# Changes in NREMT



## Ridryder911 (Sep 4, 2008)

I will be meeting with Bill Brown, RN, MS, NREMT/P Executive Director of the NREMT tomorrow. Apparently there will be new changes at the NREMT and some other information regarding their testing and re-certification process. 

I will pass any new information I receive. 

R/r 911


----------



## bstone (Sep 4, 2008)

Aren't all changes new? Ok, sorry for nitpicking. Heh. Are they going to force MA to begin accepting NREMT? That would be swell.


----------



## ILemt (Sep 5, 2008)

Rid, are you on the board or something?


... I know, you're Bledsoe... in disguise.

j/k


----------



## marineman (Sep 5, 2008)

Looking forward to hearing about it. R/r if you don't mind me asking how long have you been in EMS? Seems like there's not a question you can't answer and a person you don't know, really shows dedication to a career.


----------



## Ridryder911 (Sep 5, 2008)

marineman said:


> Looking forward to hearing about it. R/r if you don't mind me asking how long have you been in EMS? Seems like there's not a question you can't answer and a person you don't know, really shows dedication to a career.



In dog years, I would be long dead. Just past the 31'st year last June. 

R/r 911


----------



## bstone (Sep 7, 2008)

So what about them changes?


----------



## ffemt8978 (Sep 7, 2008)

Ridryder911 said:


> In dog years, I would be long dead. Just past the 31'st year last June.
> 
> R/r 911



So how many patients did you see on the Ark?


----------



## reaper (Sep 7, 2008)

Ridryder911 said:


> In dog years, I would be long dead. Just past the 31'st year last June.
> 
> R/r 911



That all? You young whippersnappers!!


----------



## karaya (Sep 7, 2008)

reaper said:


> That all? You young whippersnappers!!


 
I think he (Rid) means 31 years in the biz - not his age.


----------



## reaper (Sep 7, 2008)

I know, Just messing with him!


----------



## Ridryder911 (Sep 7, 2008)

Here's is some of information related to me from Bill Brown, CEO of NREMT when he met with educators within my state. These are some notes I was able to jot down. 


 Approximately the NREMT administers 137.137  users account are established.

 75% of the tests administered are of those are at the Basic Level

Out of those, only approximately 50% actually become an working EMT.


70% of Basic Examinations are passed on the first time

 62% of Paramedic examinations are passed on the first time

Terms seen on NREMT web site and instructor information to inform about students.
Term                                         Definition
Attempt rate                                   Percent qualified
Fail                                                Those that fail 6 times
Incomplete                                      Those that fail attempt but remain eligible


99% results are returned within 1 working day

 99% score of the practical are within one working day


----------



## Ridryder911 (Sep 7, 2008)

Sorry, for a continuation. 
NREMT is "non-profit" organization. 

*Logits* is difficulty of the question. Each question is given a weight based of logits. It is *NOT BASED upon percentages or what number it shuts off! * The more questions you get the correct the more difficult the question will become. 

Logit point- maximum 110 for Basic and 28 research logits (it is not added or placed into your score
130 for the Paramedic level and 10 pilot questions. 

So one can see, It does *NOT MATTER WHAT QUESTION YOUR TEST ENDED WITH!!!*

Yes, answering the last question wrong can affect your score. 

One can pass the test and still be inadequate. How? There is a standard level of answering right and wrong they get a few right and few wrong.They give enough right answers to "err in management", due to the low number of questions. All board exams have this probability, it is part of the risks of administering tests.  


The average time to complete the test is 90 minutes or less 88% of the participants.

 The fastest time to test the Basic exam and pass was 16 minutes


 All military medics, are tested through the NREMT.


 When asked, approx 63% (2/3) rate the exam as difficult

About 53.4% reflect the examination covers material that one needs to know


 When needed to,  about 43%  of those that needed to cancel were able to do so, without complications


 The reason most are not able to test is due to NOT having the proper ID. For example the name you list must be identical to the official ID you show.(i.e name change, marriage, etc.)

Complaints in regards to the test. Most are found non reliable. Most cannot accurately recall what was on the test. Most describe the number of questions it stopped inaccurate and as well that there were duplicated questions. Each question has its own unique identifier and level. There are similar questions (there are only so many ways you can ask about airway control).

I will post more later in regards to the future and current events per the NREMT. 

R/r 911


----------



## bstone (Sep 7, 2008)

Interesting! However, what are the "changes"? Am I to be retitled an EMT-Advanced?


----------



## Ridryder911 (Sep 8, 2008)

Sorry for mulitple postings.. 

Recommendations to instructors. See if any of these sound familiar?

*How to increase the performance level of the Basic EMT*


 Must have strong institutions support
 In other words, the school administration must want to have a *program* rather than just a class. This involves total involvement, support financially and rules to ensure a quality program


Strive institutional consistency through development of clear objectives, standard lesson plans & frequent communications


 Recant students and motivate students to succeed!


 *Admit students who either through prerequisite course work of pre-testing have demonstrated that they have academic skills such as the HOBIT test. *


Develop student tests taking skills by frequent administration of written and practical assessments and provide timely feed back on performances
 In other words, one should have multiple tests similar to the NREMT, as well as multiple skill testing within the course


 Encourage excellence by establishing passing standards that exceeds minimum of competency

Schools should develop *Mentor* programs and *Study Groups*. Allow the students to learn by investigating and reading multiple texts and resources. 

*Develop a cultural of excellence-demand a higher expectation! People will succeed!  *

Establish test that establishes success!

*The primary purpose of the NREMT examination is public protection, BUT they frequently receive inquiries regarding topics and content areas that seem to be challenging for EMS community*. 

Biggest and Most DIFFICULTY areas in the Basic EMT Testing Area or in other words *HIGHEST FAILED AREAS*:

 AHA- BLS Guidelines from the 2005 Health Care Provider


 Types, mechanism and signs and symptoms of the different types of shock


 Management of the various types of burns

At the* Paramedic *Level there is NO consistent area that is failed, it is very general. 

Low Point areas that is often seen on all examinations:


S/s of head injury

management of extremity injuries

To be able to IDENTIFY & DISTINGUISH between RESPIRATORY DISTRESS & RESPIRATORY FAILURE especially in pediatric patients

 Management of childbirth and pregnancy

*Differentiate between airway management,oxygenation, ventilation & respiratory efforts*

*The Future!*

There are many agencies involved in the development of EMS in the future. NREMT is just one of many organizations: Here is some of those agencies recommendations and plans.

National Plan

 Recommends a single national recognized accreditation agency for EMS Educational Programs

Provide National Consistency

EMS is the ONLY licensed health care profession that does NOT require graduation from a nationally acquired educational program

*Development Care Content*

Be more pro active analysis, more EMS research, learn of past experience.

*National EMS Care Content*

 Defines the "domain" of EMS
Addresses knowledgeable content globally

Medically directed

Was completed by NAEMSP in 2004

SCOPE of PRACTICE

 Defines the National License Level

Is a model for the state to follow in defining, what EMS professionals can do

Developed by NAEMSP

Reformed in 2007

*Transition Toolbox 2009 *(bench marked for 2011)

The three national levels for EMS will be *EMT, EMT Advanced and Paramedic*
Note, states may have different levels but nationally there will only be the three. 
As well notice the term "Basic" has been removed, the term "Intermediate" also has been abolished as well the "EMT" from the Paramedic. These are expected to be released in 2009 but not really take affect until 2011.

EMT and Current Intermediates will have to take a transitional course. This course will ensure that all current EMT's are on the current level. Paramedics will not be required, however; new curriculum for Paramedics will cover such areas as 12 lead and increased medication(s). 

*National EMS Certification*
 Provides a single National Independent Agency

Verifying competency at a predetermined level of proficiency

Serves as the basis for State EMS licensure

At this time there are only* 4 *States that do not use the NREMT. 

National EMS Education Program Accreditation 
Single National Independent Agency

A Non-Governmental Collegial process of Self and Peer assessment

 Defines Standards and evaluation programs relative to those standards

Accredited Programs vs. those that are NOT Accredited (Paramedic Level)
Accredited Programs produces higher score pass rates. 
Practical simulators (high simulators) increases skills and pass rates 
It is highly recommended that schools start preparing for accreditation. Developing a portfolio on each student. Providing information that the student was not just informed and evaluated but provide documentation that the student skill was re-emphasized. For example Cervical Immobilization with a C-collar not once, but three four times during the class. 
Develop a Preceptor Essay and have a Psychomotor Package. 

It is predicted (2010-2011) if the school is accredited and has such programs in place the graduating students of such programs those students may only have to test Trauma and Cardiac stations only in lieu of the other portions/stations involved.

Right now 14 states require accreditation for EMS Education Institutions. 

*Future of the NREMT reregistration process. *
A "banking" type system will be put in place. In other words, re-registration will done on computer. You enter the authorized CEU and automatically get credit for it in your file. When you are due, you "withdraw" these CEU's and refresher course number, your education/supervisor/Director enters their authorized number as well as your medical director does the same. You then can pay through electronically like Pay-Pal, etc.. Receive your card in a few days. There are already test pilot areas in place that will perform this, at the end of this year. 

NEW THINGS for NREMT

Revision of Psychomotor Exams

Implement Revised Educational Standards

Community Relations Programs

Promote more EMS Research

The main point is that changes takes time. Most of the changes that will be occuring started 10-15 years ago. It usually take > 10 years to make changes. So although it occurs, it is a very SLOW process. 

I hope as NREMT goes to various states, that everyone that can attend do so. It is very informative. I do believe that the NREMT understands the majority of our problems. That they are often misunderstood as we even see posts here. They are just a testing agency for EMS. They do understand there is a DIFFERENCE between the field and Classroom setting, however; all one can do is test logical and didactic and psychomotor skills. They do understand it is NOT perfect, but is attempting to reduce errors. 

R/r 911


----------



## bstone (Sep 8, 2008)

SO I have to take a transition course? Interesting. Did they say what the new scope for EMT-Advanced would be? I kinda like the name better, anyhow. What will they do if states do not offer the transition course and there is none within a geographical area reasonable? Can it be done online with a clinical time in some central area? I am all for quality improvement and I think these ideas are good, but they need to not leave those of us who just became NREMT certified out in the dust.


----------



## Ridryder911 (Sep 8, 2008)

From what I understood is that there will be a "grace" period for those that will need to go through the transitional phase. This is to ensure that all Advanced EMT's are up to par. Currently some are ahead (I-99) than others (I-85).  From what I understood, the 99 will disappear (not for sure). 

I am sure there will be opportunities to ensure almost everyone has a chance to meet the criteria. I do not know about the on-line choice, but I feel if it is a valid option they will try to do so. 

Again, many of these changes will occur far from now. If one starts Paramedic school, they will be in the field and working by the time most of the new changes occur. 

If you want further information on levels as well check out the National Scope of Practice website. 

R/r 911


----------



## marineman (Sep 9, 2008)

Great information R/r, the only change I'm not a fan of is dropping the EMT from paramedic. Yeah it's only a name but I have a feeling it will enlarge the head of those that walk on water.


----------



## bstone (Sep 9, 2008)

I like the title EMT-Advanced. I can get used to it. Intermediate is a little weird, to tell the truth.

Rid, where can I find the scope for EMT-Advanced? Moreover, is it more than the I-85 and less than I-99? What will happen to I-99s? Will they be given the chance to become medics or "downgraded" to Advanced? Your answers are required in essay format with MLA citations.


----------



## Jon (Sep 9, 2008)

Stone - You could always make it a null issue by going to medic school


----------



## Ridryder911 (Sep 9, 2008)

I would like to add that the longer you wait to take the test after completion of your course the higher percentage of failing occurs. In other words take the test as soon as possible from graduation. 

The percentage of those that await after 6 months to a year is very dismal and those after that is surprising that they pass. 

So again, advice is to take exams as soon as possible; while it is fresh on your mind. 


Those that have to re-take examinations more than three times, failure rate increases significantly. As well, one needs to really do a personal analyses if this is the right profession or career choice. Again, this tests is the minimum standard of safety and one will have to tests similar again for career placement. 


R/r 911


----------



## marineman (Sep 10, 2008)

R/r you hinted around the subject but didn't really come straight out and say it, was there any talk about accreditation requirements expected in 2013? Just read tonight that in 2013 the national registry will flat out no longer certify medics that graduate from unaccredited schools.


Source: http://publicsafety.com/features/article.jsp?id=8117&siteSection=5


----------



## Ridryder911 (Sep 10, 2008)

Actually all schools that want to have graduates to be eligible to take the NREMT Paramedic exam must be accredited by 2012. 

This has caused a storm, but in reality we are the *ONLY* health care profession that performs direct care that does NOT ALREADY require such accredititation. Each school has at the least of three to four years to receive it. Now, we will see if they will.

This is being fought against by the Fire Chiefs Association and many other associations related to Fire Service and Volunteer Agency Associations. Really a shame protesting that they feel quality education should be required. This is a prime example of those that place their personal interest above the patients life. 

There is no valid reason NOT to be accredited. By doing so demonstrates proper record keeping, validation of tests, skills, practical labs were performed, on site clinical instructors were available as well as instructors held at least some collegiate degree. Does this make them better? Well, yes. It has been demonstrated that graduates of such programs have a higher percentage of pass rates, job placements, promotions, longevity and lower cases of negligence. So something they are doing is right.... yet we have those that are against such? Why? 

Alike, Bill Brown discussed. One Fire Chief from CA called and was protesting that "It was ludicrous to require such, the costs was enormous and there would be no difference in the outcome!" ... after he was informed that all Paramedic educational facilities in CA was already accredited  he said..."Oh, then never mind, I would not have fought it, I had known that".... Yeah, real substance we are fighting against. 

R/r 911


----------



## phunguy (Sep 10, 2008)

"The fastest time to test the Basic exam and pass was 16 minutes "

Would be nice to know if this was me  I was done in what I thought was 15 minutes so I was damn close to the 16 minute mark...


----------



## Hastings (Sep 11, 2008)

Ridryder911 said:


> Actually all schools that want to have graduates to be eligible to take the NREMT Paramedic exam must be accredited by 2012.
> 
> This has caused a storm, but in reality we are the *ONLY* health care profession that performs direct care that does NOT ALREADY require such accredititation. Each school has at the least of three to four years to receive it. Now, we will see if they will.
> 
> ...



I think the only reason this could be a bad thing is because currently, being a graduate from one of those accredited (and one recognized throughout the entire country), puts me WAY ahead of practically anyone else when applying for a job. There are some schools that show you're a quality graduate, and I'm so glad I chose an accredited program. Thank God for the change.


----------



## marineman (Sep 11, 2008)

I think the accreditation is a wonderful first step towards universal standards of education for the field. It barely scratches the surface of the issues surrounding it but it's a good first step and that's always the hardest one to take.


----------



## firecoins (Sep 12, 2008)

Ridryder911 said:


> Alike, Bill Brown discussed. One Fire Chief from CA called and was protesting that "It was ludicrous to require such, the costs was enormous and there would be no difference in the outcome!" ... after he was informed that all Paramedic educational facilities in CA was already accredited  he said..."Oh, then never mind, I would not have fought it, I had known that".... Yeah, real substance we are fighting against.
> 
> R/r 911



This is what you get when you mix services. He probably fought it because he thought it would be harder to recruit firefighters that are required to perform a dual role.


----------



## Ridryder911 (Sep 12, 2008)

No actually he fought it because he thought it would:

 Increase education requirements

Employees would want an increase in salary

Cause an increase in his/her budget

As well knowing the more education, the more demand in patient care, which will increase more in-depth knowledge, more cost in supplies.... 

That is why it is as ironic as it is. 

R/r 911


----------



## VentMedic (Sep 12, 2008)

*About Accreditation *
*CAAHEP Accreditation FACTS*
*What This Means to EMS*​ 
http://www.coaemsp.org/aboutaccreditation.htm


----------



## EMTCop86 (Sep 13, 2008)

VentMedic said:


> *About Accreditation *
> 
> *CAAHEP Accreditation FACTS*
> *What This Means to EMS*​
> http://www.coaemsp.org/aboutaccreditation.htm


 
thank you for posting this website, there is a lot of useful information on it as well as an area to find out what schools are accredited.


----------



## emt561 (Sep 22, 2008)

*how u doing  guys*

how many months do i have to wait to do the NREMt, if i finished the EMT course  almost 2 months ago ? i would really appreciate any info ..:unsure:


----------



## Ridryder911 (Sep 22, 2008)

One can take the NREMT as soon as they have successfully completed an official EMT course. Contact your state EMS office or NREMT directly at www.NREMT.org 

R/r 911


----------



## WuLabsWuTecH (Dec 7, 2008)

I know this is an old thread, buit with 2009 approaching, what of the transitional 2009 things are being implemented right now?

I am aware that this Thread is rather old but I still want to make a reply.


----------



## Ridryder911 (Dec 7, 2008)

I believe the main focus will be getting the transitional courses in place. Also eliminating the EMT/I testing and putting in place the new additional education requirements and levels. 

Here is a link from W. Brown CEO of NREMT on the transitional courses, etc.

http://www.jems.com/news_and_articles/articles/jems/3309/from_fragmentation_to_unity.html

R/r 911


----------

