EMERGENCY MEDICAL SERVICES EDUCATION AGENDA FOR THE FUTURE
TABLE OF CONTENTS The Vision Executive Summary Introduction
EMS Education System National EMS Core Content
National EMS Practice Blueprint
National EMS Education Standards
National EMS Education Program Accreditation
National EMS Testing
Glossary Appendix A - EMS Education System Components Appendix B - Evolution of Allied Health Appendix C - Education Philosophy Educational Outcomes Appendix D - Document Identification, Description, and Responsibilities Appendix E - Strengthening Consumer Protection: Priorities for Health Care Workforce Regulation Appendix F - Document Samples Emergency Medical Services National EMS Core Content Appendix G - Members of the Task Force Appendix H - Blue Ribbon Conference Participants References The VisionIn 1996, the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration (HRSA) published the highly regarded consensus document titled the EMS Agenda for the Future, commonly referred to as the Agenda. This was a federally funded position paper completed under contract by the National Association of EMS Physicians (NAEMSP) in conjunction with the National Association of State EMS Directors (NASEMSD). The intent of the Agenda was to create a common vision for the future of EMS. This document was designed for use by government and private organizations at the national, state, and local levels to help guide planning, decision making, and policy regarding EMS. The Agenda addressed 14 attributes of EMS including the EMS education system. The Agenda provided the following overall vision for EMS in the Future: Emergency Medical Services (EMS) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and will be integrated with other health care providers and public health and public safety agencies. It will improve community health and result in a more appropriate use of acute health care resources. EMS will remain the public's emergency medical safety net. The following vision of EMS education is paraphrased from the EMS Agenda for the Future: EMS education in the year 2010 develops competence in the areas necessary for EMS providers to serve the health care needs of the population. Educational outcomes for EMS providers are congruent with the expectations of the health and public safety services that provide them. EMS education emphasizes the integration of EMS within the overall health care system. In addition to acute emergency care, all EMS educational programs teach illness and injury prevention, risk modification, the treatment of chronic conditions, as well as community and public health. EMS education is of high quality and represents the intersection of the EMS professional and the formal educational system. The content of the education is based on nationally developed National EMS Education Standards. There is significant flexibility to adapt to local needs and develop creative instructional programs. Programs are encouraged to excel beyond minimum educational quality standards. EMS education is based on sound educational principles and is broadly recognized as an achievement worthy of formal academic credit. Basic level EMS education is available in a variety of traditional and non-traditional settings. Advanced level EMS education is sponsored by institutions of higher education and most are available for college credit. Multiple entry options exist for advanced level education, including bridging from other occupations, basic EMS levels and for individuals with no previous medical or EMS experience. All levels of EMS education are available through a variety of distance learning and creative, alternative delivery formats. Educational quality is assured though a system of accreditation. This system evaluates programs relative to standards and guidelines developed by the national communities of interest. Entry level competence is assured by a combination of curricula standards, national accreditation, and national standard testing. Licensure is based upon the completion of an approved/accredited program and successful completion of the national exam. This enables career mobility, advancement, and facilitates reciprocity and recognition for all levels. Interdisciplinary and bridging programs provide avenues for EMS providers to enhance their credentials or transition to other health career roles, and for other health care professionals to acquire EMS field provider credentials. They facilitate adaption of the work force as community health care needs, and the role of EMS, evolves. In December 1996, NHTSA convened an EMS Education Conference with representatives of over 30 EMS-related organizations to identify the next logical Agenda implementation steps, including, in particular, determining NHTSA's future contributions to EMS education. This meeting's consensus is broadly summarized by the following recommendations:
In January 1998, NHTSA formed a Blueprint Modeling Group to develop the procedures for revising the National EMS Education and Practice Blueprint. During their initial deliberations, the group determined that the Blueprint should be only one component of a more comprehensiveEMS education system of the future. Consequently, they changed their name to the EMS Education Task Force. They expanded their goal to include defining both the elements of the education system and the interrelationships necessary to achieve the vision of the EMS Agenda for the Future. This document, the EMS Education Agenda for the Future: A Systems Approach, is the result of their deliberations. Executive Summary The EMS Education Agenda for the Future: A Systems Approach is a vision for the future of EMS education, and a proposal for an improved, structured system, to educate new out-of-hospital emergency providers. The EMS Education Agenda is based on the broad concepts for EMS education laid out by the 1996 EMS Agenda for the Future. The EMS Education Agenda for the Future builds on these concepts to create a comprehensive plan for an education system that will result in improved efficiency for the national EMS education process, enhanced consistency in education quality, and ultimately, greater entry-level student competence. Developed by a Task Force representing the full range of professions involved in EMS education, the EMS Education Agenda for the Future: A Systems Approach proposes an education system with five integrated primary components:
The proposed system maximizes efficiency, consistency of instruction quality, and student competence by prescribing a high degree of structure, coordination, and interdependence among the five components.  Key among the benefits of this system approach is the ability to influence consistency in instructional quality through an interaction among National EMS Education Standards, National EMS Education Program Accreditation and National EMS Testing. At the higher levels of education, this strategy for ensuring consistency allows the use of less prescriptive National EMS Education Standards in place of the current National Standard Curricula. With less dependence on a prescriptive National Standard Curriculum, instructors will have greater flexibility for targeting instruction to specific audiences, resulting in enhanced comprehension and improved student competence. The EMS Education Agenda for the Future describes an interdependent relationship among the five system components and recommends specific lead groups for development and revision responsibilities. The National EMS Core Content is a comprehensive list of skills and knowledge needed for out-of-hospital emergency care. Specification of the Core Content is primarily a medical concern and will be led by the medical community, with input from the system regulators, educators, and providers. The National EMS Practice Blueprint divides the National EMS Core Content into levels of practice, defining minimum knowledge and skills for each level. Since this determination is fundamentally a system issue, the system regulators will have the lead in its development, with input from the other stakeholders. The National EMS Education Standards take the place of the current National Standard Curricula, specifying minimum terminal learning objectives for each level of practice. Being basically an educational task, the development of the National EMS Education Standards will be led by educators, with input from other stakeholders. National EMS Education Program Accreditation and National EMS Testing will be full coverage and universal, enhancing consistency of instruction quality and outcomes by covering each of the provider levels and all education programs. Full coverage accreditation will require the development of appropriate standards and guidelines for each level of practice. To achieve accreditation, an education program will need to provide instruction which is consistent with the National EMS Education Standards. In order to be eligible for National EMS Testing, a student must have graduated from an accredited program. Administratively, the system proposed in the EMS Education Agenda offers a number of benefits, including greater predictability for component development cycles, and a clear and definite method for introducing changes to the system. These provisions will clarify the process for accommodating medical advances, technology development, and other needs that affect the scope or content of EMS education while following the attributes of the 1996 EMS Agenda for the Future. Introduction The Issue Since its inception, emergency medical services (EMS) education has evolved and matured. As is true of most new professions, no "master plan" was conceived to guide its evolution systematically. The stakeholders of EMS represented a widely diverse group who had no way to predicate the challenges that would face EMS in its rapid growth period. From paid, full-time persons to volunteers, from hospital-based to public safety-based, the diversity of persons involved with providing emergency medical services contributed special challenges unlike most other allied health care professions. Excellent individual components have grown during the last thirty years, including various national standard EMS curricula, accreditation standards, national registration and others. There is no formal EMS education system, however, in which the components are clearly defined, their interrelationships articulated and the decision-making process for modification and improvement established. Although many outstanding EMS providers have been educated during the last thirty years, the absence of a formal education system has resulted in considerable state-by-state variability in EMS education, licensing standards and a lack of clear-cut future direction. Without a formal EMS education system, it has been difficult to bridge from one level of education to another, there have been inconsistencies among the various curricula, there has not been a consistent method of providing input to the national EMS education decision-making process and the national standard curricula have limited instructor flexibility while being infrequently updated. EMS education is at a crossroads in its evolutionary process. As identified in the EMS Agenda for the Future, there are numerous challenges to preparing EMS providers for their role in the next millennium. Clearly, there is the need for a national EMS education system to serve as a "master plan." The Purpose To accommodate the increasing sophistication and changing nature of EMS systems, the EMS Education Agenda for the Future: A Systems Approach describes the structure and the process by which the EMS education system (master plan) of the next millennium will evolve. This document defines the EMS education system elements, describes their interrelationships, clarifies a decision-making process, establishes methods for input and accommodates improved data and research. It defines a system which promotes national consistency but is flexible for individual states while facilitating rapid inclusion of innovative methods of patient care. The synergistic effects of the system are enormous; clearly, the whole is greater than the sum of its parts. The system's infrastructure must outlive its architects while assuring a viable framework for national EMS education decision-making and future planning. Evolution of EMS Education The past frequently can help us to understand the present and to plan for the future. The depth of our past is how we are able to arrive at today and be prepared for tomorrow. The history of EMS education is largely synonymous with the history of emergency medical services systems. Pioneers in EMS clearly recognized the importance of strong educational programs. For each of the following time periods, a summary of the pertinent EMS education developments is presented, followed by a summary of the issues which are important to the development of the EMS Education Agenda for the Future. This summary is not to criticize the review of the processes or the decisions of those times, but to highlight opportunities for future improvements. We are able to identify these issues with the benefit of hindsight. The EMS pioneers who were instrumental in developing EMS education laid the foundation upon which future generations can build. From our current vantage point, our systems-oriented thinking and the current evolution of emergency medical services education, it is a natural time to reevaluate the past and look toward the future. 1950 to 1970 EMS Education Developments
The NAS/NRC's Accidental Death and Disability: The Neglected Disease of Modern Society, which suggested that the quality of prehospital care was an important determinant of survival in sudden injury, stimulated the development of federal funding through the Highway Safety Act of 1966. In 1969, the Highway Safety Bureau, later to become the National Highway Traffic Safety Administration (NHTSA), came into existence and the development of the first curriculum to standardize ambulance attendant training (EMT-Ambulance) was begun by Dunlap and Associates under contract to NHTSA. Issues Important to EMS Education Agenda for the Future: a Systems Approach
1970-1980 EMS Education Developments In 1971, the EMT-Ambulance: NSC was delivered to NHTSA by Dunlap and Associates. This NSC provided information on course planning and structure, objectives, detailed lesson plans, specific content material, and suggested hours of instruction. In response to model legislation recommended by NHTSA, many states adopted the national standard curriculum in either law or rules; the curriculum and the scope of practice became intertwined. The Emergency Medical Services Systems Act (P.L. 93-154), passed by Congress in 1973, provided categorical grant funds for the establishment of regional emergency medical services systems which embraced fifteen key components, including training and manpower. Training was thereby assured a prominent place in EMS system development. Perceiving a need for a separate EMS training program for law enforcement officers, NHTSA developed the 40 hour Crash Injury Management for the Law Enforcement Officer training program in the early 1970s. Subsequently, this evolved into the First Responder: NSC (1979). The first Board of Directors meeting of the National Registry of Emergency Medical Technicians (NREMT) took place in 1970. The purpose of the National Registry was to provide uniformed standards for the credentialing of ambulance attendants (NREMT, 1997). In 1975, the American Medical Association (AMA) recognized the EMT-Paramedic as an allied health occupation. The Essentials for EMT-Paramedic Program Accreditation were developed in 1976 and adopted in 1978 by the AMA Council of Medical Education. The Joint Review Committee on Education Programs for the EMT-Paramedic (JRCEMT-P) made the "Essentials" the standard for evaluating programs seeking accreditation (JRCEMT-P, 1995). Although EMS education and allied health education developed at approximately the same time, they frequently took divergent paths. Primarily in response to developments in the early management of cardiac patients, the first EMT-Paramedic: NSC was developed by NHTSA in 1977 and included 15 modules of instruction. Subsequently, the National Council of State EMS Training Coordinators, Inc. (NCSEMSTC) and the NREMT developed an additional EMS level between the EMT-Ambulance and the EMT-Paramedic levels of practice. This grew out of the perceived need to have certain emergency capabilities available to victims event though they could not support a paramedic level service. Modules I, II, & III of the EMT-Paramedic: NSC (Roles & Responsibilities, Human Systems: Patient Assessment, & Shock and Fluid Therapy) plus the esophageal obturator airway and anti-shock trouser lessons were designated as the EMT-Intermediate: NSC. Increasingly, the NHTSA curricula became national standards for EMS education and continued to be referenced in many state laws and administrative rules as the basis for scope of practice. Issues important to the EMS Education Agenda for the Future: A Systems Approach
1980-1990 EMS Education Developments In 1984, the. NCSEMSTC under contract to NHTSA, revised the EMT-Ambulance: NSC and increased the number of hours from 81 to 110. There was little EMS system involvement in this revision process. The EMT-Paramedic: NSC revision was completed by NCSEMSTC and was reorganized into a 6 division/27 subdivision format. A stand-alone EMT-Intermediate: NSC was also developed by the NCSEMSTC. Common to most of these curricula were detailed instructor lesson plans, course guides and refresher courses. In addition to an increase in the number of EMS providers trained and certified, there was an increase in both the number and the quality of textbooks and educational support material referencing the national standard curriculum. Issues Important to the EMS Education Agenda for the Future: A Systems Approach
1990-2000 EMS Education Developments Recognizing the need to look more comprehensively at the future of EMS education, NHTSA in 1990 convened the Consensus Workshop on Emergency Medical Services Training Programs. For the first time, representatives of the EMS community discussed the national curricula needs of EMS providers and identified the priority needs for EMS training. The priorities established at this consensus meeting determined the national priorities for EMS education for the 1990s. A formal, national, multi-disciplinary consensus process was used to develop the National EMS Education and Practice Blueprint in 1993. This was the first attempt to determine prospectively and systematically the levels of EMS providers. The purpose of the Blueprint was to establish: 1) nationally recognized levels of EMS providers; 2) nationally recognized scopes of practice; 3) a framework for future curriculum development projects; and 4) a standardized pathway for states to deal with legal recognition and reciprocity. This consensus process, involving initial peer review and subsequently a formal national consensus meeting moderated by an independent facilitator, set the stage for future EMS consensus activities. In 1994, Samaritan Health Services completed the EMT-Basic: NSC (renamed from EMT-Ambulance) under contract to NHTSA. The curriculum, which remained at 110 hours by contract, changed the emphasis of EMT-Basic education from diagnosis-based to assessment-based. "Nice to know" information was de-emphasized and "need to know" information was stressed. Despite an expert panel approach, the changes in the EMT-Basic curriculum generated considerable national discussion and attention. Increasingly, there was recognition that the method of changing the curriculum was as important as the content. The 1994 EMT-Basic: NSC provided detailed declarative material for each section without formal instructor lesson plans. In 1995, the First Responder: NSC was revised by the Center for Emergency Medicine of Western Pennsylvania under contract to NHTSA. The curriculum again provided detailed declarative material without formal instructor lesson plans. That same year, the EMS community, as represented by numerous national organizations, adopted the EMS Agenda for the Future. The document provided broad guidance for continuing development of the EMS system along with a number of specific EMS education recommendations. In 1996, NHTSA convened an EMS Education Conference with representatives of over 30 EMS- related organizations to identify the next logical steps to implement the education section of the EMS Agenda for the Future. The recommendations of this group eventually culminated in the preparation of this document. The proliferation of EMS textbooks and instructional materials has continued. Alternative methods of EMS education (e.g., Internet, CD-ROM, distance education) are becoming more prominent. In 1998, the EMT-Intermediate and EMT-Paramedic: NSC were revised by the Center for Emergency Medicine of Western Pennsylvania under contract to NHTSA. This revision utilized an expert panel and modified national consensus approach. Although reasonably consistent with the National EMS Education and Practice Blueprint, the emphasis on expanded skills and a more diagnosis-based approach to EMT-Paramedic education made it dichotomous with the recently revised EMT-Basic: NSC. These issues generated considerable national controversy and discussion. Although the curriculum followed the National EMS Education and Practice Blueprint, most discussion centered around the scope of practice and the degree of declarative information rather than on educational methodology. The close relationship between curriculum and scope of practice issues made the resolution of challenges more difficult. Detailed content outlines were still included. Issues Important to the EMS Education Agenda of the Future: A Systems Approach
Opportunities for Improvement During the past thirty years, considerable progress has been made in EMS education. As we approach the next millennium, public expectations and the changes in health care are creating new opportunities for EMS. This document, the EMS Education Agenda for the Future: A Systems Approach, is a proposal that will enable EMS to evolve, advancing the system capabilities during this unique period in history.
Attributes of the EMS Education System of the Future The EMS education system of the future has these attributes: 1. The EMS education system should be national in scope while allowing for reasonable state and local flexibility; 2. The EMS education system is guided by patient care needs, is educationally sound and politically feasible; 3. The components of the EMS education system are clearly articulated, with a lucid definition of their interrelationships; 4. The responsibility and time frames for updating each of the system components are clearly delineated; 5. The method of providing input to and participating in the outcome of each component is clearly defined with an established role for field providers, administrators, physicians, regulators, educators and others; 6. The ongoing system evolution is guided by research and the principles of quality improvement; 7. The EMS education system is stable enough and strong enough to outlive its architects and exist independently of the current leadership of any national EMS organization; 8. Physicians are primarily responsible for determining the medical content; regulators for determining regulatory issues; and educators for determining educational issues; 9. The EMS education system supports multiple instructional methodologies. Implicit within this document and underlying the EMS education system design are the following assumptions: 1. The EMS Education Agenda for the Future: A Systems Approach describes the framework of the EMS education system and defines the primary responsibilities for constructing each component. However, it does not describe in great detail the specific elements of its individual components. This should be done by the appropriate content experts in those respective areas. 2. The emergency medical services system will benefit from a well-organized EMS education system. 3. The federal government can play a leadership role in facilitating the design and implementation of an emergency medical services education system. 4. The National Highway Traffic Safety Administration, in concert with the Health Resources and Services Administration and other federal agencies, will continue to be the federal agency primarily responsible for coordinating the EMS Education system and for further defining the responsibilities of each system component. 5. An EMS education system which promotes reasonable national education and licensure consistency while providing for unique local variations is in the best interest of patient care. 6. Widespread EMS provider licensure reciprocity among states is a worthy goal. 8. An appropriately designed EMS education system, operating on the principles of quality improvement, will be able to assess its own performance, alter its methods and modify, if required, its very design. 9. Ongoing EMS research and data should drive, in a systematic fashion, the individual components of the EMS education system. 10. As stated in the EMS Agenda for the Future, the EMS education system will embrace the expectations and components of the EMS community. The components must be updated often enough to meet the needs of EMS patients and provide an infrastructure which supports innovative solutions addressing cultural variation, rural circumstances, increasing variability in EMS practice venues and travel and time constraints. 11. Publishers and other interested parties will continue to produce high quality, up-to-date, EMS instructional materials, including detailed instructor lesson plans which are consistent with the National EMS Education Standards while allowing for creativity and innovation. 12. With the evolution of the EMS Education Agenda for the Future, there will continue to be an improvement in the preparation of EMS instructors and in the quality of instruction. 13. The newly designed EMS education system will be able to respond to constant evolution of EMS, including the challenges of implementing the EMS Agenda for the Future. 14. The EMS Education Agenda for the Future: A Systems Approach addresses only the initial education for EMS providers. It does not address continued education or continued competency assurance. It is assumed that NHTSA will establish a process that will address a comprehensive systems approach to continued competency assurance. EMS Education System Today's education system is going thorough dramatic and profound changes. In response to extraordinary technological changes in society, education is expected to emphasize high level cognition, problem solving and the ability to deal with ambiguity and conflicting priorities. The public and employers expect graduates to be competent in a wide range of practical skills and have the ability to adapt to an ever changing and complex environment. The public and employers demand that health care education produce graduates who are responsive to the needs of the patient, have excellent communication skills, and are able to adapt to changes in their responsibilities. They demand graduates who are technically competent, socially conscious, and culturally sensitive. In addition to their traditional role as emergency care providers, EMS providers will need to be able to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to the treatment of chronic conditions and community health monitoring. The changing expectations of EMS education, the EMS provider's constantly changing role in the health care delivery system and a rapidly increasing body of EMS research necessitate a clearly defined and responsive EMS education system with the attributes defined previously in this document.
This document defines the infrastructure of an EMS education system of the future as one which will promote national uniformity while being responsive to local needs. It will be driven by research while recognizing the needs for reasonable consistency and stability. This document also articulates the responsibilities of the individuals or agencies responsible for each component of the system. This section identifies the system components and analyzes each in three ways:
Particular emphasis is placed on the interrelationships of the components and how they are mutually supportive. Consideration of individual components must include the interrelationship with the other components. The reader should strive to take a systematic view, and is cautioned against making judgments on the individual components before considering how they affect and relate to each of the other components. The EMS Education Agenda for the Future: A Systems Approach has five interrelated components:
Appendix A portrays a graphical representation of the components and their interrelationships. It demonstrates the dependent relationship each component has on the others, as well as how components and the entire process can be impacted upon. The supportive components (practice analysis, EMS research, past experience, and the EMS Agenda for the Future) are found across the top. These components guide the development of the National EMS Core Content, which represents the entire domain of out of hospital knowledge and skills. The National EMS Core Content drives the National EMS Practice Blueprint which names and defines the national levels of EMS practice. The National EMS Education Standards define the terminal knowledge and skill objectives for each level of practice identified in the National EMS Practice Blueprint. The National EMS Education Standards are also a part of the National EMS Education Program Accreditation requirements and are a resource in the development of instructional support materials and instructor development programs. National EMS Education Program Accreditation helps to assure the ongoing quality and consistency of EMS instruction. Graduation from an accredited program is required to participate in National EMS Testing which is based on the levels defined by the National EMS Practice Blueprint. In addition to the National EMS Education Standards, the practice analysis guides the development of National EMS Testing. National EMS Testing is one requirement for state licensing of EMS professionals. The entire process follows a continuous quality improvement model, with review and revisions at regularly scheduled intervals. The EMS education system is defined by a continuum ranging from National EMS Core Content through National EMS Testing. National EMS Core Content is revised the least frequently while National EMS Testing is revised the most frequently. Revision of National EMS Core Content may necessitate a revision of every other component. During the revision of each EMS education system component, interested parties may find out exactly how, and when, they may provide input and participate in the process. The decision-makers are clearly defined. In addition, the system is designed to respond to major changes immediately, if needed. Since the National EMS Education Standards reference terminal objectives, most classroom and program educational changes will occur at the local level. If a major change is needed nationally, it will be made at the level deemed appropriate by system review. EMS faces many unique local and regional challenges. The current EMS education process reflects a potpourri of solutions to these problems. Additionally, the philosophy, career needs, and professional expectations are not consistent among the various levels of current provider (First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic). Clearly, a rigid and prescriptive system will not meet the needs of all constituents. Any system must have enough flexibility to meet the needs of the diverse communities that it serves. This document draws on the experience of EMS and other allied health professions to propose an education system consistent with this vision and its stated attributes. It allows for continued and systematic growth of the EMS education system and will assist EMS leaders in making informed decisions about their future. EMS continuing education and continued competency assurance is an integral part of a comprehensive educational system, but is not addressed in this document. A similar "systems approach" to continuing education and continued competency assurance in EMS should be developed. National EMS Core Content Core content is used in some physician education programs to define the scope of a specialty discipline, develop residency training programs, and identify material for board examinations. Core content has been very useful in achieving these objectives, and can be used for similar purposes in emergency medical services. National EMS Core Content, which defines the entire domain of out of hospital EMS education, serves as the broad base for the rest of the EMS education system. It addresses knowledge content globally so that state-of-the-art changes and regional practice patterns can be reflected within its broad framework. It is medically directed, based upon research and the practice analysis, and periodically revised. Where We Are Currently, there is no National EMS Core Content. The National EMS Education and Practice Blueprint, created in 1993 by a multi-disciplinary group of EMS leaders, generally defines the domain of the prehospital EMS profession, but this is intermingled with definitions of EMS provider levels which delineate scope of practice. The 1993 Blueprint broke new ground by introducing uniformity in the definition of provider levels without dependency on a specific version of a curriculum. The validity and utility of the Blueprint could be enhanced by separating the development of the core content from the provider level designation. This would allow leadership for the development of each document to be assumed by the most appropriate group. Where We Want to Be in 2010 The National EMS Core Content presents the broad domain of knowledge and skills which encompass the out of hospital EMS disciplines by identifying the general practices of EMS providers without reference to discrete provider levels. The National EMS Core Content document is authored primarily by the EMS medical community, with input from EMS regulators, EMS educators and EMS providers. The EMS medical community is defined as physicians who have direct involvement in EMS. The National Highway Traffic Safety Administration is responsible for overseeing the process. The EMS Agenda for the Future is the guiding document setting the vision for EMS and is reviewed and updated periodically, under NHTSA leadership. The National EMS Core Content is created and revised by utilizing the EMS Agenda for the Future, practice analysis, EMS related research, and the body of knowledge created by practical experience. The National EMS Core Content is updated at regular intervals -- every 5 to 7 years, or more frequently as needed, to reflect current developments in EMS practice, clinical advances and education. A practice analysis is conducted for each nationally recognized EMS level by the national testing agency and helps to identify the practices of currently functioning EMS providers. The practice analysis is national in
scope and follows sound qualitative and quantitative methodology. The practice analysis should be updated at least every 5 years. It is one of several pieces of information used in revising the National EMS Core Content. The National EMS Core Content is the result of a consensus process, led by a group consisting of physicians with direct involvement in EMS, with input from EMS regulators, EMS educators and EMS providers. The drafts will be extensively peer and community reviewed. NHTSA should assume the leadership role for the development, implementation, and distribution of the National EMS Core Content. This document, once completed, serves as the domain of practice from which the National EMS Practice Blueprint is derived.
National EMS Practice Blueprint Few, if any other allied health profession has a document similar to the current National EMS Education and Practice Blueprint or the proposed National EMS Practice Blueprint. The diversity of EMS and the multiple levels of practice within EMS necessitates these discrete divisions in the scope of practice among these levels. The National EMS Practice Blueprint defines the national levels of EMS providers including their entry-level skills and knowledge.
In 1993, the National EMS Education and Practice Blueprint was developed through a national consensus process. This document established uniform definitions of EMS provider levels, including their entry-level knowledge and skills. Based on the assumption that EMS knowledge and skills are on a continuum, it was designed to encourage "bridging" from one level to another, to facilitate reciprocity, and to be the basis for national curriculum development and to assist states in defining scopes of practice. While the National EMS Education and Practice Blueprint received wide approval and acceptance in concept, it has been inconsistently applied in practice. Moreover, curriculum developers felt it lacked the specificity to adequately guide curricula. Many states have not changed their current provider levels to comply with the National EMS Education and Practice Blueprint, and many state laws and regulations continue to refer to the national standard curricula when defining EMS provider scope of practice. While the concept of the Blueprint is solid, it has become apparent that a single document cannot adequately address all of these issues. Since the development of the Blueprint in 1993, no revision has been completed. Where We Want to Be in 2010 The National EMS Education and Practice Blueprint is revised based upon the National EMS Core Content and re-titled the National EMS Practice Blueprint. Because the Blueprint defines levels of practice which must be recognized in state laws and administrative rules, the revision is authored and directed primarily by EMS regulators with input from the EMS medical community, EMS educators, and EMS providers. The Blueprint defines the nationally recognized levels of EMS providers and identifies their minimum entry level knowledge and skills. The National EMS Practice Blueprint is used by each state to determine scope of practice and to facilitate reciprocity.How to Get There The National EMS Core Content provides the foundation for the revision of the National EMS Education and Practice Blueprint. This revision will be renamed the National EMS Practice Blueprint. The revision is a consensus process led by a group of EMS regulators responsible for certifying and licensing EMS providers, with input from the EMS medical community, EMS educators and EMS providers. The drafts will be extensively peer and community reviewed. NHTSA should assume the leadership for the revision, implementation, and distribution of the National EMS Practice Blueprint. This document, once completed, guides the development of the National EMS Education Standards and defines uniform levels of licensure in each of the states. Licensure is the legal authority to practice granted by a state agency.
National EMS Education Standards Education standards are needed to guide programs and instructors in making appropriate decisions about what material to cover in classroom instruction. These standards are used by testing agencies to help define appropriate material for licensure exams, serve as one component of program evaluation in the accreditation process, and are used by publishers to develop instructional materials. In most allied health professions, education standards are developed by professional associations with broad community input. The complexity, interdisciplinary nature, and extensive state level oversight of EMS necessitates a slightly different approach. Where We Are Currently the content of most EMS education programs is based on a national standard curriculum. These National Standard Curricula (NSC) are funded, developed, and updated periodically by the National Highway Traffic Safety Administration (NHTSA). NSC have been developed for all nationally recognized levels of EMS education and consist of detailed, highly prescriptive objectives and declarative material. Since these documents are closely tied to scope of practice and because their revision is the only national venue for the discussion of scope of practice, the NSC revision process is time consuming and expensive. Many EMS education programs and faculty strictly follow the NSC in defining the content of their courses. A measure of quality for such programs has been their adherence to the current NSC. Although the use of the NSC has contributed to the standardization of EMS education, there remains variation in the quality and length of programs nationally. The reliance on the NSC has decreased flexibility, limited creativity, and made the development of alternative delivery methods difficult. The strict focus on the NSC may result in the development of narrow technical and conceptual skills without consideration for the broad range of professional competencies expected of today's entry level EMS providers. Where We Want to Be in 2010 The National EMS Education Standards are derived from the National EMS Practice Blueprint. Each National EMS Education Standards document will provide the minimal terminal objectives necessary for successful program completion of one of the levels of EMS providers identified in the Blueprint. These standards allow local flexibility and creative delivery methods such as problem based learning, computer aided instruction, distance learning, programed self-instruction and others. Without the constraint of an unduly prescriptive NSC, EMS educational institutions are held more accountable for the content and quality of their instruction. This would require, at a minimum, that institutions conduct evaluations of both educational process and outcome quality. With less prescriptive curriculum standards, it is much easier to modify curriculum content, both locally and nationally. Changes based on research, practice analysis, future direction of the profession and experience are quickly reflected in education content, and these changes are communicated to programs through a variety of mechanisms. While all programs must meet national standards, they are encouraged to continually improve and excel. There are a variety of outstanding instructional materials including instructor lesson plans available from publishers, educational institutions and other interested parties to support local EMS instruction. EMS instructors will utilize published materials or develop their own for classroom use. The scope of practice for EMS providers is not defined by education standards or curriculum. National EMS Education Standards are designed to prepare EMS providers who are competent to perform within a specific scope of practice. Education supports, rather than defines, scope of practice. The scope of practice for EMS providers is based on the National EMS Practice Blueprint. How to Get ThereThe National EMS Education Standards will be developed by a group of EMS educators, with input from EMS providers, the EMS medical community, and EMS regulators. The drafts will be extensively peer and community reviewed. National EMS Education Standards should be developed for and based upon each level of EMS provider specified in the National EMS Practice Blueprint. Accredited EMS programs will utilize the appropriate National EMS Education Standards document as the basis for their education program. Accreditation agencies will use the National EMS Education Standards to evaluate the appropriateness of program curriculum. The EMS community, and most EMS education programs, have a long history of reliance on the NSC. The shift from a standardized curriculum to a system of National EMS Education Standards must occur with the growth and maturation of the other system components. We cannot decrease our dependence on the NSC before strengthening other components of the system, especially accreditation and national testing. We are moving from a system where consistency was ensured through standard content to one which seeks consistent high quality educational outcome.
National EMS Education Program Accreditation Education accreditation is the accepted method of educational quality assurance and improvement in most areas of allied health and higher education. Education accreditation is a non-governmental, independent, collegial process based on self and peer assessment for public accountability and improvement of academic quality. Education accreditation generally involves three major activities:
Education accreditation provides a national standard and may eliminate the need for states to develop a separate program recognition process. Accreditation represents a method to assure the students and the community that an education program meets uniform, nationally accepted standards. For institutions, accreditation stimulates continuous self-assessment and encourages self-improvement. It promotes sound educational change and provides institutions with validation to obtain the resources that they need to improve. The essential values of accreditation are: continuous self-improvement, professional excellence, peer review and collaboration, and civic responsibility. Where We Are Currently, accreditation is voluntary and available only at the paramedic level. In most states, national accreditation is optional. In 1998 there were approximately 100 accredited paramedic programs in the United States. While no national accreditation exists at other EMS provider levels, most states have a process for approving EMS education programs. The requirements for these state approvals vary widely, from simply filing paperwork to extensive self studies and site visits. State approval is granted to institutions, courses, or individual instructors. The only nationally recognized accreditation available for EMS education is through the Commission on Accreditation of Allied Health Education Programs (CAAHEP) Joint Review Committee on Accreditation of Educational Programs for the EMT-Paramedic (JRCEMT-P). In 1998, CAAHEP accredited 18 recognized allied health occupations. Most allied health professions limit licensure eligibility to individuals who have graduated from an accredited education program. In this way, professions control educational quality. For EMS, this linkage has occurred in only five states, and only at the paramedic level as of 1999. Where We Want to Be in 2010 The concept of National EMS Education Program Accreditation is universal and supported by the EMS leadership organizations and stakeholders. A single, nationally recognized accreditation agency has established standards and guidelines for each level of EMS education which recognize the special issues involved with accrediting the entire range of EMS programs and provide unique processes for this encompassing accreditation. Universal acceptance of National EMS Education Program Accreditation has resulted in extensive self assessment of EMS education programs and the implementation of continuous quality improvement initiatives. Having clear standards and guidelines, programs have improved their faculty and the overall quality of instruction. They are structure, process, and outcome oriented. Programs and instructors use the National EMS Education Standards and commercially available or locally developed instructional support material to develop curriculum materials. Accreditation standards and guidelines provide minimum program requirements for sponsorship, resources, students, operational policies, program evaluation, and curriculum. These standards have been developed with broad community input and peer and professional review. National EMS Education Program Accreditation is universal and required for each level of EMS recognized by the AMA as an allied health occupation. In order to be eligible for National EMS Testing and state licensure, a candidate must have graduated from an accredited program. Accreditation is a process of self analysis in relation to the standards and guidelines, site evaluation, and committee review. Some EMS levels are not recognized by the AMA as allied health occupations (e.g., First Responder). Accreditation for these EMS programs is achieved by a process as close to allied health professions accreditation as possible, given the resources and constraints imposed by the system. In order to be eligible for state licensure, a candidate must have graduated from a state approved and nationally accredited program. Approval to conduct EMS education is extended by the states to all accredited programs, in accordance with state laws. How to Get There A single national accreditation agency is identified and has representation from a broad range of EMS organizations. The accreditation agency establishes accreditation standards and guidelines for all levels of EMS education with broad community input. The accreditation agency adopts the National EMS Education Standards as the basis for evaluating the content of all EMS instruction and develops a process for accreditation that is appropriate for each level of EMS instruction as determined by the National EMS Practice Blueprint. All EMS education programs must achieve National EMS Education Program Accreditation. A graduated time line will be developed for each level by the lead EMS agency in each state. Milestones will be established based on how extensive the gap is between the current level of functioning and the standards and guidelines. These milestones are consistent with the national time line. The accreditation agency should conduct regional accreditation workshops to increase the understanding of National EMS Education Program Accreditation and help programs achieve the accreditation standards and guidelines. Funding is critically needed to support short term educational improvement projects which make accreditation more achievable.
National EMS Testing Licensure is the process of a state government granting official permission to practice. Although there are subtle differences, the terms licensed and certified are often used interchangeably. Most licensure processes require some form of testing to assure minimum competencies. In most professions, the development of the examinations is the responsibility of a national agency or association, and the state uses these tests as part of the licensing process. Where We Are Testing in EMS today is one of the final stages prior to a state granting licensure to EMS providers. Testing often includes both practical and written components. There is wide variability in the quality and difficulty levels of written and practical examinations. These variations have led to problems with reciprocity and a lack of assurance of standardized minimum entry level competence. Many local and state authored examinations do not adhere to the standards established by the American Psychological Association's (APA) Standards for Educational and Psychological Testing utilized by other allied health care professions. In some instances state authored examinations are necessary because the state EMS provider levels do not match the nationally recognized levels. Currently (1999), 40 state EMS regulatory agencies use some form of the National Registry of Emergency Medical Technicians (NREMT) examinations. This may include use of a single level examination or the use of their examinations for all levels of EMS providers. The NREMT examinations are based on a current practice analysis and the National EMS Education and Practice Blueprint. Their examinations are authored by a multi-disciplinary group of experts with input from various EMS related organizations. Validation of each level of examination is done on a continuous basis. Barriers which may hinder the adoption of National EMS Testing include, but are not limited to, cost of implementation and administration of a national examination, political issues, the use of a mandated national practical examination, lack of local support, and perceived failure rate. Where We Want to Be in 2010 Prior to completing National EMS Testing, a candidate must have graduated from an accredited educational program and have met nationally established entry level requirements. These requirements address areas such as criminal history, performance requirements, minimum age, physical capabilities and other areas. How to Get There A single, national testing organization is identified and has representation from a broad range of EMS organizations. The national testing organization regularly conducts a comprehensive practice analysis for each level of nationally recognized EMS provider which is used to develop and to revise National EMS Testing for each level identified in the National EMS Practice Blueprint. Licensure testing adheres to the American Psychological Association's Standards for Educational and Psychological Testing. A graduated phase-in plan is developed for implementation of national testing. Each state should identify a graduated time line for adoption of national testing. After the phase-in date, all graduates must have completed an accredited program of instruction and have successfully completed national testing to achieve state licensure. The national testing organization should conduct regional workshops to increase the understanding of National EMS Testing and emphasize the overall system advantages. This identified national testing organization should also help states overcome the barriers of implementation whenever possible.
Glossary Academic - Based on formal education; scholarly; conventional Academic institution - A body or establishment instituted for an educational purpose and providing college credit or awarding degrees. Accreditation - The granting of approval by an official review board after specific requirements have been met. The review board is non-governmental and the review is collegial and based on self and peer assessment and judgment. The purpose of accreditation is for public accountability. CECBEMS - Continuing Education Coordination Board for Emergency Medical Services, a nationally represented board for approval of EMS continuing education. Certification - A certificate issued by a private agency based upon standards adopted by that agency that are based upon competency Continuing education - The continual process of life long learning. Core content - The central elements of a professional field of study and relations involved; does not specify the course of study. Credentialing agency - Organization which certifies an institution's or individuals authority or claim of confidence for a course of study or completion of objectives. Curriculum - A particular course of study, often in a special field. For EMS education it has traditionally included detailed lesson plans. Educational Affiliation - As association with a learning institution (academic), the extent to which can vary greatly from recognition to integration. Emergency Medical Technician - A member of the emergency medical services team who provides out of hospital emergency care; includes certifications of EMT-Basic, EMT-Intermediate, and EMT-Paramedic progressively advancing levels of care. EMS System - Any specific arrangement of emergency medical personnel, equipment, and supplies designed to function in a coordinated fashion. May be local, regional, state, or national. Expanded Role/Expanded Scope - Increased dimensions of the services, activities, or care provided by EMS. First Responder - The initial level of care within an EMS system as defined by the EMS Education and Practice Blueprint, as opposed to a bystander. Licensure - The act of granting an entity permission to do something what the entity could not legally do absent such permission. Licensing is generally viewed by legislative bodies as a regulatory effort to protect the public from potential harm. In the health care delivery system, an individual who is licensed tends to enjoy a certain amount of autonomy in delivering health care services. Conversely, the licenses individual must satisfy ongoing requirements which assure certain minimum levels of expertise. A license is generally considered a privilege and not a right. National EMS Core Content - The document which defines the domain of out of hospital care. National EMS Education Program Accreditation - The accreditation process for institutes who sponsor EMS educational programs National EMS Education Standards - The document which defines the terminal objectives for each provider level. National EMS Practice Blueprint - The document which defines scope of practice for the various levels of EMS provider Outcome - The short, intermediate, or long-term consequence or visible result of treatment, particularly as it pertains to a patient's return to societal function. Practice Analysis - A study conducted to determine the frequency and criticality of the tasks performed in practice. Registration - A listing of individuals who have met the requirements of the registration service. Regulation - Either a rule or a statute which prescribes the management, governance, or operating parameters for a given group; tends to be a function of administrative agencies to which a legislative body has delegated authority to promulgate rules/regulations to "regulate a given industry or profession. Most regulations are intended to protect the public health, safety, and welfare. Scope of practice - Defined parameters of various duties or services which may be provided by an individual with specific credentials. Whether regulated by rule, statute, or court decision, it tends to represent the limits of what services an individual may perform. Appendix A - EMS Education System Components Appendix B - Evolution of Allied Health Education As the sophistication and complexity of medical care increased, the 1960s saw a number of allied health professions join the ranks of nurses and physicians to provide care to patients in this country. In 1966, Congress passed The Allied Health Professions Training Act. This legislation provided a formal system of physician-directed practice and gave the American Medical Association (AMA) the authority to grant authorization to institutions that sponsor and provide instruction to allied health professionals. Through the Commission on Allied Health Education Accreditation (CAHEA), the AMA developed a system which accredited educational institutions to conduct allied health educational programs. The CAHEA model of accreditation (now administered by the Commission on Accreditation of Allied Health Education Programs - CAAHEP) was similar to the process used by nursing and medical schools. Each recognized allied health occupation developed a Joint Review Committee (JRC), consisting of membership from physician and professional associations. With broad community input, each JRC was charged with developing essentials or standards which would be used as the basis of evaluating and accrediting programs. Throughout the past three decades, allied health has experienced a transition from on-the-job training to education in formal institutions of higher education. Initially allied health education programs were generally sponsored by health care institutions. Since the late 1960s, the trend toward collegiate and university settings has been rapid and steady. Most allied health fields continued to press for more and better training and have instituted educational requirements which include formal academic degrees (Farber and McTernan, 1989). By 1980 over half of the allied health programs in the United States were housed in collegiate settings (Ford, 1983). By 1998 there were 16 accrediting agencies and 47 recognized health occupations (AMA, 1998). Most allied health programs have a registration or certification process which is national in scope and typically sponsored by a professional association. Although there are some exceptions, eligibility for registration or certification is typically limited to individuals who have graduated from accredited training programs. Since authorization to practice is a state function, state licensure is usually granted to individuals who have completed the examination process established or endorsed by the profession. Appendix C - Education Philosophy Educational Outcomes In addition to job oriented skills, today's workers are expected to possess a capacity for problem solving, constructive skepticism, and the ability to manage ambiguity (Barth, 1990). Recent studies on narrowly focused and task oriented curricula have concluded that "narrow emphasis on vocational skills is insufficient to achieve workforce success, and that vocational programs should emphasize the development of academic skills..."(Benz, 1997) Post-secondary education is now emphasizing the role of basic education in the context of technical or vocational education and how it is used to develop the thinking process, foster understanding, and develop mastery in any occupation. Mastery of basic academic skills improves problem-solving capabilities and prepares the student for lifelong learning. Upon completion of any course of professional education, it is expected that a graduate possesses the skills, knowledge and attitudes to enter the workforce. The safety of the public greatly depends on the competence of all health care providers.
Unfortunately, competence is an extremely complicated and multi-faceted issue. Although it is relatively easy to identify, quantify, and test cognitive and psychomotor competence, there is more to achieving competence than being technically adept.
Contextual, integrative and adaptive competence are not discrete topic areas and do not easily lend themselves to behavioral objectives. Programs and faculty members must constantly weave these issues into the conceptual and technical components of the course. It is impossible for a standardized curriculum to identify specific objective and declarative material for contextual, integrative and adaptive competence, but their importance cannot be overstated. Individual instructors and programs must keep these competencies in mind as they are developing instructional strategies to build entry level competence. These competencies are often the result of leadership, mentoring, role modeling, a focus on high level cognition, motivation and the other instructional skills of the faculty. The development of professional attitudes is influenced and shaped through role modeling, mentoring, and leading by example. It is difficult to "teach" in a didactic sense. Generally, professional attitudes, such as the following, are best nurtured through leadership and mentoring.
While it is the role of testing agencies to evaluate conceptual and technical competence, it is the role of the educational institution and the faculty to nurture, develop, encourage, mentor, and evaluate all components of professional competence. Education and Training The difference between education and training is not simply a matter of semantics. Generally speaking, education is a broad based, theoretical endeavor designed to improve cognitive skills and decision making. Training, on the other hand, tends to be specific and practically oriented. This distinction is not to imply a hierarchy or value judgment.
Education without training results in inert knowledge which lacks transfer to real life situations. Training with inadequate education results in narrow, task oriented outcomes characterized by poor understanding, inadequate long term retention, and little ability to change or adapt to situations which are dissimilar from the training environment. The most successful instruction strikes a balance between theory and practice, and is a combination of both education and training. Public expectations, political issues, legal considerations, and the need for interstate reciprocity of provider credentials all point to the need for some consistency in the content of education programs. There are two approaches to curriculum consistency: One suggests that curriculum consistency should be achieved by standardized and mandated curricula; the other utilizes firm educational standards and a monitoring program to assure that educational institutions, faculty, and regulatory agencies adhere to these standards. EMS has attempted to assure educational quality through the use of national standardized curricula. There is no doubt that these curricula have served an important function in the development of EMS and have played a major role in the growth and development of the profession. They have established the foundation of practice for EMS and were successful in defining a new area of practice. On the surface, the rationale for the continued use of standardized curricula seems logical. Standardized curricula assure that all classes are conducted in the same manner. Theoretically, this should produce similar outcomes. Unfortunately, standardized curricula do not account for variations in instructors, resources, and students. In EMS, there is still a wide variation in outcome measurements, despite the requirement that programs adhere to standardized curricula. There is little evidence that standardized curricula improve classroom instruction or the quality of education (Airasian, 1988). In addition to having little evidence validating the effectiveness of standardized curricula, some researchers have suggested that there are detrimental effects (Brooks 1991). Some of these detrimental effect are:
The second approach to curriculum consistency offers advantages for our evolving EMS education system. This model establishes standards and guidelines for process and product variables in EMS education. Typically these standards and guidelines address areas such as sponsorship, resources, curriculum, evaluation, and program planning. Programs are required to adhere to standards and guidelines with an external review process to assure compliance. This system offers a method of assuring appropriate curriculum content while placing responsibility for instruction at the local level, enabling flexibility, encouraging creativity, and facilitating rapid change.
REGULATORY BOARDS AND GOVERNANCE STRUCTURES Recommendation 1 Recommendation 2 Recommendation 3 Recommendation 4 Recommendation 5 Recommendation 6
Recommendation 7 Recommendation 8 Recommendation 9
CONTINUING COMPETENCE Recommendation 10
This section includes a sample of the format for the documents referenced in this document. These samples were created by the developers of the EMS Education Agenda for the Future using the 1990's revision of the respective EMS NSC. They are designed to be illustrative, not restrictive. The authors of each actual document may alter the format as needs and methodology evolve. These examples are presented only as an example. In the National EMS Core Content example, we have expanded the pulmonary section to illustrate the level of detail that would be included throughout the document. Each section of the final document would follow the example of that model section. The adult Pulmonary sections of the National EMS Practice Blueprint and the National EMS Education Standards are also presented to illustrate their formats and levels of detail. Emergency Medical Services National EMS Core Content Core Content Categories PREPARATORY AND OPERATIONS TRAUMA MEDICAL EMS Practice Blueprint
National EMS Education Standards First Responder The entry level First Responder must be able to recognize and provide immediate, life saving interventions for a patient with a respiratory emergency. The
entry level First Responder must be able to: Emergency Medical Technician-Basic The entry level EMT-Basic must be able to recognize and implement the treatment plan for the patient with a respiratory emergency. The entry level EMT-Basic must be able to perform all the objectives of the First Responder, plus: EMT-Intermediate The entry level EMT-intermediate must be able to apply assessment findings and implement the treatment plan for the patient with respiratory emergencies. The entry level EMT-Intermediate must be able
to perform all of the objectives of an EMT-Basic, plus: EMT-Paramedic The entry level paramedic must be able to integrate pathophysiological principles and assessment findings to formulate a field impression and implement the treatment plan for the patient with respiratory problems. The entry level paramedic must be able to perform all of the objectives of a EMT-Intermediate, plus: Appendix G - Members of the Task Force
Jeff Michael, EdD David Bryson Susan McHenry HRSA/MCHB: Robert K. Waddell, II EMS Education Task Force: James B. Allen William E.
Brown, Jr. Liza K. Burrill Arthur Cooper, MD John L. Chew Drew E. Dawson Richard Elliott Scott B. Frame, MD, FACS Dia Gainor Jon Krohmer, MD Lori Moore Steve Haracznak Michael O'Keefe Daniel L. Storer, MD Walt A. Stoy, PhD Ken Threet Paula Willoughby, DO
Gregg S. Margolis Steve Mercer Appendix H - Blue Ribbon Conference Participants INTENTIONALLY LEFT BLANK - CONFERENCE SCHEDULED APRIL 23-25, 1999 References Airasian, P.W. (1988). Symbolic Validation: The Case of State Mandated, High-Stakes Testing, Education and Policy Analysis, 10, 301-313. American Medical Association (1998). Health Professions Education Directory-26th edition. AMA, Chicago, Ill. American Psychological Association. (1986). Standards for Educational and Psychological Testing Barth, P. (1990). To Realize the Ideal. Basic Education, 351:2. Becknell, J. (1997). Time for a Change. Journal of Emergency Medical Services, 21(12), 25-58. Benz, M. R. (1997). Components that Predict Post-School Success for Students With and Without Disabilities. Exceptional Children 63, 2:151-65. Boyd, D. R., Edlich, R.F., and Micik, S. (1983). Systems Approach to Emergency Medical Care. Appleton-Century-Crofts, Norwalk, CT. Pages 16-19. Brooks, M.G. (1991). Centralized Curriculum: Effects on the Local School Level. In The Politics of Curriculum Decision-Making: Issues in Centralizing the Curriculum, edited by Klein, M. F. State University of New York Press, Albany, NY. Cross, C. T. and Applebaum K. (1998). Stretching Students' Minds Is Basic Education. Educational Leadership, March 1998, 74-6. Farber, N. E., McTernan, E. J., and Hawkins, R. O. (1989). Allied Health Education: Concepts, Organization, and Administration. Charles C. Thomas Publishers, Springfield Ill. Ford, C. W. (1983). Handbook of Health Professions Education. Jossey-Bass Publishers, San Francisco. Joint Review Committee on Accreditation of Educational Programs for the EMT-Paramedic (1995). JRC EMT-P Accreditation Handbook. National Academy of Sciences National Research Council (1966). Accidental Death and Disability: The Neglected Disease of Modern Society. National Registry of Emergency Medical Technicians (1997). National Registry of EMTs Policy and Procedure Manual. Pinocchio LJ, Dower CM, Blick NT, Gragnola CM, and the Taskforce on Health Care Workforce Regulation (October 1998). Strengthening Consumer Protection: Priorities for Health Care Workforce Regulation. San Franciso, CA: Pew Health Professions Commission. Rockwood, C. A., Mann, C. M., Farrington, J. D., Hamptom, O. P., & Motley, R. E. (1976). History of Emergency Medical Services in the United States. The Journal of Trauma, 16(4), 299-308. Stark, JS, Lowther, MA, and Hagerty, NMK (1986). Responsive Professional Education: Balancing Outcomes and Opportunities. ASHE-ERIC Higher Education Reports No. 3. Washington, D.C.: Association for the Study of Higher Education. United States Department of Transportation, National Highway Traffic Safety Administration & United States Department of Health & Human Services Public Health Services, Health Resources & Services Administration, Maternal & Child Health Bureau (1996) Emergency Medical Services Agenda for the Future. Van Geel, T. (1991). Two Visions of Federalism and the Control of the Curriculum. In The Politics of Curriculum Decision-Making: Issues in Centralizing the Curriculum, edited by Klein, M. F. State University of New York Press, Albany, NY. |
The analysis of skills in the ems profession used for education can be found in the:
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