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

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

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

4. National EMS Scope of Practice:

7. 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.”

8. 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.”

9. The First Three Domains

10. Entry level competence is achieved through accredited education programs

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

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

13. Credentialing
(The Fourth Domain)

14. 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

15. 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

16. Design

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

18. 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”)

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

20. 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.”

21. 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.

22. A quick aside:
The four domains for clinical practice…

23. 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

24. Involvement

25. 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

26. 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

28. 304

29. 304 Governmental (including fire-based)
Non-governmental (including hospital-based)
Privately-owned
Volunteer-based
All others that provide EMS by ground air or otherwise

30. Final Bullet:

31. “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.”

32. What might this look like?

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

34. 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?

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

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

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

38. Take home points…

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

40. 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

41. 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. 

42. John M Gallagher, MD, FACEP Emergency and EMS Physician
Questions?
John M Gallagher, MD, FACEP Emergency and EMS Physician