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Field Training in Today’s EMS Environment

Well it has been quite a while since I have made it on here to post anything. Holidays, work volume, new ventures, etc… keep us all busy I am sure.But recently I just finished the field training of two paramedic candidates in my system. One fresh out of school and the other a well versed EMSer. I found both of them to be above par when they arrived to me and I was stuck with a tough decision to make. Here were two people that I saw had the basics down. But is that what we need to make sure of prior to clearing someone to practice on their own?

I know there are many variations around the country on field training/certification. Some have numbers that a candidate has to hit. Some have a “Here’s the key and drug bag…don’t mess up” mentality. And other use a judgment “feeling” from the FTO’s if they would let that candidate care for their family. Still after 10+ years of doing field training I am not sure which is the best. I am fairly certain it is not the here’s your stuff mentality. But as for the other two…We know that we don’t see the critical patients day in and day out in most systems. And now even with the critical patients we have other tools to treat them with then in the past. Patients that we would intubate are now fitted with CPAP or even if they have a difficult airway we us something like a Combi-Tube (a good thing rather then screwing around). But how is an FTO supposed to judge a candidates skill level if not afforded the opportunity.

This led me to an idea…Can high fidelity patient simulators be used to certify a candidate? msuFAQSplashCertainly  it is challenging to simulate the environment of screaming bystanders, rain, and wailing sirens around you, but in reality how often does that occur? Do we keep a competent provider in field evaluation for weeks and months hoping that call comes along. Or do we us something like a simulator to run them through a strategically planned out scenario. Multiple rhythm changes, crashing airways, pneumothoracies, distended abdomens, critical vital signs. I bet there are seasoned providers out there that could fail (based on FTO criteria) that bad of a patient.

After all..Many of the students coming to you have been trained in their programs on these simulators. These are not the same as 10 years ago. They are truly almost “life-like”.

I would love to hear what others think or if this is something you are doing where you work.


Enhancing Education via simulation

I have been out of the blogging mood for a while simply because I have been busy with other things. One of those was getting my departments first simulation manikin up and running. While we are not 100% there yet, we are on the right path I believe. Image

I was approached by a higher-up in the division saying that there was some state money available for simulation equipment and did I have any ideas. Now , I had been going to EMS shows and checking these things out over the past several years and every year more and more were showing up my different manufactures. So after attending a day long training class (Discover Simulation) at Continue Reading »

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No Sir I Enjoy What I Do

After delivering a patient to the emergency room the other night I was walking back to my vehicle and as passing visitor walked by me he made the statement that my job must suck.
I quickly replied “No I love my job.”

He walked on and I started to drive away. I began to think if I really “loved” my job. I mean I get to walk into some of the cleanliest places and people are always kind to me. I am always spoken to by patients in the kindest voice and they always says thank you after I get four people to help them move off my stretcher. Are you sensing the sarcasm yet?
But in all honesty I will never forget the first patient that saw me after being discharged. It wasn’t after I had just started in EMS but rather about eight years in. He had fallen off a chair and struck his head. Nothing major but a small laceration needing a few stitches. As the family was leaving the ER he walked up a just latched onto my leg giving a big squeeze and saying thank you. That five year old made an impression on me to this day over 12 years ago. I was to the point of thinking about leaving the EMS field at that time, but this single incident made me reconsider.
I now try to get every patient to smile at least once during my brief contact with them. That’s what the young boy was able to do for me.
So as I drove off from the man who said my job must suck I thought about the patient I just transported.  They were in a great deal of pain and the medications did nothing for the pain by the time we reached the ER. But I was able to make her smile several times and take her mind off the pain if even for a brief moment.

Everyday I report to work, my day is not the same as the last. I, for the most part am free to do what I want when not on runs. And while it could be better, the pay is not that bad for doing what I enjoy.
It’s not always the medications that we push through IVs but rather the personal touch we bring to our patients that makes them feel better. And sometimes it goes both ways.

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Roadside Safety for Responders

Today I arrived in Florida for a presentation and a soon as I hit the I-75, I came upon traffic congestion. I was irritated for about a minute until I became intrigued. I saw two bright warning signs on each side of the highway alerting motorists that there was an accident ahead. These were the collapsible type and I figured that the local highway crews put them up. But as I slowly made my way closer to the crash, I saw the roadway crews responding behind me. So who put these signs up if not the roadway crews?

EMS and FD were already on the scene, as were the police.  By the time I approached the actual scene, the highway crews had passed me and were setting up traffic cones. The police had already Continue Reading »

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You’re an EMS provider? Prove It!

This past Sunday EMS Office Hours focused on the topic of how we as a profession certify people as EMS providers. I was unable to listen to the whole live show, but caught up on the rebroadcast. Multiple choice questions, essay questions, practical testing, simulation and internships were all discussed as to their validity when it comes to certifying EMS providers. It seems that wherever you go in the world, every EMS program is run differently. In the US, the NREMT is a national organization that some states have adopted as a testing clearinghouse. Many of those that have not adopted this agencies exact standards seem to have some similarities.

During the podcast, the guys talked about the pros and cons of multiple choice

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Perfecting your craft-What are you doing?

 EMSEduCast recently aired an episode that discusses what EMS providers can do outside of regular activities to improve their craft. Like athletes, chefs, and really any other progressive profession, we need to keep up on what’s new when it comes to EMS.

In this episode, Greg Friese, Rob Theriault, and Bill Toon talk about their experiences and how they go about perfecting their craft. Rob recalls a run that he went on where a patient overdosed on Cyclobenzaprine. This patient deteriorated quickly which prompted Rob to seek out information and a better understanding of Continue Reading »

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50 Shades of Grey…Protocols (Part 3)

Last Sunday I participated in a podcast discussion about the ongoing debate on protocols and how they should really be written. On this episode of EMS Office Hours, Jim Hoffman, Josh Knapp, Bob Sullivan, and Tim Noonan all  joined in as well. According to Jim, the idea of this topic came from an article I wrote on protocols( see parts 1 &2) and a brief discussion that Tim and I had the week prior.

I am all for having a system that encourages medics to use clinical judgement based on patient presentation and not just protocol practitioners. However, when a system Continue Reading »