
[Federal Register Volume 88, Number 222 (Monday, November 20, 2023)]
[Notices]
[Pages 80810-80812]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-25551]


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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), 
Department of Transportation (DOT).

ACTION: Reopening of comment period.

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SUMMARY: NHTSA published a request for information on October 13, 2023, 
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. Due to the limited comments 
received and some informal feedback indicating that the initial comment 
period was too short, NHTSA is announcing the reopening of the comment 
period for the RFI in order to solicit additional comments and request 
responses to specific questions provided in the document. The comment 
period for the RFI was originally scheduled to end on October 31, 2023. 
It will now be reopened and will end on March 31, 2024.

DATES: The comment period for the RFI published on October 13, 2023 at 
88 FR 71081 is reopened and extended to March 31, 2024.

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].

ADDRESSES: Comments must be submitted by one of the following methods:
     Federal eRulemaking Portal: go to http://www.regulations.gov. Follow the online instructions for submitting 
comments.
     Mail: Docket Management Facility, M-30, U.S. Department of 
Transportation, West Building, Ground Floor, Rm. W12-140, 1200 New 
Jersey Avenue SE, Washington, DC 20590.
     Hand Delivery or Courier: West Building Ground Floor, Room 
W12-140, 1200 New Jersey Avenue SE, between 9 a.m. and 5 p.m. Eastern 
Time, Monday through Friday, except Federal holidays. To be sure 
someone is there to help you, please call (202) 366-9322 before coming.
    Regardless of how you submit your comments, you must include the 
docket number identified in the heading of this document.
    Note that all comments received, including any personal information 
provided, will be posted without change to http://www.regulations.gov. 
Please see the ``Privacy Act'' heading below.
    You may call the Docket Management Facility at (202) 366-9322. For 
access to the docket to read background documents or comments received, 
go to http://www.regulations.gov or the street address listed above. We 
will continue to file relevant information in the docket as it becomes 
available. To be sure someone is there to help you, please call (202) 
366-9322 before coming. We will continue to file relevant information 
in the Docket as it becomes available.
    Privacy Act: In accordance with 5 U.S.C. 553(c), DOT solicits 
comments from the public to inform its decision-making process. DOT 
posts these comments, without edit, including any personal information 
the commenter provides, to http://www.regulations.gov, as described in 
the system of records notice (DOT/ALL-14 FDMS), which can be reviewed 
at https://www.transportation.gov/privacy. Anyone is able to search the 
electronic form of all comments received into any of our dockets by the 
name of the individual submitting the comment (or signing the comment, 
if submitted on behalf of an association, business, labor union, etc.). 
You may review DOT's complete Privacy Act Statement in the Federal 
Register published on April 11, 2000 (65 FR 19477-78).

SUPPLEMENTARY INFORMATION: On October 13, 2023, NHTSA published a RFI 
to obtain public comments to inform EMS Education Agenda 2050, and 
request responses to specific questions provided in this document. For 
convenience purposes, NHTSA is republishing introductory information, 
background materials and questions from its RFI in this notice.

I. Introductory Information

    In 2012, the National EMS Advisory Council (NEMSAC) convened a 
national roundtable meeting on 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

[[Page 80811]]

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.

II. Background

    NHTSA, in partnership with Health Resources and Services 
Administration, 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.

III. 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.

[[Page 80812]]

    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, 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. 2023-25551 Filed 11-17-23; 8:45 am]
BILLING CODE 4910-59-P


