The New EMT Training Program
A history

Why are we developing a new EMT training Program?

For many years, since 1995, new emergency medical technicians were trained according to the DOT National Curriculum. I myself was trained using an older program (EMT-A). What this meant to us instructors is that if you knew how to put on a Hare traction device we had to pass you even if you had no clue as to why the device was needed. We tested your skills and not your core competency. The new EMT training program is not a curriculum rather it is an set of guidelines. There are no lesson plans - only concepts that have to be taught. How those concepts are taught and ultimately evaluated has been left up to the states.

"Bryan Bledsoe has an interesting article on the new EMT training program."

The state of New Jersey has decided in 2011 to adopt the new guidelines but did not have a plan on how to implement them. A team of experienced EMT coordinators was put together during the summer and fall of 2010 to decide what should be taught and to create lesson plans for the new EMT training program beta site program.

The New Jersey Department of Health and Senior Services Office of Emergency Medical Services (hereafter known as NJOEMS) decided that there would be four beta test sites for the EMT training program. Each EMT training program is in a different part of the state.

The test sites would run their programs in the spring of 2011 and then compare notes in June 2011.

The original plan was then to roll out a full, new EMT training program for the summer of 2011. I think that is an overly ambitions plan.

One of the beta test site is the Bergen County Emergency Services Training Center.

Who am I?

My name is Jim Berthold and I have been an EMT instructor since 1997. I have worked primarily at the Bergen County Emergency Services Training Center located in Paramus, New Jersey (also known as Chaise U after Bob Chaise).

The Bergen County EMS Training Center has been around since the late 1970's and currently trains around 750 new EMT's per year and several thousand re-certifying EMT's each year. That's a lot of students. We have been given the nickname of the "Factory" which is a bit unfair but we do train the most EMTs in the state.

To be fair, we do have a large instruction staff of over 25 instructors so our ratio of student to instructor is still quite low.

I am proud to be a part of this institution and excited that we were chosen to be one of four beta test sites in New Jersey for the new EMT training program.

My goal for this page is to provide a running commentary on the implementation of the new EMT training procedure so other sites can learn from our successes and from our failures.

The Beta Test Site

One of the beta test sites for the new EMT training program in New Jersey is my site at the Bergen County Emergency Services Training Center in Paramus, NJ. I do not want to discuss the EMT training programs other sites since that will not be fair to them. I do want to discuss our site and I hope to be unbiased as possible in how we are developing the new EMT training program.

The Coordinator of the EMT training program is Michael Tarantino. He was my EMT-A instructor back in the day and is probably one of the best qualified to run this beta program.

The EMT training program is broken out to be approximately 198 hours of class time with 10 hours of either hospital service or ambulance riding time. The EMT training program has a considerable increase in time from the standard 120 hours we are used to.

There are 13 written and/or practical tests in the new EMT training program. This is also a lot more than in the past. There are 9 sections (we used to call them "MODS") covering the following:

1. Preparatory
2. Pharmacology
3. Patient Assessment
4. Airway Management
5. Shock and Resuscitation
6. Medical
7. Trauma
8. Special Patient Populations
9. EMS Operations


Each section in the EMT training program has its own test and then there will be "Over arching" test that combine sections. The first comes after section 5, the second comes after section 8 and the final after section 9 covering all sections.

As the beta-test for the new EMT training program unfolds, I will write about what we are doing. Together we will see how this works out.

We have decided on a text book for the new EMT training program. The book is the AAOS Emergency Care and Transport of the Sick and Injured 10th edition.

 

The advantage of this book and its associated programs is that the book is available on audio, has a strong online presence and online assessment. How we use this will be explained as it comes along. Remember, we are learning how to do this as well.

Disclaimer

This is a good time to make a general disclaimer. I do work for the Bergen County Emergency Services Training Center but I do not speak for them. My opinions are strictly my own and do not necessarily represent the opinions of my employers. I take full responsibility for the content of this publication.

OK, let's get started....

Day 1
We started the new EMT training program on January 24, 2011. The overall program is broken into three sections. One section (mine) meets on Monday and Wednesday evenings. The second section meets Tuesday and Thursday mornings and the final section meets Tuesday and Thursday nights. I only have data for the Monday and Wednesday evening sections but my comments could be applied to the other sections.

Now for some statistics, we had 84 students sign up for the Monday/Wednesday evening section. 82 students showed up. These students were broken down into 5 classrooms (or labs if you will). We should have 17 students per class. My class only had 15 students show up (I guess I lost the two that were missing).

The class schedule for the evening was:

7:00 PM to 8:00 PM
Administration - we needed to get the students to complete their registration process.

8:00 PM to 8:45 PM
Introduction to EMS - this is the standard lecture that all EMT books uses. This is usually chapter 1. In our book, the AAOS 10th edition, this is true.

8:45 PM to 9:00 PM
Break - we have to let the students get a respiratory therapy break (i.e., cigarettes)

9:00 PM to 9:30 PM
Continuation of the Introduction to ESM

9:30 PM to 10:30 PM
Breakdown into classes - we assigned the students to their new classrooms and they got to meet the instructors. In my class we have three instructors.


Roger - a dentist by profession
Don - the former coordinator of our program, now retired (sort of)
Jim - myself, a chemical engineer by day

What we did in this session was to give them the rules for our particular classroom such as keep it neat, use the equipment that you need, report problems, ask questions, etc. We also paired up the students with each other. We then asked each student to interview each other. They were to find out where they were from, why they want to become EMT's, did they know they were taking the new EMT training program, are they married, do they have children, what is their educational background, etc.

This turned out to be a good exercise. The students got to know each other a bit better and I got to find out where they students are from, both physically and mentally. What I found out is that I have 15 students, about 50-50 male-female.

  • Two students are under the age of 18 and still in high school.
  • Five students are ether in college or are taking a break from college the remaining eight students are all college graduates.

We concluded the night with a warning to read the book. A final note! For the new EMT training program I decided to do the workbook along with my students. It is a new book and I want to vet it out. I took the online pre-test for chapter 1 and I am embarrassed to say I got a 69%. Did I take it too fast or was over confident? Perhaps but this woke my butt up. I need to put the work in as well.

Day 2
Well it happens sometimes. Our course site is located in northern New Jersey, just outside New York City. We are having a snow storm and the superintendent of the school has closed the campus for the evening. For those of you who are thinking of implementing this new EMT training program I will let you know how the rescheduling of the course works out for us.

Day 2 - After the snow
Well our course site was hit with about 19 inches of snow and the school got closed. The "New" policy is for all students from all sections to come to the next session. That happened, all the students from my session, joined with the day students and the Tuesday/Thursday students for the snow day make up. There were about 160 students divided into 5 classrooms. 60 students did not show up and they will have to make up the material. Here was the schedule for the night:

6:45 PM to 7:00 PM
Quiz from chapter 2 of the book. Normally we record the grades but because of the large number of students this did not happen.

7:00 PM to 8:45 PM
Lecture on Well Being for the EMT (Chapter 2 from the AAOS book). This was a very long lecture with a lot of people in the room. We had no spare space available, every desk and chair we had was in use. The room temperature reached near 90 degrees Fahrenheit and almost 100 percent humidity. Not a good way to learn. I hope they read the book.

8:45 to 9:00 PM
Break. The normal "Roach" coach did not show up and there were long lines at soda and chip machine. I think I could have sold stale bagels and cold coffee and they would have bought it.

9:00 PM to 10:30 PM
Scenarios on hand washing, glove removal, exposure control and general BSI/PPE practice. My class had 36 students (we normally have 15). We had each student don gloves and show how to remove them with contaminating themselves. We then had the students put new gloves back on and I walked around the room with liquid Ivory soap. I then walked around the room and squirted a small amount into each hand. This simulates some bodily fluid and it made it much harder to remove the gloves.

Next we had each student actually wash their hands in the classroom sink. The standard is to wash for 15 seconds (that should be only about 9 minutes for all students). Unfortunately this skill took nearly 20 minutes. Finally we handed out scenarios to groups of 4. Each scenario concerned responding to a call and what (if any) BSI or PPE should be used. There were 8 scenarios in all. We had one group at a time demonstrate what they would do by actually using the PPE we had in the room. This actually worked quite well if not a bit chaotic. We only got 3 scenarios done in the time allotted. This Saturday we have our first full 8 hour day in the new EMT training program(which is repeated on Sunday). This should be fun.

 

Day 3 Saturday and Sunday
This was the first all day class of the new program. We are still in section 1 (Preparatory) of the new program. About 140 students showed up today. This was first time in my 16 year career as an instructor that I did not need equipment for such a long day. I will explain below.

Here was the schedule


8:00 AM to 9:30 AM
This was the Medical, Legal and Ethics lecture. This is chapter 3 in the new AAOS book. The lecture was taught by Craig Stewart who is an excellent lecturer and has a great deal of background in this area.

9:30 AM to 9:45 AM
Break

9:45 AM to 10:30 AM
Continuation of the lecture by Craig Stewart.

10:30 AM to 11:45 AM
Legal and ethical scenarios were practiced during this time. Unfortunately my ourse coordinator is keeping the actual text of the scenarios proprietary in the new EMT training program so I cannot share the contents with you but I can give you the summary of a few.

Scenario 1
You and your partner are called to the scene of a patient who's chief complaint is difficulty breathing. After a proper assessment you package and transport your patient to the local hospital. En route you pass a motor vehicle crash (MVC) between two vehicles. There are three patients, two of which are seriously injured. You and your partner tend to these two injured patients while calling for backup. After backup arrives and takes over care you return to your original patient, still in the back of your ambulance. You find the patient slumped to one side, drool coming from here mouth and an inability to speak.

Question: Have you abandoned the patient and can you be held negligent?

Considerations: The patient appears to have suffered a stroke, what could you have done to prevent the stroke if you were still in the ambulance?

We considered several of these kind of scenarios.

11:45 AM to 12:30 PM
Lunch

12:30 PM to 2:30 PM
A documentation and communications lecture from chapter 4 of the new AAOS book. The lecture was given by Aaron Hilliard. This lecture is very similar to the lectures given in the past. We normally wait will "Module 3" for this lecture but in the new program it is given early.

2:30 PM to 2:45 PM
Break

2:45 PM to 4:00 PM
As with the morning scenarios we practiced giving radio reports. We handed out many different scenarios and asked the students to make a radio report to the hospital. This was followed by a written report.

Conclusion
We concluded the day with an instructor meeting to see what worked and what didn't. We found that these scenarios early on in the course got the students to work together as a team and also honed there reasoning skills. We used peer review (student on student) rather and the instructors criticizing the class. This also worked very well since no student felt that they were being unfairly criticized.

Day 4 - The Human Body

Class attendance in the new EMT training program is trending downward. I lost two students because of the workload of the course. I hope the remaining 13 can still make it.

We have recovered from our full day sessions over the weekend. This new EMT training program is proving to be tiring for us instructors. Now it's back to the regular evening schedule for class. To night we cover the human body up to the various bodily systems. So the lecture, given by Cliff Field, Sr., covered basic anatomy, geography and function. The next lecture will be on bodily systems.

Here was tonight's schedule:

6:45 PM to 7:00 PM
Homeroom and chapter 5 pre-quiz. The quiz did not have very good results. There were 7 questions on the multiple choice quiz and 15 were distributed. We had two 7 out of 7 (7/7) quizzes and one 1/7 quiz. The rest were in the 4 to 5 range. The class was instructed (more like implored) to read the book.

7:00 PM to 8:45 PM
Lecture on Chapter 5. This was rough, 1:45 to be sitting in class is way too much. I don't think any knowledge was gained at the end of the lecture.

8:45 PM to 9:00 PM
Break

9:00 PM to 10:30 PM
Anatomy drills. We paired up the students and gave them flash card. On each flash card was either a portion of anatomy (such as a femur) or an anatomical position such as Supine. The student then had to show the class what that term meant. After each student went, we quizzed them on some of terms not covered. We then rounded out the night with how to read the book and do the workbook problems.

I am having the class complete each chapter in the workbook for each session and turn it in for grading. This, hopefully, will keep them up with the reading. I did find that some students were very reluctant to touch other students when pointing out body parts. This could make life difficult for them if they do EMS as a profession. It is the nature of our job to touch.

This was an evening class where there was a mega lecture. The lecture took nearly 2 hours. Afterwords we we had a show and tell where each student was given a random choice of either a body part or anatomical geography and was required to demonstrate it. For example, a student was required to locate the femur. This was quite funny in that the male student did not want to touch the female "Patients" leg. I explained that if you don't want to touch people, perhaps EMS is not for you.

The second example was to define "Distal". The student pointed out that the wrist was distal to the elbow. We made all 18 students do this.

Day 5 The human Body part II and Life Span development

Unfortunately I was not present during this class. The various bodily systems such as respiratory, circulation and endocrine

systems were defined. Each student was then asked to pick a system and give a mini lecture to the class. The class also talked

about Life Span Development. I think they pointed out the mental changes as an infant grows into adulthood.

Day 6 Baseline Vitals and SAMPLE history

For an "Experienced" instructor I found comfort in that this day in the new EMT training program was essentially the same as last 16 years. Whew! It's hard to teach an old dog new tricks sometimes.

Day 7 Lifting and Moving Patients

Gott in Himmel! This was a scary day. We had the class divided into three sections. All were scary!

  1. Stretchers
  2. Lifting Devices
  3. Stair chair

Stretchers

I know the most about this station since I taught it. We had divided the class of now 60 students into groups of 20. In this station we used large, sturdy tables to simulate hospital beds. We then used bed sheets to move the patient to the stretcher. Our ambulance stretchers were made by Stryker and by Ferno.

50 minutes were allotted for the rotation. In that time we demonstrated how to move a patient from the "Bed" to the stretcher, secure them, lower and lift them safely and then transfer them back to the "Bed." We then broke the group into 4 smaller groups, each with an instructor, and then moved them from the bed and transfer to the ambulance.

We had two ambulances for practice, both were configured to receive a man-and-a-half type stretcher without any mechanicallifting device. Each group was then shown how to lift the stretcher into the load position, lock the stretcher on to the "Lift Dog" and load the stretcher by lifting the legs. We then reversed the process instructing the students to catch the "Lift Dog" and not to let the legs of the stretcher drop and hit the ground. We did this a number of times.

Teaching the new EMT training program in norther New Jersey has some drawbacks. It was nearly 25 F weather. Many of our students were not dressed for the occasion. This is a critical fault of the instructors. I am sure many under dressed students did not learn anything but how to shiver. This became evident on Day 8

Lifting Devices

I was at another station but we covered using Orthopedic stretchers (scoops) and flexible stretchers (Reeves). I heard not horror stories from this station and it was taught inside.

Stair Chairs

We used both a Stryker stair chair and an older Ferno type chair. Again, I was not there but it was taught in a heated garage (getting the hint here?).

Day 8 Weekend Class or "Crash and Burn"

The day was very busy with our first major written and practical tests in the new EMT training program. Lets go over the crazy schedule:

Lifting and Moving part II

We finished up with the last two major parts of cervical spine collars with backboard and manual lifts. This was also a skill set held over from the old EMT-Basic program so we were pretty confident that we could teach it.

Written Test

The Section 1 written test was given covering chapters 1 through 6 plus chapter 35 in the AAOS 10th edition. It was 50 questions. Approximately 200 people took the test. 122 students failed (or a 61% failure rate). This is not encouraging.

Remediation on the written test would take place at the end of class.

Loading into an Ambulance

This test was easy and hard. We took a Rescue Randy which weight 150 pounds and had it preloaded on a stretcher. We used Stryker stretchers for this practical station. The students worked in groups of 3. Their tasks were:

  1. Secure the patient to the stretcher (we left the side rails down and the straps undone)
  2. Move the patient feet first to the stretcher
  3. Load and lock the stretcher into the ambulance
  4. Remove the stretcher from the ambulance without letting the legs drop or dropping the stretcher
  5. Prepare to move the patient to the "Bed" which was a big sturdy table.

We learned our lesson from the other day and this test took place in our heated garage. It did not matter. Some students were very adept and getting the stretcher to do what they wanted. They were efficient and communicated well. Others were not so good and potentially harmed the patient (which is why we used the manikin). What I saw (I wish I could put them on Youtube but I am not allowed to):

  • The shortest rescuer had lift the most weight and dropped the stretcher
  • Many dropped legs
  • One team got the stretcher in the ambulance and could not get it out
  • Another team dumped the stretcher on its side and the patient fell out
  • Several did not secure the patient
  • Another team lowered the stretcher and loaded it like the old two-man stretchers (I did not fail them for that)
  • And finally, one team looked for the buttons to lift and lower the stretcher. OK, I know some of you have them but the controls are not located at the head of the stretcher where the student was looking for them.

Is there a problem in the new EMT training program? Is it us (the instructors)? Or are the students not grasping the concept? I don't know but I think it is mostly the instructors fault. I take the blame. Of the 200 students who tested, 70 failed this station.

Medical Legal

We have a scenario where the patient is competent and is refusing medical care. Some things needs to be explained to the patient before they can refuse care. We tested the student if they knew what those items are:

  • Patient oriented to person, place, time and event
  • Patient informed of the consequences of not receiving care
  • Patient informed to seek follow up care as soon as possible
  • Patient informed that they are free to call for the ambulance again

I tested only a few at this station. Of those who failed, and there were not many, most did not add the last two bullet points of seeking follow up care and they should call the ambulance again if needed.

BSI/PPE

We have the students a scenario and asked them what the minimum PPE and or BSI needed for each call. We asked them to actually wear the BSI and PPE. Most students actually over dressed for this scenario but none failed because they put on the bunny suit (level A suit).

General Pharmacology

The students were pretty well beaten up by the written and practical tests. We then forced them to sit through a one and half hour lecture on General Pharmacology. They are to be tested on Day 9. We had a 1 hour practical skills session with them after lecture to show them how to use the classic drugs:

  • Nitro
  • Meter Dosed Inhalers
  • EPI
  • Glucose

The State of New Jersey is re-writing the protocols for these drugs as we speak but we instructed them using the EMT-B standards.

Remediation

After the testing was done, we brought the students who failed the written test back into our main lecture room and went over the test question by question. We explained what each question meant and how it should be answered. Those students who failed Medical Legal and BSI/PPE stations were told to go home and study.

Those who failed the Lifting and Moving got a very stern remediation by me. I was a bit cranky but I made each student lift the stretcher from the head and from the foot. I then made them touch each control and explain what it does. Finally for those who dropped the legs, I had them load and unload the stretcher from the ambulance till each person could do it and understood why (may be I should have done that first?)

Conclusion of Day 8

Of the 122 students who failed the written exam, only 5 did not pass the re-test exam. Unfortunately one was in my small group.

In the practical stations, there were no failures on the re-test. Now how do we get these results on the first time around? I think some of our students take the failure as a means of finding out what is on the test and then re-study. I am down to 12 students.

Day 9 General Pharmacology

This is the start and end of section 2 in the new EMT training program. I think the new EMT training program should be covering basics like airway and oxygen use at this point but the powers that be think pharmacology is more important.

The students had the lecture on Day 8 (but I doubt many remembers what they heard). We had an hour to go over the New Jersey Protocols (still written for EMT-Basic) and then discuss how to administer each drug as well as know each drugs indications, contra-indication, dose and side-effects.

After one hour the students went to testing. Each instructor was to test the student on a general protocol for each drug:

  1. BSI/PPE
  2. Scene Safety
  3. Give Oxygen
  4. Place patient in a position of Comfort
  5. Call Advanced Life Support
  6. Get base line vitals and SAMPLE history
  7. Determine the 6 rights
    • Right Medication
    • Right Patient
    • Right route
    • Right Date
    • Right Dose
    • Right Documentation

After that we tested on the individual drugs of Nitro, EPI, MDI and Glucose. The student had to know the indications, all contra-indications, dose and side-effects. I am happy to say most students passed. I don't have the numbers on how many did not pass either the written test (25 questions) or practical tests.

Day 10

I lost yet another student. I am down to 11. This is not going well. Tonight's topic is scene size up and the primary assessment. Now for many of you older EMT's, the new EMT training program did not simply re-instate the old primary assessment. in the new EMT training program there are some major differences. We have modified the process a bit so it is different from the AAOS text book. I don't want to teach you the new primary assessment, that is available in the texts that are coming out, rather I want to point out how we taught the skill.

We started off with lectures. The Scene Size up lecture is pretty much the same lecture that we have used in the past except we have added donning our PPE as required. We then added the primary assessment lecture. This had some new items and some got re-arranged. We still do our general impression, level of consciousness and chief complaint but now we added the Glasgow coma scale as well as AVPU.

The ABCs are also a bit different in the new EMT training program. We still open the airway as before but now we both assess breath sounds (we have always done that at our site) but now measure a rate, rhythm and quality. We still do a circulation as before but add a rate and quality as well. We moved the pulse check to the carotid artery for unresponsive patients. Responsive patients still get a radial pulse check.

The newest item is that we have moved the rapid assessment to the primary assessment and now call it the rapid scan. We perform it like the old rapid assessment except we do it for unstable and potentially unstable patients. Stable patients do not require a rapid scan.

We practiced this for the remainder of the night. Did you notice that I did not say we did anything with oxygen or airway protection? This is a flaw in the outline of the new EMT training program. The next course in the summer will have this fixed.

Day 11

We had a short lecture on history taking. In the new EMT training program this is now done at the same time as the primary assessment. It is SAMPLE, OPQRST and an investigation of the chief complaint with physical assessment.

After the lecture we went back to the labs and started the secondary survey. For those EMT-A's still hanging around, this is basically the same secondary survey we used to do. We take vitals, to a complete head-to-toe exam and intervene as necessary.

Day 12 (Weekend)

Marathon day!!! This day started at 8:00 AM and ended at 4:00 AM. The day was broken down into several segments:

  • Patient Assessment with Trauma (rote skills)
  • Patient Assessment with Medical (rote skills)
  • Patient Assessment with Trauma including lifting and moving into an ambulance (we used a "Rescue Randy" that weighs in around 180 pounds)
  • Patient Assessment with Medical including lifting and moving (we used live patients)
  • Patient Assessment with trauma scenarios
  • Patient Assessment with Medical scenarios
  • Vital sign measurement

As you can see in the new EMT training program there are a lot of patient assessment skills. By the time the students got to me (I was running the vital signs station) they were very tired but happy to do something other than patient assessment.

I did have one sour-note this weekend. One of my students "Eddie" decided not to follow the rules. He came to class late by 45 minutes. The coordinator let him stay with the idea that he had to make up the time at lunch. Eddie left for lunch and returned 30 minutes late. That was it. Goodbye! The coordinator dropped him from the EMT training program. Now I am down to 10 students.

Day 13 (Section 3 testing)

We had 48 students take the section 3 test. It was divided into 3 parts.

  1. Written test (50 multiple choice questions)
  2. Practical skills station for patient assessment (medical patient)
  3. Vital signs evaluation using a Laerdal Simulation Man to set the actual values.

All that patient assessment practice over the weekend must have paid off. Of the 48 students we had a 79 passing rate. This was very good. No student was dropped from the program and I still have 10 students.

Day 14 (Section 4)

Now we start the airway module. Personally I think this section in the EMT training program should have been before the patient assessment module and now the powers that be agree with me. In the new EMT training program we now spend a lot more time over the pathophysiology of respiration than in the past. I learned new things about CPAP that I did not know. The Lecture was delivered by George, a Hackensack University Medical Center paramedic. It was quite good if not a tad too long.

The lengthy lecture forced the omission of some ventilation and obstructed airway skills. This will come back to haunt us.

We had about 45 minutes to practice assembling the O2 cylinders and attaching non-re-breather masks and nasal cannulas.

Day 15

Today we finished the airway sections. We practiced "Fred" the head skills. We use an airway training made by Laerdhal. This is just a head manikin. Hence the name "Fred the Head". We practiced sizing and inserting oral pharyngeal and nasal pharyngeal airways. We also practiced suctioning with hard and soft catheters. We switched rooms and repeated the same skills on junior and pediatric "Heads". Finally we did some airway scenarios.

Day 16 (Section 4 Testing)

Now we find out if our new airway teaching skills in the new EMT training program worked? We divided the class into 5 stations:

  1. Written
  2. O2 therapy
  3. Airway adjuncts with suctioning (Adult)
  4. Airway adjuncts without suctioning (pediatric)
  5. CPAP

Let's go over each section.

Written Test

This was a 50 multiple choice test covering a single chapter in the 10th edition AAOS book. I am happy to say that out of 58 students there were only 5 failures and those were in the 60% range.

O2 Therapy

We are testing in the new EMT training program using a scenario. Essentially we have a conscious medical patient requiring oxygen. During the scenario the patient will ask to have a non-rebreather mask removed. The student is to both assemble the O2 regulator as we have done in the past and also recognize that a Nasal Canula is required.

Most students passed this station with only a single failure.

Airway adjuncts with suctioning (Adult)

This was a pretty involved scenario using "Fred the Head". A unresponsive, non-breathing patient requires O2. The student was to determine breathlessness and then apply O2 via a BVM. An oral airway was to be applied. During the scenario the patient will vomit and the student should recognize that suctioning is required. Finally a nasal airway is to be applied and the patient will spontaneously start to breath. The student was to apply a non-rebreather mask.

There were 12 failures from this station. Most students did not understand that you cannot apply an oral airway without first checking to see if the airway was completely open. I link this back to the lecture where we skipped obstructed airways. Shame on us.

Airway adjuncts without suctioning (Pediatric)

Similar to the adult, we used "child Fred the head's". The scenario called for an unresponsive child lying on the floor. No trauma is indicated. A full patient assessment was to be performed (a bit hard with out an actual body). Most failures in the new EMT training program(6 of them) we again because of the lack of understanding about establishing an open, patent, airway.

CPAP

Under the new EMT training program we can now administer oxygen via CPAP. Unfortunately the great state of New Jersey is limiting EMT's to just assisting the medics in this task. The is test was to properly assemble the CPAP rig and apply it to a manikin.

Day 17 of the New EMT Training Program (Weekend)

This was another full 8 hour day in the new EMT training program. As usual we divided the day into many stations. This section is on shock and resuscitation. Here are the stations we set up:

  • Basic CPR with AED. We used the American Heart Association's 2005 guidelines in the new EMT training program. We used the older guidelines since the printed material for the new guidelines are not available.
  • Basic CPR with AED in moving ambulances. We put a team of 4 in an ambulance with a recording manikin. We then drove around our campus, purposely hitting bumps. We then analyzed the results of the CPR.
  • Basic CPR with AED in a house. We created some weighted Reeves stretchers. The boards of the Reeves were removed and sand added. This gave each reeves about 50 pounds of weight. We then added a CPR board filled with lead shot for another 25 pounds. Finally the manikin was also heavy. The total weight was about 100 pounds. We then put the manikins into a house under construction with very tight corners. The students had to move the manikins out and into an ambulance. Hard work.
  • Conscious adult with respiratory distress moved from upstairs via a stair chair. For the EMT training program we now use scenarios for this kind of training.
  • Simulated patients in cardiac and respiratory distress. We took our simulation manikins and programed vital signs. A core concept of the EMT training program is that we use scenarios to hone the students skills. Each responding crew got three scenarios to solve.


Day 18 of the New EMT training Program - Over arching exams (The Mid-Term)

(Crash and burn part II)

This was not a happy day. We tested our students on sections 1 through 5 in 4 scenarios. There was also a 25 question written test. The written test was based around 5 scenarios each with 5 questions. There was a high pass rate.

The practical stations were:

  • Loading and unloading a patient into an ambulance
  • Lifting and moving using a stair chair
  • Use of Inhalers/EPI/Nitro
  • Medical/Legal scenarios

Only 48 students tested. No student passed all sections. This means a 100% failure rate. I don't have data on the individual stations. Whoa! The new EMT training program seems to be in trouble.

Our class time is scheduled from 6:30 PM to 10:30 PM. Testing concluded at 11:30 PM, one hour late.

I hope to report on the aftermath.


Day 19 (Section 6) Medical - Respiratory Emergencies

Day 19 of the New EMT training program was not a good day for both the students and for me. I was called into the administrators office and chastised for writing this blog. I was forced to remove the blog (temporarily) until the beta course is completed. I had been given permission from both the course coordinator and the public relations department from my school but this apparently means nothing.

The overall enrollment for the course had dropped significantly. I my lab I originally had 18 students and now I am down to 9. That is a 50% drop rate. Most have dropped for administrative reasons (missed classes). A few have dropped for academic reasons.

This day starts the medication section of the New EMT Training course. We had a rather lengthy lecture on the respiratory system and a general overview of medical scenarios. The lecture went for almost 2 hours and we finally got them for the last hour of the class. I take some comfort as an instructor that this part of the course is very much like the old EMT-B program. We spend most of the class going over inhaler scenarios.

Day 20 - Respiratory Emergencies

The new EMT training program requires that we provide scenario based training. Boy did we ever, the training took place all night. We went though basic inhaler scenarios to COPD scenarios. We also through in obstructed airway emergencies. The students were refreshed on how to use oxygen equipment along with suctioning equipment. We were amused that they had forgotten so much in such a short period of time.

Day 21 - Cardiovascular Emergencies

The New EMT training program stresses pathophysiology instead of a strict assessment. For this reason we spend a great deal of time in lecture. Craig Stewart was the lead instructor for this section. He has a personal reason for this, he survived a cardiac arrest event. The lecture was involved and we finished the night with nitro scenarios.

Day 22 - Weekend Class with a bunch of things going on.

This weekend class finished up cardiovascular emergencies. We put mannikins on Reeves stretchers and then added weights to them. We then had the students perform CPR up and down stairs. We also put the students in the back of ambulances and drove around the parking lot to simulate moving CPR (this is a pretty good simulation if you ask me).

We then shifted gears and introduced neurological emergencies. This is a standard stroke lecture and hasn't changed much in the way of content from previous lectures. Normally that had been my lecture but the coordinator took this away from me and gave it to Patricia Kearns to do. They "Claim" that they did not want me to talk for four hours. Pat did a very good job with the lecture.

I then gave my lecture on endocrine emergencies and hematological emergencies. These are my traditional lectures and I spent about 2 hours on them. These were done at the end of the day when the students were tired. I did my best to put them to sleep.

Day 23 - Endocrine and gynecological emergencies

We gave the students some more scenarios on altered mental status that covered diabetes and stroke. It was a good deal of fun. George Carter, MICP, from Hackensack University Medical Center gave a lecture on gynecological emergencies. George is a knowledgeable and funny instructor but I think this lecture should be taught by a woman. We had no practice scenarios regarding gynecological emergencies.

Day 24 - Immunological Emergencies

George is back to talk about allergies and the EPI pen. Hackensack University Medical Center is a good choice to pull resources from since they provide for medical direction for many local ambulance services. The new EMT training program requires that we explain all the details about the EPI pen and afterward Hackensack certifies the students in New Jersey to administer the pen. OK, the actual process is more complicated than that but the initial training counts since George gave it.

Due to an oddity in New Jersey law, George cannot demonstrate the use of the EPI pen to EMT students. Only EMT instructors can demonstrate a skill and George is not an EMT instructor. New Jersey is an odd state sometimes (most times?). This is an all night lecture, practice will have to wait for another day.

Day 25 - Toxicology Emergencies

Drugs, baby!

Cliff Field gave this lecture. It is a short lecture which explains what various drugs do to a person and what we should do to treat them. This is standard lecture that we have been doing for years so we haven't added any thing to the New EMT Training program in this area. After the lecture we had time to practice both allergic reaction scenarios and drug scenarios.

Day 26 - Psychiatric Emergencies and Section 6 Evaluation

This is also a standard lectures. I am finding that as the new EMT training program is moving along we are not really changing the content all that much. Rather, we are changing how that content is delivered. Kathy Fox gave this lecture and it was short and sweet. We practiced general medical emergencies until time for a written exam.

We have the students a 50 question written exam for section 6. We used to call the analogous exam (mod4) in the old program The Wall because either got over it or ran into it. In the new EMT training program we expect much the same results.

Day 27 Section 6 practical Exam

I am impressed, we only had 3 failures out of 48 students on the written exam. Unfortunately one was my student, Nicholas. Nick was a good kid but suffered from diagnosed ADHD (attention disorder hyperactivity disorder). He really should have been dismissed from the New EMT Training program earlier on but he always squeaked by on a retest. Not this time. Now I am down to 8 students.

The practical exam was very straight forward. We had 4 testing stations set up. Each station was a scenario station and the students tested individually. The four stations were:

  1. AED
  2. Inhalers
  3. Nitro
  4. EPI

We had a 100 % pass rate. Maybe we are doing a better job now or perhaps we have weeded out the poor performers. I would like to think the former but suspect the latter.

Day 28 Section 7 Trauma

Now on to the fun stuff. This day started out with a general overview of trauma. We also covered bleeding and shock. The lecture was long but we did get to practice bandaging and applying tourniquets. The bandaging portion was very traditional using cravats and roller gauze.

Day 29 Another Weekend Class in the New EMT Training program

This day was both lecture and practical skills. The lecture covered injuries to the head, neck and spine. This was given by Arron Hilliard. Another lecture was given about soft tissue injuries which was given by Joan Kuerzi. Afterward we went back to class to practice the application of the following:

  • KED
  • Long backboards
  • Bandages

Day 30 More Head, Neck and Spine injuries

Scenario practice is big in the new EMT training program. At the Bergen County EMS training center, we have the luxury of having a pseudo junk yard out back of our school. We have an arrangement with Hackensack Auto Wreckers to use cars for extrication purposes. In a different course, we destroy these cars with rescue tools. Before that happens, we use these donated cars for patient removal practice.

This night we used 6 cars for practice. Three were used for rapid extrication in our garage and three were used for KED extrication in our circus tent. We have interior lighting in the tent so the students can see what they are doing. The students really liked this very hands-on type of training.

Day 31 - Environmental Emergencies

Once again, Cliff Field gave this lecture. After lecture we practiced these kind of emergencies. We used cold and hot packs much to dismay of our administrator. He told us that in the New EMT Training Program that there is no pretend, we must do what we would do in the streets. In all we went through 10 cases of cold packs and 10 cases of hot packs.

Day 32 - Abdominal injuries

This was a quick lecture and then back to class to practice more bleeding and shock skills. This is very much the same as we have always done.

Day 33 - Orthopedic Injuries (Uppers)

Rene Rich gave the lecture and then we spent the rest of the night practicing splinting the upper extremities. We also showed how to apply air splints (which we have never done before) and how to apply vacuum splints (which I have never done before).

Day 34 - Orthopedic Injuries (Lowers)

No lecture tonight. To night we splinted the lower extreme ties and applied the HARE traction device.


Day 35 - Trauma Section Evaluation

We evaluated the students using scenarios for the trauma section. To evaluate KED's, Backboards and trauma assessment we used some cars. We set up a mock accident and had a number of patients. Some were ambulatory at the scene (walking wounded), some were complaining of neck and back pain (KED patients) and some were unresponsive (rapid take down patients). The students were to decide for each patient what would be the best treatment. In the New EMT Training program we test critical thinking. What we found were:

  • Students missed applying oxygen to the unresponsive patients
  • Students failed to properly apply the KED
  • Students failed to safely secure a patient to a backboard.

These were in the minority, most students showed good judgement in packaging the patients.

A second evaluation involved a skateboarding accident which required long bone splinting. Again, a scenario was given and the students, working in teams, assessed, treated and transported the patients. I did not evaluate these students.

Overall , there was a high pass rate for this section.

Day 36 - Section 8 - OBGYN and Neonatal Care

This was a lecture given by Dr. Ruis of Palisades General Hospital (Edgewater, NJ). Dr. Ruis is a unique individual since he:

  1. Started his medical career as an EMT trained in our facility
  2. Worked to help develop the current new EMT training curriculum
  3. Still rides as an EMT provider at the basic level.

Day 37 - Pediatric Emergencies

This was a weekend class. We used child and infant mannikins as well as live patients. One of the disadvantages to being the child of an EMT instructor is that sometimes you get picked to be patients. An advantage is that as the child patient you get to mess with the heads of the students. We found that most of the children we used really enjoyed the day. We are stressing scenario based teaching in the New EMT Training program.

The day consisted of several major stations:

  • Infant medical emergencies (with transport)
    • We used mannikins for this station.
    • Instructors acted as parents.
  • Infant trauma emergencies (with immobilization and transport)
    • We also used mannikins for this station.
  • Pediatric medical emergencies
    • We used real children for this station. Ages 6 through 14.
  • Pediatric trauma Emergencies
    • We used both mannikins and real children for this station.
      • Any action that required a lift or a move with a backboard was done with a mannikin.

In addition to these four stations, we ran a mini-MCI with both adult and child patients. We used mannikins and instructors. This gave the students the feel of dealing with parents as parents and as patients. This adds a complexity to the scenarios that the students will actually see in the field.

Day 38 - Geriatric Patients with Special Populations

This was a difficult day. We dressed some of our students up as geriatric patients and used material we borrowed from the GEMS course. The students, acting as patients, found out what it was like to be a geriatric patient and the students as practitioners got some "Real World" experience. Some of the tricks we used were to have the "Patients" wear ear plugs so they could not hear clearly and wear foggy goggles so they could not see clearly. We also had them wear rubber gloves which reduced their dexterity so receiving a medication like Nitro was extremely difficult.

The special populations scenarios, such as special needs children, was covered by lecture.

Day 39 - Special Patient Population Evaluations

For this evaluations we had three stations.

  • Childbirth Station
    • This consisted of a team of two students who had to deliver a child using a childbirth mannikin. The infant would require CPR after birth.
  • Child Trauma Station
    • This consisted of a team of three students who had to extricate a child from a MVC and then properly package the patient for transport.
  • Child Medical Station
    • This consisted of a team of three students who had to evaluate a medical scenario.

Day 40 - Section 9 - EMS Operations & Practice for sections 4,5,6,7 and 8

This section is pretty much the same as we have always taught. Since the Bergen County EMS Training Center also has a Heavy Rescue course, we added some lecture material on extrication. The New EMT Training program gives us a lot of flexibility to add enrichment to the course that goes beyond the guidelines.

Day 41 - Section 8 - Written Evaluations and Practical Evaluation for Sections 6, 7, and 8

This was our second over-arching evaluation in the New EMT Training program. We ran two stations:

  • Medical Section
    • We borrowed this concept from another training facility. The students tested in teams of three and had to assess and treat a medical patient. After the assessment the patient will degrade into CPR and the patient has to be moved into an ambulance.
  • Trauma Section
    • In this section we had either an adult or a child patient who received trauma such as a fall or MVC. This required some type of splinting and bleeding control. The patient did not have to be moved since the lifting and moving portion was covered in the medical section.

Day 42 - Section 9 Continued.

This was more lecture on the Incident Management System (formerly ICS) and on Terrorism. We have the distinct advantage that our coordinator - Michael Tarantino - is the retired chief investigator for the Department of Homeland Security for New Jersey. He can give a unique perspective on terrorism in our state.

Day 43 - Vehicle Extrication - our last weekend class.

Since our training site has a Heavy Rescue Course, the rescue instructors ran a one day version of their program. The EMT instructors were not involved.

Day 44 - Section 9 Evaluation and Practical Skill Practice

We are nearing the end of the New EMT Training course so we spent three hours on practice. We ran skills from day 1 to till today. At the end of the day we gave the students the written exam. There was no practical skills evaluation for Section 9.

Day 45 - Practice

Our final day of full practice. Four hours of just skills drills. Each instructor made up scenarios for the students to solve.

Day 46 - Final Written Exam and Part I of Practical Skills Evaluation

We gave the students a 100 question written exam. We then had a full up testing of a medical patient. As with other practical stations we had a team of three students. The patient was an instructor or an instructor-aid. There was no pretend, we had simulated medications that we can actually give to the patients including nitro spray (actually just a sterile saline spray). Each patient had to be transported to the ambulance and a patient care report written and submitted for review.

Our overall objective in evaluation of this final skills section was to see if the students could make critical choices in their thinking and could they properly treat the patient. If a minor item was forgotten, we allowed the student to continue as long as the forgotten item did not injure the patient. We also evaluated teamwork, if a student was not participating, they did not pass this evaluation.

Day 47 - Part II of the final practical skills evaluation

This day was trauma evaluations. Some of the scenarios involved patients assaulted with a weapon, struck by a vehicle or a parachute accident. In each case the patient sustained multi-system trauma. All patients were played by instructors. Some patients were walking wounded. Each patient had to be transported and a patient care report written.

Day 48 - State Final Exam

The State of New Jersey came to administer the test for the New EMT Training program.


Conclusions!

The New EMT Training program started with 82 students in the Monday/Wednesday sections. We had 48 students complete the course which means we had a 43% drop-out rate. Most of these drop-outs occurred early in the course and many were for administrative reasons such as missed classes. Towards the end of the New EMT Training program, the drop-outs were for academic reasons, they failed either written or practical stations.

My own personal class started with 15 students and only 6 completed the course. This was a 60 % drop-out rate. As with the overall class, most occurred early and were for administrative reasons. Toward the end, I lost two students because of academic reasons. One student had been in the previous course (which was under the old National EMT-B curriculum). He managed to get through most of the course based on past experience. When we started pushing critical thinking he began to get lost and eventually fail. The second student had always been marginal and did not do his workbook. At the end he just failed out academically.

My thoughts? I think in the New EMT Training proggram we produced a smaller number of EMT's than we had in the past but these EMT's are much better trained that in the past. The current course is 198 hours but it was still lacking time in some areas such as oxygen and lifting and moving. The New EMT Training course is being expanded to 230 hours in the fall of 2011 and eventually to 250 hours in the spring of 2012.

I will keep you posted on how this new course proceeds.


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