EMS Education Agenda for the Future:

A Vision for the Future of EMS Education

Guest Editors

Jeffrey Michael, EdD

Arthur French, MD

National Highway Traffic Safety Administration

Washington, DC

Commentary: EMS Education Agenda for the

Future: Flexner Revisited

Jon A. King, MS, NREMT-P

Department of Emergency Medicine

Emory University School of Medicine

Atlanta, GA

Section Editors

Joan S. Harris

National Highway Traffic Safety Administration

Washington, DC

B. Tilman Jolly, MD

Department of Emergency Medicine

George Washington University

Washington, DC

Jeffrey W. Runge, MD

Department of Emergency Medicine

Carolinas Medical Center

Charlotte, NC

Knox H. Todd, MD, MPH

Rollins School of Public Health

Emory University

Atlanta, GA

Reprints not available from the editors.47/1/106831doi:10.1067/mem.2000.106831

lined in the 1996 EMS Agenda for the Futureto create a comprehensive plan for an educa-tion system that promises improved effi-ciency for the national EMS education pro-cess, enhanced consistency in educationquality, and ultimately, greater entry-levelstudent competence.

The task force devoted about 1 year torefining the vision to meet the needs of theEMS community. A draft vision was first pre-sented to an audience of EMS educationexperts in April 1999. After a number ofadjustments, a revised vision was proposedat EMS scientific and professional meetingsduring the fall and winter. After additionalminor adjustments, the document was final-ized in February 2000.

The completed vision describes a struc-tured National EMS Education System with 5integrated primary components:

• National Core Content• National Scope of Practice Model • National Education Standards• National Education Program

Accreditation• National CertificationA central benefit of this systems approach

is improvement in the consistency of instruc-tional quality among EMS education pro-grams, achieved by coordinating the func-tions of the National EMS EducationStandards, National EMS Education ProgramAccreditation, and National EMSCertification. For paramedic education, thisstrategy for ensuring consistency allows theuse of less prescriptive National EMSEducation Standards in place of the currentNational Standard Curricula. With lessdependence on a prescriptive national stan-dard curriculum, instructors will have greater

National Highway Traffic Safety

Administration (NHTSA) Notes

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EMS Education Agenda forthe Future: A Vision for theFuture of EMS Education

[National Highway Traffic SafetyAdministration. EMS Education Agendafor the Future: a vision for the future ofEMS education. Ann Emerg Med. June2000;35:623-624.]

With the 1996 EMS Agenda for the Futureand its companion implementation guidepublished in 1998, the EMS communitydemonstrated its ability to pull together adiverse range of professionals and create aconsensus plan for the evolution of out-of-hospital emergency care.

This spring, the EMS community took amajor step toward realizing this plan by lay-ing out a vision for the future of one criticalcomponent of out-of-hospital emergencycare, the emergency medical services (EMS)education system. The EMS EducationAgenda for the Future: A Systems Approach,was created by a task force of EMS educationexperts representing a cross section ofnational EMS professional organizations,with support from the National HighwayTraffic Safety Administration (NHTSA) withinthe US Department of Transportation, and theMaternal and Child Health Bureau (MCHB) inthe US Department of Health and HumanServices.

Over a period of 2 years beginning inJanuary 1998, the task force assessed thestrengths of current EMS education practicesand identified areas where the process couldbe improved. They built on the concepts out-

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flexibility for targeting instruction to specificaudiences, resulting in enhanced compre-hension and improved student competence.And, by linking education standards withprogram accreditation and provider certifica-tion, the consistency of instructional qualitycan be enhanced while allowing local flexi-bility.

The vision describes an interdependentrelationship among the 5 system componentsand recommends specific lead groups for thedevelopment and periodic revision of each.

The National EMS Core Content is envi-sioned to be a comprehensive list of the skillsand knowledge needed for out-of-hospitalemergency care. Specification of the CoreContent is primarily a medical concern andwill be led by the medical community, withinput from the system regulators, educators,and providers.

The National EMS Scope of Practice Modeldivides the National EMS Core Content intolevels of practice, defining minimum knowl-edge and skills for each level. Because thisdetermination is fundamentally a systemissue, the system regulators will have thelead in its development, with input from theother stakeholders.

The National EMS Education Standardstake the place of the current NationalStandard Curricula, specifying minimumterminal learning objectives for each levelof practice. Because this is essentially aneducational task, the development of theNational EMS Education Standards will beled by educators, with input from other stake-holders.

National EMS Education ProgramAccreditation and National EMS Certificationwill be full coverage and universal, enhanc-ing the consistency of instruction quality andoutcomes by covering each of the providerlevels and all education programs. Full cover-age accreditation will require the develop-ment of appropriate standards and guide-lines for each level of practice. To achieveaccreditation, an education program willneed to provide instruction that is consistentwith the National EMS Education Standards.To be eligible for National EMS Certification,a student must have graduated from anaccredited program.

A number of administrative benefits arealso expected to result from the changesoutlined in the vision, including greater pre-

commissioned by the Carnegie Foundationfor the Advancement of Teaching, high-lighted the great discrepancy between thestate of medical science and that of medicaleducation. The report served as one of manycatalysts promoting homogeneity and cohe-siveness of the US system of medical educa-tion.

In 1996, NHTSA and the Health Resourcesand Services Administration published thehighly regarded consensus document titledEMS Agenda for the Future. The Agendaidentified 14 emergency medical services(EMS) attributes that were earmarked forcontinued development. Among these wereEMS educational systems.

In 2000, after 3 years of work by thosewith an interest and stake in EMS education,including EMS administrators, physicians,regulators, educators, and providers, a newproduct is ready. The EMS Education Agendafor the Future: A Systems Approach speakswith the many voices in EMS workingtogether to reach an improved, structuredsystem to educate new out-of-hospital emer-gency providers. The Education Agenda rep-resents a maturing of the EMS industry, andan opportunity for EMS educators to alignmore closely the growing science of EMSwith its educational efforts.

As noted in the Education Agenda,“…currently, there is no formal EMS educa-tion system in which the components areclearly defined, their interrelationships artic-ulated, and the decision-making process formodification and improvement established.”The Education Agenda also notes that thereis “…considerable state-by-state variabilityin EMS education, licensing standards and alack of clear-cut future direction.”

Consolidation and standardization oftraining was the right and proper thing for themedical profession in the first decade of the1900s. The Education Agenda is the right andproper thing for out-of-hospital EMS in thefirst decade of the new millennium. It is avision for the future. It is axiomatic that plan-ning is the most important function of man-agement, and this task falls on the leadershipof our organizations to establish a long-termagenda for the future. EMS across the UnitedStates is a diverse collection of regulators,administrators, educators, and clinicians.There is no single leadership organizationthat sets the vision for our industry. Therefore,

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dictability for component developmentcycles, and a clear and definite method forintroducing changes to the system. Theseprovisions will clarify the process for accom-modating medical advances, technologydevelopment, and other needs that affect thescope or content of EMS education.

As our national EMS system continues togrow toward the visions laid out in the EMSAgenda for the Future, it is clear that we willbe increasingly dependent on an effectiveeducation system to prepare our emergencycare providers. The central themes of theEMS Agenda for the Future, enhanced pro-fessionalism and added community value forEMS services, can only be achieved if wehave a consistent, high-quality educationsystem in place. And as we have seen withthe Agenda, a consensus vision is the bestway to start building that system.

Implementing the vision proposed in theEMS Education Agenda for the Future willrequire participation by the full EMS profes-sional community. Leadership from EMSmedical directors will be key in motivatingand guiding system evolution. Although thevision has received considerable discussionand consensus at the national level, theseconcepts need to be promoted and supportedat the state and local levels.

The EMS Education Agenda for the Future,DOT HS 809042 (June 2000) is available onthe NHTSA Web site at http://www.nhtsa.dot.gov/people/ems. Hard copies are alsoavailable by faxing a request to the NHTSAEMS Division at 202- 366-7721.

Commentary: EMSEducation Agenda for theFuture: Flexner Revisited

[King JA. NHTSA Notes Commentary:EMS Education Agenda for the Future:Flexner revisited. Ann Emerg Med. June2000;35:624-625.]

In the early 1900s, the American MedicalAssociation reported on the need forimproved education of physicians. It calledfor minimum standards for admission to med-ical schools, a minimum length of medicaltraining, and passage of a licensing testbefore being admitted to practice, amongother reforms. In 1910, the Flexner Report,

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a consensus document is the best way, at thistime, to bring together ideas from the leadersof all aspects of our industry.

In only 35 years, out-of-hospital EMS hasprogressed from ambulance drivers in funeralhome hearses with no external communica-tion capability to paramedics in mobile ICUswith voice, telemetry, and video capabilities.The knowledge base of our profession hasgrown incrementally, but our approach toeducation has often been reactionary innature and sometimes multidirectional inapproach.

Much sweat and effort has produced anEMS system that is monumentally betterthan what existed before 1966; however, itstill does not offer a clear career path for itspersonnel and is often based on conjectureand individual opinion regarding properpatient care. Our present system has devel-oped with a lack of clear national goals andimplementation plans for how to get there.

We must resist the temptation to give into political pressure to change any standardsunless a consensus exists. For some, thestandards outlined may be difficult, but notimpossible, to achieve. Local physician lead-ers should be aware of this document. If localor state voices call for deviating from thesestandards, you have a responsibility to deter-mine whether it is truly in the best interest ofyour patients to adopt a different standard.

The remaining 13 attributes of the EMSAgenda for the Future will evolve in the nearfuture. Please stay tuned to the process fromthe NHTSA Web site at www.nhtsa.dot.gov,your national physician organization, ornational out-of-hospital EMS organization.

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