[Kentucky EMS Connection]

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October 17, 2002

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Regulation Committee attempts to close EMT reciprocity loophole

By JOHN HULTGREN
Kentucky EMS Connection

LAWRENCEBURG The Regulation Committee of the Kentucky Board of EMS attempted today to close a loophole that allows registered nurses to gain their EMT-Basic national registration and state certification by simply completing a 24-hour EMT-Basic Refresher Course.

According to comments made by various people attending a scheduled committee meeting today in Lawrenceburg, 16 registered nurses who work for a Kentucky-based air medical program recently completed a 24-hour EMT-Basic Refresher Course and state skills testing and earned their National Registry of Emergency Medical Technicians EMT-Basic. Then, using their NREMT registration, were able to earn their Kentucky certification.

Prior to the meeting, a search of NREMT's Internet site revealed no provisions for such a "challenge." 

According the the NREMT's application for EMT-B registration, the "Applicant must have completed an approved EMT-Basic Training Program that equals or exceeds the objectives of the National Standard Curriculum."  Applicants must attach a copy of their course completion certificate or a copy of a current EMT-B card. Classroom hours must also be documented on the application.

The application also states that one of the entry requirements is "Successful completion of a state-approved EMT-Basic training program within the past 24 months, that equals or exceeds the behavioral objectives of the EMT-Basic National Standard Curriculum as developed and promulgated by the U.S. Department of Transportation."

Another entry requirement printed on the application reads: "If the candidate's initial EMT-Basic training completion date is beyond 24 months and the candidate has maintained state certification as an EMT-Basic, the candidate must document completion of 24 hours of state-approved EMT-Basic refresher training that meets all the objectives of the current EMT-Basic National Standard Refresher Curriculum."

There are two curriculums published by the U.S. Department of Transportation that relate to EMT-Basic training. One is the EMT-Basic National Standard Curriculum, which includes all of the education components for training an EMT-Basic. The second curriculum, the EMT-Basic National Standard Refresher Curriculum, does not cover all of the educational components from the first curriculum. 

Kentucky does not approve refresher courses.

When Brian Bishop, the executive director for KBEMS, was shown the printed NREMT requirements for EMT-Basic registration, he said that there was another checklist for registered nurses who challenge the training. Bishop explained that he had to comply with the NREMT regulations and state law.

The person who answered the phone in NREMT's Columbus, Ohio, office today said that the person who could answer questions on this matter was not in the office.

Theresa Martin, president of the Kentucky EMT Instructors Association, said "Skills taught in an EMT class are vastly different from those taught in the nursing curriculum, such as long board, KED, and Hare traction splint. There is no problem with nurses being EMTs as long as they have completed the 120 hour EMT class. These are two vastly different educational tracks, performing and applying different skills and knowledge to advance patient care."

Martin is also a registered nurse.

It is unsure whether a registered nurse who is also an EMT-Basic could use the same technique to acquire paramedic licensure by completing a paramedic refresher training course.

To close the loophole, the regulations committee approved language for EMT-First Responder, EMT-Basic, and EMT-Paramedic regulations that requires reciprocity applicants to take a complete training course.

"We'll fix it and move on," said James Ritchey, chairman of the committee.

The committee also took action on the following draft regulations:

  • Board Organization: adopted.
  • Fees: failed due to lack of a second.
  • Advisory Opinions: adopted.
  • Education: failed due to lack of a second.
  • Medical Director: failed due to lack of a motion.
  • Scope of Practice: adopted.
  • EMT-First Responder, EMT-Basic, and EMT-Paramedic: adopted with the provision that legal staff review the language to ensure for purposes of reciprocity that the applicant completes a full course taught under the national standard curriculum.
  • Ambulance Services: adopted after changes that allow an EMT-First Responder to drive, that allow an ALS ambulance service to staff a BLS ambulance, and that certain records do not have be to kept on-site. The board also adopted a motion that would remove air ambulance services from this regulation and create a separate regulation specific to air ambulances.

KBEMS board member John Blumenstock, who represents air ambulance programs, presented a proposed regulation that has been agreed to by all Kentucky air ambulance providers. 

The regulations addressing discipline and complaints, and grants, had already been approved by the board during their September meeting and have already entered the regulatory process with the state.

By adopting these regulations today, the committee has agreed to forward the adopted regulations to the full board for consideration. The board is not obligated to follow any of the committee's recommendations and could approve all or none, including the regulations that the committee did not adopt today because Anthony Stratton, board chairman, plans to call all of the draft regulations at the board meeting.

Today's meeting was the fifth in a series of six meetings held throughout the state, including Benton, Glasgow, Paintsville, and Frankfort. A final meeting is scheduled next Thursday, Oct. 24, from 6:00 p.m. until 8:00 p.m. in the auditorium of the Ambulance Care Building next to University of Louisville Hospital.

Many in the audience were confused when the committee voted to adopt regulations before the last meeting. Ritchey explained, however, that public comments could still have an impact at the final meeting.

The committee will also meet on Nov. 6 at 8:30 a.m. in Frankfort, before the afternoon board meeting, to finalize their recommendations. The board, however, has asked to have the final recommendations 10-14 days prior to their meeting so that they can review them.

If any of the regulations are not adopted by the board, then the committee plans to meet on Nov. 14 and try to work out problems. If the board follows the committee recommendations, then fees, education, and medical director regulations would need further work.

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