, there is wide agreement that it’s had a positive effect. “In the ’80s and ’90s, we talked about being able to have the same professionalism as nurses or other allied health professions, and that we ought to be able to do these things that give us that recognition,” says Debra Cason, program director for the EMS Education Program at University of Texas Southwestern Medical Center in Dallas. “We are moving in that direction, and it’s very exciting … if you’ve lived through the last 10 to 12 years, you may think it’s going slowly, but there are tremendous changes going on. We really have gained momentum, and there are people who are moving toward seeing the entire Agenda implemented.”
Among the changes: States have largely adopted three of the major Agenda components—National EMS Core Content, Scope of Practice Model, and Education Standards, all of which have helped to standardize what EMS professionals are able to do from state to state. Before 2000, for example, there were 47 different descriptions in state statutes of what an EMT-intermediate could do, Cason says. Under the Scope of Practice Model, there is now a more consistent expectation of an EMT-I’s minimum skills.
An increasing number of states also support the accreditation of EMS educational programs and the national certification of EMS professionals, an issue that has taken on more urgency recently. As of Jan. 1, 2013, the National Registry exam will require that paramedics graduate from accredited training programs in order to become Registry certified. It’s about time, according to many in EMS.
“Most other allied health programs or specialties function that way,” Cason says. “You can’t take the national exams unless you’ve gone to an accredited program.”
Meeting highlights
During the meeting, there was widespread agreement among stakeholders that revisiting the document makes sense, as scope of practice and educational standards need to be updated to reflect new equipment and new evidence about what makes a difference in the prehospital environment. “Not only have we seen many major technical changes in communications and gear, we’ve seen many changes in the medical field,” says Lori Moore-Merrell, assistant to the general president of the International Association of Firefighters (IAFF). “Older documents need to be reassessed to see if they’re still relevant. And it’s not just the document itself—the implementation also needs to be evaluated for where there are obstacles, and where there might have been adverse impacts or things that had not been anticipated.”
At the meeting, Kathy Robinson, program manager for the National Association of State EMS Officials (NASEMSO), presented the second NASEMSO Education Agenda Implementation Survey, which tracks states’ progress in adopting the Agenda’s recommendations. Three-quarters of states (74 percent) will require paramedic program accreditation by 2013; 81 percent reported they will do so by 2018. That’s up from 30 percent of states in 2007, Robinson says.
Of the states that won’t be ready by January, only a few, including Illinois, indicated they plan to continue to allow accreditation of EMS training programs to remain optional. Other states have said they need more time because of economic or legislative challenges. Michigan, for example, says it’s on track to require paramedic program accreditation by 2018, while Arizona says it has to revise state statutes before it can do so.
“If I had to give a ballpark on where the nation is in implementing the EMS Education Agenda for the Future, I’d say we’re 75 percent there,” Robinson says. “By and large, most states are going to implement the Scope of Practice Model at the EMT and paramedic levels. Most states are going to require EMS program accreditation at the paramedic level, and most states are going to use the National Registry exam for state licensure at the EMT, advanced EMT and paramedic level.”
Along with other stakeholders, Robinson reaffirmed her organization’s support for accrediting EMS training programs, which will allow EMS professionals to more easily move across state lines, put the profession more on par with the other allied health professions, and make it easier to ensure that paramedics are learning best practices and new evidence-based treatments or procedures that can help patients. Accreditation may also enable some EMS programs, such as those at community colleges, to advocate for more resources to ensure they have high-quality instructors and the right equipment, she says.
But not everyone at the meeting is supportive of the accreditation requirement. Moore-Merrell of the IAFF says some fire departments, which operate their own EMS training programs and cover the costs for employees or recruits, are under intense budget pressure and don’t have the resources to bring their programs into compliance with accreditation requirements. Several major fire departments, including those in Phoenix and San Antonio, have said they won’t make the deadline, she adds.
“When the economic crisis hit in 2008, that changed the game a little bit. Our municipalities are struggling to keep people operating on the street, to answer all the calls that come in,” Moore-Merrell says. “It’s caused some fire departments to reassess their priorities. In good times we would focus on these items of quality education, but when bad times hit, we have to focus on getting enough resources on the street to make the calls.” (Not all of the fire chiefs in the audience agree with that position, Moore-Merrell acknowledges.)
About 350 paramedic training programs are currently accredited in the United States, and about 100 more have indicated they will seek accreditation, Robinson says. Because the accrediting organization—the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions—won’t be able to get to all of those schools by the Jan. 1 deadline, there’s an interim step in place that will allow the schools to submit certain documentation and receive conditional accreditation, she says.
What’s next for the Agenda?
NEMSAC’s Education and Workforce committee will summarize what was discussed at the meeting and formulate questions that should be addressed, says Drew Dawson, director of NHTSA’s Office of Emergency Medical Services. Those questions were to be presented at the NEMSAC meeting from May 30–31.
“NHTSA has not made a decision about revising the Agenda,” Dawson says. “Instead, we are asking NEMSAC and the EMS community to begin thinking about what a revision may eventually look like and what it might include, without impeding the great progress that so many states are making in improving their EMS education systems.”
Either way, Robinson says, meetings such as the one in Washington are important for keeping the EMS community thinking about what it does and where it wants to go. “An enormous amount of progress has been made in the last five years, and that all comes from a lot of groups and a lot of disciplines working together,” she says. “The document alone isn’t as important as the ongoing discussions. Is it going to make a difference in patient care? If you believe in education, and I do, I think implementing the Education Agenda is critical.”
For more on the EMS Education Agenda for the Future, visit nasemso.org/EMSEducationImplementationPlanning/index.asp.
Choose the Toolkit link, then EMS Education Agenda: What You Needto Know About Implementation.
