-=> Quoting Blake Bowers to John Simmons <=-
 JS> you are and what you're doing. Next time, go for the gold standard. I
 JS> am.
 BB> Please don't insult the many EMT's in states such as TN, where the
 BB> state standards are much tougher than NREMT.
I'm sorry that you feel that you have been insulted. It is YOUR state
DHS that's been insulting YOU, by requiring their standards be higher
than the National Registry Testing!! This happens when your state
Dept of Health Services, including many states where there is little or
no cooperation between the EMS providers and DHS bureaucracy, who really
have no idea of what street medicine really is all about. Believe me,
I've been there, done that. Many states have DHS employees who are not
even qualified to be making the kinds of decisions they do. Arizona
is fighting that battle even today. It's so bad that most want DHS
abolished. The community colleges (teaching and testing) and the state
fire marshall's office (licensing) would then have control - where it
really belongs.
Arizona is in the process of adopting the NRT as the mechanism for
initial testing. It is still up to the individual to maintain his/her
registry and this is by C.E. (continuing education). C.E. is not just
lecture, it's skills and broad based so that the EMT has the opportunity
to grow and improve. Notice that there is a caveat here - ``has the
opportunity''...
Arizona does not have a standardized test and the NRT does and that is
why the state of Arizona is converting. By the year 2000, all of
Arizona will be NR certified. Many other states are in the process of
converting right now. It's interesting to note that IDAHO is the ONLY
state *mandating* NREMT-P at the paramedic level at this time. It is,
just like the rest of us, phasing in the requirement for all EMT's to
convert to NREMT. The key is "standardization" of the skill levels and
requirements - nationwide.
This is why the National Registry meets frequently in Ohio with
representatives from each state to hammer out a nationwide "gold
standard" and iron out the wrinkles before starting the conversion
process. I know because I'm very, very, informed, shall we say. One of
the NRT long term goals is to have the NRT replace ALL the states'
testing be standardized nationwide to the NRT level and establish new
guidelines and levels of care.
The AHA overhauled their program two years ago. Now it's time for EMT's
and Paramedics to do the same. That way, if I'm in another state, and
can assist, I ALREADY know what the protocol IS. That way, I don't have
to rely on the Good Samaritan law to bail me out should I get sued.
You'd be surprised at how many lawsuits get filed against EMT's and
Paramedics for not DOING or FOLLOWING established PROTOCOL. This never
gets published in the papers much, but it's a big problem. The National
Registry is addressing that also.
 BB> Just because some states have standards lower than NR, does not mean
 BB> that NR is the gold standard.  Maybe the overall baseline, but by
 BB> no means the gold standard.
NRT is the "gold standard". That is fact, Blake. It satisfies a *LEGAL*
level of care that will stand up in a court of law. It makes our jobs
easier. We don't have to worry about jurisdictional and procedural
problems anymore. If any current requirement is higher than the "gold
standard" perhaps "platinum", I'm happy for you because that means you
get more continuing education to meet that standard. Perhaps you could
request that you be an EMT-I level if they are that much more stringent.
Or are they stringent because supply exceeds demand?
Here's the REAL LEGAL test. If I'm traveling in another state and am
NREMT certified, and I come upon an accident scene as a first responder.
An ambulance shows up with two EMT's. As an NREMT, I identify myself as
such and I take command of the scene. An EMT must yield command to a
NREMT if the NREMT requests to do so. I cannot pass or yield command to
the EMT's. I can ask them to assist until relieved of command by 1)
another NREMT, 2) an EMT-P, 3) a NREMT-P, 4) a doctor licensed in that
state that accepts FULL responsibility for the patient(s) on the scene,
or 5) the hospital E/R physician via cellular patch.
If I were an EMT, the picture is entirely different. I must yield
command as a first responder to other EMT's arriving. I do not have
jurisdiction in that state. The other EMT's do. This frequently happens
since I travel a lot. What happens in reality, all the EMT's work as a
team to stabilize the patient and prepare for transport, if needed.
After identifying myself as an EMS provider, and since I was first on
the scene, my assessments must be transferred to medical paperwork and
police reports as well and I'm always asked to assist. That is a LEGAL
obligation. Another choice would be to drive by an accident scene that
doesn't have medical personnel there yet and ignore it. I NEVER do that.
I carry a cellular phone with me at all times. 911 calls are free. I
call to ensure that the proper police/medical/fire authorities are
dispatched for anyone and everyone needing assistance.
No matter what the regulatory body, the individual must be true to
him/her self in setting and maintaining any gold, silver or bronze
standard. Instead of looking at it from an "insulting" point of view,
Blake, consider that when TN approves the NREMT/NREMT-P you should pass
with flying colors first time through..
 BB> Many states do not recognize NREMT, or require additional training and
 BB> testing before they do.
About 95% of all states *recognize* the NREMT and NREMT-P. That's a
very important key word also. The states respective DHS departments
acknowledges the NRT, and the people that hold that level of training.
It, however, is a different matter for your state DHS to impose it as a
mandate as Idaho does. You betcha it requires additional training and
testing. More EMT's and EMT-P's flunk the basic EMT patient assessment
station than anything else. Why? They're focused so much on the new
technology that they forget the basic A, B, C that takes place FIRST,
unless the person is truly dead (i.e. rigor mortis, decomposition, and
decapitation).
There is an indirect benefit to "being involved". Since we are
providing a public service on our own time, our cellular providers have
a very special rate for fire/medical personnel. You must present proper
**fire department** ID to obtain it and must make at least twelve 911
calls a year. That's not hard to do. It's monthly rate and airtime
charges are dirt cheap - cheaper than my home phone line costs per
month! I feel good after helping someone who needs it. If any legal
problems arise, I'm protected by the Good Samaritan law (unless I'm on
duty; that's a whole 'nother story). :-) You might want to look into
this indirect benefit for your fire dept if you don't already have this
benefit. Roaming charges and daily connects and service fees via other
cellular providers are not discounted. :-(
Now that you have piqued my interest in TN standards and other states
that have standards higher than the NRT, would you like to share with me
what TN requirements that make it more stringent than NRT in terms of
accumulated C.E.? I'd like to share that with the people that keep me
very, very, informed and have them take that to the committee in Ohio
and address that issue. Thank you for your input.
John
FF/EMT
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