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EMT Fraud: Bad People or Flawed System?

Recent news from Massachusetts reporting suspension of 207 EMTs and revocation of 4 Instructors for bogus refresher training smacks of poor oversight. But it may also highlight continued frustration with recertification requirements placed on EMS providers across the United States that fail miserably at providing any real education. That's right, perhaps the system is broken. For whatever reason, EMS providers are subjected to reruns of the very same material they were taught in their original training. Year in and year out, over and over again. No other profession feels compelled to revisit basic education with such vigor, nor does any other profession reteach basic material under the guise of "continuing education." Refresher training per se, for nurses or physicians, is reserved for those who have been out of practice, or who have been removed from practice for obvious performance problems. Why have EMS educators failed to evolve recertification requirements to the needs of providers?

Don't get me wrong: I'm not endorsing falsification of training records. But I am endorsing a root cause analysis of what led a whole group of really good EMS providers to fail to take their recertification process seriously. The problem may lie with the system and I'm willing to bet that it is not confined soley to Massachusetts...

Mike McEvoy
FireEMS Technical Editor

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Comment by John K. Murphy on June 27, 2010 at 11:53am
Mike

You asked this question on your blog - Why have EMS educators failed to evolve recertification requirements to the needs of providers?

The simple answer is the Medical Program Directors only allow EMT’s and Paramedics to follow existing guidelines, do not allow advances medical practices to occur in the field and the CME curriculum offered is repetitive and boring. In CME’s we focus on the stuff believed to be of value – intubations and IV’s for the Paramedic and Advanced EMT skill sets and the same old didactic material we learned 10 to 15 years ago for everyone. In those situations most Paramedics and EMT’s could pass the written evaluations asleep and the skill evaluations (IV’s and Intubations) are a waste of time.

What makes for a field savvy EMT or Paramedic is for the EMS profession to actually evaluate what our patient load looks like (more sick people than Cardiac Arrest and more home visits than Trauma) and to develop the curriculum and CME to reflect that need. The second is to have the numerous Medical Program Directors enable advanced medical care in their communities to meet the actual medical needs and not some preconceived notion that we need to squeeze the EMS system into an educational box – you can only do what you leaned in training and nothing more and we are going to repeat the same old stuff year after year.

Our profession spends years developing “NEW” curriculum through all sorts of committees mostly dominated by physicians and by the time it gets adopted, it’s old. New equipment, new drugs and new technology changes the dynamic. We are a dinosaur in the world of modern medicine and are way to slow to change.

What we need to avoid this CME scandal is a better system of educating our EMT’s and Paramedics to higher levels of care reflecting what we see in the field; STOP the number of Paramedics and EMT’s being trained (it’s a money maker for the numerous community colleges around the country and does nothing to advance our profession) and focus on the actual needs for the communities. Coupled with that is improvement of the CME programs to reflect the advance care and knowledge requirements of our providers and profession just like physicians and nurses receive in their CME’s. I have been to hundreds of medical CME’s for nurses and Physicians and very rarely do I see or hear the same thing from year to year. We need to replicate that type of CME in our profession.

We have created this monster ourselves with the boring and repetitive EMS CME. We can change this with some innovative and creative educational programs that actually advance our EMS profession. We have created the misdirected CME entrepreneurs who exchange CME’s for money and in many cases we have created the stagnation of EMS.

My suggestion is to reduce the actual numbers of EMS providers; license Paramedics to a standard that you would find in the Nurse Practitioner or Physicians Assistants disciplines and to enable all of EMS to deliver the care necessary to meet the medical needs of the community and keeping pace with education and technology.

What to do with the perpetrators of this scandal? Termination of employment and some jail time would be a good a good start and a deterrent.
Comment by Oscar Wiltse on June 26, 2010 at 10:26am
Mike -

As I'm sure you know - any live classes taken on duty in the fire/EMS station are fraught with difficulty. Everybody sits down to take ACLS recert or protocol review and then the alarm goes off and everybody leaves on calls. When they return in an hour or two - chances are the instructor just compresses the material into the remaining time available. And the Chief may get his name on the roster and still be in his office in another part of the building!

I bet the infractions that they found are just the tip of the iceberg!

Oscar Wiltse, Retired firefighter/paramedic - owiltse@comcast.net
Comment by Robert J Buckley CSE, NIMS, DAE on June 25, 2010 at 10:52am
You got it, Barry. And thats not just EMS...EVERYBODY wants to have a say in how Fire/EMS operates. To many times it IS someone who wants to keep thier kid in a job. That EXACT problem is occuring in Albq. right now. Somehow along the way we stopped getting rid of nepotism offenders. NM is by FAR the most CORRUPT state to practice ANYTHING in. It is SOLEY because everyone in a position of power, saves jobs for thier kids, sisters, and nieghbors. We've gone through 5, yes I said FIVE FBI directors in as many years. They get the 'ell outta here as sonn as they see whats going on.
Comment by Barry Aptt on June 25, 2010 at 9:24am
This seems to be an ongoing problem. I haven't heard of nurses falsifying their training for their CEU's, just EMS. I have seen it for years..people coming in, signing the roster and leaving, doing 45 minutes time for a 3 hour class and it goes on and on. I think both the system and the EMTS are at fault. In many ways, @ least in my state of Massachsetts, it's just a money grab to keep someone's nephew in a job. The OEMS office serves no purpose, the state is also brokn up into several regional EMS committees that operate almost autonomously, all the while following a "Statewide" treatment protocol.
Comment by Robert J Buckley CSE, NIMS, DAE on June 21, 2010 at 10:22am
I wish there were an easy way to solve this, but as long as theres a buck to be made doin' CME's people are going to offer them. Another problem is that we are graduating WAY too many EMT's! The face of EMS is unrecognizable to what we had when I first got involved. We have too many people out there that get into EMS because they need a job. And they will do anything to keep it, even if it means false reporting. I DO agree Mike, we are the ONLY proffession that just HAMMERS its own with course after course after course. But more and more I find medics on scene who have NEVER extricated a pt., or have only worked a code in thier last ACLS class...and they're running the scene!!!! Call me an old firedog, but I think we need to go back to basics. The only way you should be able to advance to EMT-P, or I, for that matter, is to volunteer for a local dept. at LEAST a year. It accomplishes a couple of things: first, you'll get used to and be confident in your skills. Second, and more importantly, it seperates the 'I need a jobbers' from the 'I'd do this for free' people...the latter is the only acceptable medic, in my book anyway! Thanks for letting me share Mike.

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