CAPCE Looks Back on 30 Years

In 2022, the Commission on Accreditation for Prehospital Continuing Education (CAPCE)—the accrediting body tasked with the review and accreditation of EMS continuing education (CE) programs—celebrated 30 years of enhancing the education of those serving in the field.

Jay M. Scott, its executive director, says CAPCE—originally the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS)—was founded because of a lack of standardization and quality within EMS continuing education.

“It was and still is vital that EMS practitioners have access to high-quality, standard-driven continuing education that awards credit for the time they spend training,” Scott says. “Before the formation of CECBEMS/CAPCE, there were no standards and not much quality.”

Scott notes CAPCE’s accomplishments include:

• Standards-setting activities for medical direction, item writing, continuing education hour assignments, gating (making sure the user can’t skip the educational content), distributive education, and development of innovative processes such as virtual instructor-led training;
• Development of paperless application processes;
• CE data sharing with regulatory agencies.

Massive Database

Among its many accomplishments, CAPCE has implemented a course completion database for all CAPCE-approved CE course completions and requires CE providers to report all such courses, notes Liz Sibley, former CECBEMS CEO.

CAPCE’s most notable accomplishment has been its massive database, which provides “online assurances that classes met the accreditation standards, customer service, a new mobile application for the individual EMS provider to check on their credentials, and automatic transfer of CE to the National Registry of Emergency Medical Technicians (NREMT), assuring easy recertification and continual improvement in technology,” says Joseph A. Grafft, MS, a member of the National Association of EMS Educators’ board of directors and NAEMSE’s representative at CAPCE.

“CAPCE has set the educational standards for continuing education for EMS, ensuring EMS practitioners receive high-quality, consistent, well-researched, and valid educational content,” says Joe Holley, the Tennessee state EMS director as well as EMS medical director for Memphis and Shelby County fire departments. He also serves as the American College of Emergency Physicians representative on the CAPCE board and is currently the board’s vice chair. “CAPCE continues to innovate the process for students to find, partake of, and obtain CE credits in the easiest, most efficient manner possible.”

For years CAPCE has worked to help usher in virtual education, points out Jeremy D. Miller, MEd, NRP, director, environment of care, SUN Behavioral Columbus in Ohio.

“During the COVID-19 pandemic, with all of the quarantine requirements and remote work, CAPCE already had standards in place to allow reliable training that could be done from home, both synchronously and asynchronously,” Miller says.

‘Foundation of Truth’

Several driving factors led to the establishment of CAPCE. Sibley notes those included a “lack of consistent quality across the US in offerings of EMS CE providers: inconsistent or inaccurate information, lack of current information, no appropriate attributions or bibliographies, outright plagiarism, little adherence to a professional educational format, and no regularly enforced monitoring of reported course completions.”

“The United States’ EMS system for continuing education was a mess, with each state having its own standards to meet the need for recertification of EMTs, AEMTs, and paramedics,” says Grafft. “The NREMT had hour and other requirements for recertification but did not offer the CE needed—that was left up to the states. However, when an EMT, AEMT, or paramedic crossed state lines, [it] was often blurred as to what CE was accepted. CAPCE handled this by working with the state EMS directors to give reciprocity if CE was granted by CAPCE.”

“CAPCE grew out of the need to ensure continuing education met high standards for value, educational content, assurance of content, and appropriate credit for the work done to obtain the education,” says Holley. “Without the standards set by CAPCE, there is little way for EMS practitioners to ensure continuing education activities are legitimate.”

Says Miller: “Accreditation is the foundation of truth. It sets the standard and offers transparency for all parties to trust in the education. It is paramount to ensure that the information being taught has gone through a validation process. CAPCE does a phenomenal job of holding that standard. CAPCE utilizes subject matter experts from various backgrounds and geographical regions to minimize natural biases. All these factors allow the EMS profession to rely on CAPCE to provide the highest standard of education.”

During his time on CECBEMS, Martin Singer was the EMS division director in the New Hampshire Department of Safety. He continued to be a reviewer while on the faculty of the National Emergency Rescue and Response Training Center at Texas A&M.

“When I first became a state EMS director, Dan Manz, then the president of our national association, asked me to become our organization’s representative to CECBEMS,” Singer recalls. “I had the good fortune to become involved with Janet Head, some wonderful educators from Kirkland Medical College, and a small cadre of national EMS and medical professionals all concerned about the quality, content, and venues related to EMS CE. I can tell you the first few years were scary.”

Singer notes over the course of his 7 years on the board, he and others in EMS education reviewed instructor credentials, program content outlines, and facilities.

“We were even known to occasionally site-visit just to be sure the submission matched the delivery,” he adds. “Over the course of my tenure as chair, we recognized that some agencies were constant deliverers of quality content, and we established an organizational accreditation for program delivery by accredited institutions.”

The Future of CE

In terms of the future of continuing education and the role CAPCE will play in it, Scott says he sees continuing education evolving into a customized, individualized process where the practitioner can direct their training records toward whichever state or national regulatory body licenses them.

“The recertification process will be ongoing and not tied to a date deadline,” he says. “I see CAPCE as the central recertification data keepers that facilitate the practitioner’s recertification process through ongoing electronic record transfer.”

Sibley notes CAPCE’s ongoing mission is in continuing to develop its work in international EMS and staying abreast of technical innovations in how CE is delivered and documented.

CAPCE will develop additional ways for EMS practitioners to ensure the quality of their education and that they are appropriately credited for their efforts, notes Holley.

CAPCE has just begun its influence in the CE spectrum with technology and the NREMT giving more CE credit for renewing EMS credentials with online education, says Grafft. “As our EMS industry expands with community paramedic and other EMS-related classes and programs, CAPCE will lead the way with consistent and verifiable education-based best practices,” he adds.

“The future of CAPCE is bright, enhancing national CE/EMS programs as well as bolstering those internationally,” says E. Jackson Allison, Jr., MD, MPH, FACEP, FACPM, past chair of the CAPCE board.

Miller concurs on the importance of CAPCE’s role on the international stage and envisions its further growth.

“The need for remote learning has increased due to the pandemic, and where there is a need, I would expect CAPCE to fill that need,” he says. “They are the nation’s reliable source for online education.”

Singer notes: “I am uncertain how the current dispute between the NREMT board and the National Association of EMS Physicians and National Association of Emergency Medical Technicians organizations’ positions regarding certification and state accreditation will be resolved. It will obviously have an enormous impact on EMS educational delivery and continued medical education.

“Having taught on both the apparatus floor and in a college EMS lab, I can tell you we have come a long way. I am confident that over the years CAPCE has continued to improve our delivery of care. Isn’t that what it’s all about?”

Carol Brzozowski is a freelance journalist and former daily newspaper reporter in South Florida. Her work has been published in more than 200 media outlets. 

Sidebar: CAPCE’s Biggest Contributions

By Juan March, MD, FAEMS, FACEP

The creation of CAPCE was led by the NAEMT’s Janet Head who, along with individuals from ACEP, NAEMSP, NASEMSO, and others, realized there was a need for accreditation of EMS CE across state borders. It’s hard to imagine today, but 30 years ago, when a paramedic attended an EMS conference in another state, getting CE credit for it in their own state was a difficult and often arduous process. To get it the EMS professional had to first obtain copies of the CE course objectives, speaker CV, proof of attendance, etc. and then send all this material to their local medical director or state office of EMS.

I believe CAPCE’s biggest accomplishments over the past 30 years include development of the different CE formats, including accreditation of distributed learning (online education), and linking the CAPCE database with the NREMT database. During the pandemic this allowed EMS professionals to get CE during lockdowns and made the recredentialing process much easier.

Nothing in life is certain, and the only thing we can be sure of is change. Like all of medicine, CAPCE has come a long way in the past 30 years. One thing is certain, CAPCE will continue to evolve and grow as the methods for CE delivery do the same over the next 30 years.

Juan March, MD, FAEMS, FACEP, is a professor in the Department of Emergency Medicine and chair of the Division of EMS in the Brody School of Medicine at East Carolina University.