The scope of practice would create a national standard for emergency service providers, similar to the scope of practice for registered nurses and other medical professions. The goal is to guarantee highly trained workers to provide consistent emergency medical services across the nation.

The standards also would make it easier for EMTs to move from one state to another and for emergency medical service providers to adopt new technology.

Today was the deadline for to receive comments in the mail, according to Dan Manz, the principal investigator for the administrative group in charge of putting together the draft. Comments aren't being accepted by e-mail or by telephone.

The comments he's received show the scope's first draft has generated quite a bit of interest.

"Sitting here right now, as I survey the pile, it's about a foot thick," Manz said.

He figured the comments numbered in the thousands.

Manz said the document doesn't actually propose doubling the training hours. What is does is add more skills to the EMT-basic level. And that, he concedes, "may result in a training course that would be long enough that it would be a deal breaker for folks in rural areas."

Manz said he's also received a lot of comments about the document's proposal to drop the EMT-intermediate level, leaving just the EMT-basic and paramedic.

Another look

The comments will be compiled and included in further discussion regarding the EMS scope of practice.

"The task force gets together again in March to create a second draft, or to refine the first draft," Manz said.

When he's not reading people's comments on the draft EMS Scope of Practice, Manz is EMS director for the Vermont Department of Public Health. He's also a volunteer EMT-intermediate himself.

North Dakotans sent in many replies as they are concerned that the document, as it's currently written, would double the training hours required to become an "EMT basic." North Dakota, as other rural states, relies on volunteers to staff ambulance services. Many fear that the extra training hours will deter people from volunteering.

He said he understands the anxiety people in rural states such as North Dakota are feeling about the draft proposal, because Vermont ambulance services are made up of 70 percent volunteers, too.

But he said the current document is just a starting point and, even when it's finished, it won't include the training requirements.

Once they decide what it is they want the emergency service providers to be able to do, then they can decide what training will be required.

A national review in June could produce yet another version of the scope of practice. The final version will be done in September.

The scope of practice document is part of a bigger project called the EMS Education Agenda for the Future.

"This thing isn't going to affect you for years. We are a long, long ways away from having this system in place or to start feeling the effects of implementation," Manz said.

The result

Once the EMS scope of practice document is finished, it may still be up to individual states to decide what skills they want their emergency providers to be able to perform, Manz said.

"States have to set a scope of practice for nurses," he said. "Do states deviate from that mode? Beats me, but I would guess that some probably do."

The hope is that the state's rules will parallel the national model in an effort to elevate the professionalism and safety of emergency services throughout the nation.

A scope of practice also would make it easier for emergency medical providers to move from one state to another.

"It's very easy for my wife as an RN to move from Vermont to North Dakota," he said. "We are nowhere near that in EMS. And part of that problem is that we don't have as clear a benchmark reference for how these people were prepared and tested."

The scope of practice also would come in handy when new technology is introduced.

Under the current system, when a new piece of equipment comes out, each state has to wrestle with the decision of whether or not to use it.

"We don't have an overarching framework where we say EMTs can use airways of a certain type and, if the airway has these kinds of attributes, it could be used within an EMT basic's scope of practice."