vacant. As a result, the city is staffing ALS ambulances with a paramedic and a lesser-trained EMT rather than two paramedics (Wilber, 2005). Reports indicate that staffing shortfalls appear to be most pronounced at the paramedic level. This is likely due to the increased education required for this level of EMT and attrition of personnel to fire services (Personal communication, M. Williams, March 27, 2006).
Demand for EMTs will continue to be strong in rural and smaller metropolitan areas (Bureau of Labor Statistics, 2002). Volunteer staffing has become increasingly more difficult to maintain in rural areas for a variety of reasons. Decades ago it was common for volunteers to be on call virtually 24 hours a day. Today, increased time demands due to the need for two-income family support and vying interests create an environment in which volunteers may donate just one specific weeknight or a few hours on a weekend. Rural EMS agencies face particular volunteer staffing shortages during the weekday work hours.
Although there are National Standard Curricula for all levels of EMT training, those curricula are not mandatory, so training requirements for certification vary across states. A written exam is required in most states, and some require an additional practical exam to obtain certification. Generally, the national standards for BLS are a minimum of 110 hours of instructional training with additional field training requirements that vary by state. For ALS, training at the paramedic level entails 1,000–1,200 hours of didactic training beyond the EMT-B level (DOT, 1998), with additional practicum time. Certification in all states needs to be renewed (every 2 years for most states). Renewal usually requires completion of continuing education, verification of skills by a medical director, and current affiliation with an EMS agency.
Pediatric care has traditionally been a small component of EMT training. In a mid-1980s survey of EMT training programs nationwide, Seidel (1986) found that 41 percent of such programs offered 10 hours or less of didactic training in pediatrics; 5 percent of programs offered none. All EMTs received on average 8 hours of didactic training in pediatrics; paramedics received 15 hours. Seidel also identified wide variation in the pediatric topics covered in the curriculum. Most training programs covered epiglottitis (98 percent of agencies), croup (98 percent), respiratory distress (98 percent), asthma (97 percent), and seizures (95 percent). However, half of programs did not offer pediatric field simulation, half did not cover pediatric dysrhythmias, 36 percent did not cover hypotension, 26 percent did not cover drowning, 22 percent did not cover pediatric ALS, and 16 percent did not cover neonatal resuscitation.