How would you teach your own EMT/EMP class, assuming you were the Instructor...

[RanchoEMT]

As an EMT I've noticed a lack of structure in most EMT classes (haven't attended Paramedic School yet) both from my own experience and after reviewing the class structures of different New Hires, EMT Ride Alongs, etc… Teaching in general interest me and I have found that most classes do not address enough of the “Core Principals” (e.g. Ability to track a Drop of Blood through the Body, Step by Step Assessment and call run through, etc.) and repetition of the manipulative skills we are excepted to master after the usual ‘once and done’ instructor run thru. Given the opportunity how would you conduct your own EMT/Paramedic Program taking into account but not limited to the following…..

-How would you structure your EMT or Paramedic Class?
Ex.

1. Anatomy and Physiology
2. Patient Assessment
3. Normal Vital Signs
4. Airway Emergencies
5. Cardiac Emergencies

-What Curriculum, ideas, concepts, skills would you begin and end with in order?
-How often(frequency during the week)and how long would your class be in total?
-How would you structure your didactic/skills Tests?
-What would your “FINAL” be?
-Anything else I forgot to mention or that you would like to add?

 

[DesertMedic66]

The EMT class that I was in was set up pretty well. It was required for us to be able to trace a drop of blood thru the blood stream and trace an air molicule thru the resp system.

The only thing I would have changed about my EMT program I was in would be to make it longer then once a week for 18 weeks and way more in depth. We just got the very basic info of medical issues. We are basics so that might be why only the very basic info is usually taught.

 

[systemet]

* Current programs in my area are 2 years for a medic. I'd push the program to 3 years right away, and advocate for 4 years by 5-10 years time, e.g. 2016-2021.

* I'd want to deliver the program out of a university, working in collaboration with EM / faculty of medicine. I'd try and encourage residents to teach a lot of the clinical courses, and advocate to the faculty that this is going to improve their program.

* Everyone gets a first year science background, so Physics, (*6) Biology (*6), Chemistry (*6), Statistics (*3 - I know), Physiology (*6)=, Introductory Pharmacology(*3) (The standard simple course that just teaches pharmacokinetics / pharmacodynamics and gives a brief survey of the different drug classes). There's your first year.

* Second year; Pathophysiology (*6), Trauma management (*3 - card in BTLS-advanced, but teach to a higher level, discussing transfusion, chest tube management, hypothermia / acidosis, etc.). ECG interpretation (*3 - include 12-lead), high level pharmacology (*6), CV physiology (*3), Obstetrics (*3, throw in NRP), Practicum hours, in the ambulance at an immediate level * ~ 500 hrs, maybe throw a few hundred hours in in the hospital (ER, caseroom, random specialty wards).

* 3rd year: ALS Pharmacology (*6 - specific drugs used in EMS, or likely to be used in the near futrue, all the rote memorisation of dosages, emphasising the mechanisms that are relevant from the material in previous courses), Airway management / respiratory physiology (*3 - include vents and ABGs, capnography, actually talk about pulmonary physiology), Skills labs (*6, ETI on simulators, every device imaginable. Set up some vents., IOs, central lines, UCs, OG /NGs, cric' / PTTV, etc.). ALS medical management (*6 - ticket ACLS), Pediatrics (*3), ALS am practicum (600 hrs), another couple of hundred hours in the hospital (OR, ICU, etc.). Research & Epidemology (*3) Air ambulance practicum, 100hr.


My numbers don't quite add up, I think. This would be better done in four years. Throw in more critical care, some primary care, more practicum time, maybe some psychology, and more evidence on EBM.

-----------------------

Key concepts to introduce:

* The paramedic as a healthcare role, understanding of other roles, recognition of where we fit in in the system, and the fundamental multidisciplinary team approach to healthcare.

* Solid education in physiology, pharmacology, pathophysiology.

* Diagnostic uncertainty, e.g. sensitivity (what percentage of patients with disease state X actually show this sign / symptom / finding), specificity (What percentage of patients exhibiting this sign / symptom / finding actually have state X).

* Limitations of the prehospital environment, how care will be provided in hospital, what can wait until definitive care, what entities we can't distinguish.

------------------------------------------------

Format: Monday-Friday, first year on a standard university format, e.g. 3-5 hrs class / day. Later years on a longer day.

Didactic testing: standard testing, a combination of MC and written responses, some project work, some group presentation work.

Skills testing: minimum number of simulated procedures, some minimum numbers in the hospital / field for ETI. Preceptors pass / fail recommendation with remediation process.

Finals: see above. Finals for individual courses. No final for the program. Perhaps some prep classes for registry exams.

 

[systemet]

You know what. Looking back on that it doesn't look that great. I have to think about this some more.

 

[FourLoko]

I guess I don't know what medic school really entails but if it was what you just described I think there would be a lot less medics.

 

[firetender]

Key concepts to introduce:

* The paramedic as a healthcare role, understanding of other roles, recognition of where we fit in in the system, and the fundamental multidisciplinary team approach to healthcare.

EMS today lives in a narrowly-defined bubble with ony one escape hatch; the ER. The failure of EMS to adequately SERVE its populations is because there's nowhere else to go. Establishing a higher level of education MUST be accompanied by alternative destinations.

* Solid education in physiology, pharmacology, pathophysiology.

I feel a little foolish for not having realized this before, but that's 'cause I'm a FOG! A major difference between EMS today and when I practiced ('70's - '80's) is that the amount of drugs prescribed to manage every ailment in the book has increased one-hundredfold and that's probably an underestimate.

Add to that the vast increase of ailments that are managed by those drugs (did you know about 51% of every person over the age of 15 years is now under treatment for "chronic illness"?) and it seems it becomes essential that the paramedic on the scene must be well-aware of interactions that could cause the patient to go into a tailspin.

Curricula must include a heavy emphasis on pharmacology and because of that increased demand, must now ALSO begin to incorporate more extensive modules on physiology and patho-physiology.

Add to that identification of appropriate local resources and the proper use of them and you've got a good start here, Systemet.

I guess I don't know what medic school really entails but if it was what you just described I think there would be a lot less medics.

All to the better. EMS, if it is to survive as an effective entity, must eject the tourists and become a real profession. I trust you could muster that kind of dedication.

 

[medicnick83]

I don't think I would be a good "in classroom" teacher... but out on the road I love teaching/showing people things.

 

[systemet]

EMS today lives in a narrowly-defined bubble with ony one escape hatch; the ER. The failure of EMS to adequately SERVE its populations is because there's nowhere else to go. Establishing a higher level of education MUST be accompanied by alternative destinations.

I completely agree. I think in the more litigious environments in North America, it's going to be very hard to get physician support for refusing care, but comparatively easier to get support for diverting people away from the ER to other services.

I think, though, that we've fallen behind educationally. If we look at what the RNs are doing, what the RTs are doing, what the PAs and NPs are doing, and then you look at our education and skill set, they don't really match. Many of us have less formal education than a new-grad LPN.

It's not that we're not doing a good job with what we've got -- I think we are. I've worked with people who graduated from the first paramedic programs in my area. Most of them are excellent. But most of them will also openly admit that a lot of the skills we use now they weren't trained on when they first started, and that the training they've received on-the-job has been marginal at best. That they've overcome this is a credit to them. We certainly have a tradition of doing the most with the least resources / least favourable circumstances. I just think that we've lost our way a little.

A lot of people like to argue the value of additional education, and there seems to be a heavy anti-intellectual streak in both EMS and society. There seems to be this belief that a more educated provider is going to somehow be worse, or that a certain amount of education is "all that's needed for EMS", and that somehow there's going to be no incremental benefit for EMS from greater education. I disagree strongly with this attitude, but even it were true -- one simple reason for being more educated is to obtain more respect from the other healthcare professions and get better support in advancing our own ends.

I think an issue sometimes arises where people look at the current scope or pay, and say, well "Why would I need a 4-year degree to do these skills?" or "They have to pay me more, before I'd be willing to do more school". But I think this becomes a chicken-and-the-egg argument. If we don't get more education, how are we going to get better pay, or an expanded scope?

I feel a little foolish for not having realized this before, but that's 'cause I'm a FOG! A major difference between EMS today and when I practiced ('70's - '80's) is that the amount of drugs prescribed to manage every ailment in the book has increased one-hundredfold and that's probably an underestimate.

It would be interesting to see the numbers. This must be available somewhere.

I think there's also been a change in the skills performed on the ambulance. I imagine the average paramedic today sees a lower acuity of patient but has more technology available, and more treatment options.

I've heard a lot of the veterans say that younger paramedics are more interested in the "glory" of EMS (whatever that is), and less interested in helping people. But I think this is just a reaction against youth.

Add to that the vast increase of ailments that are managed by those drugs (did you know about 51% of every person over the age of 15 years is now under treatment for "chronic illness"?) and it seems it becomes essential that the paramedic on the scene must be well-aware of interactions that could cause the patient to go into a tailspin.

I think so. Having a more thorough knowledge of pharmacology is also great for assessing patients who are difficult historians, have a language barrier, or present without any available history. It helps focus the questioning, ensures you don't miss something, and can give you some sort of suspicion of underlying disease processes in situations where the information is the square root of nothing.

Curricula must include a heavy emphasis on pharmacology and because of that increased demand, must now ALSO begin to incorporate more extensive modules on physiology and patho-physiology.

Add to that identification of appropriate local resources and the proper use of them and you've got a good start here, Systemet.

It's a start, maybe. I've got to take a look at some of it, and perhaps tweak it a little. It's looking a little too much like a standard paramedic program with a year of biological sciences on the front end and a little more pharmacology / physiology. There's a lot of other stuff that could be added in, and might be more valuable than, for example, a year of chemistry.

We probably should have some basic nursing skills. We probably should know a lot more about wound management, for example. A lot of the primary care stuff also needs to be emphasised if we're going to be referring to other agencies, because then we may have to do some of that as well, and we're going to have to use more judgment.

Thanks for the encouragemnt.

All to the better. EMS, if it is to survive as an effective entity, must eject the tourists and become a real profession. I trust you could muster that kind of dedication.

I hope that EMS can become a profession. My experience has been that I've met a lot of individuals who have been incredible people, and acted extremely professionally. I think we have some hurdles to overcome, and that everything takes time, but I believe that EMS in 10 years will be better than it is now, and hopefully a little closer.

 

[usafmedic45]

As long as I washed out a sufficient number of people from the class, I'm OK with structuring it however the sponsoring agencies wish me to structure it.