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Ten Years After: EMS' Education Agenda in 2010

      Can it really have been 10 years since the release of the EMS Education Agenda for the Future: A Systems Approach?

   It can and in fact has, and that makes it an excellent time for taking stock. States are now in various states of embracing the National EMS Education Standards--a defining feature of that instructional master plan, released last year--and besides, the authors invited it. With each of the Education Agenda's core components, they put to paper a vision of "Where We Want to Be in 2010."

   The date is upon us. We haven't achieved everything they set out, but we've made good progress. Let's evaluate.

   National EMS Core Content

   The first of the Education Agenda's five key components, the Core Content describes the medical knowledge and skills needed by out-of-hospital providers. It was released in 2005, and the subsequent National Scope of Practice Model and National EMS Education Standards were built upon it.

   Per the Agenda, the Core Content is to be updated every 5-7 years to reflect clinical advances and changes in EMS practice and education. That's not imminent quite yet, but there's a process for it defined, and having that mechanism available is necessary and valuable.

   "I like the idea that we're going to revisit that content every 5-7 years," says Chris Nollette, EdD, NREMT-P, LP, president of the National Association of EMS Educators. "Medicine changes drastically every two years--we have major, major developments. It's important, with all the changes, the technology, the innovations, all the stuff going on, that we as educators revisit this information on a timely basis."

   National EMS Scope of Practice Model

   Released in 2006, the Scope defined four nationally recognized levels of EMS providers (emergency medical responder, EMT, advanced EMT and paramedic) and identified minimum entry-level knowledge and skills for each. That paved the way for the...

   National EMS Education Standards

   The standards, released last year, supplant the National Standard Curricula in defining the competencies, clinical behaviors and judgments required for entry-level EMS personnel at each level to practice. As many have noted, they are less prescriptive than the NSC, and enable new freedom to use approaches like problem-based learning, computer-aided instruction, distance learning and programmed self-instruction.

   That's not happening without challenges. But it's seen as vital for delivering a fuller, more comprehensive EMS education that can serve a 21st century diversity of learners.

   "The plan from the Education Agenda was that the standards would be less prescriptive, and allow some flexibility and different opportunities for student learning," says Debra Cason, RN, MS, EMT-P, who directed the project team that developed them. "We set broad standards that should allow for that. Hopefully, they'll also have a shelf life that's longer than the Curricula because of their less prescriptive nature."

   With the new standards must come new instructional materials--textbooks, lesson plans, other aids and models and accoutrements. EMS publishers have moved quickly, and organizations like the National Association of State EMS Officials have worked to provide resources. The toolbox is a work in progress, but there's good help already available, and more coming rapidly, for the challenges educators face.

   "When I talk to fellow educators, the biggest thing they're saying is they want help with the tools," says Nollette. "What are best practices? How do we up our instructor qualifications, so they're prepared to deal with these things? How do we determine our program requirements--do we need to strengthen those? Do we need to do preparatory work before students get into our programs? How do we bridge folks from what we have now to these new standards?"

   NASEMSO in particular is providing an array of resources, including fact sheets, PowerPoints, educator surveys, source documents and a gap-analysis template for those transitioning. NAEMSE is working to set up a mentoring program by the end of 2010. Other top groups are involved as well (NHTSA, the National Registry, CoAEMSP), working cooperatively to ease the transition.

   National EMS Education Program Accreditation

   The next step for EMS education will be program accreditation. This is intended to encourage self-assessment of education programs and efforts at quality improvement. Ideally, to achieve national certification and state licensure, new providers will ultimately have to graduate from accredited programs. The National Registry will require it by January 1, 2013.

   The goal for 2010 was to have achieved support for the idea from EMS organizations and stakeholders, and to have developed a single, nationally recognized accreditation agency. That we have in CAAHEP, the Commission on Accreditation of Allied Health Education Programs, and its relevant arm CoAEMSP, the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions. There's broad support for the idea of accrediting educational programs, although methods and requirements still vary greatly across the U.S.

   "Ten years later, we've certainly increased the number of paramedic programs that are accredited--maybe not at the pace we'd have liked, but we're moving in the right direction," says Cason. "There are more programs seeking initial accreditation. The Committee on Accreditation has done a lot in terms of trying to help programs become accredited, and I think the EMS education community is interested in reaching out and working with each other."

   Graduates of accredited programs do better at their national certification exams than those from unaccredited programs, notes Vermont EMS Director Dan Manz, chair of NASEMSO's Implementation Working Group. "Accreditation really is kind of a Good Housekeeping Seal of Approval on an educational program," he says. "It's a safeguard, in some ways, for the candidates going through."

   National EMS Certification

   The Agenda imagined this conducted by a single national agency and accepted by all states by 2010, with only graduates of accredited education programs eligible. We're not there yet, but the potential benefits still tantalize: verified minimum entry-level competencies, standardized testing, easier reciprocity, optimized mobility, and states still free to add and adjust as they deem appropriate.

   It shouldn't be that difficult a final step. Already, 46 states use one or more of the NREMT's examinations. "The public," notes the NREMT in promoting national certification, "cannot be expected to determine whether EMS personnel are qualified to deliver competent care... The responsibility falls on the profession, then, to ensure that safe and effective care is provided to the public. The NREMT is pleased to offer this assurance to the public through certification by way of an examination that is legally defensible and psychometrically sound."


   It's an extraordinary moment to be in EMS education. Change is never easy, but the work being done now will reshape the schooling and benefit the providers of generations to come.

   "I know it's a lot of work," says Nollette. "I know it's heartburn for a lot of our colleagues. But in the long run, the effort we're putting in now will take us leaps and bounds forward as professionals. It's a very exciting time."

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