By Dan Limmer
On July 1, 2024, the NREMT will implement its redesigned ALS exam. On this date, there will no longer be a psychomotor exam, the expanded scenario questions will move from pilot to live, and students will be required to complete student minimum competencies for skills, patient types, and team leads.
Are we ready for this transition? I don’t believe we are.
The AEMT level of certification has always been a series of contradictions. It is an ALS level that is rarely used to its full potential. Pass rates nationally are dismal. Educators frequently miss the target in content—especially in vital areas like pathophysiology, clinical content, critical thinking, and application of those advanced skills. In a way, we are stuck in the old EMT-I mentality. The AEMT certification level needs a significant jumpstart.
Is the ALS redesign enough to fix AEMT? No. But it’s a start.
We won’t have issues on the paramedic side of the ALS redesign. There is already an SMC (student minimum competency) and structure through accreditation. Whether you like accreditation or not, it has taken the paramedic level of certification and made it a tight ship. Voluntary accreditation for AEMT will begin in 2025.
Will we embrace accreditation for AEMT programs? I hope so.
The Problems with AEMT SMC
We are putting a lot of weight on the SMC for AEMTs. We have a few significant problems brewing—and I’m not sure anyone is paying attention. Consider the following:
- The AEMT SMC, spearheaded by NASEMSO, hasn’t been released. It was approved by their education council earlier this year. EDIT: NASEMSO released the SMC in August. Review it here.
- The NREMT is requesting feedback on adopting the AEMT SMC (23-Resolution-03) , due on August 8—and we haven’t seen NASEMSO’s SMC yet. (I provided this feedback officially to the NREMT.)
- According to the information presented at the poorly attended AEMT accreditation session at Accreditcon, the AEMT SMC contains reasonable and specific skill and patient categories, allows some content to be achieved through simulation, and requires the student to have successful team leads. It will up the ante for many programs—and require more hours and coordination.
This article is written in early July 2023. Classes likely to require using the AEMT SMC will begin in about six months. Many programs will have to adjust clinical hours; this may involve changes in credit hours or presentations to colleges’ curricula or advisory committees. States, which it appears will ultimately be responsible for oversight of SMC adherence, haven’t created their SMCs and distributed policies. Some states will likely have to change rules or existing laws—which will take time. And time which is relatively short.
While the NASEMSO task force has created a consensus AEMT SMC, it also appears that the NREMT will allow states to make their own. As we learned from the paramedic accreditation for registry eligibility kerfuffle, some states want to take the easy way out. Word from state officials I spoke with indicates there is still some discussion within NASEMSO about the AEMT SMC.
Moving Forward with AEMT Accreditation
We have the opportunity to improve the AEMT level of certification. The SMC isn’t enough. We need higher standards in educators, education, exams, and record keeping. We need a tighter ship like we have at the paramedic level. I recommend the following:
- The NREMT adopts the NASEMSO AEMT SMC as required. Don’t leave it up to the states. States can always require more. We are starting a process that makes AEMTs different from state to state, moving us farther from the progress of the EMS Compact.
- The NREMT and States work together to begin the process of making accreditation at the AEMT level mandatory in 2030.
- The CoA recognizes that AEMT accreditation differs from paramedic in scope, cost, and time. Keep the standards high. Keep the cost and the process reasonable.
- We recognize there is much more to do to salvage and resuscitate the AEMT level to create the functioning (and passing) levels we need in EMS.
I can hear the cries now. We won’t be able to get AEMTs! The process is too much work!
I have news for you. The pass rate for the NRAEMT is barely above 50% for the first attempt. We aren’t getting AEMTs now—and many of the ones who pass still lack education and clinical experience. Our education is substandard for what we need and expect from these providers.
It’s time to recognize that we have a fundamental education-expectation mismatch, and we need to step up as a profession to fix that, even if it is painful.