You asked why the Public Health Department has stopped approving emergency medical technician-intermediate (EMT-I) training courses and what its plans are for this certification category.

The Department of Public Health (DPH) is planning to phase out the EMT-I certification category over the next two to three years. While DPH has not completely stopped approving EMT-I training courses, no training providers or regional EMT councils are currently asking it to do so. DPH officials state that they would approve appropriate courses if requested.

DPH is just beginning to plan how the phase-out will be implemented. It has no plans to eliminate the EMT-I certificate at this time, so any current certificate holder would be able to renew a certificate if he or she met the renewal requirements. These include taking an EMT-Basic (EMT-B) refresher course and continuing medical education coursework offered by their sponsoring hospital.

DPH based its decision on (1) changes the U. S. Department of Transportation (DOT) recently made in its EMT-I curriculum and (2) the limited differences in scope of practice between the EMT-I and EMT-B certification levels. U. S. DOT revised its EMT-I national standard curriculum in 1998, raising the basic coursework required from 100 to 600 hours, plus additional modules for particular practice areas as determined by the DPH commissioner in consultation with medical directors and advisory board councils. DPH regulations require all training courses to follow the latest DOT curriculum for EMT certification. According to DPH officials, the principal difference between the scope of practice for EMT-Is and EMT-Bs is that the former can start intravenous (IV) treatment. But they report that some medical directors may have allowed EMT-Is to provide services beyond their lawful scope of practice. While the statutes allow them to do this for paramedics, they do not permit this kind of practice enhancement for EMT-Is.

The 600 hours of new coursework would, DPH determined, train EMT-Is in areas in which they could not subsequently practice under that certificate's current scope of practice. DPH believed the cost of the increased coursework, which the student bears, and the time commitment it required were not justified given these practice restrictions. These factors could also reduce the number of people who became volunteer EMT-Is. Fewer volunteers, in turn, could affect recruitment and retention, particularly in rural areas. But, DPH officials state, the overall number of providers would not be affected because the EMT-Is are also EMT-B’s.

A DPH government relations specialist, said that the EMT-I issue has been discussed in the emergency medical services (EMS) community for several years. In 2002, DPH convened a task force of volunteer EMS providers, emergency physicians, DPH staff, and EMT educators to develop a proposal to present to the EMS Advisory Board and DPH commissioner. In July 2002, the task force voted to eliminate the EMT-I certificate and create a new provider level-EMT-Enhanced, which would require about 120 hours of training beyond the EMT-B level. The report was presented to the EMS Advisory Board in July 2002. The board discussed it in October 2002 and most recently in November 2003. The Connecticut EMS Medical Advisory Committee (composed of emergency medical directors) adopted a letter supporting the task force report in November and sent it to the DPH commissioner.

This new EMT-Enhanced (EMT-E) level, the task force stated, would "allow volunteers to continue to serve EMS without an undo [sic] financial burden and without unrealistic time requirements for a volunteer provider. " The task force called for developing a statewide EMT-E curriculum based on select modules from the DOT's EMT-I curriculum, while allowing medical directors to add components (such as IV starts) to accommodate local needs.

The task force recognized that its recommendation would require (1) changing statutes and regulations to recognize the new EMT level, (2) developing a curriculum and training instructors and medical directors, and (3) designing and validating a new certification exam. It envisioned a two-year transition period to accomplish these tasks, during which people with EMT-I certificates could take approximately 50 hours of training to be recertified at the EMT-E level.

DPH Commissioner Galvin is in the process of soliciting ideas and information on this issue from local providers. Galvin has stated that any decision on EMT-I certification will be made based on clinical efficacy, that is, what is best for consumers.

SS: ro