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Number 311 March 2006

Background

The National Registry of Emergency Medical Technicians (NREMT) is a national nonprofit corporation that provides a uniform process to assess the knowledge and skills required

for competent practice by Emergency Medical Services (EMS) professionals. The NREMT, together with various State and local EMS certification and licensing bodies, is

responsible for ensuring the initial and continued clinical competence of nationally registered Emergency Medical Technician-Paramedics (NREMT-P). NREMT issues a certification

for NREMT-Ps that is valid for 24 months and requires a total of 72 hours of refresher training and continuing medical education to maintain.

Following initial certification, a difficulty arises in determining whether the EMT-Ps remain competent. Among the medical, nursing, health science, and other healing arts

professions, continuing education, required practice frequency minimums, and periodic retesting are among the most common methods of ensuring the safe practice of

clinicians. While NREMT-Ps have continuing education requirements and are required to have medical director skill verification, they do not have practice frequency minimums

or mandatory retesting.

The important health policy question that arises is whether NREMT reregistration has its intended effect of maintaining competence. The principal objective of this study was to

determine whether the continued cognitive competence of voluntarily reregistered paramedics differed from those who did not reregister.

Methods

The sample consisted of two groups: (1) NREMT-Ps who voluntarily reregistered and (2) EMT-Ps who did not voluntarily reregister after the initial 2-year registration cycle and

chose to remain only licensed by the State. Subjects were sent a letter requesting they complete a multiple-choice online survey. The survey questionnaire consisted of a

standardized exam similar to the initial certification test, an achievement test, and a demographic and professional practice questionnaire. The responses from cohorts of

NREMT-Ps initially certified 2, 4, and 6 years earlier were compared.

Findings

The table below shows the difference in achievement scores for the reregistered and non-reregistered cohorts. While the reregistered cohorts averaged just one more correct

answer on the achievement portion of the exam, all reregistered cohorts did better than their nonreregistered counterparts.

Achievement Score Differences for Reregistered and Nonreregistered EMT-Ps

Group Difference reregistered vs. nonreregistered*

(95% Confidence Intervals)

p-value

Year 2 0.95 (0.35, 1.55) 0.0020

Year 4 1.41 (0.59, 2.23) 0.0008

Year 6 1.21 (0.30, 2.12) 0.0094

Average over all years 1.07 (0.66, 1.48) <0.0001

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*

This is a difference in mean number of correct scores between reregistered and nonreregistered cohorts.

Several variables were associated with the reregistered cohorts’ higher passing rate including having completed more Continuing Medical Education (CME) and having more years

of clinical experience related to emergency calls. Future work in this area could include a more sophisticated prospective study that would assess the reasons for higher test

scores and would perform more detailed analyses of the differences between EMT-Ps who reregister with the National Registry and those who do not.

How To Order

For a copy of National Reregistration and the Continuing Competence of EMT-Paramedics write to the Office of Research and Technology, NHTSA, NTI-130, 400 Seventh Street

SW., Washington DC 20590 or send a fax to 202-366-7096, or download from www.nhtsa.dot.gov. Paul J. Tremont, Ph.D. was the NHTSA project officer.

TRAFFIC TECH is a publication to disseminate information about traffic safety programs, including evaluations, innovative programs, and new publications. Feel free to copy it as

you wish. If you would like to receive a copy, contact Patricia Ellison Potter, Ph.D., Editor, fax 202-366-7096, e-mail: patricia.Ellison-potter@nhtsa.dot.gov.

1200 New Jersey Avenue, SE, West Building, Washington, DC 20590 USA 1-888-327-4236 TTY:1-800-424-9153

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