Gap Analysis Template - NASEMSO

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2009 National EMS Education StandardsGap Analysis TemplateA Comparison of EMS Knowledge and Skills to Assist theTransition and Implementation of the National EMSEducation Standards for:Emergency Medical Responder (EMR)Emergency Medical Technician (EMT)Advanced Emergency Medical Technician (AEMT)Paramedic7/17/2009National Association of State EMS OfficialsFalls Church, VA

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009IntroductionAs a component of the EMS Education Agenda: A Systems Approach (EducationAgenda), the National Highway Traffic Safety Administration (NHTSA) publishedthe National EMS Education Standards (Education Standards) in 2009. Whileeducation is an essential component of EMS practice and practitionercredentialing, successful completion of an instructional program based on theEducation Standards does not mean an EMS practitioner is ready or authorizedto perform EMS procedures in an EMS system. States maintain the legalauthority to establish a local EMS scope of practice and to implement theEducation Standards in a way that best meets the needs of the state. Each stateestablishes the legal authority for an EMS practitioner to function by establishingeducation, certification and licensure processes and providing direction formedical oversight and credentialing: Education includes all of the cognitive, psychomotor, and affectivelearning that individuals have undergone throughout their lives. Thisincludes entry-level and continuing professional education, as well asother formal and informal learning. Clearly, many individuals haveextensive education that, in some cases, exceeds their EMS skills orroles.Certification is an external verification of the competencies that anindividual has achieved and typically involves an examination process.While certification exams can be set to any level of proficiency, in healthcare they are typically designed to verify that an individual has achievedminimum competency to assure safe and effective patient care.Licensure represents permission granted to an individual by the State toperform certain restricted activities. Scope of practice represents the legallimits of the licensed individual’s performance. States have a variety ofmechanisms to define the margins of what an individual is legallypermitted to perform.Credentialing is a local process by which an individual is permitted by aspecific entity (medical director) to practice in a specific setting (EMSagency). Credentialing processes vary in sophistication and formality.For every individual, these four domains are of slightly different relative sizes.However, one concept remains constant: an individual may only perform a skill orrole for which that person is: educated (has been trained to do the skill or role), ANDcertified (has demonstrated competence in the skill or role), ANDlicensed (has legal authority issued by the State to perform the skill orrole), ANDcredentialed (has been authorized by medical director to perform the skillor role).Page 2 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009Because states may need to revise or develop processes to facilitate a smoothtransition from the U.S. Department of Transportation National StandardCurricula (NSC) to the new Education Standards, the National Association ofState EMS Officials (NASEMSO) collaborated with a panel of experts andseveral national stakeholder groups to establish this Gap Analysis Template.The purpose of the gap analysis is to identify skills, content, and new courseconsiderations not included in the previous National Standard Curricula for eachEMS practitioner level. This Gap Analysis Template is not a ―stand-alone‖transition document; the template should serve as another tool to facilitateimplementation of the EMS Education Agenda. Its intended audience is stateEMS offices although NASEMSO acknowledges that the content may be usefulto a much broader audience.Prior to using the Education Standards, educational programs shouldcommunicate and coordinate with their state EMS office to ensure that: The state has adopted the scope of practice levels consistent with theNational Scope of Practice Model.The state has defined any instructor qualifications that must be met priorto using the Education Standards.A state-wide transition process for existing EMS personnel and instructorshas been identified.Adequate text and support materials are in place for program delivery.Certification and licensure are based on the Education Standards.Although educational programs should not independently decide to incorporatethe Education Standards into current instruction, instructors should presentupdated content to students as quickly as possible. States are encouraged todemonstrate sensitivity to the needs of the EMS community in order toaccomplish a logical and timely transition to the new Education Standards.States should consider several other important factors before implementation ofthe Education Standards: Individual states are encouraged to use the National EMS Scope ofPractice Model as a foundation to establish state EMS practitioner levels.Individual states are encouraged to use the Gap Analysis Template tohelp define system processes that support the transition of EMSpractitioners to the state-adopted scope of practice.The Education Standards promotes increased flexibility, encouragescreativity within each EMS education program and encourages alternativedelivery methods. The Education Standards do not represent aprescriptive sequence or content grouping for a class presentation. Statesand/or educational programs will need to determine the sequence forteaching the materials.Page 3 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009 Course outcome evaluations should be based on student competency, notthe time to course completion, as this may vary. Time estimates may beprovided to guide the planning for presentation of course materials.States and/or education programs should re-evaluate studentqualifications, co-requisites, or pre-requisites for all EMS practitionerlevels.States and/or programs should consider co-requisites or pre-requisites fortransition courses to help establish the depth and breadth of new content.Affective (professional behavior) evaluation is new for EMR and EMT andthe content at those levels includes new expectations and materials.Individuals transitioning within a level (i.e. EMT-P to Paramedic) areresponsible for the knowledge and skills that are implicit to all previouslevels.All EMS stakeholders are strongly encouraged to use the correct terms todescribe EMS practitioner levels—i.e. Emergency Medical Responder,Emergency Medical Technician, Advanced Emergency MedicalTechnician, and Paramedic. The term ―EMT‖ no longer represents ageneric term but instead describes a specific provider level.Essential components of EMS practice that lie outside the scope of the EducationStandards may include, but are not limited to: Vehicle operations/drivingSelected/local EMS health and safety concernsOSHA requirements and fit-testing methodsImmunizations recommended to function in an EMS environment as ahealthcare practitionerPhysical requirements for job performancePolicies or protocols related to the scope of practiceCredentialing info (educational preparation leading to state licensure andnational certification)Other State and local policies and requirementsThe Gap Analysis Template is not a policy document and it is NOT intendedto describe: Policies and procedures for State implementation of the EducationAgenda.Policies and procedures for EMS Program implementation of theEducation Agenda.Policies and procedures for EMS Agency implementation of the EducationAgenda.Regulatory language for states to implement the Education Agenda orScope of Practice Model.Education strategies for instructors and/or programs.Page 4 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009 Educational materials to create learning modules (appropriate referencesare included in the Education Standards.)Regression strategies for EMS practitioners who choose to revert to alower level of certification/licensure (i.e. I-85 to Emergency MedicalTechnician.) States are encouraged to consider appropriate credentialingpolicies in this regard. Some states may decide to consider individualrequests to revert to another level on a case-by-case basis.Figure 1 is intended to help illustrate the continuum of the knowledge and skilllevels of EMS practitioners from the previous National Standard Curriculum(NSC) to the current Education Standards (ES) based on the National Scope ofPractice Model. The overlapping areas are intentional because they help identifyand compare points of intersection and divergence between the NSC and ES.NSCESFigure ship of NSC to Education StandardsFigure 2 illustrates the components of the Education Agenda. The EducationAgenda and the following components: National EMS Core Content, NationalEMS Scope of Practice Model, and the National EMS Education Standards areavailable at www.ems.gov.The EMS Education Agenda for theFuture: A Systems ApproachThe Universe of EMSKnowledge and SkillsNational EMSCore ContentDelineation of providerpractice levelsNational EMSScope of PracticeReplaces the currentNational StandardCurriculaNational EMSEducation StandardsNational EMS CertificationNational EMS EducationProgram AccreditationFigure 2. The EMS Education Agenda for the Future: A Systems ApproachPage 5 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009The NASEMSO Implementation Working Group is available to provide technicalassistance to states with the gap analysis and other Education Agendaimplementation efforts. State officials that desire additional information cancontact NASEMSO via info@nasemso.org or call NASEMSO Program AdvisorKathy Robinson at (703) 538-1799 ext 1708.Page 6 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009Table of Contents:1.Cross Reference of Education Standards and InstructionalGuidelines (by Sections)Page 10Outline of the materials with helpful cross references, specifically the pagenumbers related to where one might find related material in the EducationStandards and Instructional Guidelines.2.Glossary of Abbreviations and TermsPage 12Complete list of acronyms used in the document and selected definitions.3.Knowledge and Skill Comparison: Emergency Medical ResponderPage 16a.Emergency Medical Responder: New Course ConsiderationsList of organizational components that require review prior to transitioning to theEducation Standards.b.Emergency Medical Responder: SkillsComparison of skill components between the National Standard Curricula andthe Education Standards at the EMR level.c.Emergency Medical Responder: ContentComparison of knowledge components between the National Standard Curriculaand Education Standards at the EMR level.4.Knowledge and Skill Comparison: Emergency Medical TechnicianPage 20a.Emergency Medical Technician: New Course ConsiderationsList of organizational components that require review prior to transitioning to theEducation Standards.b.Emergency Medical Technician: SkillsComparison of skill components between the National Standard Curricula andthe Education Standards at the EMT level.c.Emergency Medical Technician: ContentComparison of knowledge components between the National Standard Curriculaand Education Standards at the EMT level.Page 7 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 20095.Knowledge and Skill Comparison: Advanced Emergency MedicalTechnicianPage 24a.Advanced Emergency Medical Technician: New CourseConsiderationsList of organizational components that require review prior to transitioning to theEducation Standards.b.Advanced Emergency Medical Technician: SkillsComparison of skill components between the National Standard Curricula andthe Education Standards at the AEMT level.c.Advanced Emergency Medical Technician: ContentComparison of knowledge components between the National Standard Curriculaand Education Standards at the AEMT level.6.Knowledge and Skill Comparison: Paramedica.Page 29Paramedic: New Course ConsiderationsList of organizational components that require review prior to transitioning to theEducation Standards.b.Paramedic: SkillsComparison of skill components between the National Standard Curricula andthe Education Standards at the Paramedic level.c.Paramedic: ContentComparison of knowledge components between the National Standard Curriculaand Education Standards at the Paramedic level.7.―Essential‖ Content for Transition CoursesPage 34List of content considered essential for transitioning currently certified/licensedproviders to the updated levels once implementation of the Education Standardsis complete.7.1.7.2.7.3.7.4.Emergency Medical ResponderEmergency Medical TechnicianAdvanced Emergency Medical TechnicianParamedicPage 8 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 20098.Appendix A—Skill SpreadsheetNational Standard Curricula to National SOP ModelPage 41Skill components presented in a spreadsheet/checklist format compares the skillsfrom the NSC to the National EMS Scope of Practice Model.9.Appendix B—Skill SpreadsheetBlank Checklist for State EMS Office UsePage 45Skill components presented in a spreadsheet/checklist format provides the skillmatrix from the National EMS Scope of Practice Model with blank columns forstates to establish its own gap analysis.Page 9 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 20091. Cross Reference of Education Standards and InstructionalGuidelines (by Sections)Section uidelinesPage NumberEMTInstructionalGuidelinesPage NumberAEMTInstructionalGuidelinesPage eparatory EMS Systems Research Workforce Safety andWellness Documentation EMS SystemCommunication TherapeuticCommunications Medical/Legal EthicsAnatomy and PhysiologyMedical TerminologyPhysiologyLife Span DevelopmentPublic HealthPharmacology Principles ofPharmacology MedicationAdministration EmergencyMedicationsAirway Management,Respiration, and ArtificialVentilation Airway Management Respiration Artificial VentilationPatient Assessment Scene Size Up Primary Assessment History-Taking SecondaryAssessment Monitoring Devices ReassessmentMedicine Medical Overview Neurology Abdominal andGastrointestinalDisorders Immunology Infectious Diseases Endocrine Disorders Psychiatric 919396995860636568148151163166169Page 10 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009Section Title GynecologyNon-traumaticMusculoskeletalDisorders Diseases of the Eyes,Ears, Nose, and ThroatShock and ResuscitationTrauma Trauma Overview Bleeding Chest Trauma Abdominal andGenitourinary Trauma Orthopedic Trauma Soft Tissue Trauma Head, Facial, Neck andSpine Trauma Nervous SystemTrauma Special Considerationsin Trauma Environmental Trauma Multi-System TraumaSpecial Patient Populations Obstetrics Neonatal Care Pediatrics Geriatrics Patients With SpecialChallengesEMS Operations Principles of SafelyOperating a GroundAmbulance Incident Management Multiple CasualtyIncidents Air Medical Vehicle Extrication Hazardous MaterialsAwareness Mass CasualtyIncidents Due toTerrorism and alGuidelinesPage NumberEMTInstructionalGuidelinesPage NumberAEMTInstructionalGuidelinesPage 2520520721014214414738038138450126211148385Page 11 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 20092. Glossary of Abbreviations and TermsA&PAnatomy and physiologyABGArterial blood gasACLSAdvanced Cardiac Life SupportAEDAutomated external defibrillatorAEMTAdvanced EMT, this is the 3rd provider level in the Scope ofPractice, and is often thought of as the first advanced life supportlevel due to the number of invasive skills contained within thisprovider level.Affective DomainOne of three learning domains in EMS education, the affectivedomain focuses on behaviors, including morals, values and ethics.AIDSAcquired immune deficiency syndrome or acquiredimmunodeficiency syndromeAccreditationRelates to EMS programs not individual practitioners, specifically,granting of approval by an official review board after specificrequirements have been met. The review board is nongovernmental and the review is collegial and based on selfassessment, peer assessment, and judgment. The purpose ofaccreditation is public accountability.ALSAdvanced Life Support. This is the level of EMS provider that mustpossess a greater depth and breadth of knowledge. It deals withmore invasive procedures and more complicated medicalproblems. The AEMT and paramedic are considerd ALS levelproviders.ATVAutomatic transport ventilatorBiPAP/CPAPBi-level positive airway pressure/continuous positive airwaypressureBLSBasic Life Support. This level of EMS provider has thefoundational levels of depth and breadth and less invasive skillsand procedures are performed. The BLS level includes both theEMR and EMT.BSIBody substance isolationPage 12 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009BTFBrain Trauma FoundationBridgeThe process of transitioning from one practitioner level to the nexthigher practitioner level via an educational framework (i.e.Emergency Medical Technician to Advanced Emergency MedicalTechnician)BVMBag valve maskCDCCenters for Disease Control and PreventionCertificationAn external verification of the competencies that an individual hasachieved and typically involves an examination process. Whilecertification exams can be set to any level of proficiency, in healthcare they are typically designed to verify that an individual hasachieved minimum competency to assure safe and effectivepatient care. (Certification does not grant an individual permissionto perform as an EMS provider, but it is often the first step in theprocess to gain permission to volunteer or work as an EMSprovider.)CO2Carbon dioxideCoAEMSPCommittee on Accreditation of Educational Programs forthe EMS ProfessionsCognitive DomainOne of three learning domains in EMS education, the cognitivedomain focuses on knowledge and includes the depth (how muchis required on an individual topic area) as well as breadth (howmany and how varied the topics need to be in a given practitionerlevel such as EMT or AEMT.CPRCardiopulmonary resuscitationCredentialingA local process by which an individual is permitted by a specificentity (medical director) to practice in a specific setting (EMSagency). Credentialing processes vary in sophistication andformality. (Certification and licensure are prerequisites tocredentialing.)CISMCritical Incident Stress ManagementECGElectrocardiogramPage 13 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009EducationAll of the cognitive, psychomotor, and affective learning thatindividuals have undergone throughout their lives. This includesentry-level and continuing professional education, as well as otherformal and informal learning. Clearly, many individuals haveextensive education that, in some cases, exceeds their EMS skillsor rolesGIGastrointestinalHAZWOPERHazardous Waste Operations and Emergency Response, it is aspecial credential for fire and EMS providers that is earnedfollowing additional HAZMAT focused training.HIPAAHealth Insurance Portability and Accountability ActHIVHuman immunodeficiency virusIGInstructional GuidelinesILCORInternational Liaison Committee on ermission granted to an individual by the State to perform certainrestricted activities. Scope of practice represents the legal limits ofthe licensed individual’s performance. States have a variety ofmechanisms to define the margins of what an individual is legallypermitted to perform.MASTMedical anti-shock trouserMRSAMethicillin-resistant Staphylococcus aureusNASEMSONational Association of State EMS OfficialsNEMSESNational EMS Education StandardsNGNasogastricNHTSANational Highway Traffic Safety AdministrationNSCNational Standard CurriculumPage 14 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009OGOrogastricPASGPneumatic anti-shock garmentPEEPPositive end-expiratory pressurePIDPelvic inflammatory diseasePPEPersonal protective equipmentPsychomotor DomainOne of three learning domains in EMS education, thepsychomotor domain focuses on skills and body movements.STDSexually transmitted diseaseTransitionThe process of credentialing the same practitioner level from theNational Standard Curricula to the Education Standards (i.e. EMTA to Emergency Medical Technician)STEMIST-segment elevation myocardial infarctionTIATransient ischemic attackPage 15 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 20093. Knowledge and Skill Comparison (Emergency MedicalResponder)The order of content is not meant to imply the order of delivery.a. Emergency Medical Responder: New Course ConsiderationsWhen planning and conducting a new EMR course, the Program Director orCourse Coordinator must consider the following: Instructional resourcesInstructor qualificationsMedical director oversightReview and verify integration of the clinical behavior/judgment section ofthe Education Standards, particularly related to lab and clinical and fieldactivities.Include affective evaluation and professional behavior in studentassessmentProgram effectiveness evaluationb. Emergency Medical Responder: SkillsFor a current First Responder (based on 1995 First Responder NationalStandard Curriculum) transitioning to Emergency Medical Responder (EMR), thefollowing skills are no longer taught: Insertion of a nasopharyngeal airwayPressure points and elevation for hemorrhage controlFor a current 1995 First Responder transitioning to 2009 Emergency MedicalResponder, the following skills were optional in 1995 First Responder NationalStandard Curriculum with State approval: Use of supplemental oxygenUse of nasal cannulaUse of non-rebreather face maskUse of the automated external defibrillator (AED)For a current 1995 First Responder transitioning to 2009 Emergency MedicalResponder, the following skills are new: Use of a bag-valve-maskUse of an auto-injector (self or peer)Obtaining manual blood pressuresPage 16 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009 Performing eye irrigationc. Emergency Medical Responder: ContentPreparatory EMS Systems - there is more content about quality improvement here than in the FirstResponder curriculum; contains section on required affective/behavioral characteristicsResearch – extremely limited information, but new to this levelEMS System Communication – addition of fundamental information about transferringpatient care to incoming EMTsTherapeutic Communications – addition of fundamental information about improvingcommunication with the patientMedical/Legal/Ethics – Health Insurance Portability and Accountability Act (HIPAA) didnot exist when the First Responder curriculum was authored; includes a brief discussionon living wills, surrogate decision makers, and civil and criminal court cases; in thediscussion on advanced directives, the reference to ILCOR should have been removedAnatomy and Physiology Brief discussion on the life support chain focusing on oxygenation and perfusionMedical Terminology This content is new to this levelPathophysiology This content is new to this level but only focuses on respiratory dysfunction and shockLife-Span Development Minimal new information at this levelPublic Health Minimal new information at this levelPharmacology Medication administration – discussion focuses on the use of an autoinjector for selfpreservation or for use on one’s peers (chemical attack)Emergency Medications – chemical antidote autoinjector onlyAirway Management, Respiration, and Oxygenation Anatomy and Physiology – more detailed than in the previous First Respondercurriculum, especially in the area of respiratory physiology. The increases in this areaare related to enhanced skills in scope of practice and new evidence that demonstratesthe important interrelationship between ventilation and circulation.Respiration - more detailed than in the previous First Responder curriculumArtificial Ventilation - more detailed than in the previous First Responder curriculumPatient Assessment Scene Size-Up – no new information here but a re-emphasis on the need for scenesafety for everyone presentPrimary Assessment - new terminology that more closely mimics other health careprofessionalsPage 17 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009 History Taking - new terminology that more closely mimics other health careprofessionals; some content specific to geriatrics addedSecondary Assessment - new terminology that more closely mimics other health careprofessionals; more thorough than in the previous curriculum; blood pressureassessment added to this levelReassessment - blood pressure reassessment added to this levelMedicine Medical Overview – re-use of the new assessment terminologyNeurology – stroke discussion is new information at this levelAbdominal and Gastrointestinal Disorders – minimal new information at this levelImmunology - minimal new information at this levelInfectious Diseases – two definitions added and a brief discussion about transmissionroutesEndocrine – a brief discussion about diabetes, more detailed than in the previouscurriculumPsychiatric – includes new material, a brief discussion on the assessment for suicideriskCardiovascular – deeper discussion on chest pain and heart attackToxicology – new information at this level; discussion on the use of chemical antidoteautoinjectorRespiratory – deeper discussion on respiratory distressGenitourinary/Renal – discussion focuses on hemodialysisGynecology – discussion focuses on vaginal bleedingDiseases of Eyes, Ears, Nose, and Throat – focuses on nosebleedShock and Resuscitation New section that combines the CPR information from the old curriculum with more detailand a discussion on the use of the AED; more detailed shock informationTrauma Overview – discussion on the Centers for Disease Control (CDC) Field Triage DecisionScheme: The National Trauma Triage ProtocolOrthopedic Trauma - The terms fracture and dislocation appear here; they did notappear in the previous First Responder National Standard CurriculumSoft Tissue Trauma – brief discussion added about foreign bodies in the eye;assessment information added about the extent of burns.Head, Facial, Neck, and Spine Trauma – elaboration on special management situationsSpecial Considerations in Trauma – added discussion on the elderly and the pregnantpatientEnvironmental – AEDs mentioned, brief discussion on submersions addedMulti-system Trauma – new material at this levelSpecial Patient Populations Pregnant Patient – vaginal bleeding discussion added, the term Braxton Hicks did notappear in the previous First Responder National Standard CurriculumPediatrics – pediatric assessment triangle included; discussion of shock in the pediatricpatient in the previous curriculum, it was called circulatory failureGeriatrics – all new section for this levelPatients with Special Challenges – elder abuse addedPage 18 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 2009EMS Operations Principles of Safely Operating a Ground Ambulance - increased depth of discussionon the risks of emergency response and leaving the sceneIncident Management – references the incident management system and the federalrequirements for complianceAir Medical – new material at this level; patient transfer issues, interaction with flightpersonnel, scene safety, landing zone selection/prepVehicle Extrication – added discussion on situational safety and the use of simple handtoolsHazardous Materials Awareness – references Hazardous Waste Operations andEmergency Response (HAZWOPER) standardMass Casualty Incidents Due to Terrorism or Disaster – all new material at this levelPage 19 of 48

2009 National EMS Education Standards Gap Analysis TemplateFINAL: Released 17 July 20094. Knowledge and Skill Comparison (Emergency MedicalTechnician)The order of content is not meant to imply the order of delivery.a. Emergency Medical Technician: New Course ConsiderationsWhen planning and conducting a new EMT course, the Program Director orCourse Coordinator must incorporate all considerations at the EMR levels plus,

several national stakeholder groups to establish this Gap Analysis Template. The purpose of the gap analysis is to identify skills, content, and new course considerations not included in the previous National Standard Curricula for each EMS practitioner level. This Gap

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