Indiana's Next Step with the National Registry of EMTs

This blog entry is going to be a purely EMS related one for a change. Since social media and blogging tend to be a great way to get a message out... and this message needs to get out to a lot of people fairly quickly, I think this just may do the trick.

The April 29, 2016 meeting of the Indiana EMS Commission heralded in a change in how we handle initial Emergency Medical Technician certification in the state. As Chairman of the Commission, and as I am sure my fellow Commissioners would agree, I know that there will be a lot of questions, conjecture, rumors and angst regarding this decision. I even believe that the EMS staff at the Indiana Department of Homeland Security would look at history regarding certain actions of the Commission and how incorrect information grew legs (and horns) of its own before we (Commission and staff) could even get the minutes approved to release.

So... I agreed to get the details and reasons behind this decision regarding the National Registry out publicly as quickly as possible. So here we go:

Let's starts with the facts. Last year, we formed a small sub-committee within the Commission to explore moving the Indiana EMT cognitive (written) exam to the National Registry cognitive exam. That committee consisted of Commissioner Zartman (who has a vast and intricate knowledge of the National Registry and serves as the Training Institution representative to the Commission), Director Garvey and myself.

We then gleaned information from the Registry as to what this would entail from their side and the availability of testing centers. We then met with Registry on several occasions, the latest of which was a breakfast meeting just prior to the Commission meeting yesterday. These meetings were with the Chief Operations Officer of the National Registry, Rob Wagner. Depending on the topic, these meetings also included department leaders from the Registry as well.

Here are two key points to start:

1) We NEVER discussed moving the Emergency Medical Responder (EMR or old terminology, First Responder) to initial National Registry testing, and 2) We did not discuss moving the EMT psychomotor (or practical) testing to the Registry.

This is only in regards to initial EMT level testing.

After looking at this from many angles, our small committee made a series of motions through Commissioner Zartman for adoption by Indiana. Here are some of the areas angles that we looked at that had an affect on our decision:

1) Test validity: The Registry exams are all frequently going revision and validation.
2) Standards: The standards of care, curricula, research, AHA guidelines and other influences are rapidly changing. The Registry is adept and the only entity already in motion with constant change to match what is happening in EMS and the educational standards.
3) Test security: The Registry already has secure testing centers aligned through Pearson VUE testing centers that offer quiet, standardized areas to take exams.
4) Costs: It is financially irresponsible for a government agency to spend funds for test improvement on an ongoing basis when the testing already exists at an unparalleled level through the Registry.
5) Accessibility: Looking at the Pearson VUE testing centers, there are quite a few in Indiana and several that are just across the state borders, making accessibility usually less than one hour drive time anywhere in the state. Mind you that these are the same testing centers that nursing students must go to for the NCLEX exam regardless of where they live.
6) Training Institution performance: We will be better able to monitor training institution performance.

So that being said, Commissioner Zartman, with my agreement wrote his motions out so that they covered all of the needed areas regarding moving the Indiana EMT cognitive assessment to the NREMT cognitive assessment. They are verbatim (so you can see the facts as they were presented and without any conjecture) as follows:

Motion #1:  To convert the current Indiana Basic EMT Cognitive Testing required by Indiana Administrative Code to the National Registry “EMT” “Cognitive” testing, to become effective, on July 1, 2017.  At that time, Indiana will “NO” longer administer the Cognitive Indiana Basic EMT Examination.

Motion #2:  From July 1, 2016 through June 31, 2017, Certified Training Programs or individuals seeking certification may elect to use the Indiana State EMT “Cognitive” exam and/or the National Registry EMT “Cognitive” Examination for initial certification.  If the NREMT examination is utilized during this time frame, all sub components of Indiana Certification must be met and verified by the initial training program.   IE:  Post, Autism, SIDS, Haz-Mat Awareness, prior to certification. 

Motion #3:  The IDHS Staff in conjunction with NREMT will conduct Statewide District Training Institution Primary Instructor Updates to accommodate all Indiana State Districts.  These sessions will occur beginning July 1, 2016 – June 30, 2017.  It will be required that all “Training Instructions” and “Primary Instructors” attend at least one (1) of the sessions to remain active to teach at the EMT level.  Schedule to be announced within the next 30 days. 

The purpose of these sessions will be to inform the TI Directors, Coordinators, and all Primary Instructors on the overall processes for the transition/conversion to the new testing standards and processes of the NREMT testing and administrative processes as well as emphasizing the need to teach the National Educational Standards (NES).

Motion #4: All current or in-process “Primary Instructors” must attend one of the NREMT Training Institution Training Programs during the year period of July 1, 2016 – June 30, 2017 to remain certified as a “Primary Instructor”.  Failure to complete the program will suspend the Primary Instructors Certification until they have successfully completed the formal process.  This process is currently in the implementation phase and will be addressed at a later date.

After July 1, 2017, the Indiana State EMT Cognitive Examination will no longer be offered for initial testing at the EMT-Basic level and all persons requested to obtain Indiana Certification must successfully pass the National Registry EMT Examination after completion of successful completion of an Indiana approved Training program or met all entry requirements for reciprocity.

Motion #5:  The Indiana Department of Homeland Security EMS Division – State Psychomotor Examination will remain active and serve as the entry level verification for Indiana State Certification and also confirmation to the NREMT for verification of successful compliance. 

Motion #6:  IDHS and its subcommittees will develop on line training programs and testing for all Indiana specific training models required by Statute or by EMS Commission Direction to be completed by all initial entry, re-entry, or reciprocity candidates for certification.

Motion #7:  IDHS will send out notification to all TI’s and Primary Instructors of this implementation plan and the attendance requirements to remain active as an “EMS Commission Certified Training Institution and/or Primary Instructor.

These motions were seconded by various members of the Commission and were each unanimously approved. Prior to the vote, during discussion, the plan was publicly endorsed by the Indiana Emergency Medical Services Association and the EMS Education Working Group (a group of Indiana Primary Instructors who offer feedback and advice to the State EMS staff and the Commission. The idea had been previously endorsed by the Indiana EMS Technical Advisory Committee as well.

The IDHS staff is to send out a letter to all Primary Instructors that must attend the educational sessions on this process. This will occur soon.

We must weigh the pros and cons of any major change. The biggest advantage of this is that we will be insuring a more consistent, tested and frequently updated minimal standard for entry into Indiana EMS. This is an advantage to the patient. An advantage to the new EMT, if they maintain the Registry certification, is that they will be able to more easily get reciprocity in many states should they choose to change location or have need to work elsewhere.

The National Registry has already been publically identified as the "Nation's EMS Certification" via multiple entities. It was also noted as a need for Indiana in the recent NHTSA EMS assessment of our state.

Here are some more facts regarding this change:

1) We are not requiring Indiana EMTs or Paramedics to MAINTAIN National Registry Certification. This is being implemented for initial certification of EMTs just as we did with Paramedics back in the 1990's. I will add that once you get it, you really should keep it as there are some employers who will not hire without it and it does give you access to certification in many states.

2) Reiterating... this DOES NOT affect the Indiana testing at the EMR level or the psychomotor (practical) testing at the EMT level.

3) National Registry certification is an attestation to a national level of competency.

4) The CAT EMT Exam has 70-120 questions and a time limit of two hours (as compared to 80-150 questions and 2 hours, 30 minutes for the Paramedic exam). 

5) There is an accommodation process available for those with diagnosed, documented issues that will allow for private testing rooms and longer test times, but the accommodation process must be completed BEFORE scheduling your cognitive test.

6) There is no minimum number or percent of correct items needed to pass as with a traditional paper-and-pencil test (straight from the NREMT website). The exam gauges competency by area with a narrowing confidence level as the exam progresses.

7) All candidates will be challenged to the limit of their ability, so everyone taking the exam will think it is difficult (straight from the NREMT website).

8) The cost of the EMT Cognitive exam is currently $70 and will rise to $80 next year (the first increase in many years). The Registry gets very little of this fee as it is mainly eaten up in the process of the testing. This is still much less expensive than the testing for many other healthcare certifications.

9) Receipt of your National Registry certification card DOES NOT grant clinical privileges to function by the State of Indiana. A student will still need to receive a certification card from the state following initial testing before they may function as an EMT in the state. 

10) Even though some training institutions may not authorize the cognitive test until after a psychomotor test is completed, this is NOT a Registry rule. A candidate can take the cognitive prior to the psychomotor exam but cannot be certified until both have been successfully completed. There are many of us at the Commission level who are curious as to why some institutions do not allow the cognitive to be taken first as it is generally the way that it happens.

There may be some who do not agree with this decision. As a Commission, and professionals from various aspects of EMS, we believe that this is the best course of action for assuring quality and standards in the assessment and certification process and a level of competency in Indiana EMS that our patients deserve. This will be a good thing. Transitions take time and are seldom without issue, so work with us on this one and become an early adopter. Instructors and Institutions: There are some opportunities (as listed in the motions above) to go ahead and start doing the testing soon. Jump in the boat. Get your feet wet with the rest of us.

The benefits will become obvious over time in instructional quality, consistency, certification portability and most of all patient care.

Lastly, on this topic, in the side bar are the front and back of a checklist that is hot off the presses from the National Registry and hand delivered by Rob Wagner. These show a simple step-by-step process for obtaining initial Registry certification. I am sure these checklists will be available at the Primary Instructor training sessions and I can email them by request as well.

I was actually going to write on a piece of Indiana history today... Tulip Trestle. But that will have to wait as this Registry explanation is important information to get in the hands of everyone who will be wondering and it is meant to be an initial resource for dispelling the myths related to change. I did indeed finally visit the trestle yesterday, but you will have to wait for that blog entry till the near future. I hope you will find this writing today useful.

Thank you for visiting!

A Tulip Trestle teaser pic...