By Jerry Biggart
The fire service is a major provider of emergency medical services (EMS) in North America, which means that it’s only fitting that we discuss a major change to EMS education that is now upon us. Most, if not all, states are in the process of transitioning to the current EMS Educational Standards as published by National Highway Traffic Safety Administration (NHTSA). These standards have been adopted by the National Registry (NR), which means that states must either comply with these national standards or find another testing process to license or certify their EMS providers. Effective January 2012, the NR began adding new questions based on the EMS Educational Standards to its test banks. Given the expense involved in developing a stand-alone testing process and lack of financial resources to do so, staying with NR and updating to the current standards is likely a foregone conclusion for most states. Now, how do we make this user-friendly for Emergency Medical Technicians (EMTs)?
The State of ________
The dynamics of the transition material is largely based on your current state curriculum. The Educational Standards do not add much to the skills provided by the EMT, but do add to the knowledge base. The question that bears asking is, “What about all of the providers who need to transition?” There are certain parameters that each state should consider:
- A side-by-side comparison of the old curriculum versus the new educational standards.
- Extracting the new material and creating a transition document for training centers.
- Determining the hours that will be required for the transition.
- Determining how the material can be delivered to the EMT.
- In determining items 3 and 4, use an over-reaching rule of reason to ensure that the delivery options remain cost-neutral for the provider and his fire department without creating an undue hardship for the firefighter or fire administration.
So, perhaps number 5 sounds easier said than done. I’d disagree. There are many educational delivery options available to fire departments and EMS personnel. They include traditional and non-traditional methods of obtaining continuing education units (CEUs) needed for transition. The options may vary from state to state, but it is important for the fire service to ensure a seat at the table. The fire service needs to be heard and listened to with respect to the delivery of EMS education. An initial step is to contact your state’s EMS board or the group that advises the state’s EMS office and ensure that the transition to the new educational standards will be functional for the fire service. One of the most important optional delivery methods that should be permitted is distributive learning. Although I will never agree that all EMS training can be completed through the Internet or by television, certainly some of it can. In the current economic climate, we must be creative in how we educate. A balance between classroom instruction and distributive learning is the new normal.
The Training Center and the Fire Department
Many EMTs receive their continuing education, including the impending transition material, through community and technical colleges. Since the fire service is a customer of the training center, this transition will create a perfect opportunity to discuss the options for the curricula delivery. Again, there are many ways to be creative. Most colleges have a distributive learning platform that would lend itself to continuing education. Arguably, a large amount of the transition material can be reduced to an animated presentation for firefighters to view during the workday or when otherwise convenient. An additional option for distributive learning would be to establish a relationship with an Internet-based EMS continuing education company. The cost is relatively nominal, and the education modules available are accredited, easily tracked, and an effective component to a diversified EMS-training program.
It is important that the colleges and training centers understand that the fire service has limited resources and often cannot take apparatus out of service to drive to a community college or training center. However, as a point of personal opinion, I will note that if it’s between never taking a rig out of service again or conducting all training through a computer, I’d vote to take the rig out of service. Another option is having department personnel certified or trained as instructors so that your internal resources can deliver the training in a fashion and schedule that best meets the needs of the department. To build on that concept, perhaps the community college or training center could make your department a satellite training center to allow numerous departments in the area to share in the education process. If your community has not considered options for sharing services with other departments in the area, EMS continuing education may serve as an easy case study for collaboration and at the same time open other opportunities for firefighters to obtain mandated education.
The EMT transition material would appear to require 24-30 hours of education, depending on current curriculum. Transition material hours should be applied to the providers’ required continuing education for renewal. It is highly encouraged that EMTs complete the transition material in one EMT refresher cycle (typically a two-year period). Stringing out the process for longer than two years may create paperwork and tracking problems. It is certainly acceptable to receive the education in two- to four-hour blocks throughout the two-year period. Many systems cram 30 hours of “continuing education” into a one- or two-month period. Is it really continuing education if you cover material for two months but ignore it for the other 22 months of a two-year cycle? Nonetheless, the transition process must comply with National Registry of Emergency Medical Technicians (NREMT) requirements so that currently registered EMTs can maintain their NREMT status.
As we transition to the new educational standards, the question bears asking, “Are EMTs and first responders being given enough tools and training to intervene in enough time-critical medical emergencies?” Since all states are being tasked with evaluating their curricula, perhaps it’s a good time to ensure that EMTs are able to administer 1:1,000 epinephrine for anaphylaxis, albuterol for asthma, and aspirin for angina/MI rather than being limited to assisting with a patient’s own prescribed medications, as well as the other skills included in the EMT Scope of Practice. Although the new content of the EMT-B curriculum does not reflect “more extensive” care, it’s worth considering the state scope of practice while evaluating the new educational standards. Why in some states are EMTs acquiring 12-lead ECGs, placing people on CPAP, and administering medications, whereas some are not?
Critical thinking is essential in the practice of medicine. The new educational standards are designed to equip EMS providers with the knowledge they need to be critical thinkers. Broader knowledge bases mean better critical thinking, which translates into improved patient care and, ultimately, better patient outcomes.
EMS is an evolving and continually changing field of medicine. We are currently on the cusp of a substantial change in EMS across the United States given our transition to the new national EMS educational standards. While broad, system-wide changes of this nature are typically not easy, there are very effective, meaningful, and user-friendly ways of making this transition and EMS continuing education practical to an already taxed fire service.
I recommend that anyone interested in the National EMS Educational Standards visit NHTSA’s EMS Web site at www.ems.gov. Although there is a wealth of information on that site, of primary importance to this discussion are some documents available under the Education tab. Additionally, I am willing to discuss or share ideas from Wisconsin with you.
Jerry Biggart has been involved in the fire service since 1994, and is a career lieutenant and paramedic with the city of Oak Creek, Wisconsin. He is an EMS instructor/coordinator for the Milwaukee Fire Department, a fire/EMS instructor at technical colleges in southeastern Wisconsin, and a member of the Wisconsin EMS Advisory Board and chair of the EMS Education & Training Committee. Contact Jerry at firstname.lastname@example.org.