Chapter 1-2

Licensing, Certification, Registration, and Credentialing

• Registration involves a board maintaining records of a paramedic's education, licensure, and recertification.
• Completing initial paramedic education makes one eligible for a state certification exam.
• South Carolina requires the National Registry exam for initial certification at all levels.
• Certification exams ensure a standard level of knowledge and skill among healthcare providers.
• Successfully passing these exams results in a certificate or license from the state and/or National Registry.
• Licensure, controlled by states, dictates who can practice as a healthcare provider, sometimes termed certification or credentialing.
• Performing paramedic-level functions without licensure is illegal.
• Medical direction is needed at the state, local, and national levels, as seen in programs with medical directors.
• Passing the National Registry cognitive exam is often a state requirement for licensure, a written exam and practical skills demonstration are needed.
• Paramedic education through an accredited program is required for eligibility.
• The National Registry exam assesses a paramedic's psychomotor competency, with skills verifications integrated into programs.
• The Committee on Accreditation of Educational Programs for EMS Professions (CoAEMSP) is an accreditation committee within CAAHEP.
• CoAEMSP enhances EMS education quality through accreditation and recognition services.
• Reciprocity applies to training outside the paramedic's intended practice location, and each state has its own rules.
• Maintaining National Registry certification helps with reciprocity in many states.
• Training from the United States might not be automatically recognized internationally without reciprocity.
• Individual states may impose specific requirements for granting reciprocity.

Career Options for Licensed Paramedics

• Fire-based EMS systems within fire departments are typically paid and managed by the local government.
• These systems may operate with volunteers, providers paid per call, or a mix.
• EMS can operate independently within the fire department, justifying a staffed in-house department.
• Third service EMS or municipalities are standalone or shared EMS agencies dependent on financial resources.
• Some municipalities manage their own ambulance services, independently from other public safety entities.
• Independent ambulance agencies may contract with municipalities, often requiring citizen requests for response.
• Private EMS agencies, for-profit or nonprofit, function similarly to third service EMS agencies, contracting with municipalities or hospitals.
• Hospital-based EMS offers in-facility transports and air medical services, particularly in larger or remote hospitals.
• Paramedics in hospital-based services assist with patient care in other hospital areas during downtime and may serve on internal emergency response teams.
• Paramedics offer input from various medical providers having access to more patient information than most EMS providers.
• Hybrid EMS agencies are common in remote or large-scale operations like oil drilling platforms, and wind farms.
• These facilities have their own medical response facilities where paramedics collaborate with nurse practitioners or physicians.
• Specializations exist in staffing medical positions at specific locations such as national parks, amusement parks, or concerts.

EMS System Overview

• The EMS system is a complex, coordinated network providing care to the community.
• It starts with citizen involvement, teaching the public to recognize emergencies, activate the system, and provide basic care before EMS arrival.
• Factors influencing patient survival include:
  • Bystander care
  • Dispatch (including pre-arrival instructions)
  • Response mode and distance
  • Assessment and care provided
  • EMS personnel training level
  • Available transportation (ground ambulance, critical care unit, or air transport)
  • Emergency department care (trained physicians and staff availability)
  • Access to definitive care (trauma, pediatric, and neurologic specialists, and rehabilitation)
• Dispatchers, the public's initial contact, have varied training requirements across states.
• Paramedics develop a care plan and determine the appropriate facility.

Education Levels in EMS

• At the federal level, the National Highway Traffic Safety Administration (NHTSA) established the National EMS Scope of Practice Model.
• State-level licensure is a state function with laws and regulations specifying EMS provider operations regulated by state EMS administrative offices.
• States have statutes or rules governing EMS operations and a scope of practice for each EMS level.
• The service medical director develops patient care guidelines outlining approved skills and treatments.
• At the local level, the local medical director sets the day-to-day limits of EMS practice, and can further limit scope.
• National guidelines aim to standardize EMS delivery where medical directors and governments agree.
• Expanding the scope of practice may require state approval.
• In 2009, the National Standard Curricula for all levels were revised to the National EMS Education Standards.

Specific Roles in EMS

• Dispatchers activate EMS and may be trained as Emergency Medical Dispatchers (EMD).
• EMDs provide pre-arrival instructions like CPR or bleeding control, following a script.
• Emergency Medical Responders (EMR), also known as "first responders".
• EMRs are trained in CPR and basic first aid where they exist.
• EMRs can function within an organized group when they exist, though many states do not recognize EMRs as a training level.
• EMRs complete a course covering the national EMS education standard for the EMR level.
• EMRs recognize the seriousness of a patient's condition, administer basic care, and relay information to EMTs and paramedics.
• Emergency Medical Technicians (EMT), are the backbone and primary provider level, with a wide range of skills.
• EMT certification is often required before paramedic education.
• EMT skills and treatment options vary by state.
• In some states, EMTs may be trained in advanced airway intervention, medication administration, and IV fluid therapy.
• More providers are trained and certified at the EMT level than any other.
• At the Advanced EMT level, skills include established IVs, blood glucose monitoring, and advanced airway management.
• Paramedics practice the highest skill level, states may offer further training for critical care or flight paramedics.
• Testing requires students to have successfully completed training at an accredited institution.
• States require paramedics to function under licensed physicians and be affiliated with a paramedic-level service.

Initial Education for Paramedics

• States base paramedic education standards on the National EMS Education Standards and state run EMS educational standards.
• A college-level anatomy and physiology course or equivalent work experience is generally required.
• Standards outline the minimum knowledge for paramedic practice.
• States require varying education hours, with a national average of 1,000 to 1,500 hours of combined classroom, clinical, and field education.
• Some advocate structuring paramedic education through accredited associate's or bachelor's degree programs.
• States require continuing education hours or refresher programs during a certification cycle.
• Continuing education includes conferences, seminars, and EMS journals.
• Accredited organizations link directly into National Registry.

Types of Transports

• Specialty centers focus on specific types of care or patients to provide definitive care more quickly.
• Air Medical Transport may be necessary.
• Interfacility transports involve transferring patients to clinics, rehab centers, long-term care facilities, or other hospitals.
• A nurse, physician, respiratory therapist, or medical team may accompany the patient.

Working with Other Professionals

• Hospital staff need to be familiar with the receiving hospitals.
• Public safety personnel often have EMS training, cooperation between agencies ensures efficient patient care.
• Communities expect EMS to work with other community professionals and groups.
• EMS personnel can get further involved through National EMS groups.
• EMS may join state and National organizations.
• Involvement helps shape the future of EMS, provide access to resources, and promote uniform standards and practices.