The first article in this three-part series explored the general concepts of the new EMS education standards. Detailed content and conceptual differences were highlighted in the second part of the series. In this final installment, we look at how the standards will be implemented and examine some of the issues associated with a physical and philosophical change in EMS education.
After speaking to educators from all corners of the country, their feelings about the new standards might be summed up as cautious optimism. While educators are concerned about the differences in content and concept--in addition to the additional work involved in implementation--few are actually against the new standards. It appears the open process during implementation, combined with the perceived need for a more efficient and professional approach to EMS education, is behind this positive reception of the standards. After presenting workshops around the country to introduce educators to the new standards, I have gathered their most common concerns and broken them down into the following questions:
How will a course taught in one state be similar to one in another state without more detailed content description like in the old curriculum?
The short answer is, in some ways it will be the same and in other ways it will be different--just like it is now. EMT courses in the United States range from 120 hours to over 250 hours. There are significant differences in both scope and course duration in currently existing classes, which in effect makes the lack of declarative less an issue than would appear on initial impression.
As mentioned in previous articles in this series, it is widely considered to be a maturation process where we are using current science (as opposed to outdated curricula) as the basis for EMS training. This not only moves EMS to a more professional model, but one that is more in line with other allied health professions.
The lack of declarative teaching information in the standards creates a void when compared to what instructors are used to receiving. A lesson in the prior curricula may contain literally pages of objectives--something not present in the standards.
Jane Pollock, EMT-P, an EMS instructor in Greenville, NC, explains a dilemma faced by many educators and institutions: "For now, the various state-approved EMS teaching institutions have to develop objectives for their programs to meet the new EMS standards, even though our state has not yet adopted the new standards."
While the education standards offer instructional guidelines to help clarify the standards' intent, it is clear that they are simply and importantly only guidelines. It is also worth noting that the EMT guidelines as initially released contain some content not included in the EMT scope of practice and are somewhat subjective in their interpretation of the depth of material in the standards. The instructional guidelines were envisioned to help educators transition to the new standards. It is not anticipated that they will be revised or continued to other versions of future educations standards.
How will a national examination apply to providers trained in different areas?
Just as we do it now. The National Registry of EMTs does periodic practice analyses of both BLS and ALS providers. For many years, the NREMT exams have not been solely based on the curriculum, but on the skills and knowledge needed by EMS providers to practice on the street. As EMS has evolved, so has the exam. If there has been a significant change in science or the addition or deletion of a modality from the EMS providers' skill set, this is reflected in the examination--even though it goes against the curricula currently in use. Since the curricula were published throughout the 1990s, there have been significant changes in emergency medicine, including significant changes in American Heart Association guidelines, which have all been reflected in the NREMT exams. More than 40 states currently use the NREMT exam at some certification or licensure level.
Will one textbook present the standards dramatically differently than another?
Possibly. There are three main ways textbooks may be different: depth of coverage, scientific interpretation and procedurally.
Depth of coverage: Textbook authors and publishers will interpret the standards differently, which will result in different depth in coverage, such as how much pathophysiology will be covered in each text. The education standards place a significant emphasis on pathophysiology, specifically in the areas of oxygenation, ventilation and perfusion.
Scientific interpretation: Since the education standards rely on analysis of science, textbooks may interpret the literature differently and therefore present different modalities and concepts. Current practice and trends also come into play in this decision. While the extent is yet to be seen in a young profession like EMS, medicine accepts that two internal medicine textbooks may present clinical topics with different interpretations or treatment recommendation. Physicians and other professionals reading this literature evaluate several sources and make a decision on the totality and perceived relevance of the information presented.
The truest issue may be the ability of the educator and EMS program to critically evaluate conflicting sources and make an appropriate recommendation, rather than rely on the prescriptive curricula of the past. It is the change from highly prescriptive curricula to the current standards that will pose the greatest issue. Joseph Mistovich, chair and professor of the Department of Health Professions at Youngstown (OH) State University, believes this is an extremely exciting time for EMS, and EMS educators in particular. "The National EMS Education Standards require the content of EMS education to be dynamic and reflect current science and the best practices in emergency medical care, which is opposite of the old static and outdated prescriptive curricula," he says.
Procedures: Past curricula have given very specific steps for procedures like patient assessment. These structured steps are absent in the new education standards, and it is likely that textbooks will differ in step-by-step detail in patient assessment procedure. The key is to identify and manage patient life threats and to perform the assessment in a logical and efficient manner without becoming mired in the constraints of a very prescriptive procedure. EMS education has historically focused on details of the assessment procedure and has not given the same level of attention to the critical thinking and decision-making processes necessary for accurate and effective assessment.
It may be that the role of the textbook will gradually shift from a procedural manual to a more conceptual device, presenting principles rather than absolute procedures. Instructors have been plagued by unimportant differences in presentation for some time. One example is the frequent discussion of whether a patient's legs can be secured to a long spineboard after his head (as opposed to a torso, legs, head order). The only reasonable requirement is that the head is secured after the torso to prevent movement of the neck, yet many are mired by nonclinically significant minutiae. It is hoped that the education standards will eliminate this and focus on more important underlying concepts. The assessment processes used by clinicians may vary as long as the findings and subsequent clinical decisions are the same.
Will all states adopt the education standards? How will differences in scope of practice and local/state protocols be affected?
It is believed that all states will eventually move to some interpretation of the education standards. Forty-eight or 49 states have already indicated they will do so. Implementation will take place over the next several years, with the majority of states indicating they would implement the standards by late 2011 to 2012.
Materials written to the new education standards are already being published. Having educational materials available will be one of many factors that drive the decision for when states will make a switch from national standard curricula to education standards. Publishers will also assist systems and educators by providing transition material, including lesson plans and objectives to help implement the standards. Other factors will include the time necessary to review and adopt the standards, whether changes to state law or administrative rules are required, and when rollout and transitional training for educators will be available.
Why don't the standards specify how many hours a course should be?
The education standards are based on a scope of practice document that indicates what skills are to be taught at a minimum. In this minimum scenario, the education standards document estimates the EMT course would take between 150-190 hours to teach, which includes didactic, laboratory, clinical and field internship.
The standards also note that the courses are designed to be competency-based rather than based on strict hour requirements. It is likely that many states will apply more strict hourly requirements to some courses.
Educator Concerns About Implementing the Standards
- Increased hours.
- Less guidance in education.
- Increased technical material in lower education levels.
- More work in lesson preparation and objective development.
- How textbooks will handle the change.
Dan Limmer, AS, EMT-P, an EMS educator and author in Kennebunk, ME, has been involved in EMS and EMS education for more than 30 years.