The education and training requirements for EMTs and paramedics differ substantially from one state to the next, and consequently, not all EMS personnel are equally prepared. For example, while the National Standard Curricula developed by the federal government call for paramedics to receive 1,000–1,200 hours of didactic training, states vary in their requirements from as little as 270 hours to as much as 2,000 hours in the classroom. The range of responsibilities assigned to EMTs and paramedics, known as their scope of practice, varies significantly across the states as well. National efforts to promote greater uniformity have been progressing in recent years, but significant variation remains.
The National EMS Scope of Practice Model Task Force has created a national model to aid states in developing and refining their scope-of-practice parameters and licensure requirements for EMS personnel. The committee supports this effort and recommends that state governments adopt a common scope of practice for emergency medical services personnel, with state licensing reciprocity (4.1). In addition, to support greater professionalism and consistency among and between the states, the committee recommends that states accept national certification as a prerequisite for state licensure and local credentialing of emergency medical services providers (4.3). Further, to improve EMS education nationally, the committee recommends that states require national accreditation of paramedic education programs (4.2). The federal government should provide technical assistance and possibly financial support to state governments to help with this transition.
Substantial variation also exists nationwide in the way medical oversight and review are conducted; in many localities, physicians with little or no training and experience in out-of-hospital medical care provide this service. The committee believes that physicians who provide medical direction for EMS systems should meet standardized minimum requirements for training and certification that reflect their responsibilities. The specialty of emergency medicine currently offers 1- and 2-year fellowships in EMS to residency-trained emergency physicians, but there is no recognized subspecialty of EMS. Therefore, the committee recommends that the American Board of Emergency Medicine create a subspecialty certification in emergency medical services (4.4).
Dispatch, EMS, ED and trauma care providers, public safety, and public health should be fully interconnected and united in an effort to