Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — The Kansas Board of Emergency Medical Services is gearing up for some major changes.

The Legislature earlier this year approved new job definitions and in some cases titles for the different levels of EMS workers, in line with an effort promoting the adoption of national standards to replace the existing patchwork of varying state standards.

“This is probably one of the most significant changes since EMS came about in the 70’s,” said Steve Sutton, interim executive director of the Kansas Board of EMS. “This is changing how EMS functions, and trying for the first time to take a national approach to the way education is delivered and the tasks that attendants are expected to perform.”

Single set of standards

Groups have worked for years to develop a single, nationally accepted set of skills and titles for EMS workers, Sutton said.

“They’ve identified four levels that will be nationally recognized,” he said. “The idea is that these will be adopted across the nation. It’s not just the titles that will be the same, but the functions and skill sets as well.”

The single set of standards will make it easier to hire attendants who move from other states, EMS officials have said.

The national standards also rely heavily on research and best practices that EMS leaders expect will result in workers providing better quality care.

“It’s a case of ‘innovate or die,’” said Jon Friesen, of the Friesen Group, a contractor charged with developing the curriculum to help current Kansas EMS workers adapt to the new titles and skill sets. “I think that applies to us in EMS. You can’t sit still. Medicine is dynamic and it’s always changing. What we know today is different than it was last year.”

Some emergency workers will see little change. Paramedics, for instance, will see only one major change – instead of officially being known as “Mobile Intensive Care Technicians,” they will now be officially called “Paramedics.”

Other levels also will see name changes. First responders – the most basic level of EMS attendant – will now be known as Emergency Medical Responders, or EMRs. The current “Emergency Medical Technician-Basic” will become simply EMT.

EMTs, under the new standards, will have more privileges than before, including the ability to administer some medications.

‘Positive and negative’

The biggest change will come for a group of mid-level providers known as EMT-I, or intermediate-level EMTs. EMT-I’s make up about 13 percent of the state’s certified EMS workforce.

They have certain privileges – such as being able to start IV fluids – that the lower levels do not have.

The new scope of practice would change the group’s name to “Advanced EMT” and add a much-expanded set of skills and privileges, including the ability to read heart rhythms and administer more medications.

The new Advanced EMT category will bring with it a substantial increase in the number of training hours required for the license, Friesen said. Currently, EMT-I license holders must undergo 36 hours of training in a two-year period to stay certified.

It’s not clear yet how many hours will be needed to train the workers to the new standards, he said, but it will likely exceed 100 hours.

“This is going to be both positive and negative for us,” said Jayne Holle, director of Phillips County EMS in Phillipsburg.

Thirty-five of the service’s 104 attendants work as volunteer EMT-I’s, Holle said.

The volunteer EMS workers are farmers, mechanics, and teachers, Holle said. When there’s a trauma outside of town – a tractor rollover, for instance – the EMT-I’s can start IVs before the helicopter ambulance arrives to transport the patient to the hospital. Sixteen of the service’s 35 EMT-I’s live in remote areas of the county.

“It’s a comfort to me to know that level of care is out there,” she said. “We’re kind of out in the boonies – but not as much as some parts of the state.”

A few of the volunteers will train for the new Advanced EMT certification, she said. Most have said they will not because of the time commitment that would be required.

“I feel like some of the level of care that our EMT-I’s are presently able to provide will disappear because of the new laws,” she said. “Perhaps when we get things more organized, more people might come on board to further their education and become an Advanced EMT. But, progress is good. Absolutely. This is going to be positive for the whole state.”

The mid-level EMS workers are useful in smaller communities that want to provide advanced life support but can’t afford to hire paramedics, Sutton said.

“It’s going to be easier to have an Advanced EMT in some communities in the rural areas of the state than a paramedic,” he said. “To become a paramedic it takes you two years. You’ve got to get an associate’s degree from an accredited program. Some of our smaller communities don’t have the resources for that. People can’t take the time once they’re trained to maintain those skill sets to provide that care.”

Workforce concerns

A group of about 40 people met throughout 2008 to develop recommendations for the EMS board as the agency worked to redefine scopes of practice.

The group’s charge was to first consider the state’s needs and then how those needs fit with the national scope of practice proposal.

“The perception could be that by not strictly adopting the national plan, you are not on par with a national standard,” Sutton said. “In our instance, we have adopted the national standard and we are exceeding it. “

“First responders in Kansas are trained to a much higher level than in the national curriculum,” said Terry David, director of Rice County EMS in Lyons. “The reason for that is that the state, years ago, has allowed them as attendants on a truck. That was a push from areas of the state that didn’t have enough people to put on a licensed ambulance.”

If workers choose not to advance to the new training curriculum provided in continuing education courses, they will drop “down” a level, Sutton said. If an EMT-I, for example, does not do the coursework to become an Advanced EMT, they will become EMTs instead.

“People may see it as losing a step in certification,” Sutton said, “but what they need to consider is that their capabilities of intervention may be enhanced.“

Next steps

The group headed by Friesen is compiling the curriculum to train the state’s EMS workers to the new standards. A draft will be presented to the EMS Board at its bimonthly meeting next week; the final version will be submitted to the Board during its August meeting.

The transition will be a “tough pill to swallow initially,” predicted J.R. Behan, an EMS Board member from Garden City.

“There’s going to be some work involved, but it’s not going to be anything that is unmanageable,” he said. “There are states that are much more rural than Kansas that are going to adopt the national scope and go full steam ahead. If it’s possible for those states to make it work, we think we can make it work too.”

Once the board receives the curriculum, it can start to develop timelines for implementation, Behan said. The board’s staff is already looking to write the regulations necessary to integrate the new titles and responsibilities.

The goal is to start using the new curriculum in January, Sutton said.

Sutton and others said the new training requirements – specifically, the increased number of training hours for the Advanced EMT level – have caused much concern among workers who aren’t sure how they will be affected.