Att_1_PWS.docx

AIR FORCE MEDICAL OPERATIONS AGENCY

PERFORMANCE WORK STATEMENT

National Registry of Emergency Medical Technician (NREMT) Training Course

25 MARCH 2013

TABLE OF CONTENTS

Page

1.0 DESCRIPTION OF SERVICES 3

1.1 Background 3

1.2 Scope 3

1.3 Acronyms 3

2.0 SUMMARY OF REQUIREMENTS 4

2.1 Description of Requirements 4

2.2 General Contractor Personnel Requirements 5

2.3 Services Summary 7

2.4 Government Furnished Support 8

2.5 Security 8

2.6 Travel 8

2.7 Deliverables 8

2.8 Data Reporting Requirements 8

3.0 QUALITY CONTROL PLAN 9

4.0 NON PERSONAL SERVICES 9

5.0 CONTRACTOR IDENTIFICATION 9

6.0 HOURS OF OPERATION 9

7.0 APPENDICES 10

7.1 APPENDIX A: National EMS Education Standards 11

7.2 APPENDIX B: Paramedic Instructional Guidelines 12

1.0 DESCRIPTION of SERVICES

1.1 Background: The Air Force Medical Operations Agency (AFMOA) is responsible for oversight of the Emergency Medical Services programs for the U.S. Air Force Medical Services (AFMS). Its mission covers a broad range of programs including Paramedic, first emergency responders who provide Advanced Life Support (ALS) and Basic Life Support (BLS) medical care to patients at the scene and en-route to the Medical Treatment Facility (MTF). Most of AFMOA’s EMTs are BLS certified and AFMOA has a shortage of ALS certified Paramedics. AFMOA has approximately 700 EMTs that need to be trained and certified to the ALS level. Based on the above, contracted services are required to assist with the training and certification of AFMS Paramedics.

1.2 Scope: This contracted service will provide training required to certify 32 AFMS EMTs to the Paramedic level in accordance with the established standards set by the National Registry of Emergency Medical Technicians (NREMT) Paramedic certification guidelines and the National EMS Education Standards and Paramedic Instructional Guidelines. Training shall start on 03 June 2013 and end no later than 30 September 2013. Course length, including travel time for each student shall not exceed 120 calendar days.

1.3 Acronyms

ACRONYMS

2.0 SUMMARY of REQUIREMENTS:

2.1 Description of Requirements: The contractor shall:

2.1.1 Provide curricula of training that results in certification of Air Force EMTs to the Paramedic Level in accordance with the established standards set forth by NREMT, National EMS Education Standards and Paramedic Instructional Guidelines.

2.1.1.1 Provide the required training for 32 EMTs.

2.1.1.2 Start the class on 03 June 2013 and complete no later than 30 September 2013. Course length shall not exceed 120 days.

2.1.1.3 Required training shall include real world “ride along” (field internship) clinical program to all Paramedic students.

2.1.1.4 Provide a training facility located within 100 miles of a Level 1 Trauma Center; a hospital equipped to handle any level of severity of trauma, and has a trauma surgeon on-site 24/7 and an Operating Room ready at all times for trauma cases as defined by the American College of Surgeons.

2.1.2 Training will consist of ALS courses for Paramedic certification with NREMT to include:

2.1.2.1 Advanced Cardiac Life Support (ACLS)

2.1.2.2 Pediatric Advanced Life Support (PALS)

2.1.2.3 Basic Life Support (BLS)

2.1.3 Provide all textbooks and an opportunity for each student who successfully completes the program to sit for the National Registry Paramedic skills and written examinations.

2.1.4 Provide, at no cost, 1 NREMT Paramedic testing opportunity after graduation of the course but prior to student’s departure back to home station.

2.1.5 Provide, at no cost, remedial training for students following their first time failure of the NREMT Paramedic Exam. Remedial training days will be within the 120 calendar days allowed for initial training.

2.1.6 Provide all course material and any special uniforms and personal protective equipment for training, excluding pens, pencils, and writing paper.

2.1.7 Provide certificates of completion to students upon successful completion of training. (Deliverable 1)

2.2 GENERAL CONTRACTOR REQUIREMENTS.

2.2.1 The Contractor shall meet the following standards:

2.2.1.1 Program Director/Training Officer

2.2.1.1.2 Currently certified as a Paramedic

2.2.1.1.3 At least 25% of previous two years of employment must have been in direct patient care or serving in an executive position such as Paramedic Training director or training officer. Recent clinical practice may be waived if incumbent was previously a paramedic program director at a university or other educational program.

2.2.1.1.4 Read, understand, speak fluently, and write in the English language, and be a United States Citizen.

2.2.1.2 Paramedic Instructor

2.2.1.2.1 Fully certified and accredited by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) as an approved source for paramedic training and certification.

2.2.1.2.2 Possess a NREMT Paramedic Certification.

2.2.1.2.3 In-depth knowledge of emergency medical operations, instructor methodology, and associated performance improvement programs.

2.2.1.2.4 Instructors with a minimum of two years’ experience in developing, writing and presenting EMS documents, briefings and papers.

2.2.1.2.5 Instructors with a minimum of one year experience in EMS operations.

2.2.1.2.6 Guest lecturers must possess current NREMT Paramedic Certification, Registered Nurse Licensure or Physician Licensure.

2.2.1.2.7 Knowledge of and ability to work with standard software programs used by Air Force Medical Services (AFMS) such as the latest version of Microsoft Office Professional Suite.

2.2.1.2.6 Read, understand, speak fluently, and write in the English language, and be a United States Citizen.

2.2.1.3 Pass/Fail Rate

2.2.1.3.1 Contractor shall have as a minimum a 90% first time pass rate 90% of the time with students completing the training for certification to the Paramedic level with NREMT.

2.3 SERVICES SUMMARY (SS). Below are matrix tables listing a summary of performance objectives and performance thresholds required by the government in contractor performance for each of the specific categories of services required by this contract.

2.3.1 Measurable Terms

Provide, at no cost, remedial training for students following their first time failure of the NREMT Paramedic Exam. Remedial training days will be within the 120 calendar days allowed for initial training.

2.4 GOVERNMENT FURNISHED SUPPORT N/A

2.5 SECURITY REQUIREMENTS. N/A

2.6 TRAVEL. N/A

2.7 DELIVERABLES. Any papers, recommendations, etc. that the contractor submits are drafts, not final copies. Government reserves the right to make changes on delivery dates

2.7.1 Deliverables

2.7.2 Criteria for Acceptance. All deliverables shall be submitted in a draft format mutually agreed upon by the contractor and the Government.

2.8 DATA REPORTING REQUIREMENTS

2.8.1 Monthly Status Report. (Deliverable 2)

2.8.1.1 The contractor shall prepare and submit a monthly status identifying all tasks performed, status, issues, and anticipated actions consistent with performance work statement (PWS).

2.8.1.2 One hard copy of this report shall be submitted to the AFMOA/EMS PM and an electronic copy to the COR and program manager by the tenth working day of the month following the end of the reporting period.

2.8.1.3 Specific content of the report shall be coordinated with the AFMOA/EMS PM/COR and delivered in an electronic format mutually agreed by the contractor and the Government.

2.8.1.4 The report shall include the following items:

• Contract number

• Contractor name

• Period covered by report

• Management Issues

• Summary description of activities and accomplishments during the report period

• Status updates of AF student training progress

• Description of problems and issues encountered during the report period

• Work to be accomplished during the following reporting period

• Status of open problems or issues identified in previous monthly report(s). Problem solutions/recommendations

• Any additional information the contractor deems beneficial in assisting the AFMOA/EMS PM/COR.

2.8.1.5 This report shall also keep AFMOA/EMS PM/COR informed of any concerns with behavior of students.

2.8.2 OTHER DATA REQUIREMENTS. In addition to the monthly status reports, the contractor shall provide the following data deliverables:

2.8.2.1 Activities log will be submitted monthly with the monthly status report.

3.0 Quality Control Plan: The contractor shall provide to the government, a QCP at time of proposal and any updates after contract award. Any update to the QCP must be reviewed by the COR. Establish and maintain a complete QCP to ensure the requirements of this PWS are provided as specified. (Deliverable 3).

4.0 NON-PERSONAL SERVICES: The Government will neither supervise contractor employees nor control the method by which the contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual contractor employees. It shall be the responsibility of the contractor to manage its employees and to guard against any actions that are of the nature of personal services, or give the perception of personal services. If the contractor feels that any actions constitute, or are perceived to constitute personal services, it shall be the contractor’s responsibility to notify the CO immediately. These services shall not be used to perform work of a policy/decision making or management nature, i.e., inherently Governmental functions. As defined in FAR 7.5. all decisions relative to programs supported by the contractor shall be the sole responsibility of the Government.

5.0 CONTRACTOR IDENTIFICATION: N/A

6.0 HOURS OF OPERATION: Normal classroom training hours are eight hours a day between the hours of 7:00 AM and 5:00 PM, local time Monday through Friday; Ride-along (field internship)/Clinical program hours flexible to meet course requirements.

6.1 PLACE OF PERFORMANCE. The primary place of performance will be at the contractor’s training facilities.

6.2 SCHEDULED HOLIDAYS. The government trainees will abide by the contractor’s scheduled training classes, which will not exceed 120 days, including travel time.

7.0 APPENDICES

7.1 APPENDIX A. National Medical Emergency Education Standards (EMS)

7.2 APPENDIX B. National Medical Emergency Education Standards Paramedic Instructional Guidelines

7.3 APPENDIX C. Customer Complaint Record

APPENDIX A. NATIONAL MEDICAL EMERGENCY EDUCATION STANDARDS

APPENDIX B. NATIONAL MEDICAL EMERGENCY EDUCATION STANDARDS PARAMEDIC INSTRUCTIONAL GUIDELINES

APPENDIX C. Customer Complaint Record

CUSTOMER COMPLAINT RECORD

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING NUMBER

INDIVIDUAL

PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY

Customer Complaint Record Template, Feb 05 (SAF/AQCP) COMPLAINANT - 1

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING NUMBER

INDIVIDUAL

PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY

Customer Complaint Record Template, Feb 05 (SAF/AQCP) COR

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING NUMBER

INDIVIDUAL

PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY

Customer Complaint Record Template, Feb 05 (SAF/AQCP) CONTRACTOR

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION

BUILDING NUMBER

INDIVIDUAL

PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY

Customer Complaint Record Template, Feb 05 (SAF/AQCP) Contract Administrator

Attachment 1 Page 1 of 15 National EMS Education Standards.pdf

National Emergency Medical Services Education Standards i

The National EMS Education Standards Table of Contents

Executive Summary 1

Introduction 1

Historical Development of EMS in the United States 2 The National EMS Education Standards 7

National EMS Education Standards 11

Preparatory 11 EMS Systems 11 Research 11 Workforce Safety and Wellness 12 Documentation 12 EMS System Communication 12 Therapeutic Communication 13 Medical/Legal and Ethics 13

Anatomy and Physiology 14

Medical Terminology 14

Pathophysiology 14

Life Span Development 14

Public Health 15

Pharmacology 15

Principles of Pharmacology 15 Medication Administration 16 Emergency Medications 16

Airway Management, Respirations and Artificial Ventilation 17

Airway Management 17 Respiration 18 Artificial Ventilation 18

Assessment 19

Scene Size-Up 19 Primary Assessment 20 History Taking 20 Secondary Assessment 20 Monitoring Devices 21 Reassessment 21 ii

Medicine 22 Medical Overview 22 Neurology 23 Abdominal and Gastrointestinal Disorders 24 Immunology 25 Infectious Diseases 26 Endocrine Disorders 27 Psychiatric 28 Cardiovascular 29 Toxicology 30 Respiratory 31 Hematology 32 Genitourinary/Renal 33 Gynecology 34 Non-Traumatic Musculoskeletal Disorders 34 Diseases of the Eyes, Ears, Nose, and Throat 35

Shock and Resuscitation 35

Trauma 35

Trauma Overview 35 Bleeding 35 Chest Trauma 37 Abdominal and Genitourinary Trauma 38 Orthopedic Trauma 39 Soft Tissue Trauma 40 Head, Facial, Neck, and Spine Trauma 41 Environmental Emergencies 43 Multisystem Trauma 43

Special Patient Populations 44

Obstetrics 44 Neonatal care 45 Pediatrics 46 Geriatrics 47 Patients With Special Challenges 48

EMS Operations 48

Principles of Safely Operating a Ground Ambulance 48 Incident Management 49 Multiple Casualty Incidents 49 Air Medical 49 Vehicle Extrication 49 Hazardous Materials 49 Terrorism and Disaster 50 iii

Clinical Behavior/Judgment 51 Assessment 51 Therapeutic Communication and Cultural Competency 51 Psychomotor Skills 52 Professionalism 53 Decision-Making 53 Record Keeping 53 Patient Complaints 54 Scene Leadership 55 Scene Safety 55

Educational Infrastructure 56

Educational Facilities 56 Student Space 56 Instructional Resources 56 Instructor Reparation Resources 56 Storage Space 57 Sponsorship 57 Programmatic Approval 57 Faculty 57 Medical Director Oversight 57 Hospital/Clinical Experience 58 Field Experience 59 Course Length 59 Course Design 59 Student Assessment 60 Program Evaluation 60

Instructional Guidelines 61

Glossary for Education Standards 62

References 66

Acknowledgements 67 iv

Executive Summary

The National EMS Education Standards (the Standards) represent another step toward realizing the vision of the 1996 EMS Agenda for the Future, as articulated in the 2000 EMS Education Agenda for the Future: A Systems Approach.

The National EMS Education Standards outline the minimal terminal objectives for entry-level EMS personnel to achieve within the parameters outlined in the National EMS Scope of Practice Model. Although educational programs must adhere to the Standards, its format will allow diverse implementation methods to meet local needs and evolving educational practices. The less prescriptive format of the Standards will also allow for ongoing revision of content consistent with scientific evidence and community standards of care.

In implementing the Standards, EMS instructors and educational programs will have the freedom to develop their own curricula or use any of the wide variety of publishers’ lesson plans and instructional resources that are available at each licensure level.

Consistent with the EMS Education Agenda, EMS accreditation authorities will use the Standards as the framework for evaluation of program curricula.

The National EMS Education Standards are not a stand-alone document. EMS education programs will incorporate each element of the education system proposed in the Education Agenda. These elements include:

• National EMS Core Content

• National EMS Scope of Practice

• National EMS Education Standards

• National EMS Certification

• National EMS Program Accreditation

This integrated system is essential to achieving the goals of program efficiency, consistency of instructional quality, and student competence as outlined in the Education Agenda.

Introduction

As a profession, EMS is still in its early developmental stages. The formal progression of an organized civilian EMS system began in the 1960s and continues to evolve as we further define and enhance our structure, oversight, and organization.

As EMS system operations have developed, so has EMS education. In the early 1970s, registered nurses and physicians taught most EMS programs. Few student and instructor resources related directly to prehospital emergency care. No standards existed to define practice and there was no clear delineation of scopes of practice in EMS.

Historical Development of EMS in the United States

Table 1 outlines key events in the development of EMS in the United States from the 1950s to the present.

Table 1: Historical Development of EMS Year Event/Organization Result 1950s American College of

Surgeons Developed the first training program for ambulance attendants

1960 President’s Committee for Traffic Safety

Recognized the need to address “Health, Medical Care and Transportation of the Injured” to reduce traffic fatalities

1966 National Academy of Science published Accidental Death and Disability: The Neglected Disease of Modern Society (The White Paper)

Quantified the scope of traffic-related death in the United States Described the deficiencies in prehospital care in this country, including:

Call for ambulance standards State-level policies and regulations Recommendation to adopt methods for providing consistent ambulance services at the local level

1966 Highway Safety Act of

Required each State to adopt highway safety programs to comply with Federal standards (including “emergency services”) Impetus for NHTSA leadership in EMS:

Directed writing of National Standard Curricula

Provided funding to States to develop State EMS Offices

Took leadership role in EMS system development, including developing model EMS State legislation

1970s Robert Wood Johnson Foundation and Federal Government

Funded regional EMS systems and demonstration projects

1970s Crash Injury Management for the Law Enforcement Officer published by

NHTSA

40-hour program that evolved into First Responder: NSC in 1979

1970 National Registry of EMTs (NREMT)

Held first board meeting, with goal to provide uniform standards for credentialing ambulance attendants.

1971 Emergency Care and

Transportation of the Sick and Injured published by the American Academy of Orthopedic Surgeons

(AAOS)

One of the first EMS textbooks

1973 Emergency Medical Services Act of 1973 enacted by Congress as Title XII of the Public Health Services Act

Over $300 million in funding for EMS over 8 years:

Allowed for EMS system planning and implementation

Required States to focus on EMS personnel and training

Resulted in legislation and regulation of EMS personnel levels

1975 American Medical Association (AMA)

Recognized EMT-Paramedic as an allied health occupation

1977 National Standard Curriculum for EMT- Paramedic published by

15 instructional modules

1978 The Essentials for Paramedic Program Accreditation developed by AMA

Joint Review Committee on Education Programs for the EMT-Paramedic (JRCEMT-P) adopted The Essentials as the standard for accreditation

1985 First Responder, EMT- Ambulance, EMT- Intermediate, and EMT- Paramedic: NSC revised by NHTSA

EMT-Paramedic reformatted into six divisions

1990 NHTSA hosts EMS Training Workshop

This workshop facilitated the development of the 1990s curricula and introduced the assessment based education concept

1992 EMS Education and Practice Blueprint.

This document served as a template for the revised format of the 1990s NSC revision projects

1992 Initiated EMS Agenda for the Future

Funded by NHTSA, Maternal and Child Health Bureau (MCHB), and Health Resources and Services Administration (HRSA)

1994 NREMT Practice

Analysis Conducted practice analysis of EMTs and paramedics:

Determined importance of EMS actions based on assessment of frequency and potential for harm

Provided foundation for NREMT test blueprint

1994 EMT-Ambulance revised and renamed EMT-Basic:

NSC

1995 First Responder: NSC is revised

1996 EMS Agenda for the Future is created by the National Association of EMS Physicians and National Association of State EMS Directors

Vision statement for integration of EMS into the health care system and funded by NHTSA and Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), EMSC Program

1998 PEW Health Professions Commission Taskforce on Health Care Workforce Regulation published Strengthening Consumer Protection: Priorities for Health Care Workforce Regulation

Recommended:

National Policy Advisory Board to establish standards and model legislative language for uniform scope of practice authority for health professions

Emphasis on States’ responsibility to enact uniform scope of practice consistent with the recommendations of the National Policy Advisory Board.

1998 EMT-Paramedic: NSC

1999 EMT-Intermediate: NSC

2000 Education Agenda for the Future: A Systems Approach published by

Funded by NHTSA and HRSA. Designed to develop an integrated system of EMS regulation, certification, and licensure

2004 2004 National EMS Practice Analysis published by NREMT

Updates the 1994 Practice Analysis

2005 National EMS Core Content published by NHTSA and HRSA

Defines:

Domain of knowledge of EMS personnel described within the National EMS Scope of Practice

Universal knowledge and skills of EMS personnel

2005 The State of EMS

Education EMS Research Project: Characteristics of EMS Educators by Ruple et al. In Prehospital Emergency Care

Research related to:

Identifying characteristics of EMS instructors Describing infrastructure available to instructors Identifying instructor attributes necessary for implementing education standards

2006 EMS at the Crossroads Institute of Medicine Report

Recommendations related to EMS Education Agenda:

State governments should adopt a common scope of practice for EMS personnel, with State licensing reciprocity

States should require national accreditation of paramedic programs

States should accept national certification as a prerequisite for State licensure and local credentialing of EMS providers

2007 National EMS Scope of Practice published by

National guideline to define levels of EMS licensure:

Guide State legislation Promote reciprocity between States Clarify EMS roles for the community

In August 1996, the EMS Agenda for the Future (the Agenda) was published. This consensus document was developed with funding from the National Highway Traffic Safety Administration and the Health Resources and Services Administration. The National Association of EMS Physicians and the National Association of State EMS Directors led this process, which involved many stakeholders.

The Agenda document was designed to guide government and private organizations in EMS planning, development, and policy-making at the national, State, and local levels. It addressed 14 attributes of EMS, including the EMS education system. The Agenda defined a vision for the future of EMS education that “employs sound educational principles,” “based on research,” and “conducted by qualified instructors.” In December of that year, representatives of 30 EMS-related organizations met at an EMS Education Conference sponsored by NHTSA to identify the necessary steps for implementing that vision.

The outcome of the EMS Education Conference was summarized in the EMS Education Agenda for the Future: A Systems Approach. This document included the following recommendations:

• The National EMS Education and Practice Blueprint (the Blueprint) is a valuable component of the EMS education system. A multidisciplinary panel, led by NHTSA, to more explicitly identify core educational content for each licensure level, should revise it.

• National EMS education standards are necessary, but need not include specific declarative material or lesson plans. NHTSA should support and facilitate the development of national EMS education standards.

• The Blueprint and national EMS education standards should be revised periodically, with major revisions occurring every 5 to 7 years, and minor updates made every 2 to 3 years.

In 1998, NHTSA convened a Blueprint Modeling Group to revise the Blueprint. That group determined that the Blueprint represented only one component of a comprehensive EMS education system, so it redefined its mission, and the group was renamed the EMS Education Task Force. The Task Force produced a document titled the EMS Education Agenda for the Future: A Systems Approach (the Education Agenda).

The EMS education system envisioned in the EMS Agenda for the Future was further defined and articulated into the model shown in Figure 1 in the Education Agenda. This document states that, to be most effective, each component in the EMS education system should be structured, coordinated, and interdependent.

Figure 1: Model EMS System

The National EMS Core Content was published in 2005. Core Content defines the entire domain of out-of-hospital practice and identifies the universal body of knowledge and skills for EMS providers who do not function as independent practitioners. Funded by NHTSA and HRSA, this project was led by the National Association of EMS Physicians and the American College of Emergency Physicians.

The National EMS Scope of Practice Model (Scope of Practice) is a consensus document that was published in 2006. This document defines the levels of EMS personnel and delineates the practices and minimum competencies for each level of EMS personnel. The Scope of Practice does not have regulatory authority, but provides guidance to States. Adherence to the Scope of Practice would increase uniformity in EMS practice throughout this country and facilitate reciprocity between States. Leadership for this project was delegated to the National Association of State EMS Officials and funded by NHTSA and HRSA.

The Scope of Practice describes four levels of EMS personnel licensure: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), and Paramedic. The Scope of Practice further defines practice, suggests minimum educational preparation, and designates appropriate psychomotor skills at each level of licensure. Further, the document describes each level of licensure as distinct and distinguished by unique “skills, practice environment, knowledge, qualifications, services provided, risk, level of supervisory responsibility, and amount of autonomy and judgment/critical thinking/decision-making.”

The National EMS Education Standards, led by the National Association of EMS Educators, replace the NHTSA National Standard Curricula at all licensure levels. The Standards define the competencies, clinical behaviors, and judgments that must be met by entry-level EMS personnel to meet practice guidelines defined in the National EMS Scope of Practice Model. Content and concepts defined in the National EMS Core Content are also integrated within the Standards.

National EMS Certification and National EMS Education Program Accreditation are the “bookends” that support the other key elements of the system. The Education Agenda recommends an individual must graduate from a nationally accredited EMS education program to be eligible for National EMS Certification. This recommendation was also supported by the Institute of Medicine report, The Future of Emergency Care: EMS at the Crossroads. Essential components of the EMS Agenda include a single National EMS Accreditation Agency and a single National EMS Certification Agency to ensure consistency and quality of EMS personnel.

The National EMS Education Standards

The National EMS Education Standards comprise four components (Table 2):

1. Competency (designated in yellow) - This statement represents the minimum competency required for entry-level personnel at each licensure level.

2. Knowledge Required to Achieve Competency (designated in blue) - This represents an elaboration of the knowledge within each competency (when appropriate) that entry-level personnel would need to master in order to achieve competency.

3. Clinical Behaviors/Judgments (designated in green) - This section describes the clinical behaviors and judgments essential for entry-level EMS personnel at each licensure level.

4. Educational Infrastructure (designated in white) - This section describes the support standards necessary for conducting EMS training programs at each licensure level.

Table 2: Format of National EMS Education Standards EMR EMT AEMT Paramedic

Content Area Competency Competency Competency Competency

Elaboration of Knowledge

Additional knowledge related to the competency

Clinical behaviors and judgments

Educational

Infrastructure

Each statement in the Standards presumes that the expected knowledge and behaviors are within the scope of practice for that EMS licensure level, as defined by the National EMS Scope of Practice Model. Each competency applies to patients of all ages, unless a specific age group is identified.

The Standards also assume there is a progression in practice from the Emergency Medical Responder level to the Paramedic level. That is, licensed personnel at each level are responsible for all knowledge, judgments, and behaviors at their level and at all levels preceding their level.

For example, a Paramedic is responsible for knowing and doing everything identified in that specific area, as well as knowing and doing all tasks in the three preceding levels.

The descriptors used to illustrate the increasing complexity of knowledge and behaviors through the progression of licensure levels originate, in part, from the National EMS Scope of Practice Model. These terms reflect the differences in the breadth, depth, and actions required at each licensure level (Figure 2).

Figure 2: Terminology Graph

The depth of knowledge is the amount of detail a student needs to know about a particular topic.

The breadth of knowledge refers to the number of topics or issues a student needs to learn in a particular competency. For example, the Emergency Medical Responder needs to have a thorough understanding (depth) about how to safely and effectively use the bag valve mask;

however, the EMR is taught a limited number of concepts (breadth) surrounding management of a patient’s airway.

To describe the intended depth of knowledge of a particular concept within a provider level, the Project Team uses the terms simple, fundamental, and complex. This terminology better illustrates the progression of the depth of knowledge from one particular level to another. For example, the EMR’s depth of knowledge for bleeding control is simple while the EMT’s depth of knowledge for bleeding control is fundamental.

To describe the intended breadth of knowledge of a concept within a provider level, the project team uses the terms simple, foundational, and comprehensive. This terminology also better illustrates the progression of the breadth of knowledge from one particular level to another. For example, the EMT’s breadth of knowledge for cardiovascular disorders is foundational while the Paramedic’s breadth of knowledge for cardiovascular disorders is comprehensive.

From the National EMS Scope of Practice Model: EMS Personnel Licensure Levels

Emergency Medical Responder The primary focus of the Emergency Medical Responder is to initiate immediate lifesaving care to critical patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide lifesaving interventions while awaiting additional EMS response and to assist higher level personnel at the scene and during transport.

Emergency Medical Responders function as part of a comprehensive EMS response, under medical oversight. Emergency Medical Responders perform basic interventions with minimal equipment.

Emergency Medical Technician The primary focus of the Emergency Medical Technician is to provide basic emergency medical care and transportation for critical and emergent patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. Emergency Medical Technicians function as part of a comprehensive EMS response, under medical oversight. Emergency Medical Technicians perform interventions with the basic equipment typically found on an ambulance. The Emergency Medical Technician is a link from the scene to the emergency health care system.

Advanced Emergency Medical Technician The primary focus of the Advanced Emergency Medical Technician is to provide basic and limited advanced emergency medical care and transportation for critical and emergent patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. Advanced Emergency Medical Technicians function as part of a comprehensive EMS response, under medical oversight.

Advanced Emergency Medical Technicians perform interventions with the basic and advanced equipment typically found on an ambulance. The Advanced Emergency Medical Technician is a link from the scene to the emergency health care system.

Paramedic The Paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response, under medical oversight. Paramedics perform interventions with the basic and advanced equipment typically found on an ambulance. The Paramedic is a link from the scene into the health care system.

Each educational level assumes mastery of previously stated competencies. Each individual must demonstrate each competency within his or her scope of practice and for patients of all ages.

Preparatory

Uses simple knowledge of the EMS system, safety/well-being of the EMR, medical/legal issues at the scene of an emergency while awaiting a higher level of care.

Applies fundamental knowledge of the EMS system, safety/well-being of the EMT, medical/legal and ethical issues to the provision of emergency care.

knowledge of the EMS system, safety/well-being of the AEMT, medical/legal and ethical issues to the provision of emergency care.

Integrates comprehensive knowledge of EMS systems, the safety/well-being of the paramedic, and medical/legal and ethical issues which is intended to improve the health of EMS personnel, patients, and the community.

EMS Systems

Simple depth, simple breadth

• EMS systems

• Roles/ responsibilities/ professionalism of EMS

• Quality improvement

EMR Material PLUS:

Simple depth, foundational breadth

• History of EMS

• Patient safety

EMT Material PLUS:

Fundamental depth, foundational breadth

AEMT Material PLUS:

foundational breadth

• History of EMS

Complex depth, comprehensive breadth

Research

• Impact of research on EMR care

• Data collection

• Evidence-based decision making

Same as Previous Level AEMT Material PLUS:

• Research principles to interpret literature and advocate evidence-based practice

Workforce Safety and Wellness

• Standard safety precautions

• Personal protective equipment

• Stress management o Dealing with death and dying

• Prevention of response-related injuries

• Lifting and moving patients

• Personal protective equipment o Dealing with death and dying

• Prevention of work related injuries

• Disease transmission

• Wellness principles

Complex depth, comprehensive

• Provider safety and well-being

• Personal protective equipment o Dealing with death and dying

• Prevention of work related

• Disease transmission

• Wellness principles

Documentation

• Recording patient findings

• Principles of medical documentation and report writing

Complex depth, foundational

EMS System Communication

Communication needed to

• Call for Resources

• Transfer care of the patient

• Interact within the team structure

• EMS communication system

• Communication with other health care professionals

• Team communication and dynamics

Therapeutic Communication

Principles of communicating with patients in a manner that achieves a positive relationship

• Interviewing techniques

Principles of communicating with patients in a manner that

• Adjusting communication strategies for age, stage of development, patients with special needs, and differing cultures

• Verbal defusing strategies

• Family presence issues

Principles of communicating with patients in a manner that

• Dealing with difficult patients breadth Principles of communicating with patients in a manner that

• Factors that affect communication

• Dealing with difficult patients

• Adjusting communication strategies for age, stage of development, patients with special needs, and differing cultures

Medical/Legal and Ethics

• Consent/refusal of care

• Confidentiality

• Advanced directives

• Tort and criminal actions

• Evidence preservation

• Statutory responsibilities

• Mandatory reporting

• Ethical principles/moral obligations

• End-of-life issues

• Evidence preservation

• Health care regulation

• Patient rights/advocacy

• End-of-life Issues

• Ethical tests and decision making

Anatomy and Physiology anatomy and function of the upper airway, heart, vessels, blood, lungs, skin, muscles, and bones as the foundation of emergency care.

knowledge of the anatomy and function of all human systems to the practice of EMS.

Integrates complex knowledge of the anatomy and physiology of the airway, respiratory and circulatory systems to the practice of EMS.

Integrates a complex depth and comprehensive breadth of knowledge of the anatomy and physiology of all human systems

Medical Terminology

Uses simple medical and anatomical terms.

Uses foundational anatomical and medical terms and abbreviations in written and oral communication with colleagues and other health care professionals.

Same as Previous Level Integrates comprehensive anatomical and medical terminology and abbreviations into the written and oral communication with colleagues and other health care professionals.

Pathophysiology

Uses simple knowledge of shock and respiratory compromise to respond to life threats.

knowledge of the pathophysiology of respiration and perfusion to patient assessment and management.

Applies comprehensive knowledge of the pathophysiology of respiration and perfusion to patient knowledge of pathophysiology of major human systems.

Life Span Development

Uses simple knowledge of age-related differences to assess and care for patients.

knowledge of life span development to patient

Same as Previous Level Integrates comprehensive knowledge of life span development.

Public Health

Have an awareness of local public health resources and the role EMS personnel play in public health emergencies.

principles of illness and injury prevention in emergency care.

principles of the role of EMS during public health emergencies.

knowledge of principles of public health and epidemiology including public health emergencies, health promotion, and illness and injury prevention.

Pharmacology medications that the EMR may self-administer or administer to a peer in an emergency.

knowledge of the medications that the EMT may assist/administer to a patient during an emergency.

Applies to patient assessment and management fundamental knowledge of the medications carried by AEMTs that may be administered to a patient during an emergency.

knowledge of pharmacology to formulate a treatment plan intended to mitigate emergencies and improve the overall health of the patient.

Principles of Pharmacology

No knowledge related to this competency is applicable at this level.

• Medication safety

• Kinds of medications used during an emergency

Fundamental depth, foundation breadth

• Medication safety

• Medication legislation

• Naming

• Classifications

• Storage and security

• Autonomic pharmacology

• Metabolism and excretion

• Mechanism of action

• Medication response relationships

• Medication interactions

• Toxicity breadth)

• Medication safety

• Medication legislation

• Naming

• Classifications

• Schedules

• Pharmacokinetics

• Storage and security

• Autonomic pharmacology

• Metabolism and excretion

• Mechanism of action

• Phases of medication activity

• Medication response relationships

• Medication interactions

• Toxicity

Medication Administration

Within the scope of practice of the EMR, how to

• Self-administer medication

• Peer-administer medication foundational breadth Within the scope of practice of the EMT how to

• Assist/administer medications to a patient

• Routes of administration

• Within the scope of practice of the AEMT, administer

• Within the scope of practice of the paramedic, administer

Emergency Medications the EMR

• Names

• Effects

• Indications

• Dosages for the medications administered

Fundamental depth, simple breadth Within the scope of practice of the EMT

• Actions

• Contraindications

• Complications

• Side effects

• Interactions foundational breadth Within the scope of practice of the AEMT breadth Within the scope of practice of the paramedic

Airway Management, Respiration and Artificial

Ventilation

Applies knowledge (fundamental depth, foundational breadth) of general anatomy and physiology to assure a patent airway, adequate mechanical ventilation, and respiration while awaiting additional EMS response for patients of all ages.

foundational breadth) of general anatomy and physiology to patient assessment and management in order to assure a patent airway, adequate mechanical ventilation, and respiration for patients of all ages.

foundational breadth) of additional upper airway anatomy and physiology to patient assessment and management in order to assure a patent airway, adequate mechanical ventilation, and respiration for patients of all ages.

Integrates complex knowledge of anatomy, physiology, and pathophysiology into the assessment to develop and implement a treatment plan with the goal of assuring a patent airway, adequate mechanical ventilation, and respiration for patients of all ages.

Airway Management

Within the scope of practice of the EMR

• Airway anatomy

• Airway assessment

• Techniques of assuring a patent airway foundational breadth Within the scope of practice of the EMT foundational breadth Within the scope of practice of the AEMT breadth Within the scope of practice of the paramedic

Respiration

• Anatomy of the respiratory system

• Physiology and pathophysiology of respiration o Pulmonary ventilation o Oxygenation o Respiration

External Internal Cellular

• Assessment and management of adequate and inadequate

• Supplemental oxygen therapy respiration o Pulmonary ventilation

• Supplemental oxygen therapy comprehensive breadth o Pulmonary ventilation

• Physiology, and respiration o Pulmonary ventilation

Artificial Ventilation

Assessment and management of adequate and inadequate ventilation

• Artificial ventilation

• Minute ventilation

• Alveolar ventilation

• Effect of artificial ventilation on cardiac output foundational breadth Assessment and management of adequate and inadequate breadth Assessment and management of breadth Assessment and management of

Assessment

Use scene information and simple patient assessment findings to identify and manage immediate life threats and injuries within the scope of practice of the EMR.

Applies scene information and patient assessment findings (scene size up, primary and secondary assessment, patient history, and reassessment) to guide emergency management.

Same as Previous Level Integrate scene and patient assessment findings with knowledge of epidemiology and pathophysiology to form a field impression. This includes developing a list of differential diagnoses through clinical reasoning to modify the assessment and formulate a treatment plan.

Scene Size-Up

• Scene safety

• Scene management o Impact of the environment on patient care o Addressing hazards o Violence o Need for additional or specialized resources o Standard precautions o Multiple patient situations o Impact of the environment on patient care o Addressing hazards o Violence o Multiple patient situations

Primary

• Primary assessment for all patient situations o Level of consciousness o ABCs o Identifying life threats o Assessment of vital functions

• Begin interventions needed to preserve life o Initial general impression o Level of consciousness o ABCs

• Integration of treatment/ procedures needed to preserve life o Level of consciousness o ABCs procedures needed to preserve life o Level of consciousness o ABCs procedures needed to preserve life

History Taking

• Determining the chief complaint

• Mechanism of injury/nature of illness

• Associated signs and symptoms

• Investigation of the chief complaint

• Mechanism of injury/nature of illness

• Past medical history

• Associated signs and symptoms

• Pertinent negatives

• Components of the patient history

• How to integrate therapeutic communication techniques and adapt the line of inquiry based on findings and presentation

Secondary

• Performing a rapid full body scan

• Focused assessment of pain

• Assessment of vital signs foundational breadth

Techniques of physical examination

• Respiratory system o Presence of breath sounds

• Cardiovascular system

• Neurological system

• Musculoskeletal system

• All anatomical regions breadth

Assessment of

• Lung sounds breadth

Techniques of physical examination for all major

• Body systems

• Anatomical regions

Monitoring Devices the EMT

• Obtaining and using information from patient monitoring devices including (but not limited to) o Pulse oximetry o Non-invasive blood pressure the AEMT monitoring devices including (but not limited to) o Blood glucose determination foundational breadth Within the scope of practice of the paramedic monitoring devices including (but not limited to):

o Continuous ECG monitoring o 12 lead ECG interpretation o Carbon dioxide monitoring o Basic blood chemistry

Reassessment

• How and when to reassess patients

• how and when to perform a reassessment for all patient situations

Same as Previous Levels AEMT Material PLUS:

• How and when to perform a reassessment for all patient situations

Medicine

Recognizes and manages life threats based on assessment findings of a patient with a medical emergency while awaiting additional emergency response.

knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient.

and selected advanced emergency care and transportation based on acutely ill patient.

Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint.

Medical Overview

Assessment and management of a

• Medical complaint breadth Pathophysiology, assessment, and management of a medical complaints to include

• Transport mode

• Destination decisions foundational breadth Pathophysiology, assessment, and management of a medical breadth Pathophysiology, assessment, and management of medical

Neurology

Anatomy, presentations, and management of

• Decreased level of responsiveness

• Seizure

• Stroke foundational breadth Anatomy, physiology, pathophysiology, assessment and management of

• Stroke/ transient ischemic attack

• Status epilepticus

• Headache breadth Anatomy, physiology, Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of Complex depth, comprehensive

• Stroke/intracranial hemorrhage/transient ischemic attack

• Status epilepticus

• Headache Fundamental depth,

• Dementia

• Neoplasms

• Demyelinating disorders

• Parkinson’s disease

• Cranial nerve disorders

• Movement disorders

• Neurologic inflammation/ infection

• Spinal cord compression

• Hydrocephalus

• Wernicke’s encephalopathy

Abdominal and Gastrointestinal

Disorders

Anatomy, presentations and management of shock associated with abdominal emergencies

• Gastrointestinal bleeding foundational breadth Anatomy, physiology, pathophysiology, assessment,

• Acute and…