Away with the national registry

[JPINFV]

Yes. At the same time we can do away with Licensed Practical Nurses, Licensed Vocational Nurse, Registered Nurse, Certified Critical Registered Nurse, Certified Emergency Registered Nurse, Certified Registered Nurse Anesthetist, Nurse Practitioner, Advanced Registered Nurse Practitioner, Certified Nurse Specialist....shall I go on? Find one to standardize on? Certainly not. I think the nursing unions would put a stop to any attempt real quick.

Yep, EMS and nursing (including advanced practice nurses) are the same thing. :sad::unsure:

Of course those levels mentioned also have more than 2 weeks of full time school to be able to work towards that level. Nice red herring though.

Also, standardizing on paramedic is an idea of folly. It would get rid of about 80% of the volunteers out there (more?)

Whoa, wait a minute. I thought EMS was supposed to be about the patient. If the volunteers don't want to become educated to the point where they can do more than "O2, call medics, transport" then good riddens. If volunteers aren't willing to improve the care that they provide then they are in a medical field as a hobby. People's lives should not depend on a hobbyist.

eliminating their positions would leave the door wide open to no licensing, regulation, training, etc. Do you really advocate for that?

It's a false dilemma since there are plenty of other services that rural areas offer whom they either pay, or expect competency out of.

 

[JPINFV]

would never work, purely from a financial standpoint. here in mass, basics make anywhere from 11-13 or better. medics start at 14 and go from there. now the jump from 13 to 14 isnt much, but imagine if you run an entirely bls transport service( no 911, just dialysis and dr appts) and pay your guys say 11.50. so a law is passed that there is now one level(paramedic). well here, you'll have to pay them at least 14(and that really really low end). so you entire payroll just went up $3/hr/person+. i know of services that would just throw in the towel right there. just call it a day.

The assumption is that most non-emergent transports require an ambulance, and therefore EMTs (B, P, other alphabet soup level). Most of those patients can get from A to B just as easy in a van with a gurney and an oxygen tank. Of course this would also require making Medicare reimburse wheelchair/gurney van transports. This brings me to your next point.

aside from that, we cant even get a national standard curriculum. everybody gets taught something different. its insanity.

It's gotta start someplace. If someone is really concerned that everyone is being taught different things, then they should be either working towards a degree/cert that would make them eligible for system management positions, working with EMS courses, and/or working with state and federal legislators and other government offices/agencies for change. Nothing good was ever accomplished by people sitting on their hands.

 

[bstone]

Yep, EMS and nursing (including advanced practice nurses) are the same thing. :sad::unsure:

Of course those levels mentioned also have more than 2 weeks of full time school to be able to work towards that level. Nice red herring though.


Whoa, wait a minute. I thought EMS was supposed to be about the patient. If the volunteers don't want to become educated to the point where they can do more than "O2, call medics, transport" then good riddens. If volunteers aren't willing to improve the care that they provide then they are in a medical field as a hobby. People's lives should not depend on a hobbyist.


It's a false dilemma since there are plenty of other services that rural areas offer whom they either pay, or expect competency out of.

Um, no.

When you're a farmer working from the crack of dawn until late at night, I admire you for getting your Basic and volunteering. I don't fault them one bit for not taking a year out of their life for getting their medic. Not at all.

 

[Ridryder911]

Ok, but you wrote NREMT/P, when everyone else, including the NREMT, write it -P.

Sometimes I see just REMT-P. What's up with that?

Not trying to hijack but a little history lesson.

In the late 70's to early 80's there were becoming so many abbreviations that the DOT decided to determine to clarify it for paperwork and legal purposes. Hence the three major divisions were made. EMT, EMT/Advanced, EMT/Paramedic. The Registry did not test or have the level of Paramedic until early 80's and the Intermediate level was not developed until mid 80's.

The Registry used to divide the Basic level into Ambulance and non-ambulance rating with rockers on the patch and certificate, etc. Before one could describe you were ambulance rating, one had to verify they had 6 months experience. (As well before receiving any accreditation off provisional rating i.e Intermediate, Paramedic).

Patch design went from just Registered EMT (REMT) to a rocker bar on top stating "National"... hence the new abbreviation NREMT. This was their promotion of being "national" and as well being "registered".

My first EMT patch from the registry actually stated "Charted Emergency Medical Technician-Ambulance" in one round 5" patch. Very few, obtained this because it was limited to the first 10,000 EMT's. Then I switched to the to the older EMT with the ambulance rocker and then onto National rocker, etc..

Now the patch design is going to a total round with the rockers being dissolved.


Now back to the topic:

Students are very vulnerable and especially those that are at the beginning phase or Basic level. Just talk to any experience instructor and they can verify that Basic level is nice to teach, because they do not know if you have made a mistake or not. They know no difference.

The problem is just that.

Some students are taken advantage of in many ways. Poor teaching with low expectations lead to poor outcome. Just read the numerous of posts even here on this site and others EMS forums. There should never be very many questions in regards of EMT testing and their certification level or even basic medical care.

Blatant poor interpretation of legal descriptions of what is safe practice and not, as well as no continuity of being taught the "essentials". One should compare institutions endorsement of skills or lab time. Does the course have enough practice time? There should be at least one hour "lab" time per lecture time? Is there an open lab that will allow the students to practice between classes or off time?

Does the institution require thesis or scientific research papers and scientific clinical presentations for those that are enrolled in advance level courses? Does the institution have a complimentary library offering such texts, scientific journals, so these requirements can be fulfilled?

Does the educational facility have experienced licensed clinical instructors from the school on the clinical premises? Thus allowing the instructors to intervene with preceptors and observe the students performance first hand and is able to evaluate a true honest opinion, with suggestions of improvement or positive compliments.

Again, it is easy to become an EMT and definitely to simple to become a Paramedic. With additional requirements we will see our profession be more of that... a profession.

R/r 911

 

[JPINFV]

When you're a farmer working from the crack of dawn until late at night, I admire you for getting your Basic and volunteering. I don't fault them one bit for not taking a year out of their life for getting their medic. Not at all.

Who ever talked about blaming anyone for volunteering. After all, shouldn't volunteers be happy if their system goes to full time paramedic staffing?

 

[bstone]

Who ever talked about blaming anyone for volunteering. After all, shouldn't volunteers be happy if their system goes to full time paramedic staffing?

Of course, but frustratingly that is not the reality for a huge number of counties in this country. Volunteer BLS is all they have to go by. So licensing of EMT-Bs with regular training, standards and coned is the way to go. Do you disagree?

 

[Ridryder911]

Um, no.

When you're a farmer working from the crack of dawn until late at night, I admire you for getting your Basic and volunteering. I don't fault them one bit for not taking a year out of their life for getting their medic. Not at all.

Why are they not volunteering getting a professional EMS into their area? Remarkably, we do not have volunteer nurses for nursing homes or clinics then why is it we have to have it in EMS? Do you see volunteer city water and sewer personal, jailers, postal employees or road workers? Why not?

Why is it that we think that EMS should have to be volunteer? Again the role of the EMT should be strictly first responder only.

Yes, there are some areas that are very remote and that is a whole different situation.

Let's now clarify some things:

There are very few areas in the nation that have and utilize Nursing Unions.

Technically CCRN does NOT stand for Certified Critical Care Nurse.. look at the AACN site

Any board certifications above the standard RN (which already possess a degree) means they have demonstrated that they have already performed several hours of clinical experience and have successfully passed the board examination in that speciality. Similar in comparison to professional standing of a Board Certified ER physician. (No, not all ER Doc's are board certified).

When comparing the levels of CNA, LPN let's remember the rules! Those levels that are lower than the RN is considered to be assistants to the RN. They work under the direct supervision of a RN... period. Albeit per direct or standing orders, they are considered to be supervised. Hence they can have multiple levels due to always being supervised and again in the discretion of the RN to assist in the care of their level.

If the hospital is JCAHO, then LPN's, CNA or patient care representative or any other title cannot utilize them as nurses in critical care or emergency services as Vent described. Again, they are there to assist and are supervised.

Is the EMT always under direct supervision of a Paramedic? ......

Even PA's are technically under the orders and supervision of a physician.

In regards to non-emergency transport (i.e wheelchair), why do they want and use EMT's? Really, the curriculum has nothing to do with transferring of patients, lifting and assisting patients into and out of medical specialty devices.

I believe most use EMT's is because they are a dime a dozen. It looks good for their advertising, and some states require them to transport patients on oxygen. I do wonder why some outside agency has not designed a transfer technician course that includes movement of patients, precautions of different type illnesses, etc. It would be much cheaper and pertinent to the business. Then again, EMT courses are not too costly in comparison to other medical courses.

This does not usually lead many into emergency services or provide any educational or clinical experience for emergency care. In fact many educators and administrators are now suggesting a "clean slate" so bad habits have not been obtained.

 

[KillTank]

I was not asking about how it works, I know how it works, I thought maybe their contract was gunna end and someone else was gunna take over the testing. I myself dont agree on the national registry. call me stupid or ignorant but I do not agree with the test. it tests you on how good you are at taking tests, not how to be a great emt. go politics.

 

[TNEMT06]

I know Tennessee is considering getting rid of National Registry and use some other agency for curriculum and certification standards.

 

[bstone]

I know Tennessee is considering getting rid of National Registry and use some other agency for curriculum and certification standards.

What's your source?

I was considering going to a music festival over the summer and TN said they'd give me an EMT-IV license due to being an NREMT-I.

 

[Ridryder911]

I was not asking about how it works, I know how it works, I thought maybe their contract was gunna end and someone else was gunna take over the testing. I myself dont agree on the national registry. call me stupid or ignorant but I do not agree with the test. it tests you on how good you are at taking tests, not how to be a great emt. go politics.

I don't really think you truly understand .."how it works"... I see that you are from Texas. Do you know why they use NREMT? Texas used to have their own state EMT tests... Guess what ? They had a higher fail rate than that of the NREMT test. I can assure from one that was Texas Paramedic at one time, it was a horrible test (had to apply a Thomas half ring splint).

Politically motivated... maybe. It is much cheaper to have a nationally recognized tests designed by professional test writers and accredited than to attempt to fund one yourself. IT costs hundreds of thousands of dollars to develop an accredited tests. Remember, it cannot be just a test.. it has to be a scientfic based tests to tests the minimal knowledge allowed for safety.

Do medical test suck? Yes, but remember, we have to have some form of validating one's knowledge. How are we to obtain that than other than a written test?

So you much rather have each state have a separate test? If your discussing test format, I can assure that the NREMT is much easier than most medical board testing. At the least you have one in four chance on each answer... Goodness, one can still retest after failing without going back to class.

If you were not used to the NREMT testing style, then your school or program is to blame. Your instructor should understand the basic methods they use and should had been using those methods and formats during the testing phase of class. Unfortunately, most students are used the simplistic "matching, label the following, identify out of the following" etc. that they may see in workbooks; that are verily rarely utilized on medical board examinations. As well most classes never use computer testing while in the course, and students wonder why they fail?

Do I believe the NREMT has problems? Oh my YES! It is much too simplistic and has a too high percentage of passing per applicants. The tests questions need to be more straight forward and a mixture of science and patient scenarios need to be added. Follow up of what portions candidates are weak in so they can improve, as well as feed back to educators so they can emphasize and focus upon to teach.

I will agree with most, I have yet found a perfect test. That is why it is so essential for intense studying and being fully prepared

R/r 911

 

[Ridryder911]

I know Tennessee is considering getting rid of National Registry and use some other agency for curriculum and certification standards.

I have heard rumors and actually seen some states do this only to return in a few years. Thus the reason so many states are NREMT. The main reason again, it is very, very costly to maintain a professional test. As well, most states realize getting other states to recognize their tests will be difficult, so limiting the profession.

I do not think most understand the process of developing a recognized accredited test. It is a lengthy process of professional, educated test writers that have to validate tests questions in comparison to the professional standards, etc... again, it is not an easy, cheap process.

I do realize TN has been very pro-active in some of their educational standards, but again one will have to see if they will want to fund such an endeavor.

R/r 911

 

[bstone]

Plus I think that most EMTs hate it when a state stops using NREMT. It means we are less portable. And we hate that. A lot.

 

[futureemt]

I was not asking about how it works, I know how it works, I thought maybe their contract was gunna end and someone else was gunna take over the testing. I myself dont agree on the national registry. call me stupid or ignorant but I do not agree with the test. it tests you on how good you are at taking tests, not how to be a great emt. go politics.

You know what....I soooooooooooo agree with you!!!! We don't take it here anymore!!!

 

[John E]

I'm curious...

you claim that you agree with the previous poster yet you're haven't taken the NREMT yet. What are you basing your dislike on? What other people have told you?

Contrary to the previous poster, the NREMT does not test the student's test taking ability, it is a critical thinking test, you can't just memorise a bunch of facts and go in and pass it. Given that you're entering the medical field, which if nothing else, DEMANDS critical thinking, you might think about working on passing it rather than on making what sound like unfounded complaints about it.

I've found that the majority of people who dislike it have either failed it or they've been told how bad it is by others who have failed it.

No one I've spoken with who's passed it seems to have any major problems with it, with the exception of a couple of people who post here.

John E.

 

[Ridryder911]

John makes some valid points.

If you have never taken the NREMT how do you know? Also if you have never taken any other medical tests or National Boards in what comparison do you have?

As well you stated you are a Basic Student, therefore you have definitely not taken any other NREMT tests as of yet.

Finally, N.J. ... enough said. With the documented controversies within the state that still runs First-Aid units and fragmented ALS units. Ever consider really why they do not use NREMT? ... I suggest to check out the ease or shall I say the complexity of repricosity.

R/r 911

 

[disassociative]

I know Tennessee is considering getting rid of National Registry and use some other agency for curriculum and certification standards.

TN is not thinking about getting rid of the Registry. We are requiring it for initial licensure. NR is not going anywhere.

EMT-IV(NREMT-B )
EMT-P(NREMT-P)

 

[Vanatta67]

I know that the practical portion of the National Registry is now not needed after you pass your course, when you take your final before you finish your basic or medic that will count torwards your nr now.

 

[Ridryder911]

I know that the practical portion of the National Registry is now not needed after you pass your course, when you take your final before you finish your basic or medic that will count torwards your nr now.

???? WT???

Okay, once again... The NREMT has never, ever required practical portions for the Basic EMT! They will however; accept a state, the schools final examination. However; I believe you will find that one will be required to take a separate NREMT Advanced Practical Examination. It cannot be associated with educational systems, etc. It may be performed at one, but NOT associated with one.

R/R 911

 

[piranah]

well, i just took my basic NREMT exam and passed it and frankly i didnt mind it....but you have to study...i cant help but say if you cant manage the NREMT and cant recall basic knowledge for the exam.....what gives you the right to touch a patient. a smart medic once told me if you cant manage the airway you don't deserve to treat a patient...and i bring that to everything.....working EMS is a privledge(spell) not a right... you have to earn it....im in a NREMT accredited paramedic program and i had the choice between a MASS. non-NREMT course or the one im in and i think that the NREMT is the only way to go.....its a privledge...not a right....



-jim- NREMT-B / NREMT-P in training