Talking Points

• Jun 2, 2009

Talking Points for the EMS Education Agenda for the Future-A Systems Approach

States license EMS personnel and EMS agencies as a means of ensuring public health and safety. The public should have access to practitioners who practice safely and competently. Because of this common and important function, the National Association of State EMS Officials (NASEMSO) has taken the lead in coordinating implementation of theEMS Education Agenda for the Future: A Systems Approach (Education Agenda) developed with support from the National Highway Traffic Safety Administration (NHTSA) and the Emergency Medical Services for Children (EMS-C) program at the Health Resources Services Administration (HRSA). This document will assist state EMS officials and others describe the components of the Education Agenda.

Education Agenda-- Background and Components

• The Education Agenda was developed at the request of the NASEMSO following the release of the 1996 EMS Agenda for the Future.
• The Education Agenda is intended to promote quality and consistency among all EMS education programs and establish common entry level requirements for the licensure of various levels of EMS providers throughout the nation.
• Although there are currently many different certification models for EMS practitioners, the Education Agenda is intended to provide the national framework for EMS Education Program Accreditation and certification leading to state licensure.
• EMS stakeholders who participated in the development of the Education Agenda believed that:
  • An established national EMS education system would align EMS with other health professions and enhance the professional credibility of EMS practitioners.
  • National EMS Education Standards (Education Standards) should replace the National Standard Curricula (NSC) in order to increase instructor flexibility and provide a greater ability to adapt to local needs and resources.
  • Education Standards would permit the introduction of new technologies and evidence- based medicine without requiring a full revision of the entire program of education.
  • A national Education Agenda would assist states in standardizing provider levels across the Nation affording ease of reciprocity and greater opportunities for career growth in EMS.
  • EMS scope of practice should be based on evidence, including practice analysis and research of what does and doesn’t work in the field.
  • National EMS Certification standardizes entry level competency and supports EMS career mobility.
• The Education Agenda includes five components:
  • National EMS Core Content
  • National EMS Scope of Practice Model
  • National EMS Education Standards
  • National EMS Education Program Accreditation
  • National EMS Certification
• Presently, the Core Content, Scope of Practice Model, and the Education Standards are completed.
• While compliance with the Education Agenda is voluntary, NASEMSO believes it will provide career mobility for individuals who seek reciprocity among the states, assure consistent quality and content, and enhance the image of the profession.
• NASEMSO is prepared to collaborate with national EMS stakeholders and Federal partners to find solutions to the challenges states may face in implementing the Education Agenda.
• View the Education Agenda at www.ems.gov.

The National EMS Core Content

• The Core Content defines the entire domain of EMS practice.
• The Core Content serves as the basis for the National EMS Scope of Practice Model.
• The Core Content was created with primary leadership from EMS physicians and it is now available at www.ems.gov.

The National EMS Scope of Practice Model

• Scope of practice is a legal description of what a licensed person can and cannot do.
• The Scope of Practice Model defines minimum practitioner and skill levels that can be used as a benchmark for State licensure based on national certification.
• Each state has the authority and responsibility to establish the scopes of practice for their state.
• Scope of practice is not a clinical description of what should be done or how it should be done. These elements are a combined function of education and medical direction.
• The model describes a progression of knowledge and skills among levels of EMS personnel. It was based on best available research, expert consensus, and multiple national reviews.
• The Scope of Practice Model promotes consistency among the states and serves as a national foundation for EMS practice. States maintain the autonomy to consider unique local needs when creating their own scopes of practice based on the Model.
• Standardized EMS practitioner titles will help improve the public’s understanding of the EMS levels of care.
• The Scope of Practice Model describes a national standard that can be used to facilitate reciprocity when practitioners are called upon to participate in interstate mutual aid activities that support a wide area disaster response under the National Incident Management System (NIMS).
• The Scope of Practice Model was developed with primary leadership from NASEMSO using a multidisciplinary nationwide stakeholder process and it is now available at www.ems.gov.

The National EMS Education Standards

• Education standards are commonly used in the health professions to guide program personnel in making appropriate decisions about classroom materials. By adopting the Education Standards, educators and educational institutions assume a greater role in the content and quality of their instruction.
• Education standards are used by publishers to develop instructional material.
• The Education Standards identify the depth and breadth of content and provide minimal terminal educational objectives for each provider level. They are designed to increase EMS education program flexibility, and encourage creativity, while improving and facilitating alternative delivery methods.
• By their very nature, the Education Standards will:
  • be less prescriptive than the NSC.
  • be more flexible and easier to update based on evolving scientific evidence.
  • enable educators to develop curricula that comply with state regulation.
  • better meet the individual needs of learners.

National EMS Education Program Accreditation

• The primary purpose of program accreditation is student and public protection. This is achieved by providing an independent, external, objective peer-review of institutional and/or programmatic quality as compared with accepted national standards. Although accreditation benefits the institution, this is secondary to its role in student and public protection. As in other professions, the accrediting agency helps identify opportunities for improvement from an outside perspective which helps to eliminate potential local and political bias.
• At the present time, EMS is the only allied health care profession that does not require its educational programs to be accredited. If the EMS professions are to ever enjoy the stability, respect, and benefits of being considered an allied health care profession, we must strive to meet nationally established standards of adult medical education.
• The accreditation process for educational programs is similar in concept to the trauma center verification/designation process or the review and accreditation process for ground and air ambulance services. It is designed to support a philosophy of ongoing improvements within a program that will ensure the highest quality education for EMS professionals throughout the country.
• The Education Agenda calls for a phased approach to a single National EMS Education Program Accreditation agency.
• The Commission on Accreditation of Allied Health Education Programs (CAAHEP) is the parent organization of the Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP). CAAHEP is a non-profit, non-governmental agency, which reviews and accredits over 2000 educational programs in twenty (20) allied health science occupations and is the largest medical accrediting agency in the US. Their standards are relatively broad since they apply to all types of allied health programs throughout the United States. CAAHEP issues accreditation to Paramedic education programs, based on the review and recommendation of the CoAEMSP.
• Individual state laws, rules and requirements remain the central authority for who is authorized to provide EMS education in each state. States are free to establish or retain an approval process or course delivery that may be provided by an accredited educational program. The CAAHEP accreditation process is designed to supplement and support state EMS offices in providing clear guidelines and standards for delivering education. The CAAHEP process is not designed for discipline or enforcement. Individual states may have more specific requirements, or implement standards related to specific issues in their locale.
• NASEMSO remains committed to a smooth phasing in of paramedic education program accreditation and promises open communications with EMS stakeholders related to how this vision can best be accomplished. EMS is at a defining moment in its history and the move toward educational program accreditation is a necessary step.

National EMS Certification

• 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.
• 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.
• Verifying entry level competency through testing is one step leading to licensure of EMS practitioners by states. State governments then use national certification as one component of their licensing process.
• In the EMS profession, state government sometimes assumes the responsibility for certifying individuals as competent to practice based upon either locally developed, state-developed or contractor developed examinations resulting in testing inconsistencies across the country. Without a single national certification process to determine entry level competence, there is significant variability in competency among persons entering the profession. Because of these inconsistencies, reciprocity based upon standardized entry level competencies has been difficult to achieve.
• Many locally and state-created certification examinations do not adhere to the standards established by the American Psychological Association’s (APA) Standards for Educational and Psychological Testing utilized by other allied health care professions.
• In 2003, the NREMT received accreditation of all five levels of exams from the National Commission for Certifying Agencies (NCCC), a certification accrediting agency sponsored by the National Organization for Competency Assurance (NOCA) and is indicative of their commitment to professional certification process.
• Currently, 46 state EMS regulatory agencies use one or more of the National Registry of Emergency Medical Technicians (NREMT) examinations. This may include use of a single-level examination or the use of their examinations for all levels of EMS providers. NREMT examinations 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.