first responders was updated most recently in 1995, that for EMT-Bs in 1994, that for EMT-Is in 1999, and that for EMT-Ps in 1998 (NHTSA, 2006). Because the revision of these NSC documents is the only setting in which national discussions regarding EMS scopes of practice occur, the revision process is time-consuming and expensive (NHTSA, 2000).

Education standards are needed to guide program managers and instructors in making appropriate decisions about what material to cover in classroom instruction. Currently, the content of most EMS education programs is based on the NSC. But while use of the NSC has contributed to the standardization of EMS education, the quality and length of programs still vary nationally, as do state licensure requirements for each position.

The NSC for basic life support (BLS) includes a minimum of 110 hours of didactic training, but states vary in their requirements from under 110 to more than 400 hours. For advanced life support (ALS) at the EMT-P level, applicants must receive 1,000 to 1,200 hours of didactic training beyond the EMT-B level, with additional practicum time (DOT, 1998); however states vary in their requirements from 270 to 2,000 hours (Mears, 2004). Based on the NSC, the EMT-I level requires 300 to 400 total training hours beyond the EMT-B level (DOT, 1998), but the number of hours varies across states from 50 to 492 (Mears, 2004).

The overwhelming majority of states and territories require both a written and a practical exam for initial credentialing (Mears, 2004). For all EMT levels and in all 50 states, a written exam is required, although the level of difficulty of these exams varies widely (NHTSA, 2000). All states require that licensure be renewed, typically every 2–3 years. Renewal usually entails completion of continuing education courses, verification of skills by a medical director, and current affiliation with an EMS provider (the latter requirement is common for ALS but less so for BLS). Standards for EMTs developed by the National Registry of Emergency Medical Technicians (NREMT) require initial training and recertification every 2 years.

Although state variation in educational requirements is substantial, the Education Agenda asserted that reliance on the highly prescriptive NSC has resulted in a significant loss of flexibility. The report concluded that a strict focus on the NSC could result in the development of narrow technical and conceptual skills without consideration for the broad range of professional competencies now expected of entry-level EMS personnel. The report advocated greater flexibility in meeting preestablished education standards, as well as more creativity in delivery methods, including problem-based learning and computer-aided instruction. However, the Education Agenda noted that accreditation of education programs and national certification need to be in place before the transition from the NSC to the National EMS Education Standards can take place (NHTSA, 2000).

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