Friday, April 04, 2008

Accreditation - Yes or No?

A colleague e-mailed this article to me from JEMS, one of the leading EMS periodicals in our field. The author, Bryan Bledsoe, DO, FACEP, advocates for a policy change by the National Registry of Emergency Medical Technicians (the NREMT) that will require starting after 12/31/2012 anyone who graduates from an EMS training program will only be able to sit for the National Registry exam if their program is accredited. If the program isn't accredited, then no National Registry exam. It set me to thinking a lot about this issue, and I have formed some of my own opinions about it, which I will share.

It also begs another question, at least from my perspective: does that mean if you live in a state that doesn't recognize certain levels of practice from the Registry or has no affiliation with the Registry that you can't take the individual state exams? A couple of states come to mind immediately, notably Massachusetts, New York, Delaware, and Utah. Each of these states has their own system for licensing EMS providers, which in the case of Massachusetts (I can't speak to the other three) requires that a candidate take their written exam if they are licensed from another state, and their written and practical if they are not, or they are upgrading from one level to another. I am scheduled to take the Massachusetts written in a couple of weeks, but that's a story for another day....

In any case, the question that some are raising is whether or not this is a Good Thing. I capitalize the words "Good Thing" here because it is a paramount sort of question for those of us in this business. Is it? My answer to this question, without reservation and with prejudice, is a whole-hearted "yes." And I will tell you why.

First, there are many programs that are non-accredited that follow the U.S. Department of Transportation guidelines for training EMS providers to the letter. For those of you that don't know, the USDOT sets the standards and requirements for EMS as a whole. The National Registry is not a government body - it is private and non-profit, as far as I know - but they are the certification agency responsible for ensuring all of the standards set forth by the DOT are carried out. With that said, the National Registry wants to see the bar set higher for those of us who are registered nationally and licensed in the states we work in.

The main point that Dr. Bledsoe makes in the article is that through increased education we as EMS providers will be put on a more equal footing with our counterparts in allied health disciplines we interact with. I have to agree with him; education makes us all better. The more we learn, the more we are able to discern when we do our job. Further, the more you know, the easier it is to to your job to the best of your ability. In my view, that's a philosophy anyone should be able to identify with.

Another thing that accreditation does for us is increases our stature, overall. I believe this is of paramount importance; if we want anything - recognition, higher wages, a sense of acceptance by other health-care providers - accreditation will go a long way towards achieving those goals.

In my own career, I went through both accredited and non-accredited levels of education. My paramedic program was not accredited (they are working on it), but it was a solid program nonetheless. I had 16 months of didactic and field education that really did well building on what I already knew, plus in the years since I became a paramedic I've done as much as possible to continue my education, and I intend to continue doing this; after all, if I can't practice what I preach, then what does that make me?

With all of that said, I have to also say that there is one other thing that will go a long way towards increasing the stature of EMS as a profession: the level of professionalism we possess. I believe that overall we do a good job at being professional in our approach to care and to the way that we work. But there are some who need to make a better effort at that. I work with some people who are incredibly professional, both in the way that they carry themselves with patients, peers, and hospitals, and in the way that they do the other parts of the job that aren't directly about patient care, from ensuring that all of their documentation is at the level it's supposed to be to cleaning the bathrooms. There are others that I see that aren't as vigilant about that. And they should be; it's like the old 80-20 rule: 80 percent of problems are caused by 20 percent of people. And that's a part of our undoing as a field. It needs to change.


Ellie said...

I second that on the professionalism.
As a UMBC kid, I inherently disagree with everything Bledsoe says (just ask Andy), but also as a UMBC kid, I am a huge proponent of education for EMS, and believe it is the only way to advance our profession.
Thanks for bringing this to my attention!

AlexD said...

Accreditation is an absolute must before anyone can really take a Paramedic serious. Believe it or not there are still EMT classes being taught in Alabama "off site" only being affiliated with a certain Fire College. That above fact is totally INSANE and those yahoos are entering into the profession through a totally unregulated class. I shudder at the thought of one of them treating a family member of mine. I always enjoy your post. Keep up the good work.

Alex ~D~