NYS EMS Certifications

[Richard B the EMT]

Just as a historical note, when I started in 1973, while the vast majority of EMS outside of NYC was volunteer (some things never change), the volunteers, for the most part, fought tooth and nail against the upgrade that the minimum in training was to become at least one EMT, not actively driving the ambulance, be with any patients in the back. Most, then, were Advanced American Red Cross First Aid trained. Also, NYS DOH required EMT candidates to already have the ARC Advanced card in posession as prerequeset to taking the (then) 45 hour initial course (25 hour for refresher).

[EMT155]

Alex, just as a side note, (I had to check my facts before I posted this) the paramedic program at Herkimer CC is actually an AAS degree upon completion.

Just FYI

Jim

[Alex Woo]

Richard B; I appreciate the history; I love to hear more of that. its awesome to see how EMS has changed from the 70s to 80s to 90s to x004 to 10s....

Jim; I know that there are AS degrees in Paramedics; I have one but I took my Paramedic Course at a hosp in Queens, NY. Then I took the pre-req's and rec'd my AS Degree at a CC. As a result of the pre-req's I'm able to just take RN courses for my RN (excelsior). That's what I'm saying; no more private programs; only AS and BS for EMT-Ps; like nursing....

To all; My real only concern are for the medics; there's too much resistance from EMTs. My quote; "if u ask 4 more, you get some. U ask 4 less, u get none." I'm asking for a lot of change so the org can change some. My goal is to really have the EMT-P to AS only and there be a BS in every state & the EMT-P will have CCEMTP training. Can we agree on that? This seems easier to do & ALS care will be better... Can we agree the EMT-B course needs to a bit longer & there needs to be more amb & ER rotations (8 total?). Can we agree on these changes? Can we?

Thanks for all the comments...

[Richard B the EMT]

Sounds a bit like contract negotiations. Workers ask for an unrealistic high number, management asks rediculosly low, then they bargan, usually ending up with something a bit better than the last contract. Everybody postures, and at the conclusion, workers claim big win, management claims how low they kept the workers, nobody is happy, yet everyone is.

They'll do it every time.

[Alex Woo]

First I want to thank all for your comments. I've changed my proposal and have sent to all parties I've sent to before with the old proposal. I will ask EMS Magazine to do the story on this new proposal which addresses all who've commented and relayed the problems with my agressive proposal for change to the NYS EMT Certification. Plz read the new proposal and fwd all concerns and questions.... Thx y'all....

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To Whom It May Concern,

I writing for change and restructuring of the EMT Certification Curriculums. In the past I've sent emails asking for big changes and elimination of some EMT Certifications. I've received words from my peers and they have opened my eyes to the proposal I've made will hurt their services. So, I need to make it better without hindering care in rural areas in NYS. I am still pushing for change but less drastic. I want better care for our patients and my proposal is as follows.

I feel we need to expand the EMT-B curriculum. There needs to be more hours in the EMT-B program: the course needs to be a minimun of 150+ hours not the minimum of 110 hours as it is now. Remember the EMT-B can administer Aspirin, Albuterol, & Epi Pen/Jr. In addition, EMT-B can also administer medications for WMD, from Atropine to 2-Pam. These skills need to be explained in more detail and practical days need to be slotted for practice. With all these changes and with the EMT-B class hours still at 110 hours; this is absurb. I had 160 hours in my EMT and I did not learn all these medication for administration. We only learn to assist the patient in NTG administration. However, I learned about many disease and traumatic processes in my original EMT-B program; which new EMTs out of class have no idea of what I'm talking about. So how can the new EMT-B student learn all this in 110 hours? What else are we going to cut out of the curriculum? Also, there needs to more rotations for the EMT-B student; 1 rotation with a choice of the ambulance or the ER is unacceptable. In my original EMT-B program; there was no choice of ambulance rotation; we only had to do 1 ER rotation. I felt that wasn't enough; so I asked my CIC if I could do more and choose a different hospital; he was fine with that. I chose a Trauma Center and I did 7 ER rotations. The ER Director there was so nice and he was a advocate for EMS. He invited me to help in the NYC Marathon at the First Aide Station. All the illnesses & trauma I saw at Harlem Hospital was a unique learning experience. There needs to be a minimum of 5 rotations on the ambulance and 5 rotations in the ER. I feel these changes are not drastic and can be implemented without any real issues.

The EMT-I must be the EMT-I99 only. The EMT-I85 must be eliminated and EMT-I85 must upgrade to the EMT-I99. The EMT-I99 is a near equivalent to the EMT-CC and thus eliminating the EMT-CC. Since the EMT-CC is not a nationally recognize certification there's no need for this certification? Why are there so many AEMTs in NYS? Its so confusing. The EMT-I99 with additional didatic hours will be the medium between the EMT-I85 and the EMT-CC. The EMT-I99 has a strong knowledge of ALS care. My belief is if there's a need for the EMT-I85, then there's no need for EMT-B. If there's a need for the EMT-I99, then there's no need for the EMT-I85. If there's a need for the EMT-CC, then there's no need for the EMT-I99. Can you see the problem now? Too many AEMTs. I feel the remaining of the 3, should be the EMT-I99; the EMT-I85 isn't far from it and can upgrade to the EMT-I99 with a crossover program developed. The EMT-I99 has skillset that exceeds the EMT-I85 and comparable skills to the EMT-CC to have them eliminated. The EMT-CC is only recognize as an EMT-I99 by NREMT. These changes are not costly and will benefit communities in rural areas. I feel this is a change easy to implement and the care in rural areas with EMT-Is as the only ALS care; this will benefit the patients with the ALS Providers being EMT-I99. Areas who will have the EMT-CC eliminated; care will not be crippled, the EMT-CC will be known as an EMT-I99; the knowledge and skills will be almost the same.

The EMT-P must be an AS Degree program only; with the elimination of private programs. The CCEMTP course must be part of the Paramedic Curriculum along with all the different Alphabet Courses. The CCEMTP is an intense program very similiar to the CCRN. These changes will propel the Paramedic as a true profession in the eyes of lay persons, like how the RN is looked at. This will allow the Paramedic to use their AS Degree to go further in healthcare if one chooses. In addition, college builds character and the pre-reqs will set them up for Nursing, PA, and MD degrees if one chooses to do so. If the BS in Paramedicine is available; this will bridge that gap closer. The new CCEMT-P will be able to work in any Prehospital setting.

I feel that the reason the EMT certifications has not progressed is because there's so much emphasis to separate us from State to State. From NY with the EMT-CC to WI with the EMT-IV to VA with the EMT-Shock Trauma/Enhanced to VT with the EMT-I'03 to RI with the EMT-Cardiac to MI with the EMT-Specialist to AK with the EMT-II/EMT-III. So many variations. So how is one suppose to transfer one's certification if they choose to rellocate? Some may argue the needs are different. What needs? I am me, in another State. I will respond to medications the same way in AK to AL to AZ to AR. If I'm obsese in NY; I'm obese in MI and MS. If I having an AMI in CA; its an AMI in NM. If I'm SOB 2nd to APE in NH; its still APE in LA. ET Intubation is the same in NE; as it is in MA and NJ. IV Insertion is same in PA; as it is in TX and OR. Oxygen importance is the same from CO to DE to GA to FL to SD to NC to WV to WY to KS to HI to ID to KY to IL to MS to IN to MT. AHA CPR Guidelines are the same in SC to ND to TN to WA to WI to UT to NV to ME to IA to DC. So is there real difference? I don't understand why the EMT Certifications can't be the same or at least very similiar, country wide. The best EMT-B, EMT-I99, and EMT-P curriculum needs to be assimilated into all the 50 states. States can add more to meet their needs but can't decrease standards. This is a fight for NREMT, USDOT, and NHTSA but NYS DOH EMS can spark this change with my proposal to enhance the EMT-B, EMT-I99, and EMT-P.

Its all about education for better care as the basis for the EMT-B, EMT-I99, and EMT-P. These changes will allow these EMT Certifications to be more competent and confident in respects to patient care. This can be the blueprint for change. My proposal will exceed other states and NYS can pioneer this change. It is not something difficult to do and it benefits all of the people we care for on a daily basis. Lastly, this will secure the EMT-B/I/P to be the only provider of Prehospital Care. I know many services uses the CCRNs to staff their CC-Ambulances. My proposal will be the norm for Paramedics to be CCEMT-Ps thus replacing CCRNs on ambulances; maybe even on helicopters and other mode of transportation of the sick and injured. I am available to assist in this change. Please forward to all applicable parties for review. Thank you for your attention in this sensitive matter.

Regards,

Alexander G. Woo

NYS AEMT-P #214355

NYC REMAC

WREMAC

HVREMAC

[EMT155]

Alex,

I have to say, I do like this revision. I think it is more appropriate across the state. I lived in NYC for 2 years on my first college attempt and that is where I took my original basic class way back when. I have spent the vast majority of my EMS career here in Central NY and have worked with agencies across Upstate, Western and Eastern NY over the years through different groups, and I have to say that there is such a HUGE variety of scenarios for care in this state. We have everything from NYC to squads of volunteers that are an hour plus from the local hospitals, even with high speed ground transport. I think that this is the reason why the multiple levels have worked so well in this state.

Adding some hours onto the B coursework due to the expanded scope of care is not unreasonable, and I agree that it would be beneficial. Combining the I and CC or even eliminating the I altogether in attempts to match up with the NR is also not unreasonable.

Overall, I think that this revised concept is something that the entire state could work with.

The key thing to remember when looking at revisions on things like this, is that NY in particular is a very unique state in our variety of settings and situations. There are very few states out there that have this kind of variety. Everything from NYC to places where your neighbor is so far down the road, all you see at night is the stars above. This presents us with unique opportunities to be a leader in the art and science of pre-hospital care in so many different ways (check out the Farm Medic classes that Cornell offers for a great example). The key, and this isn't just for you guys in the city, but for those in the boonies as well, is to remember that we have that variety, and what will work well for one, will be a disaster for another.

Thanks for listening to our input, and i wish you well with this and would love to hear the updates as you move forward on this.

Jim

[Alex Woo]

Thank you Jim. I'm glad you agree with a lot of my revised ideas. I wanted to hear from others in NYS; so I can get a better idea of what others are deal with. I hope to get NYS and others to get on board. I want to make a positive change in EMS in NYS. I hope they're hearing us.... I will definitely continue to update you. I'm glad I placed my idea in this forum. All the best, Jim..

Alex Woo

Jim, I'm going to look into the Farm EMT at Cornell. Thanks... If this does go through; I will definitely want to thank you and others...

All the best,

Alex Woo

[NYMedics]

Thank you Jim. I'm glad you agree with a lot of my revised ideas. I wanted to hear from others in NYS; so I can get a better idea of what others are deal with. I hope to get NYS and others to get on board. I want to make a positive change in EMS in NYS. I hope they're hearing us.... I will definitely continue to update you. I'm glad I placed my idea in this forum. All the best, Jim..

Alex Woo

Jim, I'm going to look into the Farm EMT at Cornell. Thanks... If this does go through; I will definitely want to thank you and others...

All the best,

Alex Woo

One can argue that your petition cannot be taken seriously as you include no references (data) to support the benefits of changing the current system. If this is a serious proposal please share hard numbers with us. As an aside, the current minimum requirement for clinical rotation is 10 hours not one shift as you report. This type of technical error in your proposal may cause your reader to "thin slice" you and your suggestions.

Changing policy in NYS (and other places) is difficult and challenging by design. The State has specific committees and subcommittees that handle these tasks (see below). Often, one needs to direct the issue to a specific person or Chair of the committee or subcommittee.

Have you sent a well composed letter to the SEMSCO Education and Training Subcommittee? Are you planning to attend one on the public meetings in 2011 to present your case? If not, you should start first by picking one issue, compose your argument and include data with financial savings to the State, and practice, practice, practice for your 15 minute presentation (if they call).

Good Luck!

References:

State Emergency Medical Services Council

SEMSCO is an advisory body to the Commissioner of Health in areas of concern involving EMS. SEMSCO's charge and statutory authority can be found in Article 30 Section 3002 of the Public Health Law. The Bureau provides staff and financial assistance to SEMSCO.

SEMSCO assists the DOH in providing leadership and developing rules, regulations and general guidelines for operation of the state's EMS system. SEMSCO holds public meetings six time a year. Its membership is comprised of a representative from each of the regional EMS councils, and representatives from various organizations and interests in the EMS community. The Commissioner of Health appoints all council members.

There are several subcommittees of SEMSCO. Each subcommittee has a defined purpose and brings motions to SEMSCO for action. The subcommittees are the structural underpinnings of SEMSCO. The committees research issues in their areas of concern that come before SEMSCO, and make recommendations to SEMSCO on how to proceed.

The Education and Training subcommittee addresses issues involving certification and recertification of EMS providers including the certification exam issues. The subcommittee reviews course objectives, curricula, conduct, clinical requirements and scope of practice for all EMS providers.

Regional Emergency Medical Services Council (REMSCO)

The charge and authority of REMSCO can be found in Article 30 Section 3003 of the Public Health Law. Each REMSCO is comprised of representatives from local ambulance services, physicians, nurses, hospitals and other EMS organizations. The county EMS Coordinator serves as an ex-officio member of REMSCO. The primary function of the REMSCO is to encourage and facilitate regional cooperation and organization of local EMS systems. The REMSCO is the local provider's direct link to SEMSCO and the Bureau of EMS.

[Alex Woo]

I appreciate all that info.... I am producing a spark... I've sent to other organizations to back my idea; so I can pursue it... I can't just attend any of the meetings at NYC REMSCO; I've ask but I must be invited... However, I've just started this proposal of change. I don't need to have data on an email to NYS DOH EMS... I'm just doing this step by step until I can walk with this; then run. This a delicate process and I need to tread lightly. My proposal is a big change for mant ppl and can affedt their lives; it can limit ppl becoming EMTs to AEMTs... Its like a nmew Pres given the previous administration problems; I'm dealing with those problems.... I know all that info you produced; I'm doing this as a Per-Diem; I work FT and PT; so baby steps.... I'm waiting for other to join; as EMS World has. JEMS just needs sa lil push into this direction....

As for references; how I know what other AEMTs are called in other states. I have an idea; its an idea; when I can piggyback off a well known EMS Org; then I can really kick it into high gear.... Thank you..

[FredG]

I agree with the points that EMT155 posted and I also like your revisions. My original EMT was 160 hours and that didn't include Defib...that was an additional 10 hour module at the time (which included teaching basic rhythms). When NYS reduced the number of hours for EMT-B, they did the public a disservice and the quality of newer EMT-Bs was obvious. Realistically, what's another 30-40 hours of class time....another 4 weeks of evening classes? I don't consider that a hardship for an original EMT-B class.

In my neck of the woods, our paid Paramedic units and volunteer BLS ambulances get along very well. Not only do we only have 2 ambulances covering over 55 square miles, we also have a 50+ minute drive to the nearest trauma center which, I believe this is part of the reason why there is a good working relationship between volunteers and paid providers...we have to work together as a team for the patient.

Based on my 10 years as an EMS provider in NYC and 8 years in rural Western NY, I think that there should also be a module in the EMT-B curriculum to cover assisting a Paramedic. Many of the departments in my region run periodic drills taught by paramedic providers to Basic EMTs on how EMT-Bs can assit ALS. This kind of module would also give a basic EMT an understanding of what ALS brings to the table and possibly be an introduction to the idea of further advancement towards Paramedic.