I think if the NREMT made it a requirement for certification then it would start to make a large impact. You can also argue that less states would recognize the NREMT if that happened, but I think if it was implemented properly and a grandfathering process took place, it could be done easily. Maybe some states would drop the NRMET and more EMT's would be used... but overall I think the impact would be incredible. However, as others have stated I can not imagine that fire (IAFF) would ever support such a thing, so getting it passed at government level would be very difficult since the IAFF has deep pockets and lots of government support. The NREMT is an independent non-governmental certification agency, and as our nations EMS certification and registry, it could require such a thing if it wanted to (in my opinion). EMS would need to sell it to the right stakeholders and justify the reasoning and the benefits. Our biggest advocacy agency (at least in the U.S.) is the NAEMT. I have never herd them publicly advocate or make a recommendation for such a thing. However, it can be done as it has been done in some states and in most English speaking countries around the world. As the healthcare system in the U.S. continues to grow and change, EMS will become a bigger part of it (such as mobile integrated healthcare), and merit badges/2-3 day alphabet soup courses are not going to cut it.