Promoting Innovation in EMS

reasons are multifactorial and likely include traditions of volunteerism in many communities, it is at least in part due to the insufficient volume of reimbursable transports that would allow a shift to a paid (career) model in those communities. Despite being volunteers though, these providers must meet the same standards as paid providers. Even among career providers, it is unusual for the employers of EMS practitioners (EMS agencies) to incentivize practitioners to pursue higher education. Thus, legitimate questions exist over whether practitioners could or should reasonably expect to earn more if they obtain higher degrees. Hospitals and similar health care organizations have little incentive to support EMS education because in today’s environment, the relative quality of EMTs and paramedics provides little perceived incremental benefit to hospitals directly. Only when economic and policy impacts from prehospital services begin to effect hospital systems will there be sufficient justification to support more career staff with expanded educational requirements. volunteers, the EMS market is also plagued by a perceived workforce shortage particularly at the paramedic level. 77 This growing demand for paramedics has also led to new questions about the proper type, duration, and cost of education and field training, particularly for new graduates. New on-line training programs have created a generation of virtually trained students and have generated debate about the effectiveness of some forms of “distributive education” 78 . Many believe that the number of calls to which a medic has HIGH DEMAND FOR PARAMEDICS Ironically, despite the aforementioned market forces that make it difficult to incentivize education and contribute to a reliance on

While the NREMT certification makes significant strides to address this variability, even accredited training centers vary widely in student first-time pass rates on the NREMT certification exams. Not having a reliable and consistent educational system likely handicaps the industry’s ability to implement new clinical services and innovations. EMS education would be enhanced if faculty were academically better prepared and were utilizing and contributing to the scientific literature on the most effective methods of educating paramedics. MEASURING COMPETENCE Another educational challenge to EMS innovation has been the persistent difficulty defining and measuring provider competence. Rather than the number of hours, education levels should reflect the competencies required for each service level. But this transition has proved challenging. Even NREMT certification does not equate well with competency. Despite NREMT certification and demonstration of knowledge of local policies of local EMS system, EMS employers often cite a growing need to screen and remediate prospective new providers. While true for all health care disciplines, some specialties have moved more quickly than others to refine training and accreditation requirements, often in response to the public’s demand for reductions in preventable error. 76 EMS has yet to undergo such a level of scrutiny, but as prehospital care becomes bundled and reimbursed with that of others there is little doubt that greater accountability is coming. INCENTIVIZING EDUCATION Unlike other health care professions, EMS is in many areas provided by volunteers. While the

76 “To Err Is Human: Building a Safer Health System.” National Academy of Sciences. Last modified November, 1999. 77 Chapman, Susan A., Vanessa Lindler, Jennifer A. Kaiser, and Christine S. Nielsen. “Ems Workforce for the 21st Century: A National Assessment.” Washington, D.C.: National Highway Traffic Safety Administration (2008). 78 Friese, Greg. “3 Reasons to Flip the Classroom Back to Lecture.” . Last modified June 1, 2015.




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