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Sizing Up the Accreditation Debate

   Have you ever wondered if there is a plan for EMS? We're not talking about protocols and standing orders, but a plan to turn our occupation into a profession. If you find yourself thinking about where we are now and where we, as a profession, should be years down the line, you're not the only one.

   In 1996, the National Highway Traffic Safety Administration and the U.S. Department of Health & Human Services published the EMS Agenda for the Future, which discussed where we are, where we want to be, and how to get there. When discussing education systems, the EMS Agenda for the Future stated that "EMS education programs should seek accreditation by a nationally recognized accreditation agency. Accreditations should be sought to demonstrate that the educational programs provided meet a predefined national standard of quality." This sentiment was re-emphasized in the 2000 EMS Education Agenda for the Future: A Systems Approach. So what is accreditation? What does it mean to you? What does it mean to EMS? And how are we doing in getting there?


   According to Webster's Dictionary, accreditation is "to recognize (an educational institution) as maintaining standards that qualify the graduates for admission to higher or more specialized institutions or for professional practice." In plain English, that means that a credible authority is checking and documenting that your educational program meets nationally agreed upon standards. Doesn't sound too bad, right? Well, lucky for us, there is a nationally recognized accreditation body in EMS that is currently working on accrediting qualified paramedic programs nationwide. The Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP) is the accrediting agency for EMS. It is sponsored by a number of EMS organizations--the National Association of EMS Educators (NAEMSE) and the National Association of State EMS Officials (NAEMSO), among others. The Commission on Accreditation of Allied Health Education Programs (CAAHEP), a non-profit, non-governmental agency, is the parent organization for CoAEMSP and is also the largest medical accrediting agency in the United States.

   National accreditation may seem to some like a bunch of paper-pushing and bureaucratic rigmarole, but there is actually some evidence that it is worthwhile. According to Philip Dickison, et al., in a 2006 study of almost 13,000 individuals, those who attended a nationally accredited paramedic program were more likely to pass the national paramedic certification exam when compared to those whose programs were not nationally accredited. A 2008 study also found that accreditation is one of the most important factors when predicting success on the national certification exam. Success on the national certification exam is important because, in most states, you cannot become a paramedic without first passing that exam. So, in essence, attending a nationally accredited program has been shown to help you advance in the field of EMS. In fact, in the near future, attending a nationally accredited paramedic program may be the only way to advance. The National Registry of EMTs (NREMT) has stated that in 2013, only individuals who have attended a nationally accredited program will be eligible to attempt the national certification exam.

   Fourteen years ago, leadership called for national accreditation. In at least two studies national accreditation was associated with success, and it's going to be mandatory in a few years. So where are we in the quest for national accreditation? Well, as expected, there has been some pushback. Not everyone believes that national accreditation is important. But we work for the National Registry, and it may just be that the people who are the most upset speak the loudest. We wanted to know how much people knew about the process of becoming nationally accredited, how they felt about national accreditation, and what the barriers are to becoming accredited. With the help of the CoAEMSP and the National Association of State EMS Officials, we began a study.

   To get answers that would provide the most information, we went to the source--paramedic program directors, who are dealing with national accreditation more than anyone else. Since this project was done to assist in policy-making, we didn't seek approval from an ethics board and we're not seeking to publish this in a scientific journal; however, we want to share our results with you.


   First, we needed a survey instrument that we thought would ask the questions everyone wanted answered. To accomplish this, we formed a panel that included experts on national accreditation, state directors and paramedic program directors. The expert panel worked with NREMT staff to construct a survey designed to assess knowledge, attitudes and barriers to national accreditation. Once we had our survey instrument, it was distributed to every paramedic program director registered in the NREMT database. If paramedic program directors want their students to be able to attempt the NREMT exam, the program must be registered in the NREMT database.

   After most of the program directors responded, it was time to analyze our results. In order to get the best picture possible of where the nation stands on national EMS accreditation, stakeholders have looked over the results and we've analyzed it a number of different ways hoping to answer almost everyone's questions. What we want to share is the knowledge, attitudes and barriers of those programs that were not nationally accredited at the time of the study.

   Three hundred thirty-eight paramedic programs that were not nationally accredited and graduated one or more students in the year before data collection answered our survey. One of our priorities was to determine paramedic program directors' attitudes about national accreditation, and, frankly, we were quite surprised. The results of our national study were substantially different from some comments we've received from what appears to have been a vocal minority (see Table 1).

   Overall, it seems program directors have a pretty good attitude regarding national accreditation. One of the biggest worries appears to be cost, but more than 50% of individuals believe national accreditation is worth the cost.

   In addition to attitudes toward national accreditation, we wanted to get a sense of program directors' knowledge about national accreditation and its requirements. Out of 11 true/false questions asked, the average score for non-accredited programs was 81%--definitely a passing grade.

   So, if attitudes are good and these programs are well-informed, why aren't we there yet? Table 2 shows what program directors believe are the 10 biggest barriers to becoming nationally accredited. All of the barriers have something to do with finances or resources, indicating that the EMS Agenda for the Future was right when it called for additional public funds to support EMS education.


   We talked about knowledge, attitudes and barriers, but we also wanted to see where we are in the quest for national accreditation. Well, it looks like we're getting there. More than 40% of non-accredited paramedic programs reported that they were currently working to achieve national accreditation, and fewer than 10% said they had no intention of becoming nationally accredited. Additionally, 84% of programs said that if help was available to achieve accreditation, they would use it. It is very encouraging that more than 40% of programs that are not already accredited are working on it, and more than 80% will take advantage of any help offered. We know CoAEMSP offers help to programs, but further public outreach may ensure that program directors know this help is available.

   We know how important national accreditation is to EMS. We know our patients will receive care based on national standards because of national accreditation, and that EMS professionals want to be recognized for the excellent care we provide on a daily basis. We know we want our field to be recognized as a profession. Knowing all this, it's time to make it happen. We must come together and support change that will better our profession, and national accreditation is a good starting point. After all, we are the only allied health profession we could find that does not require graduation from an accredited program in order to be nationally certified.

Table 1: Attitudes Toward Accreditation
We asked: How much do you agree/disagree on the following? Non-Accredited
A single national EMS paramedic education accreditation... (n=338)
  Strongly Agree/Agree
Will benefit the EMS profession 79.60 %
Is a positive move for paramedic education 78.40 %
Has long-term benefits for students 76.40 %
Promotes continuous quality improvement in paramedic programs 76.10 %
Improves a paramedic program 69.20 %
Will improve peer recognition of paramedics as allied health professionals 57.70 %
Is worth the cost 56.80 %
Is desirable from the student's perspective 56.50 %
Will improve public recognition of paramedics as allied health professionals 52.90 %
Will produce better clinicians 51.20 %

Table 2: Barriers to Accreditation

   Initial cost

   Ongoing cost

   Cost to students

   Access to live patient intubations

   Institutional administration support

   CoAEMSP accreditation will require more resources than my program has

   Access to pediatric patients

   Preceptor education

   Faculty quantity

   Clerical/support resources

Melissa A. Bentley, BS, NREMT-P, is a research fellow at the National Registry of EMTs (NREMT) and is pursuing her master's in public health. She has been involved in EMS for four years.

Antonio R. Fernandez, MS, NREMT-P, is a research fellow for the NREMT and is currently a PhD candidate in public health. He has experience providing both prehospital and in-hospital patient care as an EMT-B and a paramedic in urban settings.

Greg Gibson, PhD, PRC, NREMT-B, is the new research director for NREMT. He is an applied sociologist by trade and specializes in survey research, social psychology and gender.

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