Paramedic certification history and state licensure requirements in the United States

EMT Paramedic

PARAMEDIC JOB OPPORTUNITIES AND STATE CERTIFICATION AND LICENSE REQUIREMENTS

The objective of this work is to historically review the paramedic career and any major developments or issues surrounding this line of work. Current issues will be reviewed and the requirements of licensure or certification in the United States.

The paramedic is a medical professional trained to respond to and treat medical emergencies before admittance to a medical facility both from site of the emergency or trauma and during the process of transportation. Paramedics may even work inside the medical facility in a transport unit.

History of the Paramedic

Almost forty years ago the United States President, Lyndon Johnson, and his Committee on Highway Traffic Safety made a recommendation that a national certification agency be created in order that uniform standards could be established for the purpose of training and examination of active personnel in the ambulance service sector of healthcare services. Thus the establishment of the National Registry of Emergency Medical Technicians (NREMT) in 1970. The pre-hospital care of those requiring emergency medical services has "continually evolved and improved." (History of the NREMT, 2006) During the 1970s the first meeting of the Task Force met and invited many organizations to participate including the following:

Ambulance Association of America

International Association of Fire Chiefs

International Rescue and First Aid Association

National Ambulance and Medical Services Association

National Forest Service

National Funeral Directors Association

National Park Service

National Safety Council

National Ski Patrol

American Heart Association

International Association of Chiefs of Police (Ibid)

In 1971 the first "basic NREMT-Ambulance exam is administered simultaneously to 1,520 ambulance personnel at 51 test sites throughout the U.S. In the year of 1973 the NREMT calls a meeting with national EMT-Paramedic leaders and educators in attendance the goal is the development of initial guidelines for the curriculum in educating future EMT-Paramedics. In 1975 continuing education requirements are set out and during this same year the American Medical Association's Committee on Health Manpower added the EMT-Paramedic to the list of approved health occupations and the "...subsequent Council of Allied Health Education and Accreditation (C.A.H.E.A) procedure." (Ibid)

II. Licensing Authorities and Certification Regulations

There are four levels of EMTs in the United States which are the:

1) EMT-Paramedic, 2) EMT-Intermediate, 3) EMT-Basic and 4) the First Responder with the most advanced being the EMT-Paramedic.

The Department of Transportation is responsible for the design of the National Standard Curriculum for the EMT-Basic, EMT-Intermediate, and EMT-Paramedic. The National Registry of Emergency Medical Technicians is the agency designated to certify paramedics in the United States.

In the beginning there was only one level of certification for the EMT-Paramedic however, in 1980 guidelines were developed for the EMT-Intermediate and as well an examination process was established. By 1984 24 states were using the NREMT exam as the "...sole basis for certification at one or more levels." (Ibid) In 1986 the NREMT incorporated the American Heart Association standards into the exams at all three levels of certification.. The same year the U.S. Department of Defense issued directive 6000.10 on Emergency Medical Services stating: "All EMS health care personnel working in an emergency care area shall have current certification in Basic Life Support. Technicians or hospital corpsman working in EMS and/or assigned to ambulance duty shall have a minimum of EMT -- A certification from the National Registry of EMTs." (Ibid)

The current position of 46 U.S. states is that the NREMT examination is the "...sole basis for certification at one or more levels." (Ibid) There are three levels of training designated in the United States which are those of: (1) BLS - Basic Life Support; (2) ILS- Intermediate Life Support; and ALS - Advanced Life Support. The paramedic is educated in many areas including basic-skills in the first level as well as learning CPR, first aid, airway management, administration of oxygen, spinal immobilization, traction splinting, bleeding control, and in the intermediate skill level IV therapy is learned along with endotracheal intubation and initial cardiac drug therapy.

The work of Shantz (nd) states that paramedics who are educated "to recognize the effects of stress, how traumatic events can effect personnel, and management of traumatic stress through stress reduction techniques" are much more likely to have a better level of physical and psychological health. The work of Deborah Belgium (1999) entitled: 'Stress, Horror of Job Mean a High Level of Burnouts" published in the Los Angeles Business Journal states of the paramedic profession that: "They see the good, the bad, and the very ugly. They watch children die and families grieve. They're called to the aftermath of gun battles, car accidents and domestic rage. They're cursed at, vomited and bled on, yet patients seldom ask their names. To say the least the professional life of a paramedic can be harsh and demanding. Their workday can last 24 to 48 hours. Some survive the stress, some don't. The national average for a paramedic to stay on the job is just eight years."

Most EMT Agencies are located within the state health agency however the states of Kansas, Kentucky, Minnesota and Maryland are independent agencies with Board or Commissions. Reports state that many states are still reliant quite heavily on volunteers and that local managers are frequently lacking in training for management. A Recent NAEMSD/HRSA Survey states findings as follows:

48.6% - private, third service or other

44.9% - fire based

6.5% - hospital based

Challenges are stated to exist particularly in urban, rural and frontier areas. Urban EMS are challenged by the high volume of service needs and the limited resources for service delivery. Rural and frontier EMS challenges include the high per-patient cost in the low-volume systems and issues in the workforce inclusive of skill retention. Challenges in the work environment are inclusive of injuries which are stated to be through lifting, assaults, vehicular crashes and at crash scenes. As well ambulance design issues exist (crash safety & ergonomics); Exposure to toxins and infectious diseases; 24/7 shift work; high-stress environments; and lack of wellness programs. The role of the paramedic is important as to the survival of patients in that the first hour is considered the 'golden hour'.

III. Pay Scales - Job Duties

Upon examining the pay scales for the profession of a Paramedic ranges appear to be between $43K and $58K in salaried positions. In an interview with a paramedic it is asked what the greatest stresses can be in the EMT job. Poor equipment, old vehicles and poor systems are stated as high on the stress list as well as the disruption to sleep experienced. Stated as well are other medical workers who fail to show respect for the EMT stating that this includes doctors, nurses, the public, as well as teachers..When asked in this interview to state whether certain skills were considered basic skills of a paramedic the following were checked by the respondent in the interview:

Creativity

Emotional Distancing

Language

Manual Dexterity

Numeracy

Physical Activity

Persistence

Summary & Conclusion

Being a fairly new profession in the United States, the EMT-Paramedic profession is one that is inclusive of much stress and has needs of physical stamina and requires ongoing education in the field in order to stay sharp on skills and knowledge. The EMT field is one that appears to be opening up and one that is becoming recognized in the medical field for its importance in provision of healthcare.