# Diary of the NREMT



## FirstResponder (Jan 2, 2019)

I just want to leave this topic wide open... 
What are some of your thoughts and opinions (maybe even nightmares) regarding the NREMT? Anything and everything about it. What's good, what's bad, what needs improvement?


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## DrParasite (Jan 2, 2019)

It's a 2 years certificate cycle.... my state cert is every 4..... 

NREMT is nice to have if you are changing states (IE moving, or working in multiple states).  

It's great to have one common test for EMS nationwide (one per level), as each state doesn't need to create and maintain their own exams (which is more expensive and time consuming that you would believe)... so in theory, everyone has the same baseline knowledge, and then individual state knowledge and experience is added once the person starts working.

Many people I work with earned their NREMT or NRP when they first were certified.... Unless you are planning on changing states, or your employer gives you a bonus for having it, there really is no reason to keep up your NR cert; just your state one.


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## mgr22 (Jan 2, 2019)

No major likes or dislikes -- just wish it were possible to retain membership without having to be active clinically.


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## PotatoMedic (Jan 2, 2019)

T


mgr22 said:


> No major likes or dislikes -- just wish it were possible to retain membership without having to be active clinically.


you can.  You recertify as inactive.  Still have to do ce but don't need an agency affiliate.


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## mgr22 (Jan 2, 2019)

PotatoMedic said:


> T
> you can.  You recertify as inactive.  Still have to do ce but don't need an agency affiliate.



Yes, I know about the "inactive" option. I meant something that doesn't label you that way. "Inactive" can mean different things, none of which would enhance one's standing.


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## CCCSD (Jan 2, 2019)

Biggest money scam in the US.


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## NomadicMedic (Jan 3, 2019)

It's a certification test, like the NCLEX. I don't have any particular feelings about it. It's an easy way to measure simple baseline competency and make it easier to get reciprocity.  I've never had an issue with it, I've recerted by test and by CE. If you work in EMS, it's part of the cost of doing business. 

I have bigger issues with paying to have my car inspected and registered every year.


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## NomadicMedic (Jan 3, 2019)

DrParasite said:


> It's a 2 years certificate cycle.... my state cert is every 4.....
> 
> NREMT is nice to have if you are changing states (IE moving, or working in multiple states).
> 
> ...



Depends on where you are, Paramedics in DE are required to have NR. There is no “state cert" per se... you receive state certification when you're current in NR. Without it, there is no mechanism to remain certified.


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## Gurby (Jan 3, 2019)

CCCSD said:


> Biggest money scam in the US.


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## ViolynEMT (Jan 4, 2019)

I just take the EMT refresher. It satisfies the 24 hours of CE required by the state. If I renew the NREMT, the state license renewal is much easier. Kill 2 birds with one stone. I'm just a little confused by the new requirements since my last renewal. It says only 20 hours of CE required, but the director of the school where the refresher course is is telling me that I need an additional 16 hours. 40 total.


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## Peak (Jan 4, 2019)

I don't think it's as bad as some make it out to be, but I still think that they have too much restriction while simultaneously doing very little to actually preserve the quality of care given by EMS providers. 

Keep in mind that when compared to the NCLEX, it does far more to involve itself in your practice after you pass. With the NCLEX you take the test, and once you pass your complete the rest of your state licensure application. You never retest on the NCLEX or submit CE to them, and if I apply to work in another state once I'm licensed NCLEX has nothing to do with it. In fact, even with the BCEN or AACN, my certs don't affect my state license or ability to work in another state. 

I do think that the minimum training requirements are pitiful, and to my knowledge the NR has done almost nothing to promote increased education. I also think that the skills checks are a bit of a joke, though my last experience was long ago, but I found that students were often failed for unimportant reasons and those being passed actually have quite poor care but checked the boxes. 

In many ways I like the idea of a national certifying body, but with such a variance in practice from state to state I'm not sure it's actually possible without significantly remodeling the system. 

As to the concern about costs, NREMT is one of the cheapest exams you can take. Take a look at the NCLEX, BCEN, AACN, ANCC, NCCPA, USMLE, ABPS, or the countless other organizations for nurses, PAs, and Docs.


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## CCCSD (Jan 5, 2019)

Gurby said:


>



So what, exactly, do you get for your money? A requirement to retest and certify locally, each time you move, no blanket across state reciprocity, etc. yep. Great way to waste money and line the pockets of some group that doesn’t do what they claim.

As to your meme, I find it offensive and unworthy of this forum. If I’m warned for calling things straight, it would seem that your action is also a violation.


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## RocketMedic (Jan 13, 2019)

CCCSD said:


> So what, exactly, do you get for your money? A requirement to retest and certify locally, each time you move, no blanket across state reciprocity, etc. yep. Great way to waste money and line the pockets of some group that doesn’t do what they claim.
> 
> As to your meme, I find it offensive and unworthy of this forum. If I’m warned for calling things straight, it would seem that your action is also a violation.



That’s a pretty big overreaction.


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## DrParasite (Jan 25, 2019)

Peak said:


> Keep in mind that when compared to the NCLEX, it does far more to involve itself in your practice after you pass. With the NCLEX you take the test, and once you pass your complete the rest of your state licensure application. You never retest on the NCLEX or submit CE to them, and if I apply to work in another state once I'm licensed NCLEX has nothing to do with it. In fact, even with the BCEN or AACN, my certs don't affect my state license or ability to work in another state.


I think this is one of the important distinctions.  the NCLEX is a TEST that every nurse has to pass.  once they pass the test, the apply to get their state's nursing license, and all future updates are through the state.  You don't need to maintain your NCLEX passing status every other year to keep your nursing license active.

NREMT is a cert that likely makes it easier to change states, but that's it (other than DE that requires medics to keep their NR).  My NR is set to expire next month, and while I will likely renew it, I'm starting to question the why I should, as I have no plans to leave my current state anytime soon.  Few places recognize it as a standalone cert, but many states will accept it as equivalent to their local cert, and issue you a local card if your cert is still valid.

So is there value in it?  well, I guess it depends on how you plan to use it, and if you plan on moving anytime soon.


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## ViolynEMT (Jan 26, 2019)

I take a refresher, which satisfies state requirements here in Arizona. I only need 16 additional hours of anything I want to take to renew my NREMT cert. I don't mind sitting for an hour here and there to get the extra hours in. For some companies that are hiring, it gives one that extra edge. Of course this is for EMT. A wee bit easier.


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## johnrsemt (Feb 5, 2019)

NR is good if you ever do an out of state transport (which you will do someday if you work for a private service);  people say they won't do it, but when I worked in Indiana I transported to or from 11 other states in 8 years at one company.  Also on the way to or back from the patient I don't remember how many times I was waved down by the police, or a family member or car driving along with us for a sick or injured person.
Not to mention being the 1st on scene at a mobile home park that was nailed by a tornado in another state at 0200 (and we weren't even positive what state we were in).
  Never had a problem from the hospitals.  Had a couple of doctors ask us for our certification numbers and states we were certified in;  partners always said Indiana, I always said NR-EMT.


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## CCCSD (Feb 5, 2019)

RocketMedic said:


> That’s a pretty big overreaction.


Not really, when I’ve been slammed for being direct.


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## DrParasite (Feb 6, 2019)

johnrsemt said:


> NR is good if you ever do an out of state transport (which you will do someday if you work for a private service);  people say they won't do it, but when I worked in Indiana I transported to or from 11 other states in 8 years at one company. Also on the way to or back from the patient I don't remember how many times I was waved down by the police, or a family member or car driving along with us for a sick or injured person.


Couple things wrong with your statement:

unless your state allows NR to be used in place of the state certification (like DE does), you are still not certified in that particular state.  For example, when I came to NC, I had both NJ and NR certs, so NC gave me a NC card with no real issues.  but if I just had my NR cert, I wouldn't be certified in NC, nor would any company hire me until I had my NC cert.  So I'm not an NC certified provider, even though I have my NR.
As I just mentioned, you might be flagged down by PD, or someone else, you still aren't certified in that state, nor is your ambulance registered in that state, nor are you part of the local EMS system, nor do you fall under that location's local medical direction.  You are still operating in an area when the state EMS system hasn't recognized you as an appropriate provider.  If you want to be technical, the best think you can do liability wise would be to ask the family member to call 911, or tell the cop to request the AHJ, and you provide stabilizing interventions until the AHJ gets there.
As long as nothing bad happens, you're likely to be fine, provided no one asks questions or knows any better.  But when someone does ask questions, or the state OEMS asks you why you are operating an unlicensed ambulance in their state, treating patients without an approved medical director, and transporting people from the scene to a hospital, and then fines you for your actions, will you have a good defense?  Before you say it would never happen, New Jersey has a list of agencies who were caught doing this



johnrsemt said:


> Not to mention being the 1st on scene at a mobile home park that was nailed by a tornado in another state at 0200 (and we weren't even positive what state we were in).


Border calls you can always plead ignorance.  The tornado destroyed the line, and we could _*see* _people in need.  And it's not like we haven't assisted that area in the past.  Now if you are driving 50 miles out of your primary area, and going through multiple agencies to get to that mobile home park, without being asked, that's going to raise some red flags, and NR isn't going to help you.

Ditto MCIs on the border.  No one will care, especially if you were requested to respond by the AHJ, and your agencies have an MOU in place.  When 9/11 happened, do you really think anyone cared that you had NJ ambulances with NJ EMTs (most who weren't certified in NY or NR at all) ready to cross into NYC and assist?  


johnrsemt said:


> Never had a problem from the hospitals.  Had a couple of doctors ask us for our certification numbers and states we were certified in;  partners always said Indiana, I always said NR-EMT.


I have never had a doctor ask for my certification number, nor the state I was certified in.   And I've been on ambulances in NY, NJ, PA, and NC.  If a doctor is asking for my certification number, it's likely to file a formal complaint, and I'm more likely to give him my supervisor's number instead.   Otherwise, there is no need for the doc to even need it.

I've never had a hospital or any hospital personnel ask for my certification number.  heck, I couldn't tell you my NR number without looking it up.


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## hometownmedic5 (Feb 7, 2019)

DrParasite said:


> Couple things wrong with your statement:
> 
> unless your state allows NR to be used in place of the state certification (like DE does), you are still not certified in that particular state.  For example, when I came to NC, I had both NJ and NR certs, so NC gave me a NC card with no real issues.  but if I just had my NR cert, I wouldn't be certified in NC, nor would any company hire me until I had my NC cert.  So I'm not an NC certified provider, even though I have my NR.
> As I just mentioned, you might be flagged down by PD, or someone else, you still aren't certified in that state, nor is your ambulance registered in that state, nor are you part of the local EMS system, nor do you fall under that location's local medical direction.  You are still operating in an area when the state EMS system hasn't recognized you as an appropriate provider.  If you want to be technical, the best think you can do liability wise would be to ask the family member to call 911, or tell the cop to request the AHJ, and you provide stabilizing interventions until the AHJ gets there.
> ...



Thanks for taking one for the team and writing that all out. I was formulating my thoughts to do the same, but yours was better.


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## johnrsemt (Feb 16, 2019)

To Dr Parasite and Hometownmedic:
1:     Where I was working before we had to be NR; and then the state would give us their certification as long as we had a letter from the supervisor of the company that we were going to work from and our new medical director (although a phone call for the MD would work too).

2:   When we would get flagged down we would ask the trooper, who had a car in the ditch, who he thought the driver had a seizure;  (turned out the driver had an MI) to ask his dispatcher how far out their EMS was (it was during a bad ice storm) and the trooper's dispatch said that it was up to 2 hours before they could get an ambulance there, they were backed up with runs do to the storm and she asked if we would take the patient to the hospital.  We asked the trooper if he would lead us, since we didn't know where the local hospital was.  He did, we followed.  When we got to the hospital, my partner/medic explained to the ED Doc what happened where we  were from, who our Medical Director was and his phone number, and the doc took our names and cert numbers.     Our MD gave us nice comments at the next Audit and Review for it.
3:   Prior to a long distant transport, our company would check with the State EMS offices of the states we were transports to or from and through to see if they had problems and none of the states had a problem with it.  A few EMS offices would ask if any of our people were nationally registered.   Sometimes when I was in Dispatch and I would make those calls (which was fun when I was setting up long distance transports for me to take) I would ask the State EMS offices what they thought if during a return we got waved down for help:  usually the answer was "help people, just like we expect our people to do".

Every time we got waved down to help we would call 911 on cell phone mainly to say this is who we are, and were we are and what we got, are you going to send an ambulance to take the patient?  If they asked us to transport, We would have to ask for directions to the closest hospitals.  Probably only had local EMS come out 3 out of 5 or 6 times other times we would transport.   
  I did probably 50 plus out of state transports.  100's of long distance in state transports.

With the Tornado it wasn't a border call we were on the way back from Missouri and were close to the MO/IL border at 2am and went through an area that was just nailed by a tornado;  it took 20 minutes to get a cell call out;  in fact I had to send my partner in the ambulance on a 10 minute drive before she got cell service to call 911 and report it, and then come back.  Myself and the 3rd on the truck stayed with the trauma gear, and continue searching and treating who we could.   3 died, nothing we could do;  We didn't transport any on that one;  we did triage and treatment.  45 or so serious injuries.


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## DrParasite (Feb 16, 2019)

johnrsemt said:


> To Dr Parasite and Hometownmedic:
> 1:     Where I was working before we had to be NR; and then the state would give us their certification as long as we had a letter from the supervisor of the company that we were going to work from and our new medical director (although a phone call for the MD would work too).


yeah, that's called reciprocity, it's very common.  It's how I got my NYS EMT.  and NC EMT.  but the big difference is you were given a state cert from that state, with a state number; you weren't operating under NR, you had the state approval with a state card.


johnrsemt said:


> 2:   When we would get flagged down we would ask the trooper, who had a car in the ditch, who he thought the driver had a seizure;  (turned out the driver had an MI) to ask his dispatcher how far out their EMS was (it was during a bad ice storm) and the trooper's dispatch said that it was up to 2 hours before they could get an ambulance there, they were backed up with runs do to the storm and she asked if we would take the patient to the hospital.  We asked the trooper if he would lead us, since we didn't know where the local hospital was.  He did, we followed.  When we got to the hospital, my partner/medic explained to the ED Doc what happened where we  were from, who our Medical Director was and his phone number, and the doc took our names and cert numbers.     Our MD gave us nice comments at the next Audit and Review for it.


I have no problem with anything you did; in fact, I'd probably do the same thing.   Actually, I know I would.  It's a lot easier to defend taking someone to the hospital in an ambulance than not, however if someone wanted to make a big deal about it, I'm pretty sure my former management would back me.  But I still know the rules, which is why I would be ok with breaking them and dealing with any consequences.  I'm actually surprised the doc took your names and cert numbers; most don't care, because once you are out of the ER, they forget about you, unless you do something that makes you super memorable.  But has nothing to do with national registry.


johnrsemt said:


> 3:   Prior to a long distant transport, our company would check with the State EMS offices of the states we were transports to or from and through to see if they had problems and none of the states had a problem with it.  A few EMS offices would ask if any of our people were nationally registered.   Sometimes when I was in Dispatch and I would make those calls (which was fun when I was setting up long distance transports for me to take) I would ask the State EMS offices what they thought if during a return we got waved down for help:  usually the answer was "help people, just like we expect our people to do".


I'm a little fuzzy on the rules, but typically as long as the ambulance is registered by either the source or destination hospital, no one cared.  I've transported to NY from NJ several times, as well as into PA.  Never had a PA card, and my NY card is long expired.  And I have never asked a state EMS office that question, but I'm not surprised by the response; when in doubt, err on the side of the patient.  But none of this has anything to do with national registry.


johnrsemt said:


> Every time we got waved down to help we would call 911 on cell phone mainly to say this is who we are, and were we are and what we got, are you going to send an ambulance to take the patient?  If they asked us to transport, We would have to ask for directions to the closest hospitals.  Probably only had local EMS come out 3 out of 5 or 6 times other times we would transport.
> I did probably 50 plus out of state transports.  100's of long distance in state transports.


So when I was in the 911 center, on a few occasions, I had BLS ambulances calling in stuff.  Maybe it was an MVA.  maybe it was that they needed ALS from our agency.  If they have an ambulance, why would I not tell them to take them to the hospital?  I'm not that territorial.  We had one of our ambulances going to an address, that somehow ended up being in the next town over.  like several blocks into the next town.  they asked what they should do.  our supervisors response: "go inside, treat them appropriately, and take them to the hospital if needed.  They take one of ours, we will take one of theirs, it all balances out in the end."  But it has nothing to do with national registry, and should someone make an issue out of it, there are the potential for consequences.





johnrsemt said:


> With the Tornado it wasn't a border call we were on the way back from Missouri and were close to the MO/IL border at 2am and went through an area that was just nailed by a tornado;  it took 20 minutes to get a cell call out;  in fact I had to send my partner in the ambulance on a 10 minute drive before she got cell service to call 911 and report it, and then come back.  Myself and the 3rd on the truck stayed with the trauma gear, and continue searching and treating who we could.   3 died, nothing we could do;  We didn't transport any on that one;  we did triage and treatment.  45 or so serious injuries.


Good for you, I probably wouldn't have sent my partner away with the ambulance and no way to reach them, but that's jsut me..  Has nothing to do with national registry.

Let me try to explain this whole thing: everything you said is great, but has absolutely nothing to do with your national registry card.  the exception is having an NR card helps with reciprocity (sometimes).  But even then, you still need state approval to be an EMT; NR alone doesn't cut it, unless your state uses NR as their state card.  

If you are in a marked vehicle, and you get flagged down, and you take someone to the hospital, and there are no negative consequences to your actions, good for you.  bonus points if you ask the AHJ if they are ok with it, and they say yes.  Same applies if you drive up on an MCI.  You might have to do some paperwork afterwards, maybe even call your state office of EMS to report the unusual activity, but most of the time, they will say "thanks for letting us know, good job, a shiny gold star for all involved."  Has nothing to do if you are NR certified or not.

It's when you are doing it when you aren't supposed to, or when someone does complain, or you aren't following the regulations like you are supposed to, that is when there can be consequences.  But that has nothing to do with NREMT at all.

for the TLR crowd: everything you said was great, your a hero in my book, but the only thing that had any relevance to NREMT was the first line, which says that NREMT makes it reciprocity easier.


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## Alan L Serve (Feb 17, 2019)

NREMT, "Where our ConEd requirements change as often as the seasons and we rejected your ConEd despite state and CBCEMSBENMS approval because our people can't be bothered to read that the approvals are there in big bold blue letters."


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## toreishi (Mar 13, 2019)

CCCSD said:


> Biggest money scam in the US.


YES !!!!!  They created a need and filled it (with themselves) !


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