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National Registry to Vote on Accreditation Resolution August 17
The National Registry of Emergency Medical Technicians (NREMT) announced June 17, 2022, that during its June 2022 meeting, the board of directors introduced a draft resolution that would update eligibility criteria for initial EMS education.
Resolution 22-Resolution-13 includes “updated eligibility criteria” for initial EMS education at all levels (EMR, EMT, AEMT, and paramedic) that would allow the option of state EMS offices to approve paramedic education programs that have not received accreditation or a letter of review from the Commission on Accreditation of Allied Health Education Programs (CAAHEP) through the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP).
The resolution is currently in a public comment phase, and the National Registry’s board of directors will vote on whether to approve the resolution on August 17.
Background and Resolution Details
In 2007, the NREMT board of directors voted to require all students who wished to sit for the NREMT exam to graduate from a CAAHEP-accredited paramedic educational program (beginning in 2013), or one which had received a letter of review from CoAEMSP.
The current proposed resolution would effectively reverse that requirement and open a pathway for candidates to sit for the NREMT exam after graduating a program that has not been accredited by CAAHEP or received a letter of review from CoAEMSP.
The proposed National Registry resolution:
“Updates the eligibility criteria for all levels (EMR, EMT, AEMT, and paramedic) to include successful completion of an EMS education program that meets or exceeds the National Emergency Medical Services Education Standards and:
- Has been awarded CAAHEP accreditation, or
- Has been issued a CoAEMSP “Letter of Review,” or
- Has received state EMS office approval.
Furthermore, this resolution allows for the use of the paramedic examination for state licensure until this resolution is fully implemented to include development of a pathway leading to national certification for graduates of paramedic programs.”
“The National Registry of EMTs recognizes that alternatives to delivering and independently ensuring quality EMS education exist and are worthy of exploration,” the resolution states in part.
How We Got Here
The board of directors of the National Registry is a multidisciplinary assembly covering expertise across medicine, business, health policy, paramedicine, emergency management and more.
Bill Seifarth, MS, NRP, ICE-CCP, executive director of the National Registry, shared with EMS World how proposed resolutions become officially adopted as National Registry policy. Any potential addition or change to current certification or examination processes is first assigned to a committee, which “meets and does the heavy lifting as far as business and research matters of the proposed change,” said Seifarth.
During June and November board meetings, recommendations from various committees of the National Registry take the form of resolutions that are debated by board members and voted on. If the resolutions pass, they are deemed draft and subject to a 60-day public comment period. The 60-day public comment applies to any matters related to certification or examination criteria or other issues of impact. Minor resolutions related to internal board functions often don’t have a public comment period.
“It’s a lengthy, deliberative process,” Seifarth said, adding that the board governance process seeks to be nimble, yet ensures that there is always feedback from the public before enacting any resolutions and subsequent policies.
Kevin Mackey, MD, FACEP, National Registry board chair and medical director for Sacramento Regional Fire Services in California, explained that the accreditation resolution arose from a rapidly escalating issue that was occurring on the state level and feedback from several EMS organizations.
“There had been several conversations about challenges with the accreditation process,” Mackey shared with EMS World. “Government officials in a handful of states were approached to vacate National Registry certification due to challenges arising from accreditation. Some were very large [states] were considering this action. We didn’t feel like we had the luxury to wait,” Mackey said, adding that while the committee’s debate and voting period was more swift than typical, no procedures were skipped and the resolution was given thorough and thoughtful deliberation at every stage prior to reaching the current point.
“Furthermore, the 60-day comment period has solicited the public’s perspective prior to any final action taken by the board of directors,” said Mackey. “The open conversation is a positive consequence of the 60-day comment period.”
Pros and Cons
While most board decisions receive little to no public comment, the accreditation resolution is an exception, Seifarth said. He noted that currently, significant majority of public comments the board has received to date are in opposition to the resolution as written, though this is difficult to quantify as many comments are mixed with pros and cons. CoAEMSP, NAEMT, NASEMSO, NAEMSP and others have also released position statements opposing the resolution.
“The CoAEMSP is highly concerned with the direction the NREMT is taking,” reads a position statement coauthored by CoAEMSP Executive Director George Hatch and Board Chair Paul Berlin. “CoAEMSP serves to advance the quality of EMS education through accreditation, which serves to ensure paramedic programs meet minimum educational standards and best practices. In doing so CoAEMSP advocates in the best interest of patient safety, ensures competent entry-level paramedic graduates, and advances the profession as a key member of the healthcare continuum.”
A recent EMS World editorial authored by Gregg Margolis, director of health policy fellowships and leadership programs at the National Academy of Medicine, stated that the resolution would represent “a dramatic reversal of years of progress in paramedic education, in violation of the EMS Education Agenda for the Future and to the detriment of our profession.”
The majority of comments on the editorial agreed with Margolis, such as these excerpts:
- “By having a double standard in emergency healthcare, who does this benefit? When two paramedics arrive on the scene, are they equally equipped to handle what society expects them to be able to professionally execute? These and other questions should [be] honestly answered.”
- “I feel in order to obtain the recognition and be compensated properly, we must maintain some type of single accreditation for licensure. If unaccredited programs are allowed to pass anyone through their courses with no oversight, then the care that is displayed once licensed might be short of substandard.”
- “I have been an EMS medical director for 49 years. I have seen the evolution of change in EMS providers’ training during this time and have found the importance of a standardized training program given through an accredited academic agency to be critical in assuring that patient care, being given under my watch, is of the highest quality.”
Not all commenters agreed, however. Contrasting positions maintain that CoAEMSP accreditation is a fairly recent development, CoAEMSP accreditation can be lengthy and cumbersome, and states should maintain control over accrediting educational programs within their borders:
- “We did quite well supplying EMS personnel to the field prior to accreditation, and will continue to do so. The NREMT was and is a verified testing alternative to state exams—nothing more. Now there are multiple sources of verifiable exam resources and there is no need to give NREMT a monopoly on testing. States should take an active role in the certification of EMS personnel, seeing as how NREMT “certification” gives candidates clearance to become state certified or licensed.”
- The lack of support and overall poor attitude of the accepted accreditation agency chosen was the [reason] we have come to this point. CoAEMSP as an organization was less than “user friendly” to say the least. Every former program director that I have spoken to points to [CoAEMSP] as the reason that they are no longer involved with EMS education. Leadership in the organization is arrogant and they soak down to educators who have been mentoring paramedics for the entirety of their careers. There has to be a better way.”
Finally, a common theme proposed by EMS program directors is the added workload that would be placed upon them by adding another time-consuming element to their already-cumbersome accrediting procedures, which must be conducted by ever-decreasing staff:
- “Having attended a paramedic program prior to national accreditation and now being a program director of a nationally accredited program, the only difference I see is the strain on program directors to ‘check all the boxes’ for the accreditation. I have worked as a medic for over 20 years and I was a product of my state approving my education hours and competencies to test the National Registry. I believe the problem exists due to the inability of the accreditor to deliver what was promised 20 years ago. We are spending large amounts of money every year for what? My teaching isn’t going to change…just my paperwork workload.”
Opening a Dialogue
Seifarth and Mackey urge interested stakeholders to voice their concerns to the board prior to Aug. 17.
Public comments can be entered here and Seifarth stresses that the board is listening. While comments are not made available to the general public—due to potential conflicts and to encourage free opinions—they are shared with board members and given strong consideration prior to any board action.
“Never before have the directors [of CoAEMSP and National Registry] sat together in a room like this to discuss challenges in a transparent way,” Mackey said. “It has opened a dialogue.”
“A positive effect from this is that there is a conversation taking place,” said Seifarth. “There is an increased sense of observation and concern.”
Seifarth and Mackey acknowledge that this resolution (if approved) would not address core underlying challenges with national accreditation and the issues it presents, such as those outlined above. But it has brought attention to the accreditation process, its perceived value, and what EMS can learn from nursing and medical programs. An open discussion and eventual cohesive standard is the goal.
Comments
I think allowing the states to approve/accredit programs would be a great disservice to the profession. For many years there was a difference in scope of practice among different states and it created confusion during times of national responses. If there were minimum guidelines set that all states must follow, then sure, let the states review the programs. Without a national standard, I think we are moving backwards as a profession.
—Kenneth Moorhouse
As a Paramedic for over 25 years. I feel we have all seen the evolution of EMS. As with anything we need to change with the times and requirements. To better establish our profession we need better governing agencies, which means our education needs to be better regulated. This means an accrediting agency needs to assist and help guide our education process with some sort of checks and balances by a National accrediting agency. Each state needs to fall in line with following the education plan and accept its requirements as well as being accredited.
—Chris Pritchard
I oppose changing the process. If we don't set or keep a standard, soon there will not be one.
—Ronald Almand
Opting to wait to the end of this comment period has allowed me to read and hear from others regarding this vitally important question brought to the EMS community. As for my position regarding this event – it is of utmost importance that we continue to keep accreditation in place. That said, the viewpoints of the others believe there is a need for significant changes in the efforts of CoAEMSP as well as NREMT. Both organizations must continue to strive for and achieve success regarding the educational endeavors that impacts our society. We must work together to assure we address the current and future needs for the appropriate growth and development of our EMS systems. Without question, this process these last two months has been most enlightening. We have got to continue to have open and frank communications regarding the numerous topics that will surely be before us. All of us should stay informed and be positioned to mutually and respectfully engage with our EMS community to enhance the efforts in the out-of-hospital arena. I look forward to exploring future topics worthy of our debate.
—Walt Stoy
I worked very hard at nationally accredited school to obtain a paramedic education.
I am totally against allowing students to get a paramedic education at an unaccredited school.
We are already lowest paid of any medical professional and you want to lower the worth of paramedic certification more.
—Paul Miller
I think discontinuing the accreditation requirements for Paramedic Programs is just another way that the lazy EMS programs and rubber stamping certification states will now get away from providing competent level certifications. Its just another low blow putting our profession in a backwards trend. I have been actively involved with Pre-Hospital Emergency Medicine for over 26 years and I have seen the success and growth of having the standards and requirements. Many of us over the years have been trying to get our profession recognized to a higher level due to many that can stand toe-to-toe with courses like nursing. I do agree that the scope is changing, but we must continue to move forward, not backwards., I have proof of a particular state in the western region who rubber stamped and falsified their Paramedic educations prior to the NREMT coming in and requiring them to change in 2005-2006. I still have all the documents to prove the facts and worry that with discontinuing the requirements will now allow them to return to this very scary certification process. We need to have our medical directors and the government establish better SOP's. Please, lets keep the National accrediting requirements and lets look for ways to adapt the guidelines. Thanks Jamie
—Jamie R.
If every program met an acceptable standard, this move might be warranted. The fact is, there are programs that are substandard. We need a high standard nationally that transfers across states and agencies. This is not a step forward nor three steps backwards. It is going to result in miles backward. Who do you want treating you or your loved ones in a prehospital environment?
—Sarah Gowan
Both NREMT and the current accrediting bodies are self serving instead of industry advocating.
BOTH are and have been academic TERRORIST to persons entering in to the profession, persons in profession, and agencies providing EMS education and patient care for many decades.
Look at nursing credentialing as an example: 1) students can get an Associates or Bachelors degree and both take the same State or national testing and either practice as RN, this pathway doesn't seem to down grade the quality of patient care being delivered, 2) they have various validated testing processes/organizations versus the monopoly concept of NREMT, 3) NREMT has enjoyed governmental regulatory authority for many decades which a private business should NEVER be allowed to have.
NREMT has helped raise the standards of the industry as part of their enjoyment of regulatory authority.
I do agree dropping or "dumbing down" the quality of EMS education and patient care is a fatal error for the profession.
Maybe we, as a profession should be more honest from within and establish standards for evidence based, quality outcome based education leading to improved patient outcomes instead of our long standing practice of "putting lipstick on the pig" to make the practice of EMS sound good yet do little to raise our standards to a full recognized profession with the working conditions, salaries, and decision making capabilities compensatory. Just my opinion
—Bob Waddell