It's about time! NREMT to require accreditation

[triemal04]

Whoops, knew I forgot something. No, currently I am not a NREMT-Paramedic; I let it lapse this last go around, mostly because I don't plan on going out of state anytime soon. Course if I do I know I'll have to jump through some hoops to get it back. Why do you ask?

Oh, and despite my state having some of the tougher requirements for paramedic certification, it is still required here that initially you become a dual state certified/NREMT certified medic. And pretty much every ambulance service here gives some form of test before making a job offer.

Guess that's what happens when the system works and places only want good, qualified people working for them.

 

[Asclepius]

California has a county system that even if the paramedic has a state license, each county and/or municipality establishes its own way of doing things by powers granted to them by the state of California.

For EMTs it gets even more complicated as they must apply for certification with each county even if they are state certified.

I don't know how that works in St. Louis, but where I work in Illinois the same is true. We have an "area wide" EMS system. You must take a protocol test to function, but that is different. The protocol tests your knowledge on what the protocols for the system are. That is way different then having to prove to an employer that you can pass their testing of something you've already demonstrated that you can pass.

 

[Asclepius]

Whoops, knew I forgot something. No, currently I am not a NREMT-Paramedic; I let it lapse this last go around, mostly because I don't plan on going out of state anytime soon. Course if I do I know I'll have to jump through some hoops to get it back. Why do you ask?

Oh, and despite my state having some of the tougher requirements for paramedic certification, it is still required here that initially you become a dual state certified/NREMT certified medic. And pretty much every ambulance service here gives some form of test before making a job offer.

Guess that's what happens when the system works and places only want good, qualified people working for them.

I just wondered. You seem really down on NREMT. I have no objection to only wanting good candidates, but redundant testing does not insure that. The way to insure good candidates is to look at the employees training, education, and experience. Just because a person can not pass a written test doesn't mean they would be a poor candidate.

 

[triemal04]

I just wondered. You seem really down on NREMT. I have no objection to only wanting good candidates, but redundant testing does not insure that. The way to insure good candidates is to look at the employees training, education, and experience. Just because a person can not pass a written test doesn't mean they would be a poor candidate.

I agree somewhat actually, there's a lot that goes into it, including how they perform during what ever probationary/entry-level/whatever you call it period they have (assuming they have one). That's more important than everything that either of us has listed so far, because, let's face it, you can do great in school and be a complete and utter f&ck-up on the street. But, a written test, or scenario based test or both that tests someones minimum knowledge level (or just knowledge level period if that service doesn't want someone with only the bare minimum) isn't wrong either; like I said it's going to help weed out the people who shouldn't be there in the first place. Hopefully. Guess my final word on that is: with what you're saying, it's the same as saying that you don't think we should have to recertify in ACLS, PALS, PEPP, PHTLS, BTLS, the rest of the alphabet soup, and even recertify as medics. After all, we allready proved we could do it once.

Far as NREMT...it's not that I'm down on it. I would like to see a system in place in which there was one and only one paramedic certification for all 50 states, and this isn't to far off. (it'd have to be a lot more advanced than the current minimum standards and the requirements would also have to be really jacked up to make me happy too...I'm so needy ) I really like the accreditation deal they're doing now; long as the minimum requirements to get that accreditation are adequate...I like, I like. Hopefully it'll get rid of medic mills. I'd like it even more if all 50 states passed a requirement that you had to get your NREMT cert initially; that way nobody can bypass this.

What I don't like about NREMT is that the test is so damned easy to pass. 70% and you're good. With a lot of the questions being BLS (think scene safety/BSI)...swing and a miss. Same goes for the practical portion, though I'm not sure how that can be fixed.

 

[VentMedic]

Florida has its own state Paramedic exam. The argument has been its passing score is higher than the NR, 80 vs 70. However, Florida adds questions about its state trauma regulations which is state specific and not so much medicine specific.

There were a couple of counties in Florida that wanted their paramedics to be dual certified with the state and the NR. That has since been challenged unfortunately.

Florida also has many PDQ Medic Marts where Florida believes they are adequate if the students take the state exam. If someone from out of state seeks retroprocity with the NR but is a graduate of an unaccredited PDQ Mart, they must also take the NR. At least the EMT-B is NR in Florida.

Attempts to make the NR the state test have been tried many times with various trial offerings. The last one was about 3 years ago. I may try to find the data in the Florida system to see what the pass rate was. That had been the problem in previous years when the NR came to town.

Florida has many community colleges that offer the 2 year degree but have allowed for the certificate program to develop within the program. The number of private tech schools are exceeding the colleges. Thus, many students choose the shortest route because they can.

I think Florida will continue to hold off the NR at the paramedic level for awhile. Florida just changed testing vendors again also. It is expensive for a state to do its own testing.

Other medical professions have required graduation from accredited schools with established minimum educational standards for many years to sit for the boards. Even physicians from other countries or the Americans that choose to get their M.D. at "alternative" locations may have difficulty with the boards.

 

[Ridryder911]

Remember, all boards are only asking for the minimum allowable requirements on what ever they are testing. Although, I do agree NREMT is appearantly too easy, it is at least a start. To contrary beliefs there are "national standards" and all states has to go with them as a minmum or loose federal funding. They are the National Curriculum, again out of date and poor, but they are scheduled to change within the next 1-2 years.

One has to understand that most health care professions started out this way, to change training into education base level. The license/ board /certification has to have some weight (teeth) to be able to validate itself. Requiring education and training facilities to have accreditation to meet rigorous standardsto ensure patient safety and provide the student with at least then minimum educational programs.

Just because someone has attended a specific University, Medical School, Hospital, Trade School, does not ensure that student or person is qualified; hence the reason for board examinations. Rather an accreditation does mean that the school has met its obligations providing students quality instructions per accreditated instructors, quality clinical sites to meet the objectives, and the institution will be held upon those standards. Hence, they will be reviewed like other professions in many things, such as board pass rates, employment rates, instructors level of education and professional development.

Hopefully, this will remove the so called back-room fire station schools, fly by night programs and programs that fail to offer quality clinicals (no more cofee clinicals!) by having the ability to place instructional systems on probation or even removing their ability to teach at all. Just like other medical programs such as nursing, respiratory therapy, physical therapy, etc.

Wow! Professional standards and requirements for schools ! What could be next?

R/r 911

 

[Asclepius]

Guess my final word on that is: with what you're saying, it's the same as saying that you don't think we should have to recertify in ACLS, PALS, PEPP, PHTLS, BTLS, the rest of the alphabet soup, and even recertify as medics. After all, we allready proved we could do it once.

See, I don't agree with that line of thinking. We recertify by a process of CONTINUING education, which again are measurable. You shouldn't have to prove something you've already proven you know. Receiving CE, refreshers, etc. is all a necessary part of EMS and any employer can check to insure that a person has kept up on those aspects. The rest is a matter of determining if they have good experience, if they have had discipline issues, and if they've had any QA issues. Oh yeah, and determining if they're behind on child-support (maybe that's just a local thing).

I agree that we need to strengthen our base. I just don't think it needs to be done in a redundant manner. We tend to eat our young in EMS and I have seen people enter EMS being, at best, a mental, but turning out a leader after some fine tuning. I have also seen people that can ace any test you put in front of them, but clinical skills suck or the have the bedside manner and professionalism of Marilyn Manson. It's our job to help educate and strengthen our colleagues. After all, we all started some place.

Vent -

I've never really worked anywhere but Illinois. I can only speak for my experience there. Illinois used to offer a state test. I am not really sure how it compared to the NREMT, but recently they have switched or are switching the the NREMT.

Wouldn't the equivalent to an MDs boards be the NREMT or a state test? We receive our training by passing the educational institutions requirements. At least that is how I look at it.

 

[VentMedic]

Wouldn't the equivalent to an MDs boards be the NREMT or a state test? We receive our training by passing the educational institutions requirements. At least that is how I look at it.

If the school is not accredited, they may not be able to sit for the boards. Hence, we have several foreign trained M.D.s working in other professions. The other factor concerns if they still need to do their residency. This is a very competitive part of their training and if they again are not graduates from an accredited school, even if they were allowed to take the boards, they may not get a residency position.

 

[Asclepius]

If the school is not accredited, they may not be able to sit for the boards.

I'm sorry, I mentioned being in an accredited institution earlier and just assumed that we were all talking about them.

 

[triemal04]

Sorry, you can't have it both ways. Refreshers for the alphabet soup include a test. And recertifying as a medic requires a test at various times (for some places, not all I know). What's good for one is good for the other in this case.

CE hours are not measurable, beyond the actual amount of time spent on it; that's why many states require a written test to be taken. You can spend 8 hours on cardiology, but if you didn't pay attention you won't learn anything. But you still get 8 hours of CE in cardiology.

I'm sorry that you think that you can take one test and never have to do it again, but that's not the way it works. Maybe someday (a long, long, LONG time) in the future the educational requirements, standards and testing process will be advanced and strict enough that it won't be as neccasary. (though even then I'd be ok if various places still did it) But right now it most definetly is. You don't like it...start working on fixing the problems with education that we have in EMS. That's the root problem here.