By Patricia L. Tritt, RN, MA & Debra Cason RN, MS, EMT-PHave you ever heard the refrain in EMS:
"Why won't they treat us as professionals?"
Are you familiar with the defining characteristics of a
profession? Some of the characteristics
include: skill based on theoretical knowledge; extensive period of education
where specialized practical experience is provided; testing of competence;
formal qualifications based upon education; regulation (typically) by statute;
affairs of its members regulated by professional bodies; training involving
obtaining degrees and professional qualifications; regular up-dating of skills
through continuing education; and standardization of professional training.
So how do we stack up? There are some hits and some misses. But a recurring theme appears to be
education: and of course not just any
education but
quality education. How do we assess quality in EMS 'training'
programs? And by the way, is it
'training' or is it 'education'? There
is an old saying, after all, that we train pets but we educate people.
Quality begins by evaluating ourselves against a set of
industry established standards. Do we meet the minimum S
tandards and Guidelines set by our peer group under the auspices
of the
Commission on Accreditation of Allied Health Education
Programs (CAAHEP)? That is really
how accreditation works in Paramedic education--and every other health
profession field. We evaluate ourselves
against the CAAHEP
Standards. The most recent
Standards and Guidelines were established by the EMS community in 2005. Once we evaluate ourselves against these
Standards and Guidelines and document our findings, we invite our peers to come to our program and see
for themselves how it is done. They will
look for the following: How we deliver our services; how we evaluate the
competency of our graduates; how we assure that each graduate is competent--not
just in what he/she knows but also how he/she performs and behaves
professionally.
A ten year old document titled the
EMS Education Agenda for the Future calls for a
system of education in EMS
that is similar to other health professions. That system has not previously existed in EMS
education because our birth, growth and development have taken a different path
than most health professions. EMS has definitely grown and matured but our system of education
has primarily been dependent on a single component: a national standard curriculum. The authors of the
Education Agenda, and the many groups and individuals that provided
input into the document, called for a
system that included a systematic development of education standards and graduation
from an accredited Paramedic program in order to take the national
credentialing exam. This system approach
is common and expected in other more mature health professions as well as other
disciplines. This 2000 document was not
the first time that accreditation was called for by the EMS
community. The 1996 document
EMS Agenda for the Future recommended
"accreditation should be sought to demonstrate that educational programs
provided meet a predefined national standard of quality."
Since that
time, research has been published that validates the role of accreditation in
quality. Current research articles
published in peer-review academic journals indicate an increased success rate
on national certification exams from graduates of nationally accredited Paramedic
programs.*
After
years of discussion, in June 2008, the NREMT Board of Directors formally
discussed the possibility of requiring graduation from a CAAHEP
accredited program in order to take the Paramedic NREMT exam. Discussion included concerns about acceptance
of the concept by state governments, EMS
provider agencies, Paramedic education programs as well as others. More
discussion followed about how long the EMS
community has discussed the concept, how many other professions require
accreditation, that the NREMT is the only entity that could make the change,
and that the role of the NREMT is to protect citizens. In June 2008, the NREMT Board decided to
table any action and continue these discussions with the EMS
community.
In November 2008, the NREMT board voted to require graduation
from a CAAHEP accredited program in order to take the NREMT exam
beginning 2013. As predicted, many
agencies and governments and individuals were distressed about the impact of the
plan. And yet, many were also saying
that the time had come and why continue to discuss accreditation without any
movement in the direction recommended 14 years ago? Many have said this is the path to
professionalism and they want to travel there along with their colleagues.
The CoAEMSP has been reaching out to state officials,
professional organizations such as the IAFC, NAEMSE, NASEMSO, and individual
institutions to provide information on accreditation, the benefits, and the
process. These forums for discussion and
technical assistance facilitate the preparation of Paramedic programs that are
not currently accredited and provide guidance in completing the process. One of the incentives for early submission of
a self study provides additional time for a program director to obtain a Bachelors
degree if the initial self study is submitted before January 1, 2011. Many new tools, such as sample documents and
reports, have been developed to assist programs and are available at
coaemsp.org. If you would like more
information or if you would like a CoAEMSP member to address your organization,
call 817-330-0080.
The accreditation process is one more step toward the
acceptance of Paramedics as 'professionals' and accreditation as
credible education.
RESOURCES
*"Estimating the Probability of
Passing the National Paramedic Certification Examination", Antonio R.
Fernandez, BS, NREMT-P; Jonathan Studnek, MS, NREMT-P; Gregg S. Margolis, PhD,
NREMT-P (2008).
"Program Accreditation Effect on Paramedic Credentialing Examination Success
Rate", Philip Dickison, RN, BBA; David Hostler, PhD; Thomas E. Platt, Med;
Henry E. Wang, MD, MPH (2006).
"Strategies of High Performing Paramedic Programs", Gregg Margolis, PhD,
NREMT-P; Gabe Romero, MBA, NREMT-P; Antonio R. Fernandez, BS, NREMT-P; Jonathan
Studnek, PhD, NREMT-P (2009). Patricia Tritt, RN,
MA
is Director of EMS and Trauma at HealthONE EMS in Englewood, CO. She is
also a member of the Board of Directors for the Committee on Accreditation of
Educational Programs for the Emergency Medical Services Professions (CoAEMSP).
Debra Cason, RN, MS, EMT-P
is the Program
Director and Associate Professor of Emergency Medicine Education at the
University of Texas Southwestern Medical Center, Dallas, Texas. She is also Vice-Chair of the Board of Directors
for the Committee on Accreditation of Educational Programs for the Emergency
Medical Services Professions (CoAEMSP).