Competencies and Components

A couple months ago I recieved the following letter:

Dear Mr. Canning,

The National Registry of EMTs is forming a committee to help define the essential competencies of paramedic practice. This committee will consist of paramedics from around the country who will participate in a focus group lead by faculty members from The Ohio State University Center on Education and Training for Employment. You have been nominated for this committee by ——-.

The meeting will be held in Columbus, OH on July 11-12, 2006. The National Registry will cover all reasonable and customary travel expenses for your participation. There will be no pre-meeting preparation, and minimal post meeting follow-up. We are primarily interested in your experiences as a paramedic and what you feel are the essential components of your job.

If you are interested and able to participate in this important project, please forward me a copy of your current resume and/or a brief summary of your background. If you are selected, I forward more detailed information and instructions on how to make your travel arrangements. I hope you are interested, and I am looking forward to the opportunity to work together.


Gregg S. Margolis, Ph.D., NREMT-P
Associate Director
National Registry of EMTs

Well, anyway I was selected and am going. I’m not exactly certain what they mean by competencies and components(I’m guessing it has something to do with the scope of practice issue), but I am ready to add my voice.

In addition to the basic stuff, I have three things I think all paramedics should be trained in and should be using as part of their practice.

1) Pain Management
2) Capnography
3) Research Training

I’m not leaving until Monday, and I will give you all a report on how it goes, but in the mean time if anyone has any ideas, send me your comments.

What do you feel are the essential components of your job?


  • SM says:

    You hit my biggest one right on the head with research training.My agency is currently weighing the evidence surrounding the efficacy of tracheal intubation and whether or not it should continue as a routine practice. Most Paramedics in our system have fallen in to two camps: those who have reviewed the evidence and have realized that it’s, at the very least, worth discussing… and those who view it as something they’re entitled to do, regardless of the fact that we’re a system of 38K calls/years and it’s only performed < 290 times per year (that's 1.1 intubation per paramedic per year).Too many people in our industry do things just because they always have (the fact that many of them tend to be supervisors and managers is a different thread). Showing the new generation of paramedics how to find out WHY we do what we do will, in my opinion, help EMS agencies to become more evidence based and less tradition-based.

  • Anonymous says:

    Hey Peter,Ya mon ya had a gawd time didga…have a good time with the NREMT Folks and continue with your good work. Ya know I am YOUR biggest fan and we should hit Black-eyed Sally’s when ya get back.-Whammo

  • Anonymous says:

    Ditto on the research. Paramedics should understand how to find decent peer-reviewed research, understand how to read and interpret research, and be informed about how research is actually conducted.A good example of the failings of research on pre-hospital care is the amiodarone vs. lidocaine debate, which really isn’t much of a debate except in prehospital care:Grizzled street medic:I don’t care what AHA says. I’m not using amiodarone. It’s never worked for me. AHA is a bunch of fools that never have been in an ambulance. They’re academics and nothing more than academics. They don’t see what we see.–Meanwhile, there’s nothing in current research from Circulation to the NEJM that supports this claim. Everything says people that get amiodarone have a MUCH better discharge rate from the hospital than those getting lido.Here’s a medic I work with:I don’t care about the new ACLS protocols. Are you telling me that I should do 2 min of CPR before I even do anything? That’s stupid. I’m not going to sit there and do CPR. I’m going to defib. Some asshole at AHA just needs to justify his job, and the only way he can do this is by making all sorts of BS changes to the protocols. That’s the only reason why this new crap comes out every five years.–It really pisses me off since Best Practices change over time. People see changing CPR and ACLS and take it personally. These are research supported things that are probably the best researched interventions in all of pre-hospital care. I come from a academic based field and got into preshospital care as a different career. It’s just plain shocking how little street medics care about best practices and research results. They just don’t read it, and when they do, they think of the one example where a research-supported intervention failed them, forgetting all the times their early 1990s thinking didn’t.I could go on and on — why we use morphine instead of fentanyl for pain relief outside of an AMI. Why it’s henious to be aggressive in pain relief. (Another quote from a medic: “I want my patients to be in pain. That way I know they’re still present. I can take it from a 10 to a 2, but I don’t want it less than a 6.”) I hope he never is my medic.–But one of the biggest things other than understanding research is some empathy and compassion for mental disorders. Medics HATE mental disorders. They’re just as legit as any medical disorder, since all medical disorders ultimately manifest in the mind. Pain for instance is an exclusively mind-based thing. No brain, no pain. Medics mis-handle eating disorders on a routine basis, as well as psych patients. So many of the people I haul are on a huge list of anti-psychotics, anti depressants, or benzos for PTSD, depression, anxiety, etc… it would be akin to never discussing the basics of beta blockers and ace inhibitors and accusing people with chronic hypertension as lazy slobs who don’t deserve humanity.Humility and compassion aren’t part of the paramedic curriculum, and without these two traits there’s nothing that treats the whole person.I like your site specifically I enjoy learning the best practices and take a good deal of my own time to find out why things change, and how I can be better. It’s about patient survival, not just about getting a save on the board — discharge from the hospital be damned.

  • Aucklandir says:

    Hey I love your site. What a great opportunity for you to attend this seminar you have been invited to!I think the top competencies are:1) Empathy2) Excellent verbal communication skills3) Good practical & problem solving skills4) Ability to remain calm

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