National Registry...not so national

bstone

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http://www.jems.com/emsinsider/23-9/13358/

I came across this article from JEMS and I think it warrants some discussion. I am hugely in favor of a national EMS certification. As some of you may know I am rather critical of the NREMT. NREMT is a private, for-profit organization. If you fail something they don't tell you what. It takes weeks to get results. However, since they have a virtual strangle-hold on EMS certification it makes sense to get certified by them (and if you want to be portable in your licensure).

Anyways, another company, I/O Solutions, is getting their foot in the door in a few states. Included in these is Illinois and Mass. I float between these two states (IL in the summers as its where I grew up and where mom and dad live) and MA during the year (school).

It seems that IL is still accepting NREMT for reciprocity, but MA doesn't. I will be taking the MA test in a few months and so it seems I'll be dual certified by NREMT and I/O. At that point, I'll have 2 certifications which IL accepts and a state license. Cute.

Anyhow, I'd love to hear what people have to say about this. It boils down to: We need a national certification standard which all states accept. The company doing it must be open, transparent and have high professional standards. And they have to tell us what we did wrong when they say we failed a test.
 
I believe whenever other companies begin to enter the "testing" and certification business, we are on a slippery slope of disaster. I/O is another for profit company that is multi tasked with a new interest in EMS, rather considering it a "public safety" in which I totally disagree. We are MEDICAL not public safety, which is two different avenues of profession.

I was never taught any formal safety courses within my EMS career nor should I. Again, I/O testing is from prison guards to LEO, to firefighter now wants to place their hands in EMS. Sorry, the difference between the professions is I am white collared and they are blue collared for a reason. My profession should require a degree, and clinical requirements before any testing occurs.

I may not believe in everything NREMT does and performs, but they are composed of medical advisory board, for the sole purpose of EMS, not just another test like a security guards.

Compare multiple testing such as in radiology and respiratory therapy, and you will find problems. They have fought for years to remove one from another, only now to go with a formal one. Let's not make the same mistake.

As for not letting you know what you missed on a test, that is part of professional testing and any company that does has very little credibility ! Part of professional competency in testing is maintaining the secrecy and security of testing, without compromising and divulging exact areas of a participants failure.

I have taken over six nationally board examinations in nursing and EMS and as of yet, ever been offered what parts I failed on if any. I would never expect them to do so as well. Did ACT/SAT inform you on specifics areas you failed or a general section, like every other national merit and qualified test. As well NREMT has went to CAT, and results are immediate on most levels. Talk to attorneys and physicians, see how long it took to get their results as well if it told them were they failed.

I/O is a private sector testing firm again is for entry level to a private sector. I do not see according to their web site of any credibility of endorsement from any national health associations, such American Heart Association, the American College of Emergency Physicians, National Association of EMS Physicians, International Association of Fire Chiefs, National Association of EMT's, and on.

Your right we do need a national certification, it is called NREMT. Sorry, Illinois has had problems adjusting to national standards. They have opted to dilute their testing because of high failure rates. Instead of actually fixing the problem of poor instructing meeting national standards, they chose to remove themselves. This has been a highly debated area for months.

Personally, those states that do not want to participate in NREMT can only to be excluded from the other 46 states as being formally educated in EMS. When their EMT's apply for license and certifications, they should be denied as not meeting the nationally standards. Since this was the sole purpose of removing themselves from the NREMT. They felt they did not have to "learn" the entire EMT agenda, rather specifics. That is nice if they never have to work in another state or area, but who can guarantee that?

I have enclosed the quotes that initially started the problem.

Addressing EMT certification deserves priority
By the Pantagraph Editorial Board


When we dial 9-1-1 in a medical emergency, we want to know someone will be there to help — someone who is properly trained.

But when the certification process becomes so cumbersome that it reduces the supply of trained emergency medical personnel, without improving necessary skills, a change is needed.

The state is finally getting around to addressing the matter and involving the Illinois Fire Chiefs Association — which said it had been excluded from the process for two years. The chiefs should have been part of the process from the beginning.

Among the problems is the national certification test required by the Illinois Department of Public Health for emergency medical technicians.

The national test includes material irrelevant to Illinois and has testing locations that are not always convenient. Critics say the national process is more costly and lacks flexibility to meet the needs of many departments and agencies.

At this point, many larger departments — including the Bloomington Fire Department — require applicants to be certified emergency medical technicians before they are hired. For the eligibility list Bloomington is putting together for its next round of hiring, applicants will need to be certified paramedics.

But in smaller communities, especially those with volunteer rescue squads, the certification process is an even larger issue. At least five emergency medical service agencies in Illinois have had to reduce service because of the inability to put new EMTs on the job. Farmer City is one of the affected communities, according to the Illinois Fire Chiefs Association.

The process of becoming an emergency medical technician is difficult enough without additional barriers. The certification test should be tailored to the needs of Illinois, rather than covering every conceivable situation that could be encountered nationwide, from scorpion stings to coral snake bites.

Bloomington Fire Chief Keith Ranney said Illinois is required to have a state test.

The chiefs’ association is not trying to “dumb down” the test, he said. Rather, the group is trying to “satisfy the logistics of getting this in place.”

For the sake of would-be emergency medical technicians — and especially for the sake of those relying on the availability of EMTs in an emergency — we urge the state and all the other players in this issue to resolve the situation swiftly and not leave it simmering on the back burner.


My personal opinion is those few states, want their own special test. Instead of teaching broad and general care that may expand in other areas and locals. Again, if you start this don't expect national reprocicity

R/r 911
 
Rid, I agree that the NREMT might be the way to go about a national certification. However, I firmly believe they need to be more transparent. Their written exams suck. A lot. At least with the written exam they tell you your percentages for each section. As well, I am convinced that they must tell people why they failed. Otherwise how can people trust them? There needs to be more transparency, openness and communication. Anything less and the current situation will continue: some states accepting NREMT, others firing NREMT and going with I/O and others doing just state tests.

That said, I am glad I am now NREMT certified. But it's frustrating to go through all that school and taking the practical patient assessment twice....only to have a certification which is useless in MA (with no easy way of getting reciprocity).
 
The states that have fired or considering NREMT has always had problems. MA, NY, even Kansas has always had attempted their own test. Truthfully, they usually are taught their own specific way ... i.e. Kansas had MICT in lieu of Paramedics for a while.

I agree, that NREMT is not the best, but it is at least attempting to correct some of their problems.

The same states has had problems for a long time, even more so with reprocicity between states, it appears they never can find a solution.

You will never find a test in medical license or certification that will give you what you missed. (at least a competent one) I see you are going for medical school, have you taken MCAT yet? If not, you will never complain about NREMT afterwards.

The same as GRE (Graduate Review Exam), which to me is a lot harder than the MCAT test. GRE is four years of university in one test, that is not to base your intelligence rather how well you can take test (over statistical ananylsis to advanced physics and argumentative socialogical debate -judging your writing for grammar, spelling, thought anaylsis and pyscho-social political science). I'll take the med school entrance exam again anyday...

As I described, even the NCLEX for nursing only gives you a final score as pass or fail. You do not know what areas even you did poorly in. The same as my specialty boards will only give low percentage versus high and critical care paramedic was pass fail option. None these were allowed to be reviewed after grading.

My advice get used to that type, you will be seeing more of them in the future..


Good luck in school !

R/r 911
 
Compare multiple testing such as in radiology and respiratory therapy, and you will find problems. They have fought for years to remove one from another, only now to go with a formal one. Let's not make the same mistake.

Actually respiratory has had 1 national board for credentialing since 1960, which is now called NBRC. It has been recognized by almost all states (one state had its own exam but has been dropped) as the credentialing board. Even the Veteran's Administration recognized the NBRC at it credentialing agency. However, the problem for the first two decades was getting the states to enact licensing for the profession. That changed in the 1980s. The NBRC along with our national professional organization (AARC formed by 50 state org.), are responsible for raising the standard for a minimum educational degree of Associates for entry into the profession. Each time the standard was raised, RTs were given 5 years to get compliant. "Get it or forget it". Slackers will be left behind with a minimal credential or out of the profession totally. The end of this year will close for the standards set in 2002. RT National board now also requires RE-credentialing every 5 years. The "tech mill" days for RT are in the distant past now. Between the RT National credentialing board and national professional organization, they have impressive representation with lobbying in Washington, D.C. Unity is key. www.nbrc.org www.aarc.org

EMS started out great in the 70s. I got my A.S. in EMS in the late 70s because that was the future as I was told. My home state had a state exam but Alabama had the National Registry. Many of us crossed the state line to also take the National Resgistry at that time because we wanted to be ahead of things. 30 years later the NREMT has finally arrived to my state.

In the 1980s my state EMS wanted to remain separate and at that time they had to be separate because the state exam "certified" us and did not "license" us. We went under a different state agency from nursing and RT who were licensed. We eventually got the wording changed to licensed but remained apart under a different state agencies for many years. Finally, we are all under the same state agency for professional recognition.

The 1980s brought about PDQ training centers or "tech mills" for EMS. FDs wanted to train their own paramedics. Eventually everybody was doing their own thing and not worrying about the broader picture. Every company and agency had its own agenda. The inter-fighting and lack of agreement amongst EMS has been the down fall for establishing standards even within a state. The attitude of "I can do anything you can do in just 4 months of training" has put EMS into an area for ridicule by other professions.

I have seen the system in California and could use it for several examples of what can happen when there are too many governmental agencies involved.

A national exam for all is long over due. Unity within each state with some goals for the future development of educational standards and representation at the national level would be great too.
 
I've always thought the national scope, standards, and in turn the National Registry should be geared towards every conceivable measure. It should be demanding, intense, and of great breadth with an inclusive scope. It is a confirmation that the person is guaranteed to do whatever they might need to wherever they might need to do it. That is what NATIONAL is all about. This is how you have true national reciprocity, standards, and portability! It is then up to the states, or the region, or the particular service director to decide what parts of the scope should be used to meet the needs of their area. FDNY has different needs than the Nome Alaska Volunteer Ambulance Dept. However, a NREMT under the type of system proposed above would be able to fulfill the needs of either service!

Having a smaller breadth covered, or focusing for a particular region, all but rules out transfer and reciprocity as each state must then reeducate the individual for their own specific needs and standards just as how some districts with waivers must reeducate anyone they hire for their expanded or different scope.
 
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I must lament that here we are in 2007 and there still isn't a national certification that is truly portable to all 50 states. If we are extensions of physicians, and since physicians don't need to test from state to state, then why can't the same be granted for us? It's truly sad that the country treats such an important aspect of society this way.

I am also frustrated that I hold EMT licenses in two states, a "national certification" and I still cannot work in the state where I live. Amazing.

While the MCAT is certainly more difficult than the NREMT, you do get scored for each subject section of the MCAT- thus you know where your weaknesses are. The same is true with the NREMT written exam. I maintain, however, that if they fail you on a practical exam then they must fully disclose to you where you went wrong and why. Otherwise how do you know what to work on for the next time?

The one time I called the NREMT to discuss this I got an INCREDIBLY rude man who claimed to be the "associate director". He isn't worth my time, money or respect.

I guess the NREMT is the best way to do. I just hope that the states which dont make their EMTs test for NREMT will at least accept it for licensure.
 
Two things.

1. Summit you brought back some old memories and where did you pull that name from? By the way it is the Nome Volunteer Ambulance Squad (NVAS), not department as I was a member while lilving there...lol.

2. bstone..why do they not tell you where you went wrong on the day you test? I have taken the NR twice due to allowing mine to lapse and I have also proctored many, many of these exams. We always tell the student where they erred on the practical. That is only fair. The second time I tested, I failed one station and this was due to the guy testing me saying I didnt say BSI. I was informed of this, so when I retested I ensured the examiner heard me the second time.The NR rep who is overseer of the process ensures that this is done.

Is this unique only to our area, is this guy breaking protocol, or what?
 
Two things.

1. Summit you brought back some old memories and where did you pull that name from? By the way it is the Nome Volunteer Ambulance Squad (NVAS), not department as I was a member while lilving there...lol.

2. bstone..why do they not tell you where you went wrong on the day you test? I have taken the NR twice due to allowing mine to lapse and I have also proctored many, many of these exams. We always tell the student where they erred on the practical. That is only fair. The second time I tested, I failed one station and this was due to the guy testing me saying I didnt say BSI. I was informed of this, so when I retested I ensured the examiner heard me the second time.The NR rep who is overseer of the process ensures that this is done.

Is this unique only to our area, is this guy breaking protocol, or what?

AFK,

In both written and verbal communication, the NREMT specifically told me that they DO NOT share with a student the reason why they failed. This was told to me (written and verbal) by the associate director for training. I told him I felt it was a terrible policy and anti-student. By anti-student, I mean the following: a student is someone who is learning a new topic and attempting to master it. If they learn something improperly or confuse something, it is beneficial to the student to inform him/her of areas which are weak and need improvement. Because the "Advanced Level Trauma Patient Assessment" incorporated many different skills, it is anti-student to withhold information as to why the student failed.

Did your proctor break protocol when he told you specifically where you went wrong? I don't know. But every time I called the testing center, state and NREMT in order to find out why I failed, I was repeatedly told "we do not divulge that information".
 
Thats my confusion and I dont know how to respond.

I agree with you, I believe in correction after failure of the practicals.

But also you are in a totally different system because you said every time you wrote or called them to find out why you failed......when in my area you are told the day of practicals if you failed or not. You know because you are offered a chance to retest that same day.

For some reason this conversation feels like de ja vous, but I post on many different forums so I am not sure if we have discussed it here or not.

This policy really sucks for you, I agree.

The proctor pulls you aside one at a time and asks if you have any questions, comments or concerns before you get your results. This is your time to speak up if you felt the tester was biased against you or may have missed something. Once you say no or say your piece, he tells you if you passed or failed and what you were dinged on. Oh well, que sera sera.

As for the written, no I do not believe they should change the way it is done. You are told what areas you performed weak on which should suffice IMO.


Summit...son of a gun you are right!! My jacket is no longer relevant...lol. Doesnt matter anyways, it is too bulky and hot for FL or AFghanistan, so I will probably never use it again. I pulled up the roster for giggles and sure enough my name is still there!!!
 
Not all testing facilities are alike. The one I went to SPECIFICALLY does not tell you if you passed or failed and *does not* allow for same-day retests.

However, this is tangental to the actual issue. That being that the NREMT is falsely advertising themselves as "the nation's ems certification" when they know full well that this is not the case. In Mass you can't even use an NREMT card as the basis for challenging the state test. With more states going away from the NREMT exam in favor of I/O Systems, we have an added issue. Poly-regional certification at best.

I wonder when this issue will become resolved.
 
It is dependent upon the NREMT Representative and State that is offering the test at the time.

I would not say that NREMT is loosing states, or I/O is gaining. According to both web sites, this does not appear to be the case. I/O is a company that will design a test meeting your specific testing needs. This can be from firefighter to a nightwatchman. Sorry, this does not sound to credible and medical to me. Most of the states that have not been active with NREMT is the same states that always have had problems or are small for border for reciprocity. I can definitely see using I/O for employment type testing.

They also describe that their EMT tests are taken from several textbooks. Okay, which ones, and how about the national standard or AHA standards? Is there a practical involved?

I don't believe there is a paradigm shift away from NREMT, especially, with the new curriculum that will be introduced next year.

Like I described, there are plenty of problems wrong with NREMT, but overall it is usually minor ones that can be handled administratively. Personally, wanting to know specifics on how one did on a exam is never usually divulged on a professional level tests.

R/r 911
 
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