This article in the New York Daily News describes a legislative effort in New York State to earn a bachelor’s degree within 10 years of becoming a nurse. This article sparked a spirited discussion on the National EMS Managers Association (NEMSMA) list serve. It also was a topic on the EMSEduCast and EMS Garage.

EMSEduCast Episode 126: Improving EMS Education in 2012

EMS Garage Episode 154: BS for Paramedics

What do you think? Does a BS degree make for a better paramedic?

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This is a guest post from Rom Duckworth, paramedic and educator that follows-up on this post about my experience in the CIRC trial. If you want to guest post or review on this blog, check out the guidelines here.

CIRC Trial and IBP ALS

Having had the opportunity to attend the ACLS Guidelines roll-out in Chicago in October of 2010 I noticed something profound in both the recommendations and the research (though not the ACLS algorithms or course, but that is another topic). In the process of evaluating the science behind the guidelines four things became apparent to me.

1)     The overall scientific strength of the guidelines (not every recommendation, but the guidelines taken as a whole).

2)     The specificity of what works, what doesn’t, and what needs further evaluation.

3)     The difference in success rates between comparable EMS systems (rural to rural, urban to urban, etc.) throughout North America. Read as “room to improve”.

4)     Potential for the continuation of obsolete practices and paradigms among healthcare providers, even those attending regular BLS, ACLS and PALS recertification programs.

These four items led to me picturing an equation of:

(local implementation of guidelines) + (Time) = (Real Lives Saved)

This equation motivated me as an EMS Coordinator and educator in a small regional system to see what changes I could begin in my own service and then, hopefully, propagate throughout the rest of our region.

Initiative for Best Practices in ALS Education Program

I put together an education program that addressed the five areas of a systemic approach to improving resuscitation.

1)     Early CPR and Defib

2)     True high quality CPR

3)     Uninterrupted CPR

4)     Meaningful Medications

5)     Post ROSC Care

Unfortunately the project would be restricted not only by time and money, but it could also deviate only minimally from our current Regional Paramedic Protocols.

So in January of 2011, with more focus on the process than the name of the project we began the Initiative for Best Practices in ALS (IBP ALS). With the support of our department’s Chief and our Medical Director we placed our community-based ALS service as the hub of a program with five spokes.

1)     Early access to CPR and defibrillation was improved by providing community stakeholders with educational resources and grant materials as well as updating the training for ALL dispatchers and first responders in proper BLS.

2)     The quality and consistency of CPR was improved through education programs that emphasized the WHY (affective) of BLS as much as the HOW (psychomotor) in order to eliminate low quality and outdated BLS practices. We also stressed the importance of continuous EtCO2 as a tool to monitor effectiveness of CPR, airway management, and achievement of ROSC.

3)     In addition, our service worked to minimize interruptions of CPR through the use of mechanical CPR devices, automatic ventilators and a modified airway protocol.

4)     While we couldn’t move completely away from general administration of algorithm based medications during resuscitation, we did implement a drastic change (for us) to using Vasopressin and Amiodarone as “One-and-Done” meds rather than the “rinse and repeat” of epi-lido-epi-lido-epi-lido. We also emphasized medics evaluating and addressing the patient’s underlying problem through history and assessment, as opposed to primarily following an algorithm until arrival at ED was achieved.

5)     We put protocols and education in place for immediate-post ROSC BP maintenance, 12 lead acquisition and transmission and eventually, hypothermia.

Lessons Learned

As we wind up our first year of the program I’ve been surprised by some of the lessons learned.

1)     Trials and special programs give focus: Many participants in our IBP ALS program were invigorated just by the fact that our service was a part of something special.

2)     Direct Follow up: I too believe that face-to-face follow up after each call helps to improve the quality of care not just in the types of calls addressed in the project (for us, resuscitation) but positively affects all aspects of EMS care in the system.

3)     Rise of the machines: While some complain that machines haven’t proved to be the be-all, end-all of resuscitation, I can tell you for certain that in our system they have dramatically improved our ability to provide continuous, high-quality CPR.

4)     Save lives with your MIND, rather than your HANDS: If I had to choose the central concept of the IBP ALS program, this is it right here. Do I believe that we’ll save more lives because Vasopressin is such a great drug? Nope. But I DO believe that paramedics will save more lives when they’re focusing on evaluating and addressing correctable problems, rather than just watching the clock for the next “rinse and repeat” med administration.

5)     Change attracts attention: Our program required a change in the ambulance load-out. I (very subjectively) believe that this stimulated better rig-checks as the crews took the opportunity to review the new equipment.

6)     And more change: We took the opportunity to attach other small changes to the program not directly related to resuscitation. Some change lends itself to improve in ways you might not have previously considered.

7)     Teamwork: While I encountered initial resistance to Pit-Crew CPR concepts (“We get everything done that needs doing! Why change?”), I emphasized that the idea here is, as when you work with a great partner, with Pit-Crew CPR’s pre-assignments, things don’t just “get done”, they get done automagically. Less effort+improved CPR=happy crews.

So if you have the opportunity to participate in a research or pilot program, by all means do so. Even better, you may want to start one yourself! Yes, it will take a great deal of work, but you’ll be contributing quality data to pre-hospital medicine, and you may find yourself surprised at the return on investment for you and your service.

A passionate emergency responder and recognized speaker and educator on leadership and emergency services living in Connecticut, Rom Duckworth has more than twenty years of experience working in career and volunteer fire departments, public and private emergency medical services and hospital based healthcare systems. Connect at www.romduck.com
or the www.RescueDigest.com blog and podcast.

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At the 2011 National Association of EMS Educators Conference I was asked to share three tips for new EMS educators. What are your tips for new EMS educators?

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After a visit to British Columbia two paramedics from Hong Kong discuss why they are paramedics and their experience. I am trying to contact these paramedics to be guests on the EMSEduCast – the podcast by and for EMS educators. Incidentally, we are always looking for EMS educators from outside North America to be show guests.

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Blog.CentreLearn.com – My day job is being the Director of Education for CentreLearn Solutions. I add about two posts a week to the CentreLearn blog and manage our social media accounts.

Top Questions about CL Courses for Firefighters, Paramedics, and EMTs

Build your own Online Training Content

FDA Drug Safety Communication on Zofran – this article was contributed by paramedic Steve Cole. It is packed with information.

Medical Author Chat – on the EMSBlogs.com network I host the Medical Author Chat podcasts. Episodes are infrequent. When I can I also add posts related to my enjoyment of reading and writing.

Interview with Dr. Benjamin Luft about We’re Not Leaving about the initial and long-term response at the World Trade Center on 9/11.

My review of We’re Not Leaving.

Recent reads and news will bring you up to speed on my late summer and early fall reading list. I also announce taking the tablet plunge and pre-ordering an Amazon Kindle Fire.

EMS1.com

How are you doing in EMT Class? Use the ideas in this article to assess your progress. Self Assessment: Tracking Your Progress in EMT Class.

A new Everyday EMS Tip at EMS1.com on using Slideshare for EMS.

EMSEduCast

Rob Theriault and I helped Bill Toon by presenting at workshop for Kansas EMS educators. The workshop was repeated on three consecutive days. Rob recorded our 3rd session which was about teaching EMS and technology. You can view our recorded presentation.

PIOSocialMediaTraining.com

Some ideas on how a public safety agency can use an auto responder email campaign.

Loving the Run Blog

I shared my tips for running while on business or leisure travel at the Loving the Run Blog.

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I recorded this video interview with Chris Montera at Pinnacle EMS 2010 in Miami for EMS1.com. In our conversation we discuss cheating in fire and EMS education, the responsibilities of students and educators, and the implications on content developers. Developing more engaging and interesting educational content often comes at the expense of time and energy I am expending to build the wall higher against cheating and fraud.

Is cheating happening in your organization? And more importantly what are you doing about it?

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Most times “Sick” will hit you over the head when you see a child from across the room or as you stand in the doorway. Other times it is less obvious and a good way to determine if the child is ill and how ill is to compare your assessment findings to normal.

Activity: What is the child’s level of activity during play with others or alone like compared to normal?

Bathroom: When was the child’s last bathroom activity or soiled diaper? Is the frequency and volume as expected?

Consolable: Are parents or caregivers able to console the child with quiet talk, soothing touch, and or distraction?

Drinking: Is the child drinking normal volume and at a normal rate? Sips, when a child normally gulps, might indicate airway swelling, discomfort, or irritation.

Eating: Is the child eating normal amounts and at regular times?

Fever: Does the child have a fever? Review this tip on infant rectal temperature assessment.

Sick or not sick? Compare normal to abnormal.

ABCDEF … I couldn’t keep the list going, but here are a few other things to consider.

Pain and Discomfort

Look for non-verbal clues about pain which might include eye rubbing, hair pulling, or other self-soothing behaviors. For a verbal child ask about where the pain is located, what it feels like, and use the faces pain assessment scale. For an adolescent use the OPQRST pain assessment questions.

Parent Interventions

Have the parents administering any medications? What, when and how much? And importantly what was the child’s response.

Pedi-U Podcast

Make sure you listen to the Pedi-U Podcast, an amazing informative and free pediatric education resource.

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Last week I presented at the Ohio Society of Fire Service Instructors Symposium on the topics of online education and social media content creation. I also had a chance to share some general classroom teaching tips. These are my three best:

Columbus Division of Fire training academy lecture hall

1. Start on time and end on time. You can’t always control the start time, but you can control the end time. Ending on time is an important part of honoring your student’s time.

2. Learn the names of all of your students as quickly as possible. For any course longer than four hours learning names is essential for connecting with the audience. On shorter program, such as a conference presentation, I try to arrive early enough to meet a few people in the audience that I can mention by name or call on during the presentation.

3. Ask, “What questions do you have?” to start a discussion/Q and A period instead of asking the discussion killer, “Do you have any questions?” The former is an invitation to ask a question. The latter is a yes or no that doesn’t allow a question to be the response.

Bonus Tip: The teacher is critical. The technology is useful. During my Friday presentations I had several technological mishaps as I was foiled by my computer’s virus checker. Despite all of my efforts I couldn’t implement the audience polling system I had planned to use. I am confident that because I know the material so well that I could be reduced to some sand on the ground and a stick and teach just about anything.

What are your top tips for fire and EMS educators?

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One of my favorite alternate posting locations is EMS1. com. I appreciate their recent publication of “The Benefits of Online EMS Education.”

Is your department using online education for initial, refresher, or recertification training? What is working well and what could be better?

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Even though my official family motto is “Can I make a Suggestion.” (note that is with a period and not a question mark) I often struggle with responding to feature requests and service improvement suggestions on the education programs I create.

Over time I have developed a set of general replies that are finessed to the specific suggestion. So student/customer etc. suggests a feature.

1. We actually already have that service, functionality, or design you are seeking. I can explain it now or show you later.

2. We have had that same idea and our working on implementing it. Variation: many other users have made that same suggestion and we are working on implementing it.

3. That is an interesting request. I need more information and will schedule a time to discuss it with you more.

4. What other suggestions do you or others have?

How do you handle feature requests and service improvements?

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