National EMS Scope of Practice Transition
- 1Jan 4, '09 by GilaRRTIt is now 2009. From what I understand, significant changes to EMS educational and curriculum guidelines will begin to occur this year. This will effect our EMS colleagues and many of us nurses who have dual credentials. Nurses such as my self with NREMT-I85 credentials will have to deal with fairly significant changes. Lucky you if you are an I99, transition to paramedic with no additional clinical or psychomotor testing requirements. Hu?
In any even, here are links to background material and tentative educational outlines for the new levels of EMS providers. This will most likely be an educational experience for nurses unfamiliar with the specifics of EMS.
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- 0Jan 5, '09 by CraigB-RNI dont expect much of any change for a long time. You have 50 state legislators that would have to change EMS acts and as many state EMS agencies. None want to give up control of anything. It's a nice goal, but I wouldn't worry about anything yet. Just keep your eyes open and stay informed.
- 0Jan 6, '09 by GilaRRTFrom what I understand, this will effect individuals who are registered with the NREMT. The states may be slow to implement changes; however, people who want to maintain NREMT registration will have to make the transition. Obviously, this could effect states who utilize NREMT and people who move out of state who rely on NREMT to assist in the reciprocity process. Unfortunately, part of my current contract requires me to maintain NREMT-I credentials. So, I will have to make the transition.
- 0Jan 7, '09 by getoveritThis is very interesting. I wonder how much of this is educational, meaning if someone wants to be eligible to sit for the national registry then they have to have didactic and skills to cover these changes. I don't believe the National Registry can dictate a scope of practice to a state EMS board. In my state, I know they can't.
I believe Craig B-RN is probably right, it's a nice goal, but not much of anything is going to happen anytime soon. We'll see. Thanks for pointing out and linking us to the site.
- 0Jan 7, '09 by CraigB-RNIt's definitely worth watching. Some people will be happy about things and others will hate it. There is such a difference nation wide in scope of practice. Especially with some of the new studies that seem to question the usefulness of ALS intervention in some areas.
Look at all the other certifying bodies out there. Non of them dictate to the states and professional organizations the scope of practice. This goes for Docs' NP's, PA's, PT's you name it. The national registry can dictate who gets to take their test, but that's about it. It's actually non-constitutional in some places to allow for things like that. And there is no federal office that can do that either. In all those above licenses, the NP's and PA's were "grandfathered" in and given lots of time to change, if they even have to. I know of at least on CRNA who never got a degree and a PA friend that never got the degree. Practiced right up till about 5 years or so ago with just his certificate.
I don't think anyone questions standardizing and accreditation will help EMS. It's so much better now than it used to be, but there is still a long way to go. There is such a difference in the physical location and resources in each jurisdiction to make a standardized scope of practice really work.
Accreditation of teaching institutions is a first step and a good one. We'll see what happens.
Of course I could be a wrong about this as I am about lots of things.
I did give my NREMT-P up about 10 years ago because it was to much of a pain to get the refreshers in and keep up all my nursing certs which just shows how smart I am.
- 0Jan 7, '09 by getoveritok, i've just re-read the two links. here are two quotes that stood out to me:
under theprovide to patients.
sop, education for each level will be based on
practice, rather than national curricula
standards, resolving the disconnect between
whatís taught in class and the care we actually
[color=#231f20]itís time that ems is recognized by other[color=#231f20]obtain this recognition.
[color=#231f20]health-care specialties as a true profession
[color=#231f20]and not a trade. implementation of the sop
[color=#231f20]will reduce fragmentation, lead to better
[color=#231f20]patient care across the nation and help us
i agree with the first quote, we do need to change the discrepancy between classroom and street practice. like we've said earlier, i wonder how easy it will be to "sell" this scope of practice to the individual state ems boards. mr. brown mentions in his article that he is "calling on states to adopt the standard". last i checked, about 31 states accept the registry--and that was several years ago.
as for the second quote, i agree in theory but don't see how making this scope of practice is going to change perception from a "trade" to a "profession". this has been the topic of many debates, both here and on other website forums, but there are many standards that make a profession.
this may be a sore spot for some people, but one of the first things to do is make a minimum education level for entry into ems. associate degree. there are crnas and pas who were grandfathered with only a certificate, but i'm not aware of many programs like that anymore.
ems has come a long way since the white paper (remember that one??) but it does have a long way to go. another thing is to have a national representation/lobby group. i gave up on the naemt and stopped renewing my membership about 12 years ago when a co-worker asked me "what have they done for you, or anyone you know?" i couldn't answer the question.
the best thing that seems to be coming from this process is the potential for uniformity nationwide in the provision of emergency medical care. a person in wyoming deserves the same care as someone in florida, and even more importantly, when that person from florida is on vacation in wyoming and needs to call 911, they do expect and should receive the same care they would be given back home.
- 0Jan 7, '09 by CraigB-RNBeing a nurse now, I have to agree that being recognized as a "proffesion" isn't going to happen by just changing education or proactice standard. Nurses have been trying to that for the 30+ years I've been doing this and are still fighting the battle.
I wish they were spending their time and money proving that ALS actually made a difference.
- 0Jan 12, '09 by UMichSCN07Quote from RNREMT-P;3357969While state-to-state uniformity of care would be great, right now I'd settle for uniformity of care within the same state. Where I am in SE Michigan, we have a "regional" treatment protocol that spans 4-5 counties, but there are some counties that have opted out of some provisions and others that have added some provisions (usually centered on research protocols in their county), to say nothing of the counties that have multiple EMS providers through the various township and city fire departments who put their own "spin" on county protocols.
The best thing that seems to be coming from this process is the potential for uniformity nationwide in the provision of emergency medical care. A person in Wyoming deserves the same care as someone in Florida, and even more importantly, when that person from Florida is on vacation in Wyoming and needs to call 911, they [Udo expect and should receive[/U] the same care they would be given back home.
Mike in Michigan
- 0Jan 13, '09 by getoveritMike,
I know what you mean. I've been on flights in certain counties where the EMS has said "You can't perform that procedure in this county" in reference to RSI, cricothyrotomy, etc. I've thought "do you think we're functioning under YOUR protocols?" when you call an aircraft, we operate under our own medical direction. Of course I've never said anything remotely like that on a scene, but it's made me wonder.
I agree with states' rights, but I think for emergency medical care there needs to be a central office in the state capital that makes a formulary for all state providers to follow. That might be a step in the direction toward a national uniformity.
I remember an old supervisor told me that the perception of the general public is what really guides EMS delivery. Someone who calls 911 doesn't care what the decals on the ambulance say, whether a patch says paramedic or basic...they expect to see the same level of performance that they've seen before on TV or wherever. I used this in an unsuccessful argument to equip EMT-B certified ambulances with AEDs. (yes, the management did not want to do that and to my knowledge, it never happened). I said, if the ambulance is flagged down or dispatched to a person who needs to be shocked, you've got a lawsuit waiting to happen....heck, I'd even consider quitting my day job to represent them myself!! But stronger wits prevailed and the decision was made that a paramedic unit could be requested later. And that's all within the same service.