In order to be initially certified as a Nationally Registered Emergency Medical Technician-Paramedic, a candidate must graduate from a State or nationally accredited program that meets or exceeds the National Highway Traffic Safety Administration (NHTSA) standardized curriculum. Periodic reregistration in most States is the primary method of ensuring the continued competence of EMT-Ps. The lengths of State licensure for EMT-Ps and required CME vary significantly from State to State.
Appendix A lists the current lengths of State licensure and the required amounts of continuing education to be completed on an average yearly basis ( EMS, 2002). The average length of a State license for EMT-P is currently 29.2 months (range 12 months to permanent licensure) with 33 States issuing an EMT-P credential valid for 24 months. The average number of hours of CME required per year is 31.6 with a wide variation (range 0 to 94.5 hours). For example, a rural State with a small number of services currently requires the greatest amount of continuing education (94.5 hours/year). In contrast, a very small urban State whose entire population is serviced by a 9-1-1 response system currently does not require its paramedics to complete any continuing education to renew the State-issued EMT-Paramedic license.
The National Registry of EMTs issues a National Registry EMT-P (NREMT-P) certification that is valid for 24 months and requires a total of 72 hours of refresher training and CME be completed. Some States require that EMT-Ps maintain their NREMT-P status, and other States require the NREMT-P exam for entry to the profession and then adherence to State requirements for renewal, while other States use their own exam for both entry and renewal.
Various factors may influence the continued clinical competence of EMT-Ps including: CME, practice frequency, average length of transport, quality assurance measures, medical control, initial education, employer policies, consumer expectations, and peer professionalism. Renewal of NREMT registration or State certification incorporates some of these factors including the reporting of CME, professional activity, and sponsorship by a medical director.
An important question to be answered (although not directly addressed by this study) is how to ensure the continued competence of EMT-Ps. This is a difficult and costly problem for most licensing and certification agencies. Among the medical, nursing, health science, and other healing arts professions, CME, required practice frequency minimums, and periodic retesting, appear to be among the most common forms of ensuring the practices of clinicians are safe. Of the foregoing, CME is the most commonly used method of ensuring competence.