When I went to paramedic school in 1978, my entire paramedic schooling consisted of 600 hours of training. Those 600 hours included not only classroom time, but clinical hours in the emergency room, operating room and cardiac care unit (CCU). We were being taught mostly by doctors and nurses who were used to teaching medical and nursing students. Back then, there was a document (published in 1977) detailing the 15 instructional modules of a paramedic program, but there were different interpretations of it state by state and school by school. (Believe me, this is not one of those "I walked five miles to school every day in the snow" stories!)
We studied from medical school textbooks and copied handouts from medical journals. Some of the words we did not understand and everybody had to run out and buy a medical dictionary. Years later, paramedic students got the luxury of a paramedic textbook written by Dr. Nancy Caroline. At least with her textbook, there was some consistency with how and what paramedics were being taught in the classroom. Eventually, the National Highway Traffic Safety Administration (NHTSA), the arm of the federal government that oversees EMS on a national level, commissioned groups to form a national standard curriculum for EMT and paramedic programs. These national standard curriculums for EMT and paramedic have gone through several revisions.
Now, work is underway to develop a new set of education standards for EMS called the National EMS Education Standards. This new set of standards will replace the old curriculum and will be used as a basis for the writing of first responder, EMT and paramedic textbooks by various publishers. The standard will also be used in the future as a basis for educational course development in EMS educational programs.
Again, the new standards are just in draft form. The basis for formulating the standards came from three different documents. The first document was called the Education Agenda, which had its roots in the 1996 document EMS Agenda for the Future. The EMS Agenda called for a proposed new and improved national EMS educational system that would increase efficiency and produce greater entry-level graduate competencies. The second document used to draft the new National EMS Education Standards comes from the National EMS Core Content. The document lists all that is necessary to be learned in EMS education including conditions, chief complaints, operational issues, and psychomotor skills. The third document is the National EMS Scope of Practice Model, written in 2005. This document identifies the four EMS personnel licensure levels and what each level of licensure is capable of doing or their scope of practice.
A broad scope of individuals and organizations has been involved in the development of the new National EMS Education Standards. The individuals are mostly EMS educators and come from a broad background of EMS, including urban, rural and volunteer EMS systems. Additionally, a large group of EMS stakeholders also provided input into the development of the draft document. The fire organizations involved include the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF) and National Volunteer Fire Council (NVFC).
Over the summer months, the four different standards for the four licensure levels were open for public comment. The goal is to submit the standard to the NHTSA in September 2008.
Some of the major changes you will see with the implementation of the new standard are four different titles and licensure levels. This comes about as a result of the National EMS Scope of Practice Model. The model was an effort to standardize licensure levels. Most states have EMT-Bs, but others have EMT-Is, EMT-IVs or EMT-Ds. Some states just have EMT-Bs and paramedics. The four new licensure levels will be Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT) and paramedic. The recommended clock hours of education for the EMR would move up to 48, for EMT 166 to 198 hours, 140 to 166 hours for AEMT and approximately 1,300 hours for paramedic.
One of the more interesting recommendations in the draft standards calls for competency-based rather than hours-based education. In essence, you can sit for 1,300 hours for a paramedic and still not be competent at intubating a patient. Essentially, instead of emphasizing the amount of hours a student sits in the classroom, the new standard would address the issue of the student demonstrating and proving their competency in certain skills.
One big issue for the fire service is how additional hours of education impact fire departments. There is no doubt that additional hours can impact fire departments because firefighters will be in EMS education programs for longer periods. This translates to a firefighter possibly being less available to respond to emergencies and additional costs to fire departments. This could have a tremendous impact on the volunteer fire service, which is already challenged with retaining and recruiting members. The new draft standards also no longer involve ambulance driving, staging and scene positioning. The project team that drew up the draft standards felt these operational issues were best left to the employer who would teach these skills during orientation or on-the-job training.
The stakeholders group will be getting together in early 2008 with the goal of reviewing the comments received during the comment period. It widely expected that the new EMS education standards will be released in 2010. Shortly thereafter, publishers will begin publishing textbooks with the new standards. Stand by!