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Emergency Medical Services at the Crossroads
two key groups of ancillary EMS personnel: emergency medical dispatchers (EMDs) and EMS medical directors
RESTRUCTURING OF WORKFORCE REQUIREMENTS
EMS personnel have become part of the health care workforce only within the past 40 years. Over the past 10–15 years, concerted efforts have been made to change professional education and training standards for EMS personnel, as well as their scope of practice requirements. In 1993, a national, multidisciplinary consensus process culminated in the publication of the National EMS Education and Practice Blueprint (NREMT, 1993). This report sought to establish recognized levels of EMS personnel, nationally recognized scopes of practice, and frameworks for curriculum development and workforce reciprocity (NHTSA, 2000). The report established standard knowledge and practice expectations for four levels of EMS personnel: first responder, emergency medical technician (EMT)-B (Basic), EMT-I (Intermediate), and EMT-P (Paramedic). At the time, more than 40 different levels of EMT certification existed (NHTSA, 1996).
The 1996 report of the National Highway Traffic Safety Administration (NHTSA) Emergency Medical Services Agenda for the Future included education systems as one of its 14 priority areas for improvement. The report emphasized the need to develop national core content for curricula for providers at various levels and asserted that all EMS education must be conducted with the benefit of qualified medical direction (NHTSA, 1996). Goals included in the report are detailed in Box 4-1.
The Emergency Medical Services Agenda for the Future: Implementation Guide, released in 1998, expanded upon these goals, providing specific objectives and timeframes for accomplishing the goals (NHTSA, 1998). The report emphasized the need to update and adopt the National EMSEducation and Practice Blueprint to promote consistency in the levels of EMS practice, and asserted that core content for EMS curricula should comply with the guidelines of the Blueprint. In addition, the ImplementationGuide advocated the creation of a system for reciprocity of EMS provider credentials, with the goal of eliminating legal barriers to intra- and interstate reciprocity (NHTSA, 1998).
One of the outgrowths of the Emergency Medical Services Agendafor the Future was the development of the Emergency Medical ServicesEducation Agenda for the Future: A Systems Approach, published in 2000 (NHTSA, 2000). The purpose of the Education Agenda was to create a more logical and uniform approach to EMS education and to maximize student competence. The report called for an education system with five integrated primary components: National EMS Core Content, National EMS Scope of Practice Model, National EMS Education Standards, National EMS