Commentary: Who`s Blocking Changes in CA EMT Certification?

The vast majority of emergency medical technicians and paramedics are hardworking, ethical folks. That being said, let's look at how some delinquents fell through the cracks.

A report by The Sacramento Bee that was published in The Modesto Bee ("Busted EMTs still working in flawed system," Feb. 26, Page A-1) put a spotlight on the haphazard patchwork of agencies in California that certify emergency medical technicians.

An EMT certified by officials in Orange County can use his or her certification in Stanislaus County, even if the standards for obtaining the certification differ between the two counties. The same is true anywhere in the state -- pick any two counties.

It's hard to see who benefits from such disparities. Obviously, those who exploit the system to obtain EMT certification are getting something they wouldn't get if the system was centralized. However, that small minority of miscreants doesn't have the political power to keep a broken system in place.

In this case, the blame falls directly on those who employ EMTs. These organizations have the political power to influence decisions made at the state level -- the kinds of decisions that lead to such a screwed-up system. Turf wars and control of a potentially lucrative industry have led to nobody keeping all the marbles.

The biggest players in this tug of war are the fire service and ambulance lobbies; both groups see problems with making EMTs more accountable.

Emergency medical training is only one part of the fire service, but it's required. If firefighters suddenly started losing EMT certifications because a single, unified state agency was treating EMT certification with the respect it deserves, the fire service would have to rethink its dual-role mentality or meet the need for better training. Either way, fire agencies all over the state could not afford to start losing people they've spent a lot of money to train.

Ambulance companies don't want EMT certifications to become any more exclusive, either. The harder it is to become an EMT, the fewer there are available -- and the more pay and benefits they command. Ambulance agencies are watching hospitals with concern. When registered nurses fought for -- and won -- a law restricting the number of patients each nurse could care for, the number of nurses hospitals needed to hire jumped, and so did their pay.

The fire service and ambulance industry have tried to look like they're addressing the issue by giving up centralized control over paramedic licensure and rolling over on initial certification for EMTs, making each new candidate take a standardized test. At the same time, they made EMT recertification easier; employers now have the ability to vouch for an EMT's skill level in-house, with no oversight.

There always will be a need for local control over treatment guidelines and service contracts -- there isn't much need for a rule on how to treat a jellyfish sting in Modesto like there is in Monterey.

Still, all licensure of paramedics and certification of EMTs should rest squarely on the state Emergency Medical Services Authority. The public should never have to fear the rescuers they call for help.

Brouhard is a paramedic in Modesto.

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