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Emergency Medical Services at the Crossroads
EMS Education and Training Programs
The majority of EMTs and paramedics receive their education and training in programs offered by EMS agencies, community colleges, universities, hospitals and medical centers, fire departments, or private training programs. Increasing numbers of colleges offer bachelor’s degrees in EMS (Delbridge et al., 1998). However, medical education for EMS careers varies widely across the country, and it is frequently inadequate. Adherence to the NSC does not in itself ensure quality (NHTSA, 2000), and as noted, considerable state-level variation continues to exist.
This situation mirrors the challenges faced by the broader medical education system in the early 20th century. At the time, there were no standards for medical education programs and no adequate system to ensure quality. A report issued by Abraham Flexner in 1910 called for the establishment of more rigorous standards for medical education programs (Beck, 2004). Flexner visited 168 graduate and postgraduate medical schools in the United States and Canada and evaluated them on the basis of several criteria, including entrance requirements, faculty training, and financing to support the institution. The report was highly critical of the majority of schools visited. In the years following the report’s release, a large percentage of those schools closed, while others merged (Hiatt and Stockton, 2003). Consequently, the report is credited with triggering reforms in the standards, organization, and curriculum of medical schools across North America. In many respects, today’s EMS education system calls for a similar response.
The Education Agenda proposed national EMS education program accreditation as a way to address this problem. Currently, most states have some process for approving EMS education programs; however, these requirements vary widely. Some states require only that proper paperwork be filed (NHTSA, 2000). State education program approvals typically focus only on the paramedic level, and national accreditation is usually optional. The only nationally recognized accreditation available for EMS education is through the Committee on Accreditation of Emergency Medical Services Professions (CoAEMSP) under the auspices of the Commission on Accreditation of Allied Health Education Programs (CAAHEP). The EducationAgenda advocated that a single national accreditation agency be identified and accepted by state regulatory offices.
The committee maintains that greater standardization and higher quality standards are needed to improve EMS education nationally and at the state level. Therefore, the committee recommends that states require national accreditation of paramedic education programs (4.2). However, the committee recognizes that this requirement would increase the cost of and thus likely reduce access to paramedic education in many states. Access to EMS education programs is a critical issue in many areas of the country but especially in rural states, where reasonable access is necessary for communities to train and