The final report of EMS Agenda 2050: A People-Centered Vision for the Future of Emergency Medical Services is released. I am impressed with the 58-page document and recommend that everyone read this document. This report is “… the culmination of a collaborative and inclusive two-year effort to create a bold plan for the next several decades. Building on the foundation established by the landmark 1996 EMS Agenda for the Future, EMS Agenda 2050 lays out a vision for EMS systems that serve the needs of patients, families, clinicians, and communities.”
While EMS Agenda 2050 creates a description of what could be, it will not result in the release of a significant amount of federal funding to accomplish this vision. EMS leaders of a certain age speak wistfully of the impact of the landmark National Academy of Sciences and National Research Council’s Accidental Death and Disability: The Neglected Disease of Modern Society (1966). This report and others started the momentum that created the National Highway Traffic Safety Act in 1966 along with federal funding to improve emergency medical services in the United States, including the initial 70-hour EMT training program.
Initial efforts were deemed inadequate and Congress enacted the EMS Systems Act in 1973 that funded the nationwide development of regional EMS programs to the tune of $300 million in federal grants over 5 years to – the equivalent of $1.8 billion in 2019 dollars. At the same time, the Robert Wood Johnson Foundation allocated $15 million ($88.7 million in 2019) to fund 44 regional EMS projects.
There were high hopes that the 2007 consensus study report by the Institute of Medicine, Emergency Medical Services: At the Crossroads, would provide another injection of federal financial support, but the Great Recession of 2008 obliterated any effort.
ROLE OF THE 2050 EMS CLINICIAN
The EMS clinician of 2050 will be an integrated member of a community linked through information, technology, and evidence-based best practices. The goal is to provide the most appropriate level of care to the patient.
People-centered community care reinforces the current American Heart Association out-of-hospital chain of survival, including citizen responders:
The EMS clinician will be a contributing and collaborative member of the healthcare profession, with the first out-of-hospital patient contact by the EMS clinician recorded as part of the patient’s medical record.
A future EMS system will rely on a strong backbone of responders with training to provide immediate lifesaving care. Supplementing and overseeing that level of response will be a highly educated EMS professional providing more advanced care. The deployment of all of these clinicians will be based on providing the best care, with the best outcomes, in the most efficient way possible, while providing joy in work for the practitioners.
Fire-Based EMS 2020
The advocacy of requiring an associate degree in 2031 along with graduating from a Commission on Accreditation of Allied Health Education Programs (CAAHEP) paramedic program before sitting for an initial National Registry Paramedic examination energized the fire organizations to oppose this concept. Considering the EMS Agenda 2050 vision, perhaps we can come to an agreement by separating the expectations of EMS caregivers:
Emergency Medical Responders
This group of EMS caregivers is focused on unscheduled medical events that require an urgent response. They are part of a 9-1-1 public safety response, provide initial clinical care and either arrange/provide medical transportation, document a refusal, or make a referral to an appropriate resource.
These responders are credentialed through the 2009 National EMS Educational Standards as an Emergency Medical Responder (EMR), Emergency Medical Technician (EMT) or Advanced Emergency Medical Technician (AEMT).
AEMTs are trained to provide the Advanced Life Support interventions needed to treat a critical patient: IV medications, advanced airways, and medical monitoring. They are not required to have an associate degree. The local medical director can provide any additional clinical interventions required for the community being served.
The challenge in some states is to revise existing administrative regulations requiring a state or National Registry paramedic to function as the paramedic unit caregiver-in-charge. This may also require negotiations with the local Medical Society or regional EMS council. You will need the support of your medical director to accomplish this change. This could be a disruptive and challenging endeavor.
EMS Clinician
The EMS clinician is the first step into the community of professional health care practitioners. The 2050 vision shows a wider range of roles and responsibilities for an educated and licensed EMS clinician. EMS clinicians may be part of a fire-based or community 9-1-1 response team, but their scope of practice will be wider. EMS clinicians may function in the current paramedic specialties of Advanced Practice, Community Paramedicine, Critical Care, Tactical EMS or Flight Medic.
Honoring the fire-based training-experience-education professional development model
Fire departments start with a physically fit candidate with a high school diploma (or equivalent). They provide the basic skills and knowledge training and send the recruit to work under the close supervision of a fire officer during a probationary period. Though a 20 to 35 year career, the firefighter obtains additional training, experience with different assignments and completes formal education to progress into specialized positions or start up the professional development pyramid.
Having the Advanced EMT function as a first-line ALS provider eliminates the need for an associate degree to start a fire-based career.
Revisiting the formal education scheme
Implementing the 2009 National EMS Educational Standard took years of good-faith efforts by hundreds of dedicated educators, regulators, professional organizations, caregivers, and employers. They successfully crammed a paramedic curriculum into a two-year academic program.
Making the Advanced EMT as the primary Advanced Life Support emergency medical responder provides an opportunity to reconsider the formal education process.
An associate degree that leads to sitting for the Advanced EMT credential frees up credit space to meet more of the General Education requirements for transfer or progression into a bachelor degree.
Year 3 of a four-year formal education process could cover an Advanced EMT-to-Paramedic bridge and provide additional coursework in clinical critical thinking.
Year 4 of a four-year formal education process could cover Community Paramedicine, Critical Care, Advanced Practice, Tactical or Flight Medic. Additional coursework could cover topics like evidence-based medicine, small-group leadership, and clinical preceptorship.
Changing the formal EMS Clinician educational path will be just as disrupting to our education colleagues as changing administrative law to allow an AEMT to function as the paramedic unit caregiver-in-charge will impact our state regulatory colleagues.
This suggestion for a Fire-Based EMS approach provides one possible pathway to prepare for the future of out-of-hospital unscheduled medical care.
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EMS Agenda 2050 Technical Expert Panel. (2019, January). EMS Agenda 2050: A People-Centered Vision for the Future of Emergency Medical Services (Report No. DOT HS 812 664). Washington, DC: National Highway Traffic Safety Administration.
Shah M. N. (2006). The formation of the emergency medical services system. American journal of public health, 96(3), 414-23.
Institute of Medicine (2007) Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press.