A Different Kind of Paramedic

For EMS education programs that plan to get accredited, the clock is ticking down. Without accreditation from the Commission on Accreditation of Allied Health Education Programs (CAAHEP) by January 2013, EMS education programs will not be able to test providers through the National Registry.

An unusual twist to that story has unfolded in Montana. To get to the bottom of it, I spoke with Dave Gurchiek, PhD, NREMT-P, who chairs the Department of Health and Public Safety Occupations at Montana State University Billings.

How go preparations for the 2013 CAAHEP accreditation deadline with your paramedic program at MSU Billings?

Our program received CAAHEP accreditation in 2002, so we feel fortunate we’ve already cleared the initial accreditation hurdle. Currently we are looking into developing a satellite program, which would fall under our accreditation umbrella to assure quality education for students seeking careers in paramedicine in other parts of the state.

Rumor has it not all Montana paramedic programs plan to come online with CAAHEP. What’s going on?

The Montana Board of Medical Examiners (MBOME) is considering a rule revision that would circumvent the program accreditation requirement by developing an optional path for graduates of nonaccredited paramedic programs to utilize a Montana-only paramedic (MOP) certification pathway that would not meet national standards. These graduates would not take the NREMT examination to obtain an initial Montana paramedic license, but rather a certification examination approved by MBOME. This of course wouldn’t be a choice, since graduates of nonaccredited programs (excluding programs with Letter of Review status) are not eligible for NREMT certification.

Montana has two accredited paramedic programs and one with Letter of Review status (i.e., becoming accredited). I assume graduates from all three programs will obtain NREMT certification and apply for their Montana paramedic licensure. For the other couple of programs throughout the state that choose to be nonaccredited, this new MOP certification pathway has been developed for their graduates. It’s a pathway that should read buyer beware.

What problems does this scenario pose to the citizens of Montana and the EMS profession as a whole?

What we’re really talking about is paramedic segregation—a licensing process that has one group of graduates meeting national standards and one group of graduates that does not. Historically, separate but equal has never been a formula for success, so I am somewhat perplexed as to why MBOME is considering this formula in the first place. Will this new licensing process really benefit the health, safety and well-being of the citizens of Montana? I believe it won’t, since potentially you’ll have areas of the state that will choose to do MOP training instead of having paramedics that meet national standards. In other words, services will choose patches over quality patient care.

I also assume individuals with MOP certifications will be treated like equipment on ambulances and not as part of their overall healthcare team, since they will be seen as nonaccredited personnel with limited career mobility options. If you don’t have the ability to leave, you don’t have the ability to negotiate better working conditions, better pay, etc.

Overall, not everyone can or should have their own paramedic-training program. For example, nursing as a profession moved from hospital-based diploma programs to college- and university-based degree programs. This improved the quality of nursing throughout the country and enhanced the overall professional image of nurses. I’m not suggesting all paramedic programs need to be housed in colleges or universities, but it’s time to move the paramedic profession in the same direction as other healthcare fields in regards to accreditation.

How do you see this playing out?

Our state will be having a public hearing on the proposed rule changes soon. I assume the majority of career paramedics will voice their concerns passionately but respectfully. Hopefully MBOME will not adopt the proposed rules and will maintain national standards by requiring programmatic accreditation for all Montana paramedic-training programs. This recognition will go a long way in the development and implementation of quality educational programs, which in turn will enhance the quality of paramedic practice. I have my fingers crossed.

What a strange world in which EMS exists. It will be interesting to see how this shakes out. Thanks to Dave for sharing his insights. Until next month…

Disclaimer: The views and opinions presented in this interview are solely those of Dr. Gurchiek and do not necessarily represent those of Montana State University Billings.

Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.