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Implementation Challenges of the National EMS Education Standards

As the face of EMS education changes, the delivery of EMS education can't stop. That means our states and programs and educators can't miss a beat as they convert to the National EMS Education Standards.

"It's like rebuilding the car's engine while driving down the highway at 60 miles an hour," says Vermont EMS Director Dan Manz, who chairs the National Association of State EMS Officials' Implementation Working Group. "The system's in motion and has to stay in motion, and we have to do this transition in a way that's not so disruptive and complicated that nobody can figure out how to get it done."

For states embracing the new standards and larger vision of the Education Agenda, the challenges surround crafting law and regulation to support the Scope of Practice Model and Education Standards within their governmental and educational infrastructure--"Not that difficult to understand conceptually," notes Manz, "but complicated to actually get into place."

Consider California--a large and diverse state to say the least. Its EMS education setup is fairly complex. State regulations set scopes of practice and training program requirements, with the actual day-to-day delivered through 31 local-level agencies. These approve EMT training; paramedic programs are overseen by the state EMS Authority (EMSA), with local curriculum approval. EMSA provides overall statewide coordination and integration.

Adopting the standards is "a complex process that requires the integration of lots of players and the engagement of a state regulatory process," says EMSA Director Steve Tharratt, MD. "As you can imagine, in a state with the breadth and depth of California, it isn't a regulatory item that turns on a dime."

You eat this elephant one bite at a time: Right now the state's aligning its regulatory definitions to match the EMT, AEMT and paramedic levels described in the Core Content. That's occurring in conjunction with new coordination and standardization of local EMT certification processes. Scopes of practice will be substantially similar to the National Scope, with some modifications. The EMR level will be addressed afterward. Then it's about working with educators on curricular changes and other logistics of bringing the standards to life. "That will require input from our physicians, our provider community, our educators, our agencies, our community college system--a whole lot of players have to come together," says Tharratt.

Educators may have trepidation too, but there's help available. Start with NASEMSO's Education Agenda Implementation website, prominently linked from Its Toolkit section provides background and transition materials, including a publication schedule for updated textbooks, and will eventually feature model legislation/regulations. A Resources page offers assistance with curriculum development, program evaluation and legislative considerations. An Implementation Guide and timeline are also available, and NASEMSO is sponsoring a series of webinars on different aspects of implementing the Education Agenda. These will occur monthly through November.

"Some of those subjects may relate primarily to state EMS officials, some to educators, and some to medical directors," says Manz, "but I think many of them are of interest across the spectrum of all those groups. These represent a substantial way we can get information out and answer questions from the EMS community."

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