Emergency Medical Services Education Agenda 2050: Request for Information

Emergency Medical Services Education Agenda 2050: Request for Information

Publication: Federal Register
Agency: National Highway Traffic Safety Administration
Byline: Nanda Narayanan Srinivasan
Date: 20 November 2023
Subject: American Government

[Federal Register Volume 88, Number 222 (Monday, November 20, 2023)]
[Notices]
[Pages 80810-80812]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-25551]

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DEPARTMENT OF TRANSPORTATION

National Highway Traffic Safety Administration

[DOT-NHTSA-2023-0037]

Emergency Medical Services Education Agenda 2050: Request for
Information

AGENCY: National Highway Traffic Safety Administration (NHTSA),
Department of Transportation (DOT).

ACTION: Reopening of comment period.

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SUMMARY: NHTSA published a request for information on October 13, 2023,
seeking comments from all sources (public, private, government,
academic, professional, public interest groups, and other interested
parties) on the planned re-envisioning of the 2000 EMS Education Agenda
for the Future: A Systems Approach. Due to the limited comments
received and some informal feedback indicating that the initial comment
period was too short, NHTSA is announcing the reopening of the comment
period for the RFI in order to solicit additional comments and request
responses to specific questions provided in the document. The comment
period for the RFI was originally scheduled to end on October 31, 2023.
It will now be reopened and will end on March 31, 2024.

DATES: The comment period for the RFI published on October 13, 2023 at
88 FR 71081 is reopened and extended to March 31, 2024.

FOR FURTHER INFORMATION CONTACT: Clary Mole, EMS Specialist, National
Highway Traffic Safety Administration, U.S. Department of
Transportation is available by phone at (202) 868-3275 or by email at
Clary.Mole@dot.gov.

ADDRESSES: Comments must be submitted by one of the following methods:
Federal eRulemaking Portal: go to http://www.regulations.gov. Follow the online instructions for submitting
comments.
Mail: Docket Management Facility, M-30, U.S. Department of
Transportation, West Building, Ground Floor, Rm. W12-140, 1200 New
Jersey Avenue SE, Washington, DC 20590.
Hand Delivery or Courier: West Building Ground Floor, Room
W12-140, 1200 New Jersey Avenue SE, between 9 a.m. and 5 p.m. Eastern
Time, Monday through Friday, except Federal holidays. To be sure
someone is there to help you, please call (202) 366-9322 before coming.
Regardless of how you submit your comments, you must include the
docket number identified in the heading of this document.
Note that all comments received, including any personal information
provided, will be posted without change to http://www.regulations.gov.
Please see the ``Privacy Act'' heading below.
You may call the Docket Management Facility at (202) 366-9322. For
access to the docket to read background documents or comments received,
go to http://www.regulations.gov or the street address listed above. We
will continue to file relevant information in the docket as it becomes
available. To be sure someone is there to help you, please call (202)
366-9322 before coming. We will continue to file relevant information
in the Docket as it becomes available.
Privacy Act: In accordance with 5 U.S.C. 553(c), DOT solicits
comments from the public to inform its decision-making process. DOT
posts these comments, without edit, including any personal information
the commenter provides, to http://www.regulations.gov, as described in
the system of records notice (DOT/ALL-14 FDMS), which can be reviewed
at https://www.transportation.gov/privacy. Anyone is able to search the
electronic form of all comments received into any of our dockets by the
name of the individual submitting the comment (or signing the comment,
if submitted on behalf of an association, business, labor union, etc.).
You may review DOT's complete Privacy Act Statement in the Federal
Register published on April 11, 2000 (65 FR 19477-78).

SUPPLEMENTARY INFORMATION: On October 13, 2023, NHTSA published a RFI
to obtain public comments to inform EMS Education Agenda 2050, and
request responses to specific questions provided in this document. For
convenience purposes, NHTSA is republishing introductory information,
background materials and questions from its RFI in this notice.

I. Introductory Information

In 2012, the National EMS Advisory Council (NEMSAC) convened a
national roundtable meeting on EMS Education Agenda for the Future: A
Systems Approach. In a 2014 report on these proceedings, NEMSAC advised
that stakeholders at the State and local level had just begun to
experience the full impact of the evolution toward a national
integrated system of education for EMS personnel. While stakeholders
were reticent to move forward with a new education agenda, they did
provide feedback about themes that should be considered in the future
publication. From the feedback collected at the meeting, NEMSAC
developed recommendations to be used in the eventual re-envision of the
agenda for EMS. These recommendations are summarized below:
Educational content should retain the flexibility accorded
by the National EMS Education standards, but programs should use
nationally recognized evidence-based guidelines to drive local
curriculum development.
The National EMS Information System data, evidence-based
research, and practice analyses should be sourced in developing
evidence-based guidelines and curriculum.
Mobile Integrated Healthcare has received considerable
attention from the EMS Community. This and other alternative community-
based healthcare

[[Page 80811]]

delivery models (of the future) should evoke an expanded foundational
knowledge and critical thinking capabilities that will poise future EMS
practitioners to be able to evolve with the changing healthcare system
or rapidly adjust to emerging healthcare crises.
EMS educators should begin a career in academia with
expertise in adult learning, educational theory, curriculum
development, and competency evaluation but also possess experiential
knowledge in evidence-based care.
In the 10 years since NEMSAC's roundtable meeting, the national EMS
education system continued to evolve--especially during the COVID-19
pandemic. In late 2021, the Federal Interagency Committee on EMS
(FICEMS) began sponsoring listening sessions to inform a consensus-
driven, national report entitled, FICEMS: EMS and 911 COVID-19 Response
White Paper. This publication cited challenges and solutions collected
during stakeholder listening sessions for the EMS education system.
Among the challenges, EMS education stakeholders cited scarcity (in
some cases deficits) in resources for education, rigidity of curriculum
delivery modalities, the increased employer demands on students, and
inconsistent or delayed responses to the needs of the national EMS
education system as major contributors that led to the breakdown in the
EMS workforce pipeline.
Prior to the COVID-19 pandemic, NHTSA published EMS Agenda 2050: A
People-centered Vision for the Future of EMS (Agenda 2050). This
collaborative project set a vision for a people-centered EMS systems
that serves every individual in every community across the Nation.
Later this year, NHTSA and its partners will begin a new project to
develop EMS Education Agenda 2050. This project will not replace but
build upon the achievements of the 2000 EMS Education Agenda for the
Future: A Systems Approach to lead a national conversation around the
future vision for EMS Education and EMS as a profession.

II. Background

NHTSA, in partnership with Health Resources and Services
Administration, published EMS Education Agenda for the Future: A
Systems Approach (Education Agenda) in 2000. This document was founded
on the broad national EMS education system concepts introduced in the
EMS Agenda for the Future (1996). The Education Agenda described a
consensus vision of an EMS education system with a high degree of
structure, coordination, and interdependence. It proposed a less
prescriptive system that offered educators flexibility in creating a
student-centered learning environment and a process for accommodating
future advancements in technology and medicine. The proposed system
maximized efficiency, consistency in instructional quality, and entry
level graduate competency by prescribing a high degree of structure,
coordination, and interdependence. To achieve this vision, the
education system of the future centered on five integrated primary
components:

National EMS Core Content
National EMS Scope of Practice Model
National EMS Education Standards
National EMS Education Program Accreditation
National EMS Certification
After the Education Agenda was published, stakeholders began
implementing their respective integrated system components. Almost 25
years later, the national EMS education system has successfully evolved
into one that exemplifies both consistency and flexibility. System
interdependencies have helped to avoid duplication of effort in
curriculum and education program development, evaluating the minimum
competencies of graduates, certification and licensing processes, and
facilitation of practitioner reciprocity.
In 2020, the EMS education system interdependencies modernized by
the Education Agenda were tested. Challenges presented by the COVID-19
pandemic forced a variety of adaptations. Traditional education
programs reported a lag in students' capabilities of achieving the
programmatic competencies requirements for graduation. The lag was
attributed to a variety of causes including a focus on pandemic
response activities over training and education, employer demands on
working students, and the rigidity of in-person, classroom-based
education delivery models. After the majority of programs adjusted to
the challenges, lags in graduation were cured, and students achieved
programmatic competencies at rates similar to those pre-pandemic. The
response to the pandemic did not impact education programs only. The
impact to EMS agency daily operations was felt as well. During the
COVID pandemic, agencies experienced increases in EMS activation and
response rates which created additional stressors for student EMS
practitioners already working in a high stress job environment but also
enrolled in an EMS education program. These stressors were a major
contributor to a migration of practitioners away from the EMS
workforce. Agencies and organizational stakeholders asserted that it
could be education program graduation requirements causing breakdown in
the workforce pipeline; however, there were no observed decreases in
graduation or certification testing rates. These observations prompt
two questions: If graduation and certification testing rates have
remained unchanged, why have agencies reported recruitment and
retention issues? If graduates are not entering the EMS workforce,
where are they finding jobs?
With agencies experiencing increased demand and a deficiency in
qualified EMS practitioners to respond to it, service delivery models
had to evolve. To bridge the gap in community-based care resources,
community paramedicine and mobile integrated healthcare (CP-MIH)
service delivery models increased in prevalence, and improvised
training programs were used to close new job-specific competency gaps
among existing EMS practitioners and individuals in training. Other
themes brought to the forefront during the pandemic include addressing
healthcare disparities; the use of EMS data as a tool for surveillance
and nationwide quality of care improvements; and a greater value to
having an EMS workforce that is not only equitable, inclusive, and
accessible, but as diverse as the community it serves. These themes,
evolving service delivery models, and the subsequent evolution of
competencies needed by practitioners suggest that it is time for NHTSA
to gather our partners to begin a new conversation about the future of
EMS Education and EMS as a profession in the United States.

III. Questions Regarding EMS Education Agenda 2050

Responses to the following questions are requested to help plan the
revision of the Education Agenda. Please be as specific as possible and
as appropriate please provide references.
1. What are the most critical issues facing EMS education system
that should be addressed in the revision of the EMS Education Agenda?
Please provide specific examples.
2. What progress has been made in implementing the EMS Education
Agenda since 2000?
3. How have you used EMS Education Agenda? Please provide specific
examples.

[[Page 80812]]

4. As an EMS Stakeholder, how might a revised EMS Education Agenda
be most useful to you?
5. What significant changes have occurred in the EMS education
system at the national, Federal, State, and local levels since 2000?
6. What significant changes will impact the EMS education system in
the next 25 years?
7. How might the revised EMS Education Agenda contribute to
enhanced EMS for children?
8. How might the revised EMS Education Agenda support and/or
promote data-driven and evidence-based improvements in EMS education
systems and EMS practitioner practice?
9. How could the revised EMS Education Agenda enhance collaboration
among EMS systems, health care providers and facilities, public safety
answering points, public health, public safety, emergency management,
insurers, and others?
10. How could the revised EMS Education Agenda be used to promote
community sustainability and resilience?
11. How could the revised EMS Education Agenda contribute to
improved coordination for disaster response, recovery, preparedness,
and mitigation?
12. How could the revised EMS Education Agenda enhance the exchange
of evidence-based practices between national, Federal (and military),
State, and local levels?
13. How could the revised EMS Education Agenda support the seamless
and unimpeded transfer of military EMS personnel to roles as civilian
EMS providers?
14. How could the revised EMS Education Agenda support interstate
credentialing of EMS personnel?
15. How could the revised EMS Education Agenda support improved
patient outcomes in rural and frontier communities?
16. How could the revised EMS Education Agenda lead to improved EMS
systems in tribal communities?
17. How could the revised EMS Education Agenda promote a culture of
safety among EMS personnel, agencies, and organizations?
18. Are there additional EMS attributes that should be included in
the revised EMS Education Agenda? If so, please provide an explanation
for why these additional EMS attributes should be included.
19. Are there EMS attributes in the 2000 EMS Education Agenda that
should be eliminated from the revised edition? If so, please provide an
explanation for why these EMS attributes should be eliminated.
20. What are your suggestions for the process that should be used
in revising the EMS Education Agenda?
21. What specific agencies/organizations/entities are essential to
involve, in a revision of the EMS Education Agenda?
22. Do you have any additional comments regarding the revision of
the EMS Education Agenda?

(Authority: 23 U.S.C. 403(b)(1)(A)(iv); 49 CFR 1.95; 501.8)
Issued in Washington, DC.

Nanda Narayanan Srinivasan,
Associate Administrator, Research and Program Development.
[FR Doc. 2023-25551 Filed 11-17-23; 8:45 am]
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