Field Internship Requirement for EMT-I Original and EMT-P Original Courses

Bureau of EMS Policy Statement
Policy Statement #89-11
Date05/31/89
SubjectField Internship Requirement for EMT-I Original and EMT-P Original Courses
Supercedes/Updates85-7

This policy is intended to describe the field internship requirement. It is also designed to issue notice to ALS sponsors offering EMT-Intermediate (EMT-I) or EMT-Paramedic (EMT-P) courses which begin after January 1, 1990, that students will not be eligible to take the State certifying examination until they have completed all the course requirements including: didactic sessions, skill labs, clinical in-hospital experience and the field internship experience.

Actually, both the EMT-P, which has been in effect since September 1988, and the EMT-I which becomes effective September 1989, require an internship as part of the course prior to completion of the State certifying examination. This policy statement should give ALS course sponsors who are presently providing internships after the certifying examination ample time to reorganize their course schedules so that the internship will be done before the State exam.

What is the "Field Internship Experience?"

The field internship is a period of supervised experience on a prehospital ALS unit. It provides the student with increasing patient care responsibilities which proceed from observation to working as a member of a team. It is the responsibility of the course Certified Instructor Coordinator (CIC) and the Course Medical Director to prepare the behavioral objectives for the internship program. Students should be familiar with these objectives before the internship begins so the students know exactly what will be expected of them during this phase of their training. The internship generally begins after the students have mastered the skills of the course in the classroom and clinical setting and comes before the final practical skills examination. There should be a provision for physician evaluation of student progress in acquiring the desired skills developed through this experience.

The prehospital ALS unit must have communications with on-line Physician Medical Control. The student must be under the direct supervision and observation of a physician, or preceptor who is certified at the level he/she is supervising or a higher level and has been approved by the Course Medical Director to evaluate the performance of the student during this field internship.

The initial position of the student on the prehospital care team should be that of an observer. After progressing through recordkeeping and participation in actual patient care, the student should eventually function as the patient care team leader. However, the student should not be placed in the position of being an essential part of the patient care team. Since the student has not yet been certified by the NYS Department of Health as an EMT-I or EMT-P in this phase of his/her training program, he/she is not authorized to provide any ALS patient care in the absence of the specified preceptor that the Course Medical Director has named and authorized to act in a supervisory capacity during the internship.

Occasionally, an Advanced EMT student's basic EMT card has expired during the Advanced course. Because the student will be applying his/her skills, under supervision, on patients in both the clinical experience and internship experience phases of the course, it is essential that the student continue to hold a current EMT certification throughout the entire Advanced training course. For this reason admission requirements for all Original Advanced EMT courses must include a valid EMT certification that extends throughout the entire Advanced EMT training course.

EMT-I Field Internship Requirements

The EMT-I student needs to see a sufficient number of patients requiring ALS procedures to ensure appropriate patient care exposure. It is not the intention of the State EMS Program to define the term sufficient. At this time the specific quality, aside from the list of skills listed below, and quantity of exposure will rest in the hands of the Course Medical Director in concert with any existing Regional Medical Control requirements that specifically address the field internship. Since the Course Medical Director is ultimately responsible for the quality of the student's education, he/she must define the number of procedures or calls each student must experience during the internship. Before successful field internship completion, the EMT-I student must exhibit competence in the following skills while caring for a patient(s):

  1. Patient assessment.
  2. Venipuncture and administration of intravenous fluids.
  3. Endotracheal intubation.
  4. Esophageal obturator airway.
  5. Defibrillation
  6. Medical communications.

EMT-P Field Internship Requirements

The EMT-P student needs to see a sufficient number of patients requiring ALS procedures to ensure appropriate patient care exposure. It is not the intention of the State EMS Program to define the term sufficient. At this time the specific quality, aside from the list of skills listed below, and quantity of exposure will rest in the hands of the Course Medical Director in concert with any existing Regional Medical Control requirements that specifically address the field internship. Since the Course Medical Director is ultimately responsible for the quality of the student's education, he/she must define the number of procedures or calls each student must experience during the internship. Before successful field internship completion, the EMT-P student must exhibit competence in the following skills while caring for a patient(s):

  1. Patient assessment.
  2. Venipuncture and administration of intravenous fluids and medications to adult and pediatric patients.
  3. Subcutaneous and intramuscular injections.
  4. Endotracheal intubation.
  5. Defibrillation
  6. ECG interpretation.
  7. Medical communications.

Because these skills, with the exception of radio medical communications, are going to be learned in the classroom and hospital environment, it is important that the Advanced EMT student learn how to handle the peculiarities of these skills which the field environment brings. Starting an IV in a wrecked automobile in the dark with rain pouring down is much more difficult than starting it in the clean environment of an operating room or an emergency department. It is the same skill, but more difficult in one area than another.

Although completion of a field internship is not a specific requirement for course completion, at this time, in the Original EMT-Critical Care (EMT-CC) course, it will most likely be a requirement upon the next revision of the curriculum. Current EMT-CC training programs are encouraged to provide a field internship experience for their students at this time.

Issued by: Robert Elling, Associate Director for Educational Services

Authorized by: Michael Gilbertson, Director