[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]

HELPING VETERANS WITH EMERGENCY MEDICAL TRAINING TRANSITION TO CIVILIAN
SERVICE

=======================================================================

HEARING

BEFORE THE

SUBCOMMITTEE ON HEALTH

OF THE

COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES

ONE HUNDRED TWELFTH CONGRESS

SECOND SESSION

__________

JULY 11, 2012

__________

Serial No. 112-162

Printed for the use of the Committee on Energy and Commerce

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COMMITTEE ON ENERGY AND COMMERCE

FRED UPTON, Michigan
Chairman

JOE BARTON, Texas HENRY A. WAXMAN, California
Chairman Emeritus Ranking Member
CLIFF STEARNS, Florida JOHN D. DINGELL, Michigan
ED WHITFIELD, Kentucky Chairman Emeritus
JOHN SHIMKUS, Illinois EDWARD J. MARKEY, Massachusetts
JOSEPH R. PITTS, Pennsylvania EDOLPHUS TOWNS, New York
MARY BONO MACK, California FRANK PALLONE, Jr., New Jersey
GREG WALDEN, Oregon BOBBY L. RUSH, Illinois
LEE TERRY, Nebraska ANNA G. ESHOO, California
MIKE ROGERS, Michigan ELIOT L. ENGEL, New York
SUE WILKINS MYRICK, North Carolina GENE GREEN, Texas
Vice Chairman DIANA DeGETTE, Colorado
JOHN SULLIVAN, Oklahoma LOIS CAPPS, California
TIM MURPHY, Pennsylvania MICHAEL F. DOYLE, Pennsylvania
MICHAEL C. BURGESS, Texas JANICE D. SCHAKOWSKY, Illinois
MARSHA BLACKBURN, Tennessee CHARLES A. GONZALEZ, Texas
BRIAN P. BILBRAY, California TAMMY BALDWIN, Wisconsin
CHARLES F. BASS, New Hampshire MIKE ROSS, Arkansas
PHIL GINGREY, Georgia JIM MATHESON, Utah
STEVE SCALISE, Louisiana G.K. BUTTERFIELD, North Carolina
ROBERT E. LATTA, Ohio JOHN BARROW, Georgia
CATHY McMORRIS RODGERS, Washington DORIS O. MATSUI, California
GREGG HARPER, Mississippi DONNA M. CHRISTENSEN, Virgin
LEONARD LANCE, New Jersey Islands
BILL CASSIDY, Louisiana KATHY CASTOR, Florida
BRETT GUTHRIE, Kentucky JOHN P. SARBANES, Maryland
PETE OLSON, Texas
DAVID B. McKINLEY, West Virginia
CORY GARDNER, Colorado
MIKE POMPEO, Kansas
ADAM KINZINGER, Illinois
H. MORGAN GRIFFITH, Virginia

7_____

Subcommittee on Health

JOSEPH R. PITTS, Pennsylvania
Chairman
MICHAEL C. BURGESS, Texas FRANK PALLONE, Jr., New Jersey
Vice Chairman Ranking Member
ED WHITFIELD, Kentucky JOHN D. DINGELL, Michigan
JOHN SHIMKUS, Illinois EDOLPHUS TOWNS, New York
MIKE ROGERS, Michigan ELIOT L. ENGEL, New York
SUE WILKINS MYRICK, North Carolina LOIS CAPPS, California
TIM MURPHY, Pennsylvania JANICE D. SCHAKOWSKY, Illinois
MARSHA BLACKBURN, Tennessee CHARLES A. GONZALEZ, Texas
PHIL GINGREY, Georgia TAMMY BALDWIN, Wisconsin
ROBERT E. LATTA, Ohio MIKE ROSS, Arkansas
CATHY McMORRIS RODGERS, Washington ANTHONY D. WEINER, New York
LEONARD LANCE, New Jersey JIM MATHESON, Utah
BILL CASSIDY, Louisiana HENRY A. WAXMAN, California (ex
BRETT GUTHRIE, Kentucky officio)
JOE BARTON, Texas
FRED UPTON, Michigan (ex officio)

(ii)

C O N T E N T S

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Page
Hon. Joseph R. Pitts, a Representative in Congress from the
Commonwealth of Pennsylvania, opening statement................ 1
Prepared statement........................................... 3
Hon. Joe Barton, a Representative in Congress from the State of
Texas, opening statement....................................... 4
Hon. Adam Kinzinger, a Representative in Congress from the State
of Illinois, opening statement................................. 4
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 5
Hon. Lois Capps, a Representative in Congress from the State of
California, opening statement.................................. 6
Hon. John D. Dingell, a Representative in Congress from the State
of Michigan, prepared statement................................ 37
Hon. Henry A. Waxman, a Representative in Congress from the State
of California, prepared statement.............................. 42

Witnesses

Ben D. Chlapek, Deputy Chief, Central Jackson County Fire
Protection District, Blue Springs, Missouri, and Chair,
Military Relations Committee, National Association of Emergency
Medical Technicians............................................ 8
Prepared statement........................................... 10
Daniel M. Nichols, Senior Vice President, Victory Media, and
Chief Executive Officer, Victory Tech.......................... 18
Prepared statement........................................... 20

HELPING VETERANS WITH EMERGENCY MEDICAL TRAINING TRANSITION TO CIVILIAN
SERVICE

----------

WEDNESDAY, JULY 11, 2012

House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:16 a.m., in
room 2123, Rayburn House Office Building, Hon. Joseph R. Pitts
(chairman of the subcommittee) presiding.
Members present: Representatives Pitts, Shimkus, Murphy,
Gingrey, Latta, Lance, Cassidy, Guthrie, Barton, Kinzinger,
Pallone, Dingell, Capps, and Schakowsky.
Staff present: Anita Bradley, Senior Policy, Advisor to
Chairman Emeritus; Brenda Destro, Professional Staff Member,
Health; Ryan Long, Chief Counsel, Health; Katie Novaria,
Legislative Clerk; Monica Popp, Professional Staff Member,
Health; Andrew Powaleny, Deputy Press Secretary; Heidi Stirrup,
Health Policy Coordinator; Alli Corr, Democratic Policy
Analyst; Ruth Katz, Democratic Chief Public Health Counsel; and
Anne Morris Reid, Democratic Professional Staff Member.
Mr. Pitts. The subcommittee will come to order. The Chair
will recognize himself for 5 minutes for an opening statement.

OPENING STATEMENT OF HON. JOSEPH R. PITTS, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA

We are here today to discuss H.R. 4124, the Veteran
Emergency Medical Technician Support Act of 2012, which would
give States demonstration grants to study how to better
integrate military medics into civilian EMT jobs.
Emergency response is a crucial component of our health
care system, as EMTs are often the first point of contact in a
crisis situation, and their care can make the difference
between life and death. Emergency response is even more crucial
on the battlefield, where military medics respond to
emergencies and provide care for the soldiers until a physician
or other health professional can take over. These soldiers,
trained as combat medics, become very experienced dealing with
massive trauma injuries and other complex health problems.
It seems that utilizing those with combat medic experience
in our EMT workforce here at home would be good for the
returning soldiers, good for the health care system, and good
for patients. Many areas throughout the U.S. are experiencing a
shortage of EMTs, both paid and volunteers, and military medics
could potentially fill those workforce gaps. However, there are
a number of issues keeping military medics from EMT employment.
Most importantly are State licensing requirements, which can
require duplicative training and education that is likely to be
unnecessary for someone with significant experience. There is a
need to better understand the differences in military medic
training versus traditional EMT training and bridge the gap
between the two to make it easier for our returning soldiers to
find jobs. It is our hope that this bill would allow States to
study this and streamline their EMT requirements for those
returning from the military who have the experience so
desperately needed in many communities.
I look forward to hearing from our witnesses today, and I
would like to thank our witnesses for being here. I look
forward to your testimony, and I now yield to chair emeritus of
the committee, Representative Barton.
[The prepared statement of Mr. Pitts follows:]

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OPENING STATEMENT OF HON. JOE BARTON, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS

Mr. Barton. Thank you, Chairman Pitts, and thank you and
Mr. Pallone for holding this hearing today. Helping veterans
with emergency medical training transition to civilian service,
this is a discussion that is long overdue.
As we all know, our United States military forces have tens
of thousands of veterans who have been trained as medics and
who can make a contribution immediately in most cases in the
private sector if they choose to continue that vocation. Once
their service is concluded, sometimes, though, it is very
difficult for them to find civilian jobs due to a variety of
different State occupational license requirements. It is a fact
that military emergency medical technicians are highly trained
and offer the civilian market a heightened skill set,
particularly when it is related to a trauma situation.
We spend billions of dollars every year in the military to
provide this medical training. We have over 21 million men and
women who have served in the military. Of this number, over 2
million have served since September of 2001. We have a
bipartisan bill that is introduced by Congressman Kinzinger,
Congresswoman Capps, and other members that would help in this
transition between the military and the civilian EMT market.
The bill would incentivize States to initiate under
demonstration programs a method to streamline the requirements
and procedures so that the training and skill set that the
military, the veterans already have can be immediately
recognized. Our veterans should not have to completely redo the
medical training that they have already received in the
military to receive civilian certification. I support the
bipartisan bill, and I support this hearing.
With that, Mr. Chairman, I yield back to you or to any
other member the remaining time that I have.
Mr. Pitts. Mr. Kinzinger.

OPENING STATEMENT OF HON. ADAM KINZINGER, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF ILLINOIS

Mr. Kinzinger. Thank you, Mr. Chairman, and Ranking Member
Pallone, members of the Health subcommittee, and I want to
express my appreciation to you for holding this important
hearing on this, the Veterans Emergency Medical Technician
Support Act of 2012.
I also want to express my gratitude to Ms. Capps for
working with me on this very important piece of legislation.
Our corpsmen, medics, and soldiers receive some of the best
emergency medicine training in the world, and they prove it
every day on the battlefield, both in Iraq and Afghanistan.
Unfortunately, many veteran EMTs are required to take classes
they have already completed in the military to satisfy the
civilian licensure system, needlessly delaying their entry into
the civilian workforce.
This legislation would streamline the process by providing
grants to States so they can make the requirements easier and
streamline it with military EMT training to become certified
civilian EMTs. In doing so, returning veterans will not have to
start over at square one in their training and they can enter
the civilian workforce much sooner.
And just to wrap up, I will say last week's job numbers
highlighted the incredible difficulty that returning veterans
are having in the civilian workforce, so I think this is a very
important first step. Again, I thank the subcommittee for
having the hearing, and I yield back.
Mr. Pitts. The Chair thanks the gentleman.
I now recognize the ranking member, Mr. Pallone, for 5
minutes for an opening statement.

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY

Mr. Pallone. Thank you, Mr. Chairman.
I welcome today's hearing on the Helping Veterans With
Emergency Medical Training to Civilian Service Act.
As we continue working to improve the health quality and
coverage of our Nation, we have a unique opportunity and
responsibility to address two very important issues that are
critical to achieving that goal. First, ensuring that our
Nation's veterans have career opportunities when they come
home, and, second, addressing shortages in a vital sector of
health care service and delivery. I believe this bill is good
health policy. It was good policy when it passed the committee
as part of the America's Affordable Health Choices Act of 2009,
and it is good policy now.
By assisting veterans with military medical training to
meet the requirements for becoming civilian medical
technicians, we help ensure that the brave men and women who
protect our freedom have an opportunity to support themselves
while helping attenuate the shortage of emergency medical
services upon which Americans depend.
Last week we celebrated our Nation's 236th anniversary, and
we remembered the sacrifices of those who served in Iraq and
Afghanistan and elsewhere around the world. Although we
celebrate our independence once a year, it is important to
always remember the remarkable sacrifice and service of our men
and women in uniform to provide the opportunity to make the
U.S. stronger around the world and at home, building an
American future worthy of our veterans' sacrifice, and as part
of keeping our promises to our veterans, the President and
Congress have to focus on taking major steps to help our men
and women in uniform obtain good jobs when they come home.
As we honor their nobility and patriotism, we must also
speak to the stark realities they face. In September, the
unemployment rate for returning Iraq and Afghanistan veterans
was a staggering 11.7 percent, leaving 235,000 veterans
struggling to find jobs after the most severe economic
recession since the depression, and younger returning veterans
ages 18 to 24 are facing an even more difficult challenge, with
more than one in five out of work and looking for a job last
year. So we have an obligation to make sure our veterans have
the necessary tools to navigate this difficult labor market.
At the same time, emergency medical services are a vital
part of the American health care system, and they are critical
to both emergency and nonemergency situations. However, studies
over the past decade have shown that poor recruitment and
retention of qualified professionals may have a detrimental
effect on the health of our communities--this is especially
true in rural areas where access to health care is often
limited or unavailable--and that there is a high turnover and
shortages of qualified emergency medical technicians or EMTs
and paramedics and emergency medical service, both during
normal conditions and following disasters or similar events.
In these fiscally strained times, we must find ways to
adequately address the needs of our communities and our
veterans. We must be efficient, creative, and innovative in our
approaches, and this bill gives us a way to help with their
transition to civilian life. The bill allows the streamlining
of training and certification so that our veterans who have
received military emergency medical training can apply their
skills and talents to communities at home where they are needed
and where they can become an integral part of their community
and economy.
On the battlefield, the military pledges to leave no
soldier behind, and, Mr. Chairman, as a Nation, let it be our
pledge that when they return home, we leave no veteran behind.
I yield back.
Mr. Pitts. Do you want to yield to Ms. Capps?
Mr. Pallone. I think she is going to use Mr. Waxman's time.
Is that OK?
Mr. Pitts. Yes, that is fine. We recognize Ms. Capps for 5
minutes for an opening statement.

OPENING STATEMENT OF HON. LOIS CAPPS, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA

Mrs. Capps. Thank you, Mr. Chairman, and thank you and
Ranking Member Pallone for holding this important hearing
today. I am really excited by the prospect.
The individuals who serve our Nation in uniform do so with
distinction. Our military men and women are trained to perform
at the highest level in a host of jobs. However, there is so
much more to be done to help these men and women and their
families when they return home to translate those skills and
experience into civilian service. The service we need, by the
way. And that disconnect is why we are here today.
Our men and women receive some of the best technical
training in emergency medicine, and they prove their skills on
the battlefield every day. However, when they return home,
experienced military medics are often required to begin at
entry level curricula, as though they were just graduating from
high school, to receive certification for civilian jobs.
Similarly, military medics with civilian credentials often must
let their civilian certifications lapse--this is another
problem--while they are defending our country. Either way, this
keeps our veterans out of the civilian workforce, and it also
withholds valuable medical personnel from our communities.
As a nurse, I know the importance of having qualified and
capable first responders available in our community, and as our
Nation climbs out of this recession, it is so important to
realize that the health care sector has continued to grow with
good-paying jobs often left unfilled and waiting for qualified
providers. That is why we must do all we can to break down the
artificial barriers, and they are very artificial, both in
licensure and resources, that obstruct our military medics from
civilian opportunities.
I am so pleased to be working with my colleagues from both
sides of the aisle to make that happen. I am proud to have
introduced H.R. 3884, the Emergency Medic Transition Act, with
Congressman Todd Young from Indiana to help support our
military medics reach civilian licensure and help the colleges
and technical schools develop appropriate fast track military-
to-community programs. Similar legislation, as my colleague has
said, passed the House in a near unanimous vote in the 111th
Congress.
And I am also pleased to have joined Congressman Adam
Kinzinger to introduce H.R. 4124, the Veteran Emergency Medical
Technician Support Act. Again, this is a straightforward
bipartisan bill which will help States streamline their
certification processes to take military medic training into
account for civilian licensure.
Finally, I wanted to take a second to recognize a former
member, Congresswoman Jane Harman, who spearheaded this issue
in the last Congress. So now I am hopeful we continue to work
together in a bipartisan way and move this important
legislation out of the committee so that we can begin to
actually help these talented professionals join our health care
workforce, improve the health care options in our communities,
actually make our communities and Nation a safer place.
And I yield back.
Mr. Pitts. The Chair thanks the gentlelady.
I would like now to introduce today's witnesses.
Mr. Ben Chlapek is the deputy chief of Central Jackson
County Fire Protection District in Blue Springs, Missouri, and
he represents the National Association of Emergency Medical
Technicians.
Mr. Chlapek, I understand you recently retired from the
U.S. Army after 36 years of service. I think I can speak for
all members in thanking you for your many years of service and
offering our congratulations. We are glad to have you with us
today.
And Mr. Daniel Nichols is senior vice president of Victory
Media, Inc., a disabled veteran-owned business, and CEO of
Victory Tech, a vocational and workforce training institute.
Mr. Nichols is also a Navy Reserve officer and a veteran of
Operation Iraqi Freedom.
Thank you for your service, Mr. Nichols. And we are happy
to have you here with us today as well.

STATEMENTS OF BEN D. CHLAPEK, DEPUTY CHIEF, CENTRAL JACKSON
COUNTY FIRE PROTECTION DISTRICT, BLUE SPRINGS, MISSOURI, AND
CHAIR, MILITARY RELATIONS COMMITTEE, NATIONAL ASSOCIATION OF
EMERGENCY MEDICAL TECHNICIANS; AND DANIEL M. NICHOLS, SENIOR
VICE PRESIDENT, VICTORY MEDIA, AND CHIEF EXECUTIVE OFFICER,
VICTORY TECH

Mr. Pitts. At this time, Mr. Chlapek, your written
testimony will be entered into the record. You are recognized
for 5 minutes to summarize.

STATEMENT OF BEN D. CHLAPEK

Mr. Chlapek. Thank you, Chairman Pitts, Ranking Member
Pallone, and members of the committee. We appreciate this
opportunity to discuss this issue with you to assess veterans
who are getting out of the military and trying to transition
into the civilian EMS world.
Today I represent the National Association of Emergency
Medical Technicians, formed in 1975. The association represents
over 32,000 EMS professionals, first responders, fire
department EMTs and medics, private, industrial, and other
forms of even some of the military EMTs and paramedics.
A smooth transition of our veterans into civilian life
underscores the importance of the hearings and the
responsibilities today in developing policies that honor the
training of our military medics and seamlessly transitioning
our veterans into the workforce and providing valuable military
medical personnel to our communities.
As has been previously stated, our military members and
specifically medics receive some of the best training in the
world and are some of the best there are at trauma care and
other facets of medical care. Currently when military medics
leave the service, many are required, most are required to redo
their medical training, to either renew their license or obtain
a license to practice in a civilian EMS capacity.
A Navy independent duty corpsman, a Navy SEAL medic, an
Army special forces medic, or 18 Delta, and Air Force
pararescue medics receive advanced medical training. Most of
these medics can put external fixation devices on mangled limbs
to restore an anatomical structure so innervation and
circulation is reestablished to save a limb. They can put in
chest tubes. They routinely perform surgical procedures, and
they can even tie--some are even trained in vascular surgery,
so we can tie vessels back together and restore circulation in
the field in austere environments when we have to maintain a
patient for more than 72 hours. These are procedures that are
normally reserved for emergency rooms, operating rooms, and
trauma suites.
Unfortunately, these folks are having to complete an entire
paramedic program over the course of a year-plus to obtain a
civilian paramedic license. These folks should be able to take
a week, at the most, refresher training, maybe brush up on some
geriatric training, and then be able to challenge the practical
and written test, whether it is State or nationally.
Basic medics in the services leave the service and could
easily challenge the EMT test, the basic emergency medical
technician test, both practical and written. The Army and the
Air Force medics in their advanced individual training courses
obtain those licenses, but many aren't renewed or they are
still required if they don't have a current license to go back
through a course, depending on how long they have been expired.
Some States have made adjustments. Texas, Arkansas,
Missouri, Alabama, and Tennessee are just a few who have State
EMS agencies that are willing to take these on an individual
basis or allow medics with a little bit of refresher to
challenge a test and become licensed.
However, right now, for example, Kansas City, Missouri,
fire has 26 paramedic options, and they don't have people
applying for the jobs because there is a shortage. Olathe fire
in Kansas, a southern suburb of Kansas City, has six openings
and as most of the suburban departments require an EMT or
paramedic license to come to work, and streamlining this would
really help our veterans.
National Registry of Emergency Medical Technicians offers
90 days of leeway upon return to work with this, and Bill
Brown, a retired pararescue jumper, was a former executive
director and really helped us with that.
This subcommittee has the potential to help veterans return
to work upon their completion of military duty and reduce
unemployment among veterans. NAMT wholly supports any process
and legislation that helps military medics transition into the
civilian world and use their skills and expertise to make our
communities safer and better. Thank you.
[The prepared statement of Mr. Chlapek follows:]

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Mr. Pitts. The Chair thanks the gentleman.
Mr. Nichols, you are recognized for 5 minutes for an
opening statement.

STATEMENT OF DANIEL M. NICHOLS

Mr. Nichols. Chairman Pitts, Congressman Pallone, members
of the committee, I appreciate the opportunity to testify
before you today. I am Daniel Nichols, and I offer my testimony
to you as an OIF veteran, a member of the Navy Reserve, and one
of the growing number of veteran entrepreneurs who has
dedicated their time and creative efforts to creating jobs and
successful business enterprises that are capable of returning
value and resource back to my military family and to our local
community.
For far too long we have known precisely what the
challenges are in military transition, and as a Nation, we have
been unable to adequately address the perceived gap between
military training outcomes and civilian workplace skills, and
that includes the health care sector. Our military members have
skills, and they have no problem being put to the test to prove
their competence.
As recruitment director for a prominent health system, I
led the development and implementation of a new competency-
based selection process for emergency medical technicians and
clinical technicians across our hospital system where we are
facing significant turnover and shortage. At the time, my team
of recruiters handled about 85,000 resums for these positions.
The vast majority of the applicants were unqualified. The
workload for them was grueling; the conditions, which persist
due to high unemployment, resulted in costly turnover. Military
resumes were typically flushed straight out of the process by
our electronic applicant tracking system.
Our methodology was straightforward. We performed a
comprehensive competency review of the position requirements,
we developed assessments and tests for the most relevant and
predictive foundational competencies. We determined appropriate
passing levels and provided the assessments to each applicant
to determine their eligibility for the positions. Military
talent rose to the top time and again. Yet the problems for
veteran talent continued. We found that we either could not
hire them because they lacked the State required credentials,
or we had to first employ them in lesser positions because the
credentials they did have were well below the position for
which they were found sufficiently qualified.
Success on the job is about competency or sufficiency of
qualification. The hire, however, is a business transaction
that is highly regulated and controlled. The hire is an
artificial process that discriminates inherently against our
military service members. I believe the ultimate solution would
be to create a means by which training provided by the
Department of Defense could be accredited by civilian standards
and therefore allow military training and skills to easily
transition into existing safeguards and competency standards
established by civilian and State institutions.
H.R. 4124 on the surface appears to be small change. These
changes, however, would positively affect the livelihood of our
veterans and improve health care delivery. H.R. 4124 provides
for two specific possibilities that have not yet been
considered by other legislation. First, it allows for military
training to be mapped to equivalencies and credentials above
the basic entry level qualifications. The emergency medical
technician credentialing letter has basic, intermediate, and
advanced specialty certifications. To date, military training
has only been mapped to the EMT basic, which falls well below
the pay rate and functional capability of service members who
have honed their skills on the front lines.
The second, H.R. 4124, calls for the development of methods
to establish equivalency. Solutions to date have forced skilled
medics into lengthy and costly training programs, a redundancy
that is ineffective, inefficient, and detrimental to the
economic success of our military members. Using GI bill
benefits to sit in classes that they could teach is not a good
use of their hard-earned benefits. According to UCX data that
was released from the Army in fiscal year 2011, there were
190,000 DD-214s; 100,000 of those applied for unemployment
insurance, and nearly 3,000 of those that were applying were
Army medics. They were the third largest military occupational
specialty to do so. There is a problem, and we have not yet
solved it.
We founded Victory Tech for the express purpose of creating
an alternative for our military families, a means of achieving
the required academic validation of competency to qualify for
the appropriate level of credential without unnecessary use of
time, benefits or personal income.
I wish to commend this legislation to the committee, and I
and my colleagues stand ready to assist in any way possible.
Thank you for the opportunity to provide this testimony to you,
and I would like to submit the remainder of the testimony for
the record.
[The prepared statement of Mr. Nichols follows:]

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Mr. Pitts. The Chair thanks the gentleman.
And now we will begin questioning, and I will recognize
myself 5 minutes for that purpose.
We will start with you, Mr. Nichols.
Do some States have certification and some have licensure?
It sounds like there is significant variation between State
requirements that would help EMTs if the States had more
reciprocity or at least consistent requirements. Are there any
good reasons that States would differ with regard to their
training requirements? Walk us through, if you will, the
traditional State credentialing and licensing process.
Mr. Nichols. There are a number of, from State to State,
there are reciprocity allowances, largely because the emergency
medical technician is not covered under the medical or the same
branch of State legislature, you run into issues there. Some it
is under the Department of Transportation, other areas it is
medical. It may be just a State board all by itself. So you do
have issues on the reciprocity side of things.
The key challenge, though, is that there is no reciprocity
granted between the military training and between the State, so
while an individual may have training and then go through a
shorter reciprocity period to, say, move from California into
Pennsylvania, the military is not afforded that because their
training is not accredited basically. So the key challenge that
you do find from that reciprocity side is, yes, there are
differences; there are different areas of State government. It
is a State license typically, which means that it is personal
property, so it is controlled on the State level, and that is
why I think your legislation is a good approach because it has
to be a State solution to figure those things out.
I think national certifying agencies have made the greatest
effort in our stand there in place to try to create the
reciprocity and an equalization of credentials and
requirements. That is extremely important, but not all States
actually recognize or embrace that or they add on to what has
been established by the national agencies, like my colleague
represents today.
Mr. Pitts. Mr. Chlapek, you mentioned the gaps that
military medics have in their knowledge, such as geriatrics.
Would there be a way to implement a shortened curriculum to
train former medics on anything they may have missed in their
military training without duplicating the entire EMT training?
Who do you recommend create and implement this supplemental
curriculum, and are there enough returning medics that the
schools could run profitable supplemental programs?
Mr. Chlapek. Absolutely, Chairman Pitts.
There is a process with each training entity where
refresher courses are taught one weekend--they can be taught in
one weekend for basic emergency medical technicians and over
two weekends for the advanced level paramedics. This is
something that is commonly done to help people recertify or re-
license, recertify with the National Registry of Emergency
Medical Technicians or re-license with the State. You are right
in that some States have certifications, and some have
licensure. There are some discrepancies there. Most, with the
exception of one or two, offer reciprocity, as Mr. Nichols
said, but there is no reason that those gaps could not be
covered over a week at the most to get these people ready, the
military medics, to challenge the written and practical test
that the State or national registry offer.
Mr. Pitts. All right. If you would like to continue or both
of you, if you were making recommendations to the States to
streamline the process for veterans to become EMTs, what would
you focus on?
Mr. Nichols. I will be glad to field that.
Mr. Pitts. Mr. Nichols?
Mr. Nichols. Yes, sir. In fact, I had written some
legislation that was passed in several States last year. There
are three different approaches you can take, which one is
direct reciprocity, I believe the State of North Carolina
looked at that as an issue where they are doing what this bill
is suggesting; they are allowing for direct reciprocity. Others
have backed off from that direct approach and taken the
approach of streamlining the education process, allowing for
some shorter times.
From my standpoint, you do want to protect the public for
certain to make sure the individuals have the right skill sets
and they meet the standards that are set, so I think some kind
of a testing mechanism to just validate the skills would
probably be the best approach on the State level.
Mr. Pitts. Now, someone with training as a military medic,
would they be qualified as an EMT basic, an EMT intermediate or
an EMT paramedic?
Mr. Chlapek. The common combat medical training for medics
that staff the majority of the Army and Air Force as well as
the Navy corpsman is a basic EMT level training. Currently the
schools with the Air Force and the Army graduate their medics,
specifically in the Army the 68-whiskey program, with the
qualifications to test, and they test and get a national
registry card as a basic EMT.
Now, the Special Forces or Special Operations medical
personnel throughout all the services through U.S. SOCOM and
then through Fort Sam Houston and Fort Bragg qualify at the
paramedic level, obviously, but they don't have the license
most of the time. It has become a political and who-is-in-
charge issue as to whether or not they get licenses or not.
Mr. Pitts. Mr. Nichols.
Mr. Nichols. Navy corpsmen are often recruited with an
existing EMT-B, and some of the Army service members that come
in already have that EMT-B. The Corps and the Army and the Air
Force as well, they are having a joint school that is now
established down in San Antonio; there are significant
differences in those training. When a corpsman completes their
training, they are very much closer to an RN or to at least a
licensed practical nurse in terms of what is allowed. The EMT
basic is the very, very basic level they complete with. The
minute they step on and start really practicing this hands on,
they receive that.
Mr. Pitts. The Chair thanks the gentlemen, and now
recognize the ranking member, Mr. Pallone, for 5 minutes for
questions.
Mr. Pallone. Thank you, Mr. Chairman.
I wanted to start with Chief Chlapek. I want to thank you
for your service and your testimony, and you have explained to
us the challenges that many veterans face when entering the EMS
workforce; classes, clinical work, waiting for a test date once
they have completed all the course work, and all these issues
can delay the licensure of qualified veterans sometimes for
many months.
So I had two questions. First, if you could address the
costs associated with achieving the training and education
required, and what are the costs? And then what about the
opportunity costs for veterans by investing in that training?
That may be redundant. In other words, you know, they can't get
another job. They are out of work. While doing that training,
they could be doing something else. So I wanted you to address
those two things, you know, actual costs and then, you know,
what it might mean for the individual because, you know, they
are doing this redundant training when they could be doing
something else, and they are not making any money.
Mr. Chlapek. Yes, sir.
Mr. Pallone, it varies across the board as far as EMT
training and paramedic training. An EMT course may be anywhere
from $500 at a local small fire department to $1,500 at a
larger department to the cost of a semester of schooling at a
community college to obtain that as well as the $150 or
whatever is paid to test depending on the testing entity. So
that is the real cost. The paramedic school can routinely run
$5,000 or a year's worth of community college tuition, plus
testing costs that are similar to the EMT.
In reality, if a service member has to spend a year in
college going 2 or 3 days a week throughout the day or
evenings, they are limited to part-time work to meet the
schedule of that. So it essentially costs a year's worth of
salary minus whatever they might make on a part-time job.
Mr. Pallone. All right. I wanted to ask Mr. Nichols again--
it is Commander Nichols, correct?
Mr. Nichols. Yes, sir.
Mr. Pallone. Again, thanks for your remarks and your
service, and I couldn't agree with you more that members of the
military have skills and competencies that would provide
critical services in the communities.
However--and the latest reports from the Institute of
Medicine and RTI International suggest that EMT shortages are
due at least in part to high turnover rates and other retention
difficulties.
But I think that you already addressed the streamlining of
the licensure and the credentialing renewal process. So I
wanted to ask in these IOM and RTI reports, they identified
additional retention issues that contribute to EMT shortages,
such as career advancement. Could you comment on other ways in
which this bill may help address retention issues? You know,
you answered--in response to the chairman, I think you talked
about the whole issue of streamlining the licensure and how you
would do that, but talk a little bit about the retention issues
and to what extent, you know, we need to address career
advancement and how this bill would get into that.
Mr. Nichols. Many of the individuals that we would hire
into these positions, the EMT basic was not sufficient as a
qualification, but for those positions that were very, very
entry level who did hire EMT basic, the pay rate is anywhere
from $10 to $15 an hour, so a service member coming out, that
is well below typically what they have expected and what they
have received in the military, and that becomes a key challenge
for them, is sustaining their lifestyle on that.
EMT intermediate level, which many of them could likely
qualify for or the paramedic level, which is a much higher
level certification, pay at much higher rates, closer to the
$20 to $25, sometimes above that, and these are DC-area
numbers, so they may differ across the States. That one piece
alone is a significant issue. It is what work you are allowed
to do.
My colleague talked about what some of the higher level
skilled individuals were able to do from tracheotomies in the
field to a lot of fairly highly technical things that only
physicians or practical nurses may be here able to do. So
coming out and transitioning to the EMT basic, they are doing
very, very little work, and a lot of that is more to do with
cleaning and repair and maintenance of equipment as opposed to
really the hands-on stuff that they have been skilled at doing.
So it is a big step down. It oftentimes is a blow to their
psyche, their sense of personal pride.
Mr. Pallone. But how can we correct that? Does the bill
help in that respect?
Mr. Nichols. I believe it does in that if it is handled
properly on the State level, it allows for an individual not to
find equivalency at the basic level but to find equivalency
upward in that ladder, equivalency to their skill experience.
And that is a huge piece that I haven't seen in other
legislation before. It allows for that. I don't know if it is
quite as specifically directed toward that, but it certainly
allows for States to be able to do that.
Mr. Pallone. All right. Thank you very much.
Mr. Pitts. The Chair thanks the gentleman.
I recognize the gentleman from Pennsylvania, Dr. Murphy,
for 5 minutes for questions.
Mr. Murphy. Thank you, Mr. Chairman.
I want to also state, too, that I have the distinct
pleasure and honor of serving in the Navy Reserve with many of
these corpsmen, and they are pretty remarkable what they have
gone through in training. I would like to ask our witnesses
here to comment, too, that when it comes to doing EMT work, in
addition to the training, there is also what one does on the
job. Can you give me a little rundown of the typical kind of
crisis or situation a paramedic or EMT might be facing in a
day's work?
Mr. Chlapek. Yes, sir. Congressman, Doctor, it can be--a
day's work can be anything from multiple post changes without
running a call on a patient to call after call after call,
responding from one call, clearing the hospital quickly to run
another one, and it may be anything from whether a large system
or a small system, anything from holding the hand of a 96-year-
old patient and making them as comfortable as you can on the
way to the emergency room, back to their residential care
facility or anything like that, to treating gunshot victims or
explosion victims and being in hazardous environments while we
do that. The day varies greatly, and that EMT and paramedic
have to work as a team, regardless of how many are there and
within their scope of practice.
Mr. Murphy. Given that, I imagine a lot of people go
through the training, the book training, the course training,
the lector training, and yet when they actually get on site and
they are dealing with someone who is a gunshot victim or who is
in a horrendous auto accident or pulling someone with third
degree burns out of a fire, I imagine that the horrors of the
situation itself also weed some people out, some people say
this I can't do. Am I correct in that?
Mr. Chlapek. That is correct, sir.
Mr. Murphy. That is not something you can necessarily test
for or question for when someone is applying for the job.
Mr. Chlapek. That is correct. We do background checks. In
my educational facility, we do further testing to try to weed
some of those folks out, but they are few and far between. In
reality, once you go through the training and the clinical
work, you know whether or not you will make it on the street,
and once you get out on the street or whatever environment you
are working in, you do what you are trained to do, and you let
the emotional part come later, and running a SIDS baby is a
prime example. You do what you are trained to do and try to
resuscitate the baby if they are viable at all, but afterwards,
you get to the emergency room and transfer care or back to your
station, once like a pediatrician told me, and we go home at
night and cry like anybody else or call our spouses and say,
give the kids an extra hug. So you can weed those people out,
and of course, with PTSD, it adds up over time, just like it
does with soldiers and sailors.
Mr. Murphy. You may guess where I am going with this, and
that is this is part of the training that you just can't deal
with in a classroom. You can't talk to someone about this, and
this is an incredible skill that many of those who have gone
through corpsman training experiences in Afghanistan and Iraq
bring to the situation where they can probably be a source of
strength and teaching to their colleagues. How do we make sure
that we account for this, I ask both of you this, in terms of
it is not just a matter of giving them credit for what they
have already learned, but those things that happen in the
classroom and the battlefield in putting someone back together,
dealing with some of the atrocities of war, some of the things
that we know that the al Qaeda and Taliban do to children in
torturing them and damaging them. I am thinking here of a book
called ``Outlaw Platoon'' by Sean Parnell, a best seller where
he spent some 400 days in Afghanistan and particularly outlines
the story of a corpsman there who probably ought to be
nominated for the congressional medal of honor who was running
from wounded soldier to soldier in his platoon, they were shot
up, while he was getting shot himself, with incredible courage
under fire. And I want to make sure that such people are
getting credit, an opportunity to have jobs.
It almost seems silly to me that we have to have an act of
Congress to say to do this. So perhaps if each of you could
comment on why we need to move forward on a bill like this
quickly. Go ahead.
Mr. Nichols. Thank you, Congressman, thank you for
representing our district at home very well in the Pittsburgh
area. I had the privilege as well to serve. As a Navy chaplain,
we serve right alongside the medical corpsmen and did so
throughout Iraq, and to watch them work as a team to see
leadership develop and leadership expressed, that is absolutely
something you cannot train. The challenge they find in coming
home is too many barriers, too many people saying no, too many
regulations and long processes of filling out paperwork and
following this step and that step and talking to the right
person. We learned that as Navy personnel, how to kind of work
through the system that is fairly difficult, but it is a
challenge for them when you try to start feeding your family
and to do that at the same time.
The other challenge they bump into is the issue of
liability. So there are a lot of strictures that our civilian
hospitals who really make sure you don't step over and do more,
and that becomes, you know, that additional challenge. I think
to take that leadership piece that has been honed, you can't
grow it, but we could sure use that on the front lines of our
communities.
Mr. Pitts. The Chair thanks the gentleman and now
recognizes the gentlelady from California, Mrs. Capps, for 5
minutes for questions.
Mrs. Capps. Thank you, Mr. Chairman.
Thank you, each of you, for your excellent testimony today
from your perspectives. Both your testimonies express very
clearly that there are a host of contributing barriers to a
smooth transition from military to civilian service. I agree
with you that H.R. 4124 is an important step toward breaking
down some of these barriers, but there are other roadblocks
noted in your testimony that would also have to be addressed,
and I would like to get to maybe a few of those in my time with
you.
Mr. Chlapek or Chief Chlapek, excuse me, I want to use your
title, can you speak a bit more about the potential issues
around medics finding and facilities developing refresher or
booster EMT courses to satisfy any gaps in military training?
Geriatrics, someone mentioned that, I think that can be sort of
filled in quite quickly. But I will start with that question to
you.
Mr. Chlapek. Thank you, Congresswoman Capps. It can be done
at the training entities, and it has been done in some States
at the training entities as far as what does this person need.
You know what, they can spend a weekend with us, and our
training entity specifically has done that and they will spend
a weekend with us, and then we get them signed up for a test to
challenge the test. That is where the refinement lies.
The National Highway Traffic Safety Agency has gone so far
as to help rewrite and reclassify some of the curriculum so
that it is more malleable to put people through the streamlined
process, it makes it a little easier to do. Agencies like ours,
NAMT, puts in their employer guides how to help make this
happen, and we embrace veterans. Veterans get credit at our
institution or my place of employment as well as many others,
and we bring them, we give preferential treatment to hiring
veterans because we know they have seen what Congressman Murphy
addressed. We know what their leadership skills are, as
Commander Nichols talked about, but it all goes to the training
entities and the States allowing them to do that, and that is
what we do. You can absolutely get somebody prepared in a
weekend or a week to challenge the test.
Mrs. Capps. So there is some good models out there for how
to do this in States, and your agency, your group is prepared
to give advice and sort of support this transition should
States wish to go down this path?
Mr. Chlapek. Yes, ma'am, and we do that now. We have
developed a guide for deploying soldiers who have licenses who
are members of NAMT, and we have also developed a guide for the
employers to help these folks, keep them licensed if they have
a license and if not help them get licensed when they get back.
Mrs. Capps. All right. Thank you.
Mr. Chlapek. Yes, there are some States, those I mentioned
Texas, Missouri, Alabama, several of those, Tennessee.
Mrs. Capps. Right. That is good to know. Thank you very
much.
Commander Nichols, your testimony noted the sheer costs of
taking the certification. That is a barrier for some of our
returning vets, isn't it, returning soldiers?
Mr. Nichols. Absolutely. And, again, typically when an
individual chooses where they are going to take that
certification or whatever else remaining skill level that they
need, they will take the quickest path there, but oftentimes,
they also want some of the more expensive options that may have
a better name or better brand associated with it, and I think
where we hope that this bill would help to address is that they
don't use their benefits to retrain on skills they already
have.
Mrs. Capps. Exactly.
Mr. Nichols. Use the benefits to take the next step and the
next level in their career. That is why I believe it was
created after World War II to begin with.
Mrs. Capps. Right. These are important considerations, and
they kind of go beyond the scope of H.R. 4124's focus on State
certification changes. There are issues that I address in
another bill, EMT bill, H.R. 3884. Mr. Chairman, I am hoping
this committee will also look at this companion piece of
legislation in some future hearings or markups on this matter.
There is a lot here that can carry us a great deal. There is
also some more that we could do to ensure that we are doing all
we can to remove every barrier that we can to make this
successful transition for our medics. It is such an important
topic.
There is another one, I just have 2 seconds, I will put it
out on the table in case there is another way to explore the
barriers that exist for current EMTs, civilian EMTs who want to
join the National Guard, that is sort of the flip side of this,
but it is also of very big importance to both of you and I
think to our Congress as we are talking about getting out of
this recession. Thank you, and I will yield back.
Mr. Pitts. The Chair thanks the gentlelady and recognizes
the gentleman from Ohio, Mr. Latta, for 5 minutes for
questions.
Mr. Latta. Thank you, Mr. Chairman, and Colonel and
Commander, thank you very much for being with us today. I
really appreciated your testimony.
Colonel, if I could just kind of back up to what you said a
little bit earlier and the questions going to some of the
difficulties that were at the State level, you said it becomes
kind of a political issue. Do you want to explain what you
meant by becoming a political issue?
Mr. Chlapek. Yes, sir. It deals with who is in charge of
the bureau, if the bureau still exists. Some bureaus of EMS in
certain States have been eliminated for budgetary reasons, and
they fall under some other area of health or public safety. As
far as the politics of it, it depends on who is in charge of
the licensing agency at the time and, for example, in Missouri
we have a veteran in charge, the director of the bureau of EMS,
and he takes veterans issues on a one-by-one basis and helps
these veterans get licensed in the most efficient and quickest
way possible, but still making sure they have the
qualifications. When he retires in January, we don't know who
will go in there, but it is possible someone without his
knowledge or passion for veterans employment, and that gets to
be an issue, much like in the military schools. Depending on
who is in charge of that specific school, they may or may not
like the national registry, certification or they may or may
not like the Texas certification, in the case of Fort Sam
Houston, and licensing process. If they don't like it, then
these medics start and EMTs start coming out of school without
licenses, and if they do like it, then they are given the
opportunity to test and all the training they need to test.
Mr. Latta. Let me follow up if I could. You said the
gentleman that you said that is going to be retiring does it on
a one-on-one basis, but wouldn't it be easier if he would look
at everybody and say that all these people that graduated or
came out of the Army medic or the National Guard--pardon me,
not National Guard, but the Air Force or if they are Navy
corpsmen, that he could already categorize them so he could
already say they are qualified to save that time?
Mr. Chlapek. Absolutely, Congressman Latta, and last
session, I believe Representative McCaffrey introduced a bill
that should come up this time for passage this next session
doing exactly what you said.
Mr. Latta. You know, and also just sitting here thinking
about this, especially since every Governor in this country is
the head of the National Guard units, you would think they
would be able to say, you know what, we have got these people
that are trained, and they know it because they are in such
close contact with the adjutant generals in each of the States
that they ought to be able to get something worked together
that they could say at the State level, you know, that they
would have, they would know right off the bat that, yes, these
people are qualified to do X or X plus 1 or X plus 2, but we
can get them categorized, they don't need that extra training.
So it seems to me that the Governors could be doing more just
as the head of the National Guards in their respective States.
Mr. Chlapek. Absolutely, sir. It works the other way, too.
At Camp Atterbury, Indiana, I had a medic who had been a Navy
independent duty corpsman and done two tours in Iraq as an
independent duty corpsman, and the Army, even though he was
designated as 68-whiskey by the Army Guard of his State, the
Army folks at Fort Sam would not recognize that, and he had to
go all the way through a basic EMT class while we were at MOB
station before he could join up with us 2 weeks into the
deployment. So it works both ways. We need to get the military
and the civilian sector on the same sheet of music.
Mr. Latta. Well, thank you very much, Mr. Chairman, and I
yield back my time.
Mr. Pitts. The Chair thanks the gentleman.
Recognize the gentlelady from Illinois, Ms. Schakowsky, for
5 minutes for questions.
Ms. Schakowsky. Thank you, Mr. Chairman, and thank you,
gentlemen. For a number of years now in Illinois I have been
working with an organization mostly sponsored by the Teamsters,
Helmets to Hardhats, and I think there is another organization
or focus, Heroes to Healthcare, where we are trying to work on
these kinds of smooth transitions. It makes so much sense. We
are spending sometimes $100,000 training individuals in the
military, and then they come home, and this skill, these skills
are not recognized.
In Illinois, we have made some progress on members of the
military who have been driving trucks getting commercial
driver's licenses, so that is one area. But clearly, in this
area of EMTs, when we have the most extreme conditions on the
battlefield that would perfectly meld, and thank you for the
progress that you have made.
We have talked a lot about the States and the licensing
processes and the barriers there, but I want to focus a little
bit more on the military side and how that transition, how the
military itself can be more helpful. Are certificates given?
Are hours of training, some kind of piece of paper that a
veteran can take when discharged from the military that says, I
have had this kind of training, this number of hours--not
necessarily that I am qualified in Texas or in Illinois for
this job--but this is what I have learned, how many hours I
have experienced? You talked about in your testimony dealing,
talking with veterans on a case-by-case basis, this is
Missouri. I mean, isn't there some way of routinizing that in a
better way so that the person doesn't have to explain
individual by individual but have a piece of paper?
Commander, either one of you who really knows how to answer
that or both, I would appreciate it.
Mr. Nichols. I would love to jump in there, Congresswoman,
and I am very familiar with the work the Teamsters are doing
with Helmets to Hardhats and Heroes to Healthcare. They are
doing excellent, outstanding work, have for many, many years
now.
The key challenge that you find is in order for that
training to qualify against the credential or the license, it
must be provided by a licensed or accredited school. The
military is neither licensed nor accredited, and that is what I
have really boiled it down to is the key issue.
The Department of Education and these accreditation
councils do not recognize the Department of Defense as an
accredited training institution. Therefore, all the training
that comes from them cannot be, unless some specific
legislation says so, accepted.
Ms. Schakowsky. Well, isn't that sort of the bottleneck,
then? Isn't that something that we ought to directly deal with
is acknowledging the military as a place that is qualified and
certified?
Mr. Nichols. Ma'am, if there is one area where there is a
national ability to take action, that to me is the one area
where there is the national ability to take action and allow
the military in some way or other to achieve and to be
accredited according to those civilian standards or to set up
some kind of a reciprocity piece there.
Ms. Schakowsky. I heard the chairman talk about
reciprocity.
So--did you want to add to that, Colonel?
Mr. Chlapek. Yes, ma'am. Our military relations committee
with NAMT has recently done a gap analysis on the military
medical training, and there is no consistency between the
different schools. The Army doesn't train exactly what the Air
Force trains, and they don't train what the Navy trains. So
there is a lack of consistency with the training, and that
leads to a problem with reciprocity. In addition----
Ms. Schakowsky. Let me just interrupt for a second. So
then, maybe, we can work with the military to make sure that if
it is a couple more hours of this or something instead of that,
that it is with an eye toward discharge and what they are going
to do afterwards.
Mr. Chlapek. Yes, ma'am, and we have worked with this
reciprocity issue within the military and in the civilian
sector for several decades now, since the EMS came about. It
has constantly been an issue, and one thing that we are doing
with our checklist for employers and checklist for deploying
civilian providers is saying, get all of your training
records--it is up to the individual soldier, sailor, airman or
Marine when they get out to get all their training records from
mobilization station and what they may have received overseas.
And then they can take that to the State and say here are my
training hours. It might not be part of your curriculum, but I
have 3 weeks of HAZMAT training, and that goes a long way
toward satisfying some of the requirements. Right now
reciprocity is hit and miss.
Ms. Schakowsky. I just want to say, I want to work with
whoever is taking the lead. I just think this is something that
we can figure out together and with the expertise of people
like our witnesses.
Mr. Pitts. The Chair thanks the gentlelady.
I recognize the gentleman from Georgia, Dr. Gingrey, for 5
minutes for questions.
Mr. Gingrey. Mr. Chairman, thank you for the recognition.
And Mrs. Capps, thank you for your comments.
And Ms. Schakowsky, absolutely. I am one on this side
ready, willing and able--I don't know whether I am able so much
as ready and willing, but I want to thank Lois and Adam and
others that, you know, have put together this piece of
legislation because clearly it seems to me, and Congresswoman
Schakowsky just made this comment, why in the world wouldn't
there be consistency, at least some consistency across the
services in regard to the 68-whiskey designation, the same that
you would have in the Air Force and the Navy as well as in the
Army.
I mean, if you have got a soldier that is hit by a torpedo
or run over by a tank or shot by a sniper, you know, you have
got pretty much the same amount of damage and what you need to
do to save their lives, and it seems to me that there should be
consistency no matter what branch they happen to be in, and the
accreditation should be granted across all service lines,
assuming that they have developed that consistency of training.
When doctors who are fully trained and accredited and
licensed in whatever subspecialty and from whatever State, when
they go down range for a couple of years, do you think that
they don't continue to get accredited and have continuing
education during some part of that deployment time? Of course,
they do. They don't just--they are not out there at the tip of
the sphere with their hand in a wound stopping blood and
holding a lacerated artery 24/7. They clean up, dust off, go
back and take a course periodically during their military
training.
I am sure the same thing exists for these EMSs, and if it
doesn't exist, it is deplorable if they are working 24/7 and
have no time to go in a classroom and keep their skills up and
keep that accreditation, particularly those who come into the
military who are already licensed as paramedics or EMTs. I
mean, that should be a no-brainer.
Now, I don't know whether I put that in the form of a
question, but I would love a response from our two witnesses.
But, you know, one thing that is missing here from this
hearing is you all are doing a great job, but obviously, you
both have sort of a military background bent on this in regards
to what you think needs to be done to streamline our military
EMTs and paramedics to get them more quickly into civilian
workforce.
I couldn't agree more, but I would love to hear from
someone who maybe is kind of an expert, worked in an emergency
room for years or run an ambulance service or whatever with
very little, if any, military background who could bring to us
some concerns that maybe some of these people from the military
are bringing to the civilian side, whether it is post-traumatic
stress syndrome or trying to resuscitate every single person
before even giving them an opportunity to fog a mirror, you
know. So maybe you all can comment on that a little bit as
well.
Mr. Nichols. Thank you, Congressman, I will grab one or two
of them.
The first time when I first became director of recruitment
for Inova Health System in the area here, I did a survey of all
the hiring managers across our facilities there, talking
specifically about this issue of military, and it was 100
percent--it wasn't even 90 percent that--yes, they would take
military hands down. Obviously, they want to make sure the
skills are there to meet the requirements for the issue of
liability sake, but absolutely would take military hands down.
On the other, for the other question, the first portion of
that, there has been about $1.2 billion or so invested in the
new training facility down in San Antonio, which is a purple
training facility for health care technicians from the E5 and
below level, and from what I understand, all services will be
transitioning through there, they can hold up to 8,000 students
a day and will transition about, train about 24,000 students
per year through that facility. Now, will the courses be the
same? Probably not right immediately, even among the chaplain
corps, and we made a purple training facility for all the
chaplains going through, we still had separate buildings for
the Army, the Navy, and the Air Force and kind of did a little
bit of our own thing.
You know, as long as when you break it down to the
competency level and you look across all the curriculum from a
competency standpoint and find those similarities and then
allow them to maybe add on what they might need for, say, sea
service, I think you will find similarities. I think they are
moving in that direction right now with the investment that you
are seeing in the Department of Defense, but still it doesn't
address the issue that they are not an accredited training
facility. From the States' side that is still an issue.
Mr. Pitts. The Chair thanks the gentleman.
I recognize the ranking member emeritus, Mr. Dingell, 5
minutes for questions.
Mr. Dingell. Thank you, Mr. Chairman. I commend you for
holding this important hearing today. As a veteran myself and
as a student of military history, I find this piece of
legislation to be a no-brainer. It is more than a two-fer. I
ask unanimous consent that I can be permitted to insert into
the record a rather excellent statement upon which I worked
very hard.
Mr. Pitts. Without objection, sir.
[The prepared statement of Mr. Dingell follows:]
[GRAPHIC] [TIFF OMITTED] T2106.015

Mr. Dingell. I also want to make it very clear that when I
came out of the Army back in 1946, I would observe that I was
given by the school that I returned to, Georgetown, full credit
for a lot of the things that I had learned and done in the
military. That same thing is true about a lot of our veterans
who are returning home, particularly in the area of medical
care, because they are seeing things and doing things under the
most appalling conditions, involving the most terrifying kinds
of wounds and injuries and damages and diseases and all kinds
of weird parasitic diseases that you get by serving in places
like that, and they are having to learn things that people are
desperately anxious to know about in the field of organized
medicine, but they don't ever get exposure to these kinds of
situations.
So here we have got a bunch of veterans who we want to put
back to work. We have got a problem with unemployment, which is
a very significant problem to the veterans, homelessness and
all the other things that attend that, but we have also got
another little problem that I think very frankly we should take
a hard doggone look at, and that is we are going to have a
growing and increasing shortage of people who are qualified to
give health care.
Here we have people who are deserving of it by their
service, who are skilled and have experience that is enormously
valuable. I am satisfied that the schools and education and
higher learning in this country are anxious to have these
people come. I am equally satisfied that they are happy to have
them contribute to the well-being of the schools by paying
tuition and things of that kind. We are providing tuition for
those people, but in addition to that, we have the opportunity
to see to it that all of a sudden, we get an influx of valuable
people who saw the need for this kind of service while they
were in the military.
So we are going to give them, we have already given them a
lot of training, including ongoing training which they get in
the service dealing with their particular specialties. Now I
have talked to a lot of the people in the military who are
doing this kind of work. It is very clear to me that they want
to continue in this kind of area. They want to make a
contribution. If you look, you will find a lot of the people
who are corpsmen and other things have plans to become nurses
or have plans to move on into being specialists in some kind of
disease or to have a doctor's degree or something of that kind,
and these are a tremendous resource, and I don't see how we
could do other than to save the money that it takes to put
those kind of people to work to see to it that they have the
opportunity to benefit themselves and benefit the country by
their skills that they have learned and why we can't move about
speedily to moving this legislation forward.
So I congratulate you for the hearing, Mr. Chairman. I urge
my colleagues to support this legislation.
I congratulate the authors of the legislation because it is
going to be something that is going to be useful.
And to our witnesses in the committee well, I do have some
comments, I would be delighted to hear, starting with you, in
whichever order, Mr. Chlapek or Mr. Nichols, if you have some
comments to make, you have the remainder of my time, which is a
minute and 19 seconds.
Mr. Chlapek. Thank you, Congressman Dingell.
The military can set the baseline here, much like Mr.
Nichols talked about on the training at Fort Sam Houston in San
Antonio, and they are going a long way toward standardizing the
training. We just have to make sure these youngsters come out
of the military with the license or the ability to test at that
point.
And you talked about the records you walked away with or
the training and education in 1946, and I believe we could do
the same here with that.
Mr. Dingell. If you can't, you are wasting a lot of
something.
Mr. Chlapek. Say again, sir?
Mr. Dingell. If you can't, you are going to be wasting a
lot of talent, skills, and money.
Mr. Chlapek. Yes, sir, agree.
Mr. Nichols. Thank you, Congressman, thank you for your
service to our Nation.
Mr. Dingell. Thank you.
Mr. Nichols. And I am sure you know probably more than most
of us that really the foundation for the community college
system and the workforce system of the country was based on the
return of soldiers from World War II, and we have come a long
way and a lot of good work that has come from there, but in
some respects, that transition from out of the military----
Mr. Dingell. This is so much more beneficial today and so
much better, and they are dealing with new things that we never
had to deal with. World War II, most of it was shrapnel or
rifle bullets or something like that or some guy get hit by a
tank, you know, or all kinds of things including some weird
diseases that we got in places like Africa.
The hard fact of the matter is now we are having to contend
with a whole new array of diseases, damages, injuries,
including the effects of blast, which is beginning to show up
as having effects we never understood or never were able to
address, and these people have got skills that I think in many
ways exceed those which are available through the training
programs we now have or through the organized system that we
have delivering medicine, hospitals and things of that type. A
lot of this stuff is brand new to American medicine and the
medicine of the world. But you go ahead. I interrupted you, and
you have my apologies.
Mr. Nichols. Sir, with that, I concur.
Mr. Pitts. The Chair thanks the gentleman.
I now recognize Mr. Kinzinger, one of the authors of the
legislation, for 5 minutes for questions.
Mr. Kinzinger. Thank you, Mr. Chairman, again, for holding
the hearing and allowing me to ask some questions here.
You know, actually as I was sitting here, this intended to
be part of my questioning, but I am actually a major in the
military. In the Air National Guard, I am a pilot. And the one
thing that really hit me is when I finished pilot training in
2004, I went to an FAA examiner, and I took a test, and I
actually had a master question file that you study. And I went
and I took a very quick test, and immediately my training in
the military transferred to an instrument rating; it
transferred to a multi-engine rating and also a rating in the
various aircraft I flew with the military, all by taking a
test. I didn't have to go and get retrained and get my civilian
equivalent of an instrument rating; I got it in the military. I
didn't have to go get my civilian equivalent of a multi-engine;
I got it in the military.
And so from the piloting perspective, they recognize that
what you learn in the military should transition to the
civilian force. In fact, we see that every day when you see
military pilots that do their 20 years, and then they go get a
job with United or American or one of the airlines and, if you
are lucky, Fed Ex or UPS or something like that. So when you
look at where the--and I don't see being a pilot as being much
different than an EMT. You are faced with situations. You learn
how to control a situation, how to address it, and how to move
on. Very recently, actually within the last few years, the FAA
also began to recognize an instructor rating in the military as
well. So if you are an instructor pilot in the military, you
used to have to come out and actually go through the whole
instructor rating process civilian wise. A few years ago, they
said, you know what, that is stupid, you are an instructor on
the civilian side. Guess what? We have not had major
catastrophes as a result of it. In fact, we got a whole new
breadth of talent I think into the civilian piloting world as a
result of that recognition.
And I see this as not very different from that. I see this
as the same kind of idea and I think something that can be
learned from what has happened in the piloting community.
But here is a question for both of you. So we talk about
somebody coming out of the military and being able to
transition to having their civilian EMT equivalent. What do you
think--and maybe not an exact but kind of a general, what would
be a basic time frame? Obviously, somebody can come in and say,
hey, I was a civilian--or I was a military EMT in 1991. They
probably should not be granted immediately the ability to
transition to a civilian EMT. So there has to be some kind of a
time limit. Maybe it is a year; maybe it is 2 years. I just
wanted to get your general thought, we will start with you, Mr.
Nichols, on what you think would be a good time frame between I
came out with this military experience, and now this can
transition to the civilian side.
Mr. Nichols. I believe since the transition out of the
military is typically not a surprise for individuals that they
should start that process and be allowed to start that process
before they get out so they don't have a gap in between the
two. I think that really is where the issue is or at least at a
minimum allow them to have a testing and a verification in the
military so they know what the gap is and know what their
requirements will be so they can properly economically plan.
The chief difference, though, between what the FAA has and
the health care side is the FAA has a national standard of
skills that crosses all the States; whereas with the health
care and the EMT, there is no national standard that is
recognized by every State.
Mr. Dingell. Would the gentleman yield?
Mr. Kinzinger. Sure, sir.
Mr. Dingell. He makes a very good point. We could
overcomplicate what we are doing here today by drafting in all
kinds of requirements and standards and things or we could just
use the State and the professional accreditation agencies to do
the work that we are talking about. They have the full ability
to define how long it would be, what the particular skills are,
and if we need any help when we take the next look at this, I
think we could address all these questions.
I do want to commend the gentleman for what he has done on
this.
Mr. Kinzinger. Thank you.
Mr. Chlapek, did you have any input on that?
Mr. Chlapek. I don't know, Congressman Kinzinger, if there
is actually a magic number as far as 1 year, 2 years, something
like that. A lot depends on the individual and their ability to
retain things, but absolutely, it can't be someone from the
Vietnam War or World War II coming back and saying, I want to
re-license. At some point you have to go back through the
training.
Mr. Kinzinger. Thank you. And then just quickly, so 10
seconds apiece basically, do most of these guys come back, men
and women, come back with experience from their 16 weeks of
training or is it experience that they have received on the
job? I mean, which is the most beneficial, the formal training
or the fact that they were in Iraq and Afghanistan fixing
wounds et cetera?
Mr. Chlapek. Without fail, I would say their real world
experience when they are deployed.
Mr. Kinzinger. Right. Which is something you can't, not to
downtrod on civilian EMTs at all, but it is something that
can't be replicated necessarily, you know, on the civilian side
hopefully.
Mr. Nichols. I absolutely agree. Employers want to hire
experienced individuals.
Mr. Kinzinger. With that, Mr. Chairman, I yield back, and I
thank you for your courtesy.
Mr. Pitts. The Chair thanks the gentleman, and that
concludes the questioning, and the Chair looks forward to
working with the members in a bipartisan way to address the
issues that have been brought up today and moving legislation.
Mr. Pallone, you have a unanimous consent request?
Mr. Pallone. Thank you, Mr. Chairman.
I just wanted to ask unanimous consent to enter into the
record the statement by our ranking member, Henry Waxman.
Mr. Pitts. Without objection, so ordered.
[The prepared statement of Mr. Waxman follows:]

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Mr. Pitts. Excellent testimony, excellent hearing. Thank
you. We will be in touch with you. I remind members that they
have 10 business days to submit questions for the record.
And I ask the witnesses to respond to the questions
promptly.
Members should submit their questions by close of business
on Wednesday, July 25th.
Without objection, the subcommittee is adjourned.
[Whereupon, at 11:31 a.m., the subcommittee was adjourned.]