# Education Standards Gap Analysis Documents



## Ridryder911 (Jul 20, 2009)

Here is a link to the Education Standards Gap Analysis Documents, which is the study for developing bridge courses according to the new levels. Developing educational standards to those standards that is currently used at this time, in other words education vs. training. 



http://www.nasemso.org/EMSEducationImplementationPlanning/Toolkit.asp#GAT071709


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## Tincanfireman (Jul 20, 2009)

I didn't read the entire 48 page document, but the message is clearly made that we are seeing the first steps of a paradigm shift in our profession. This publication is the future of EMS; thanks for sending it along, Rid.


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## Shishkabob (Jul 20, 2009)

Not much changed for EMT's in Texas, as most of that is already taught.


As for medic, nice to see some new things added like central line access.






My wonder is, how will the transition affect current students who are being taught the old curriculum when it comes time to test for the NR?  Is there a lag time?  Yes, I know "your school should be shifting", but it's a 'what if' scenario.


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## Ridryder911 (Jul 20, 2009)

From my understanding is that most states that are at least NREMT associated will adopt a "transitonal bridge" that will be added to their refresher. To say, when you obtain a refresher with a three year window, one has better attended such program or recognize they will not be recertified or licensed. There will be no "grandfathering" in clause, etc. Basic must attend and Intermediates as well for the advanced, I-99 must either complete Paramedic or take the bridge for the Advanced level. 

Of the semantics is still being worked out. 

R/r 911


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## Mountain Res-Q (Jul 20, 2009)

Ridryder911 said:


> From my understanding is that most states that are at least NREMT associated will adopt a "transitonal bridge" that will be added to their refresher. To say, when you obtain a refresher with a three year window, one has better attended such program or recognize they will not be recertified or licensed. There will be no "grandfathering" in clause, etc. Basic must attend and Intermediates as well for the advanced, I-99 must either complete Paramedic or take the bridge for the Advanced level.
> 
> Of the semantics is still being worked out.
> 
> R/r 911



The question for me is always, "What will the bass ackwards California EMSA Morons do (if anything) and how will they choose to screw up the implamentation."  I know, the answer is always, "Who the hell knows."


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## Ridryder911 (Jul 20, 2009)

Mountain Res-Q said:


> The question for me is always, "What will the bass ackwards California EMSA Morons do (if anything) and how will they choose to screw up the implamentation."  I know, the answer is always, "Who the hell knows."



I believe although states have the options (yes, usually screw things up) most will not have an option. One can either participate and develop true educational foundation or have the option of risking the withholding of Federal Aid and Compensation as in highway, safety funding and medicare reimbursements, in which I doubt California (or any other state) would attempt to risk. 

I would like to point out, that this as well is the beginning of non-objective based teaching and learning. A new concept for EMS but not for those within a true educational background. Making a requirement for teachers to be educators not instructors. Lesson plans, a full understanding of the adult learner and teaching process. Although, a slow and tedious process we will slowly force the "good ole boy" instructors out. Gone will be the days, of just because you are a good EMT you are automatically assumed to be a good instructor. 

R/r 911


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## 8jimi8 (Jul 21, 2009)

I thought that once you obtained a certain level of certification, you need only maintain your CEU's to remain certified / licensed.  Is there a point at which you must take a refresher course, regardless of CEU hours earned?


**BTW tried to follow the link and its broken.

*** Nevermind, its working now


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## Foxbat (Jul 21, 2009)

What surprised me the most is the proposed use of ATVs by EMT-Bs.


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## Ridryder911 (Jul 21, 2009)

8jimi8 said:


> I thought that once you obtained a certain level of certification, you need only maintain your CEU's to remain certified / licensed.  Is there a point at which you must take a refresher course, regardless of CEU hours earned?
> 
> 
> **BTW tried to follow the link and its broken.
> ...



Most states & especially those that are NREMT associated require a refresher level and a set number of CEU's for recertification. NREMT requires 48 hrs of CEU's, bi-annual CPR and a refresher, for the current Intermediate it is 36 hours of CEU's and refresher plus CPR and documentation of skill review and signature of your medical director affirming that you are working at that level. The Paramedic has different options, retake the test (& pass) or complete 24 hours of CEU's & refresher or in lieu of CEU's complete the alphabet courses (ACLS, PHTLS/ITLS, PALS) and alike Intermediate documentation of skills and verification that you are or have been working as a Paramedic. 

All levels are equal in 60 hours to recertify (again this for the NREMT)
R/r 911


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## Shishkabob (Jul 21, 2009)

I guess I should phrase differently--

Say right now I'm learning A, B and C, while the new curriculum says I should learn A, B, C, and D.  The NR switches to A,B,C,D.  How will this affect me come testing?


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## 8jimi8 (Jul 21, 2009)

Another quick question.


Did I read this correctly?
They moving ET intubation to only Paramedic level, and leaving Intermediates (AEMT) to supraglottic devices?


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## 8jimi8 (Jul 21, 2009)

Linuss said:


> I guess I should phrase differently--
> 
> Say right now I'm learning A, B and C, while the new curriculum says I should learn A, B, C, and D.  The NR switches to A,B,C,D.  How will this affect me come testing?



This education agenda does not affect any current students unless you start paramedic school after january 1st 2013.

Except for the refresher curriculae as Rid has detailed in his OP


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## Ridryder911 (Jul 21, 2009)

Linuss said:


> I guess I should phrase differently--
> 
> Say right now I'm learning A, B and C, while the new curriculum says I should learn A, B, C, and D.  The NR switches to A,B,C,D.  How will this affect me come testing?



Chances are this will not be totally in affect until after you have graduated. Most programs are reviewing the material and some (limited) are initiating some changes this fall. Most of the new texts are still being reviewed and was being attempted to be out this fall but doubtful, I have heard most will be out this spring. 

Again, if one reviews the current scope when they graduate and current ACLS standards there will be no new surprises. 

I do hope many will notice the changes from MFR and EMT and the removal of intubation from advanced level. Also lab draws from the Paramedic level has been removed but lab chemistry (in depth) has been added. 

Public Health and research has been added to each level from MFR to Paramedic and anatomy cellular level has been addressed from the basic level upward with more intensity and demands of knowledge. True many may not require collegiate level anatomy, but the way to ensure that this level will be taught is for the questions and testing to reflect one will have obtain this to pass. 

This is just the beginning and much more work is needed but alas more changes are on the way. 

R/r 911


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## Ridryder911 (Jul 21, 2009)

8jimi8 said:


> This education agenda does not affect any current students unless you start paramedic school after january 1st 2013.
> 
> Except for the refresher curriculae as Rid has detailed in his OP



Actually, the first testing of the new scope will be out by 2012. 

R/r 911


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## Shishkabob (Jul 21, 2009)

Ridryder911 said:


> Chances are this will not be totally in affect until after you have graduated.
> R/r 911





You all heard it!  Rid thinks I'm going to graduate!  B)




Thanks for the info.


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## 8jimi8 (Jul 21, 2009)

Ridryder911 said:


> Actually, the first testing of the new scope will be out by 2012.
> 
> R/r 911



I may be quoting an old agenda paper.  Oh... wait i think it was the "all schools must be accredited" by 01.01.2013

am i incorrect on this date too?


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## Summit (Jul 21, 2009)

It seems like this is an excellent remind as to why I should absolutely not take the EMT-I class right now even though there is an excellently scheduled nearby class for very cheap.

Who would think about becoming an I with this on the horizon?


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## xlq771 (Jul 21, 2009)

If I am understanding the gap analysis document correctly, it states on page 42 that AEMT will not be performing EKG monitoring.  Why would they remove this, and how could that be considered an improvement?  With the exception of BC, Canadian PCP paramedics do at least 3 lead EKG, and some do 12 lead.


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## Ridryder911 (Jul 22, 2009)

xlq771 said:


> If I am understanding the gap analysis document correctly, it states on page 42 that AEMT will not be performing EKG monitoring.  Why would they remove this, and how could that be considered an improvement?  With the exception of BC, Canadian PCP paramedics do at least 3 lead EKG, and some do 12 lead.



AEMT or Intermediate level was never taught ECG interpertation except for the I-99 which was more a psuedo Paramedic. Why teach intepertation(s) if one cannot treat it? 

R/r 911


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## 8jimi8 (Jul 22, 2009)

well, at least i was already planning a paramedic class in december.


maybe i'll get a live intubation before they take it away from me! The county that I practice in is quite slow.


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## Summit (Jul 22, 2009)

It all looks very good. The *ONLY* skill qualm I have is why remove needle decomp from the AEMT?


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## timmy84 (Jul 22, 2009)

I think they are really considering I/99 and Paramedic too close to distinguish the difference.  I/85 and AEMT seem to be very similar.  EMT-B and EMT except the removal of activated charcoal, and NG/OG which is not in Indiana's scope anyway.  Of course all of this needs to be adopted by every state, and I am not sure if I have confidence in that happening.  I HOPE IT ALL DOES.  I think I would like to see EMS advance itself to a bonafide profession by the time I retire (approx 2040), LOL.


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## Summit (Jul 22, 2009)

timmy84 said:


> I think they are really considering I/99 and Paramedic too close to distinguish the difference.



Certainly so by looking at skillset alone, thus the choice. With the elimination of the I-99 on the horizon, enrolling in an I-99 class would be stupid. Paramedic school is the way.


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## timmy84 (Jul 22, 2009)

Summit said:


> Certainly so by looking at skillset alone, thus the choice. With the elimination of the I-99 on the horizon, enrolling in an I-99 class would be stupid. Paramedic school is the way.



I would hope that no school even offer I/99 at this point.  We should all want to become paramedics anyway.  Why would one not want to learn everything they can to help people out of the hospital.  I do not really understand why one would go to I/99 school instead of paramedic school anyway.


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## Aidey (Jul 22, 2009)

I've only looked at part of this so far, but I've got a few questions on it. 

1. With the increase in education for A&P, why remove pressure points and elevation from the AEMT and Paramedic level for bleeding control? Did I miss some big finding in trauma resuscitation stating these aren't effective? Are they recommending that when direct pressure fails we go straight to a tourniquet?

2. How is this going to affect states that don't use NREMT for their EMT levels?

3. Why no umbilical vein access? Are they thinking that we go straight to IO if a IV access is unable to be obtained through a peripheral vein? 

4. Why remove urinary caths? I understand that for most urban areas they aren't necessary, but for rural areas they can be.

Also, will these changes affect an agency's or medical director's ability to increase the scope? For example, a rural area could still keep urinary caths if their medical director/protocols called for it. Or will it still be handled the same that it is now?


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## triemal04 (Jul 22, 2009)

Aidey said:


> I've only looked at part of this so far, but I've got a few questions on it.
> 
> 1. With the increase in education for A&P, why remove pressure points and elevation from the AEMT and Paramedic level for bleeding control? Did I miss some big finding in trauma resuscitation stating these aren't effective? Are they recommending that when direct pressure fails we go straight to a tourniquet?  Actually, yes.  It's now generally more recommended to move to the use of a tourniquet if bandaging/direct pressure isn't effective.  Been a lot of new info on how to control bleeding found in the last couple of years...
> 
> ...


I like the path that this is going down, but it doesn't go far enough.  Unless medicare starts to only pay bills for services/states that follow these levels, this won't have an impact nationwide.  As well, the anyalsis doesn't really give out a lot of information as to what the paramedic level needs to add in certain areas, (A&P being one), just that it needs to improve.  Someone correct me if I'm wrong, but I can't recall anywhere in the new standards that defines that, just that a "comprehesive" understanding is needed...which could vary from area to area unless it get's more specific.


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## Aidey (Jul 22, 2009)

Thanks for the reply. I understand that in severe bleeding definitive control needs to be obtained, and providers shouldn't be worried about "going through the steps" before attempting a tourniquet. It just seemed strange to me that they would remove it, rather than emphasizing the tourniquet. I knew pressure points had fallen out of favor, but I guess I hadn't realized elevation had too. Granted, elevation is really only helpful in isolated bleeding injuries with no structural issues.


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## Shishkabob (Jul 23, 2009)

The army found that in bleeds, pressure points and elevation were worse then useless.  If pressure alone didn't stop the bleed, you don't waste time doing anything else but putting on a TQ.

The NR changed their standards back in January.


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## Aidey (Jul 23, 2009)

I guess I'm just used to doing both elevation and pressure at the same time in the cases where you can safely elevate without risking aggravating an underlying injury. The most common ones I can think of are self-injurious/suicide attempt lacerations to the wrist.


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## Summit (Aug 3, 2009)

Colorado will apparently be keeping the I-99 level.


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## emtbill (Aug 3, 2009)

Summit said:


> Colorado will apparently be keeping the I-99 level.



Virginia as well. It is evidently a state's prerogative to keep their current levels and virginia choose to keep the Intermediate level (scope of practice is NREMT-I/99). My protocols are literally identical to the paramedic level except for RSI and crichothyrotomies. I believe Virginia is keeping the intermediate level because many ALS providers in rural areas would be unable to commit to bridging to paramedic when the scope of practices are essentially the same. Taking away Intermediate would mean less ALS availability in rural areas where patients need it the most.


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## MrBrown (Aug 3, 2009)

A positive step, allbeit limited and on the whole dissapointing .... the scopes of practice for EMT and A-EMT are still very limited, much below what is allowed here.  I know it's like comparing bananas to rocks but still I hardly think salbutamol, glucagon, entonox and GTN should be "advanced" procedures (they are basic skills I can perform here)


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## ResTech (Aug 3, 2009)

I personally find this move in EMS to be exciting. I hope this plan for education over training is not optional for States and that the Federal Government forces compliance. 

I been only remotely following the National Agenda and Scope over the years but it seems like a great deal of time and research has led up to this point. As EMS professionals we need to embrace this progression.


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## Dominion (Aug 11, 2009)

In my opinion no more letting states decide their own protocols and skill levels.  All states use the same national protocols and EMT, AEMT, and Paramedic are taught everything on that protocol.  Then let medical directors (who are approved by this same nationwide governing board) decide what is and what isn't valid for their area. For example some protocols might be more for rural EMS while urban EMS doesn't really need that specific skill.  

This would be the most logical step in the right direction I believe but the complications would be how do you enforce such a policy and would the government be willing to front the budget to form such a national committee.  How do you decide who's on it and determines the protocols?  Like above also how can you perfectly balance the many many different situations out there.  For example some services don't do CPAP because of a cost issue (I know of 3 in the area that won't do CPAP because they can't afford it in the budget as well as other useful but 'considered' non-essential items.

Edit: Reading over the proposal I also find the new standards exciting and taking steps towards a proper solution.  As far as I can remember Kentucky will be adopting the new standards.  As of right now there is only one accredited program in Kentucky.  (EKU AS Program)


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## daedalus (Aug 11, 2009)

MrBrown said:


> A positive step, allbeit limited and on the whole dissapointing .... the scopes of practice for EMT and A-EMT are still very limited, much below what is allowed here.  I know it's like comparing bananas to rocks but still I hardly think salbutamol, glucagon, entonox and GTN should be "advanced" procedures (they are basic skills I can perform here)



At the educational status of these "providers" in the United States, any medication administration is an advanced procedure. The pharmacology section of the EMT book is 6 pages long, lol.


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## daedalus (Aug 11, 2009)

emtbill said:


> Virginia as well. It is evidently a state's prerogative to keep their current levels and virginia choose to keep the Intermediate level (scope of practice is NREMT-I/99). My protocols are literally identical to the paramedic level except for RSI and crichothyrotomies. I believe Virginia is keeping the intermediate level because many ALS providers in rural areas would be unable to commit to bridging to paramedic when the scope of practices are essentially the same. Taking away Intermediate would mean less ALS availability in rural areas where patients need it the most.



Than Colorado and Virginia are choosing to keep EMS in the dumpster it is in now.


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## 46Young (Aug 15, 2009)

Do you see what I mean whan I speak repeatedly about organizing? Achieving educational reform on a national scale isn't likely without strong political influence. 

Like emtbill said, some areas won't have any advanced care otherwise, so why would they agree to do away with what little they do have?

I've been told in VA that there will be no more new EMT-I classes, but current providers can re-cert. Fairfax is currently pushing their EMT-I's to upgrade to the P level.


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## Ridryder911 (Aug 15, 2009)

46Young said:


> Do you see what I mean whan I speak repeatedly about organizing? Achieving educational reform on a national scale isn't likely without strong political influence.
> 
> Like emtbill said, some areas won't have any advanced care otherwise, so why would they agree to do away with what little they do have?
> 
> I've been told in VA that there will be no more new EMT-I classes, but current providers can re-cert. Fairfax is currently pushing their EMT-I's to upgrade to the P level.



As the EMT/I level is being abolished and transformed into the Advanced level. EMT-I 99's will be a thing of the past. Truthfully, the Intermediate level was never designed to allow advanced care forever. It was designed as a transitional period while obtaining your Paramedic and areas that could not immediately employ Paramedics; unfortunately employers and systems/cities found that they can bill as an ALS and never have to move forward. 

One of the reason state's still want to maintain it is simple economics. Less pay to employees and increase revenue or being able to state they have ALS when in fact that is partially correct. 

R/r 911


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## 46Young (Aug 17, 2009)

Ridryder911 said:


> As the EMT/I level is being abolished and transformed into the Advanced level. EMT-I 99's will be a thing of the past. Truthfully, the Intermediate level was never designed to allow advanced care forever. It was designed as a transitional period while obtaining your Paramedic and areas that could not immediately employ Paramedics; unfortunately employers and systems/cities found that they can bill as an ALS and never have to move forward.
> 
> One of the reason state's still want to maintain it is simple economics. Less pay to employees and increase revenue or being able to state they have ALS when in fact that is partially correct.
> 
> R/r 911



Sounds about right. Fairfax is trying to get those who want to go ALS from in house to get their I while they still can, then upgrade all existing I's to P's.


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