It is well known that the Boston location is often far ahead of the curve when it comes to the level of available health care and emergency medicine. As a part of the emergency response in the state, I have been able to see the exposed side of the requirements and process of becoming a first responder EMT, and have had contacts with other state EMTs. Disucssing with other EMTs has shown the differences in expectations in areas across the country and exposed the underlying causes. Firstly, Massachusetts EMT are required to pass a vigurous state practical exam that include five basic skills: splinting, long-board, medical, trauma, and KED. Next, all Maschusetts EMTs have to be nationally certified by a 80-120 question exam that can take up to four hours to complete. These two hurdles combined yield a strong professional and well training EMT fully capable of fullfilling their duty and following the protocol. While other states' EMTs are not lacking in these skills, it's a more facilitated process elsewhere to obtain the same certifications for the job. Most of the other states do not require the national certification. The reason behind this is the educational opportunity. If the national exams were required for other states, a significant amount of the emergency medicine working force would not be able to work because they often cannot pass the test. This is combined with the fact that most state protocols are much more limited than the enforced national protocol, giving EMTs less responsibility and fewer abilities on-shift. In Massachusetts however it is true that the national protocol is the limiting factor in what EMTs can perform, with the state protocol giving many abilities on the job. This is all due to the opportunity for advanced EMT education in our state in comparison to that available in other states.
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