National Emergency Care Enterprise Advancing Care Through Collaboration: Workshop Summary (2009) / Chapter Skim
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5 Health Professions Training
5 Health Professions Training
Pages 49-60
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From page 49... ...
He described the panel as multidisciplinary, focusing on hospital and prehospital perspectives, including those of emergency physicians, emergency nurses, trauma surgeons and other specialists involved in providing on-call coverage, and emergency medical services (EMS) personnel.
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From page 50... ...
It is critically important to note, Haley said, that there is no current certification for either of those groups for specialty training in emergency medicine. A few PA programs are designed to help train PAs in emergency medicine, but there is no defined certification, nor is there defined certification for nurse practitioners.
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From page 51... ...
"This should be part of our planning for Homeland Security and for health system reform." A Shortage of Emergency Nurses Patricia Kunz Howard, operations manager for Emergency and Trauma Services at the University of Kentucky Chandler Medical Center and EMS training coordinator for Lexington Fire and Emergency Medical Services, reported that the nursing shortage is alive and well. Demand for nurses is continuing to rise by 2–3 percent every year, which is significant especially given the nursing faculty shortage.
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From page 52... ...
The Universe of EMS National EMS Knowledge and Skills Core Content Delineation of Provider National EMS Practice Levels Scope of Practice Replaces the Current National EMS National Standard Education Standards Curricula National EMS Education National EMS Certification Program Accreditation FIGURE 5-1 The EMS Education Agenda for the Future: A systems approach.
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From page 53... ...
Finally, personnel graduating from those accredited programs take a national certification exam to demonstrate their competency. This model would put EMS education parallel with other allied health professionals.
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From page 54... ...
Although we have been doing a remarkable job of trying to catch up, "we are still behind the curve." Even as we try to expand our residency programs, he said, "there is a limit to the number of training sites that we can come up with," given how emergency medicine training is structured. "We will reach a point where we probably won't produce enough emergency physicians to staff every ED in the country with a board-certified emergency physician on a 24/7 basis." Instead, he said, "we'll need to think about how to provide support with PAs, nurse practitioners, and other trainees."
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From page 55... ...
"We have heard that emergency physicians are behind and can't catch up; the surgical workforce can't reproduce itself to keep up with population growth; the nursing workforce is trying to stop the hemorrhage by stuffing an economic crisis in the wound; and the EMS workforce might be pulled off the streets and placed in the hospital," Handrigan said. He noted that Homeland Security's mission centers mainly on catastrophic events.
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From page 56... ...
Jerry Johnson, immediate past president of the National Association of EMTs, agreed that "the rubber is really going to hit the road with implementation." The education standards and the scope of practice model were great work, but he noted that national certification is not achievable unless the states adopt the standards. So, he asked, how do we get the states to see the benefits of adopting it?
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From page 57... ...
We are not going to solve the physician or nursing shortages by doing things the way they have always been done. He asked the panel whether they thought it would be possible for emergency nurses and EMS personnel to develop a common model for use by mid-level and EMS providers in an emergency setting that might solve some of these problems.
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From page 58... ...
Jane Scott, of the National Heart, Lung, and Blood Institute at the National Institutes of Health, said the entire domain of emergency medicine has grown enormously in the past 40 years. Nursing complexity, medical complexity, EMS complexity, the technologies that are in use, she said, "You name it; it's become vastly more complicated." She remarked that "people are getting pushed to the hilt and are being put in positions that they shouldn't have to be in." Scott asked whether people in nursing and medicine who are taking on leadership roles should take coursework to start developing their skills in management, strategic planning, and team building.
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From page 59... ...
Haley said certification for critical care training is really a turf issue. Surgeons in the room probably have a different perspective, but there are critical care fellowship training programs that emergency physicians have completed, but they are still not allowed to be board certified in critical care.
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From page 60... ...
You guys treat critically ill patients every day. What you need is a very specialized curriculum and fellowship training program that focuses on topics like obstetrical emergencies, neonatal, children, cardiac, and renal," Fildes said.
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