[Federal Register Volume 88, Number 197 (Friday, October 13, 2023)]
[Notices]
[Pages 71081-71083]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-22625]


-----------------------------------------------------------------------

DEPARTMENT OF TRANSPORTATION

National Highway Traffic Safety Administration

[DOT-NHTSA-2023-0037]


Emergency Medical Services Education Agenda 2050: Request for 
Information

AGENCY: National Highway Traffic Safety Administration (NHTSA), U.S. 
Department of Transportation (DOT).

ACTION: Notice of Request for Information (RFI).

-----------------------------------------------------------------------

SUMMARY: This notice announces a RFI. The NHTSA Office of Emergency 
Medical Services (EMS) is seeking comments from all sources (public, 
private, government, academic, professional, public interest groups, 
and other interested parties) on the planned re-envisioning of the 2000 
EMS Education Agenda for the Future: A Systems Approach. The purpose of 
this document is to solicit comments on EMS Education Agenda 2050, and 
request responses to specific questions provided in this document. This 
is neither a request for proposals nor an invitation for bids.

DATES: It is requested that comments on this announcement be submitted 
by October 31, 2023.

FOR FURTHER INFORMATION CONTACT: Clary Mole, EMS Specialist, National 
Highway Traffic Safety Administration, U.S. Department of 
Transportation is available by phone at (202) 868-3275 or by email at 
[email protected].

SUPPLEMENTARY INFORMATION: In 2012, the National EMS Advisory Council 
(NEMSAC) convened a national roundtable meeting on the EMS Education 
Agenda for the Future: A Systems Approach. In a 2014 report on these 
proceedings, NEMSAC advised that stakeholders at the State and local 
level had just begun to experience the full impact of the evolution 
toward a national integrated system of education for EMS personnel. 
While stakeholders were reticent to move forward with a new education 
agenda, they did provide feedback about themes that should be 
considered in the future publication. From the feedback collected at 
the meeting, NEMSAC developed recommendations to be used in the 
eventual re-envision of the agenda for EMS. These recommendations are 
summarized below:
     Educational content should retain the flexibility accorded 
by the National EMS Education standards, but programs should use 
nationally recognized evidence-based guidelines to drive local 
curriculum development.
     The National EMS Information System data, evidence-based 
research, and practice analyses should be sourced in developing 
evidence-based guidelines and curriculum.
     Mobile Integrated Healthcare has received considerable 
attention from the EMS Community. This and other alternative community-
based healthcare delivery models (of the future) should evoke an 
expanded foundational knowledge and critical thinking capabilities that 
will poise future EMS practitioners to be able to evolve with the 
changing healthcare system or rapidly adjust to emerging healthcare 
crises.
     EMS educators should begin a career in academia with 
expertise in adult learning, educational theory, curriculum 
development, and competency evaluation but also possess experiential 
knowledge in evidence-based care.
    In the 10 years since NEMSAC's roundtable meeting, the national EMS 
education system continued to evolve--especially during the COVID-19 
pandemic. In late 2021, the Federal Interagency Committee on EMS 
(FICEMS) began sponsoring listening sessions to inform a consensus-
driven, national report entitled, FICEMS: EMS and 911 COVID-19 Response 
White Paper. This publication cited challenges and solutions collected 
during stakeholder listening sessions for the EMS education system. 
Among the challenges, EMS education stakeholders cited scarcity (in 
some cases deficits) in resources for education, rigidity of curriculum 
delivery modalities, the increased employer demands on students, and 
inconsistent or delayed responses to the needs of the national EMS 
education system as major contributors that led to the breakdown in the 
EMS workforce pipeline.
    Prior to the COVID-19 pandemic, NHTSA published EMS Agenda 2050: A 
People-centered Vision for the Future of EMS (Agenda 2050). This 
collaborative project set a vision for a people-centered EMS systems 
that serves every individual in every community across the Nation. 
Later this year, NHTSA and its partners will begin a new project to 
develop EMS Education Agenda 2050. This project will not replace but 
build upon the achievements of the 2000 EMS Education Agenda for the 
Future: A Systems Approach to lead a national conversation around the 
future vision for EMS Education and EMS as a profession.

I. Background

    NHTSA, in partnership with Health Resources and Services 
Administration,

[[Page 71082]]

published EMS Education Agenda for the Future: A Systems Approach 
(Education Agenda) in 2000. This document was founded on the broad 
national EMS education system concepts introduced in the EMS Agenda for 
the Future (1996). The Education Agenda described a consensus vision of 
an EMS education system with a high degree of structure, coordination, 
and interdependence. It proposed a less prescriptive system that 
offered educators flexibility in creating a student-centered learning 
environment and a process for accommodating future advancements in 
technology and medicine. The proposed system maximized efficiency, 
consistency in instructional quality, and entry level graduate 
competency by prescribing a high degree of structure, coordination, and 
interdependence. To achieve this vision, the education system of the 
future centered on five integrated primary components:

 National EMS Core Content
 National EMS Scope of Practice Model
 National EMS Education Standards
 National EMS Education Program Accreditation
 National EMS Certification

    After the Education Agenda was published, stakeholders began 
implementing their respective integrated system components. Almost 25 
years later, the national EMS education system has successfully evolved 
into one that exemplifies both consistency and flexibility. System 
interdependencies have helped to avoid duplication of effort in 
curriculum and education program development, evaluating the minimum 
competencies of graduates, certification and licensing processes, and 
facilitation of practitioner reciprocity.
    In 2020, the EMS education system interdependencies modernized by 
the Education Agenda were tested. Challenges presented by the COVID-19 
pandemic forced a variety of adaptations. Traditional education 
programs reported a lag in students' capabilities of achieving the 
programmatic competencies requirements for graduation. The lag was 
attributed to a variety of causes including a focus on pandemic 
response activities over training and education, employer demands on 
working students, and the rigidity of in-person, classroom-based 
education delivery models. After the majority of programs adjusted to 
the challenges, lags in graduation were cured, and students achieved 
programmatic competencies at rates similar to those pre-pandemic.
    The response to the pandemic did not impact education programs 
only. The impact to EMS agency daily operations was felt as well. 
During the COVID pandemic, agencies experienced increases in EMS 
activation and response rates which created additional stressors for 
student EMS practitioners already working in a high stress job 
environment but also enrolled in an EMS education program. These 
stressors were a major contributor to a migration of practitioners away 
from the EMS workforce. Agencies and organizational stakeholders 
asserted that it could be education program graduation requirements 
causing breakdown in the workforce pipeline; however, there were no 
observed decreases in graduation or certification testing rates. These 
observations prompt two questions: If graduation and certification 
testing rates have remained unchanged, why have agencies reported 
recruitment and retention issues? If graduates are not entering the EMS 
workforce, where are they finding jobs?
    With agencies experiencing increased demand and a deficiency in 
qualified EMS practitioners to respond to it, service delivery models 
had to evolve. To bridge the gap in community-based care resources, 
community paramedicine and mobile integrated healthcare (CP-MIH) 
service delivery models increased in prevalence, and improvised 
training programs were used to close new job-specific competency gaps 
among existing EMS practitioners and individuals in training.
    Other themes brought to the forefront during the pandemic include 
addressing healthcare disparities; the use of EMS data as a tool for 
surveillance and nationwide quality of care improvements; and a greater 
value to having an EMS workforce that is not only equitable, inclusive, 
and accessible, but as diverse as the community it serves. These 
themes, evolving service delivery models, and the subsequent evolution 
of competencies needed by practitioners suggest that it is time for 
NHTSA to gather our partners to begin a new conversation about the 
future of EMS Education and EMS as a profession in the United States.

II. Questions Regarding EMS Education Agenda 2050

    Responses to the following questions are requested to help plan the 
revision of the Education Agenda. Please be as specific as possible and 
as appropriate please provide references.
    1. What are the most critical issues facing EMS education system 
that should be addressed in the revision of the EMS Education Agenda? 
Please provide specific examples.
    2. What progress has been made in implementing the EMS Education 
Agenda since 2000?
    3. How have you used EMS Education Agenda? Please provide specific 
examples.
    4. As an EMS Stakeholder, how might a revised EMS Education Agenda 
be most useful to you?
    5. What significant changes have occurred in the EMS education 
system at the national, Federal, State, and local levels since 2000?
    6. What significant changes will impact the EMS education system in 
the next 25 years?
    7. How might the revised EMS Education Agenda contribute to 
enhanced EMS for children?
    8. How might the revised EMS Education Agenda support and/or 
promote data-driven and evidence-based improvements in EMS education 
systems and EMS practitioner practice?
    9. How could the revised EMS Education Agenda enhance collaboration 
among EMS systems, health care providers and facilities, public safety 
answering points, public health, public safety, emergency management, 
insurers, and others?
    10. How could the revised EMS Education Agenda be used to promote 
community sustainability and resilience?
    11. How could the revised EMS Education Agenda contribute to 
improved coordination for disaster response, recovery, preparedness, 
and mitigation?
    12. How could the revised EMS Education Agenda enhance the exchange 
of evidence-based practices between national, Federal (and military), 
State, and local levels?
    13. How could the revised EMS Education Agenda support the seamless 
and unimpeded transfer of military EMS personnel to roles as civilian 
EMS providers?
    14. How could the revised EMS Education Agenda support interstate 
credentialing of EMS personnel?
    15. How could the revised EMS Education Agenda support improved 
patient outcomes in rural and frontier communities?
    16. How could the revised EMS Education Agenda lead to improved EMS 
systems in tribal communities?
    17. How could the revised EMS Education Agenda promote a culture of 
safety among EMS personnel, agencies, and organizations?
    18. Are there additional EMS attributes that should be included in 
the revised EMS Education Agenda? If so,

[[Page 71083]]

please provide an explanation for why these additional EMS attributes 
should be included.
    19. Are there EMS attributes in the 2000 EMS Education Agenda that 
should be eliminated from the revised edition? If so, please provide an 
explanation for why these EMS attributes should be eliminated.
    20. What are your suggestions for the process that should be used 
in revising the EMS Education Agenda?
    21. What specific agencies/organizations/entities are essential to 
involve, in a revision of the EMS Education Agenda?
    22. Do you have any additional comments regarding the revision of 
the EMS Education Agenda?

(Authority: 23 U.S.C. 403(b)(1)(A)(iv); 49 CFR 1.95; 501.8)

    Issued in Washington, DC.
Nanda Narayanan Srinivasan,
Associate Administrator, Research and Program Development.
[FR Doc. 2023-22625 Filed 10-12-23; 8:45 am]
BILLING CODE 4910-59-P