Medical Education, EMS

Understanding EMS Provider Education and How to Participate as a Resident

The most effective medical education is designed with specific learners in mind. Using that as a guiding principle, the emergency medicine faculty and residents at Doctors Hospital came up with an engaging approach to EMS training.

Health care providers are attracted to their specialties for a variety of reasons. Like EM residents, EMS providers don’t particularly enjoy learning via hours of PowerPoint lecture. EM residents did not choose the busy and chaotic practice environments of the ED or the back of an ambulance because we enjoy warming chairs. To understand how to create educational and fun events in residency it is important to understand the training process of EMS providers.

Background of EMS Education
EMS education requirements were first laid out in 1993 with a document called “the Blueprint” and further delineated in 2005 with the “EMS Education Agenda.” This consensus document itemizes the five tenets of EMS education, their respective associated goals, and a game-plan for achieving them. These tenets include: Core Content, Scope of Practice, Education Standards, Education Program Accreditation, and EMS Certification. We now have a national credentialing body, the National Registry of Emergency Medical Technicians (NREMT), and a national scope of practice model that defines the different types of providers:

  • Emergency Medical Technician (EMT)
  • Advanced EMT (AEMT)
  • Paramedic

EMT, AEMT, and paramedic training courses are typically sequential with increasing hour requirements ranging from 100-1300 hours of classroom, clinical, and simulation (SIM). Additionally, providers must pass the NREMT exam for their respective level of certification. Recertification is typically completed every 2 years and requirements can be met with courses, conferences, research, online resources.

As there is significant state and local variation in the educational methods used and the requirements themselves, identifying exactly what teaching modalities are most commonly used would be quite difficult. For example, Seattle Fire requires considerably more classroom, SIM, and actually cadaver lab and operating room (OR) time for intubations than the national guidelines.1 This extra education, as well as their greater-than-average number of intubations per year may contribute to their higher success rates.1

Things to Consider

  1. EMS providers treat a lot of people! That is 25-30 million patients per year, to be exact.2
  2. Not all EMS providers have the same skill set. The scope of practice varies greatly between first responders, EMTs, and paramedics.
  3. There are national guidelines. The EMS Education Agenda lays the foundations governing EMS education.
  4. State lines actually matter. The state-to-state variation regarding educational requirements and scope of practice is huge!
  5. Everyone loves airways. Everyone also loves a good, old-fashioned competition.

There are undeniable similarities both in the education and practice of EMS providers and EM residents. Airway management is one such critical clinical skill shared by both sets of providers. Intubations performed in the field or the ED are often challenging for a variety of reasons: austere environments, trauma, critically ill patients, or the recent ingestion of cheeseburger, to name a few.

Historically, EM resident involvement in EMS education has been limited to going on ride-alongs and possibly giving lectures. Only 89% of residencies in a recent survey had a designated EMS rotation and only 64% noted a requirement for education of EMS providers by residents.3 Contrary to this, 92% had a requirement for direct medical control.3

Effectively Fun
After learning all this (and more), Doctors Hospital decided to shake it up with an event meant to be both fun and educational for everyone involved: an airway competition.

This contest consisted of sequential stations meant to simulate different difficult airway scenarios. The 23 competing EMS providers from several local agencies performed the challenges in a head-to-head race for time.

Seeking to repair potentially bruised relationships caused by the individual competition, we then paired providers for a team-based challenge in which they, literally, had to be each other’s eyes and hands to intubate a “victim” trapped in a building collapse.

The stellar EM residents involved either served as race officiators or performed a debrief with discussion of difficult airway techniques, equipment, indications, and trouble-shooting with the EMS providers after their competition.

Doctors Hospital EMS Airway Competition

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Overall, participating EMS providers said they enjoyed the competition and found the debriefing sessions to be valuable. We aim to continue pioneering future educational ventures and plan to put more than bragging rights on the table next time.

This event not only helped EM residents gain insight into how EMS education is structured, but additionally improved our camaraderie and relationships with the EMS providers we take signout from each shift. Resident instruction of our EMS and prehospital colleagues can be a valuable experience for both parties and helps to strengthen the acute care team.


References

1. Warner K, Carlborn D, Cooke C, Bulger E, Copass M, Sharar S. Paramedic training for proficient prehospital endotracheal intubation. Prehospital Emerg Care. 2010;14(1):103-108.
2. Sayre MR, White LJ, Brown LH, McHenry SD. National EMS Research Agenda: Proceedings of the Implementation Symposium. Acad Emerg Med. 2003;10(10):1100-1108.
3. Katzer R, Cabanas JG, Martin-Gill C. Emergency medical services education in emergency medicine residency programs: A national survey. Acad Emerg Med. 2012;19(2):174-179.

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