Bill Brown, RN, MS, CEN, NREMT-P

"10 Minutes With" is a bimonthly column that presents brief interviews with EMS leaders involved in many facets of emergency medical services. Future interviews will cover such topics as EMS research, legal issues and education. Suggestions for topics and subjects can be sent to the author at rbarishansky@onebox.com.

There are few elements in EMS that share a standard component industry-wide. Specifics such as equipment, vehicles, performance standards and even treatment modalities vary from state to state, and even from region to region. In the face of such "home rule" philosophies, the National Registry of Emergency Medical Technicians (NREMT) has successfully established universal benchmarks affecting EMS providers across the U.S.

One of the hallmarks of a true profession (law, medicine, etc.) is the portability that goes with a degree or certification. NREMT has consistently led the attempt to bring EMS up to a level of professionalism in this regard. While the National Highway Traffic Safety Administration (NHTSA) creates a minimum curriculum for EMTs, NREMT strives to raise the bar of required knowledge and skills. In this column, NREMT Executive Director Bill Brown, RN, MS, CEN, NREMT-P, discusses the various aspects that comprise the role of the National Registry in EMS. Brown has been a paramedic for over 20 years, and a member of numerous regional, state and federal committees that examine various facets of EMS, such as education and the factors that affect longevity in the industry. He is a published author and frequent lecturer at conferences, where he discusses the role of the National Registry and the future of EMS.

What is the role of the National Registry in EMS?

The National Registry is the national EMS certification organization. As a certification agency, our primary responsibility is to help protect the public. We are not a membership association and thus do not provide association-type activities, e.g., lobby, provide position statements, endorse products, etc. NREMT has been involved with initiatives that include the EMS Education and Practice Blueprint, NHTSA's EMS training curricula and others. The NREMT finds it important to be a responsible member of the national EMS community; therefore, we sponsor other organizations like the Committee on Accreditation of Educational Programs for the EMS Professions and the Continuing Education Coordinating Board for EMS.

You've been critical of ambulance manufacturers regarding crash safety and crash-worthiness. Can you expound on this?

I personally am interested in ambulance safety issues. EMTs are exposed to dangers beyond the ambulance crash, including equipment that flies around during a crash and structures within the ambulance that can fracture skulls and do some serious body damage during deceleration. I am appalled that manufacturers of lifesaving transportation vehicles don't place a major emphasis on worker safety in the vehicles they sell. I simply am not impressed with nice paint jobs and "trinkets" when the vehicle cannot sustain a rollover and/or the EMT can be ejected out the back doors as a result of a crash. I have spoken with NHTSA officials and other EMS leaders about this, but, frankly, it will take the owners of ambulance services-those who purchase ambulances-to insist on high levels of safety for their EMTs and patients.

How can the National Registry affect day-to-day issues that face EMS providers?

As an organization, the Registry is interested in identifying a number of issues that concern EMTs. We cannot mandate that employers provide pay raises to EMTs, for example, but we can expose the problems and help employers, government and EMTs improve the profession. We are hopeful that many of our projects, such as the Longitudinal EMT Attributes and Demographics (LEADS) project, can be of some benefit in this regard. This project is a national study that has a number of research questions. Currently they are:

• How are EMTs different from the U.S. population with regard to selected demographic characteristics?
• Who are we as a profession?
• What factors influence attrition in EMS at every level over time?
• What are the factors that influence professional advancement in EMS at every level over time?
• Which EMTs choose to leave the profession?
• What are the factors that influence attrition/retention among the EMS population?
• What factors affect EMT motivation?

We will track what happens to a large group of EMTs over a 20-year period. We currently have five years of data, more than 120,000 data elements. We hope these data provide scientifically valid information to employers, EMS chiefs, government officials and other policymakers on what is happening to our EMS workforce. If EMS is to be a profession, we must know ourselves: What affects us, what keeps us in the profession and what causes us to leave.

Is core national certification in the future for EMS?

The goal of almost everyone is to achieve some type of portability within a "states' rights" context. In our country, each state has the right and the responsibility to make laws that govern licensure. A state can make it easy or difficult for EMTs to gain their license. We hope that National Registry certification is a part of this licensure process, but it cannot and should not be all that is necessary to obtain a state license or the right to practice. This concept is outlined in the NHTSA document, EMS Education Agenda for the Future: A Systems Approach (www.nhtsa.dot.gov/people/injury/ems/ems_agenda.html).

To learn more about the National Registry of Emergency Medical Technicians and the LEADS study, visit www.nremt.org, or call 614/888-4484.