Signature Approaches: Considerations in Credentialing EMS Providers John M Gallagher, MD, FACEP EMS System Medical Director Wichita/Sedgwick County Kansas Eagles 2017

Conflicts: Disclosures: None but looking Chair of the NAEMSP Standards and Practice Committee

If I picked a name at random from your provider roster… …would you stake your career on their performance abilities?

National EMS Scope of Practice:

National EMS Scope of Practice: “...where all the four elements overlap, represents skills and roles for which an individual has been educated, certified, licensed by a State, and credentialed.” “This is the only acceptable region of performance, as it entails four overlapping and mutually dependent levels of public protection: education, certification, licensure, and credentialing.”

National EMS Scope of Practice: “...where all the four elements overlap, represents skills and roles for which an individual has been educated, certified, licensed by a State, and credentialed.” “This is the only acceptable region of performance, as it entails four overlapping and mutually dependent levels of public protection: education, certification, licensure, and credentialing.”

The First Three Domains

Entry level competence is achieved through accredited education programs

National certification = attestation to entry level competence of knowledge, skills, and abilities State licensure = the privilege to practice in the specific profession

However, these processes do not ensure readiness to work at a specific organization

Credentialing (The Fourth Domain)

Credentialing is attestation by an organization’s EMS physician medical director that the EMS provider possesses required competencies Both initial and ongoing assessments are important components

Credentialing at a minimum involves: Cognitive knowledge Mature, responsible affective ability Psychomotor skills Integration of the above in critical thinking towards application of clinical care

Design

Fair, consistent, objective Feedback Remediation Additional attempt(s) if and when reasonable Continuous review… ...adaptive Identify systemic knowledge or skill gaps in an organization

The medical director may choose to: Establish requirements apart from governmentally-regulated EMS scopes of practice…that may or may not be more restrictive Establish different competencies for initial vs continued credentialing (“re-credentialing”)

Credentials may be granted for differing lengths of time…however...

Credentials may be granted for differing lengths of time…however... “The public is best served when re-verification...occurs no less frequently than every two years.”

Credentialing substantively helps to promote the practice of EMS medicine on par with the legitimacy that hospital medical staff credentialing promotes the practice of hospital-based medicine.

A quick aside: The four domains for clinical practice…

A quick aside: The four domains for clinical practice… Domain: Physician: EMS: Accredited Education LCME/ACGME & AMA PRA Cat 1 CoAEMSP/CAAHEP & CAPCE Certification ABEM NREMT Licensure Medical License State license/certificate Local Oversight Hospital Privileges Medical Director Credentialing

Involvement

Credentialing is expected to occur in all organizations that provide emergency medical services. Governmental (including fire-based) Non-governmental (including hospital-based) Privately-owned Volunteer-based All others that provide EMS by ground air or otherwise

Sound familiar to anyone??? Credentialing is expected to occur in all organizations that provide emergency medical services. Governmental (including fire-based) Non-governmental (including hospital-based) Privately-owned Volunteer-based All others that provide EMS by ground air or otherwise

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304 Governmental (including fire-based) Non-governmental (including hospital-based) Privately-owned Volunteer-based All others that provide EMS by ground air or otherwise

Final Bullet:

“The public is best served when EMS providers receive externally accredited education, are nationally certified, state or provincial licensed, and when credentialed by the local EMS physician medical director.”

What might this look like?

What might this look like? Well...     "If you've seen one EMS system..."

What might this look like? Matched to the service or system: Performed directly by the Medical Director? Performed through delegated staff? Who can be delegated? Staff under the Medical Director? Uncredentialled supervisors? Supervisors with lower credentialing?

What might this look like? Cognitive knowledge: Written test? Home grown? Purchased sitting? Subscription based (intact exam vs question bank)? Protocol test?

What might this look like? Psychomotor skills Classroom (skills fair)? Simulation Center? Direct observation in the field? Logs?, charting databases?

What might this look like? Integration of critical thinking in the application of EMS Medicine: Case reviews? Simulation Center? M&M?

Take home points…

Take home points… Credentialing has been given importance on par with initial education, certification, and licensure. We now have defined best practices and expectations

Take home points… Occur not less frequently than every 2 years All types of services and organizations need to credential under the medical director Needs to include assessment of cognitive knowledge, affective abilities, psychomotor skills, and critical thinking

Take home points… This is in line with our peers throughout the healthcare industry and promotes the movement towards being accepted as a medical sub-specialty. 

John M Gallagher, MD, FACEP Emergency and EMS Physician Questions? John M Gallagher, MD, FACEP Emergency and EMS Physician JGallagherEMS@Gmail.com