EDUCATION STANDARDS

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EDUCATION STANDARDS

• RURAL FRONTIER SUMMIT
• May 2008
• Deb Cason
• NHTSA HRSA (EMS-C) contract with

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Objectives

• Review the components of the EMS Education Agenda
  including Scope of Practice model
• Discuss the 3rd draft of the Education Standards
  and how you can participate
• Identify challenges for implementation,
  especially in rural and frontier areas

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The EMS Education Agenda for the Future A
Systems Approach
The Universe of EMS Knowledge Skills
National EMS Core Content
Periodic updates of these three documents
National EMS Scope of Practice
Delineation of provider practice levels
Replaces the current National Standard Curricula
National EMS Education Standards
National EMS Certification
National EMS Education Program Accreditation
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CORE CONTENT

• Led by NAEMSP and ACEP
• Identifies the ENTIRE DOMAIN of EMS
• Visit NEMSES.org to download a copy

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The National EMS Scope of Practice Model

• Led by State Directors and Training Coordinators

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Scope of Practice MODEL

• Provides direction for Education Standards
• Names and identifies role of each provider level
• Identifies skills for each level

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Who defines a Scope of Practice?
States

• have the authority and responsibility to set
  scopes of practice

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So, what is a National EMS Scope of Practice
Model?

• A template for states
• to create SOP
• laws or regulations
• States may choose to deviate from the SOP model
  to accommodate unique local needs and
  circumstances

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The Emergency Medical Responder

• Very similar to todays First Responder
• Focus immediate lifesaving care to critical
  patients who access the emergency medical system,
  while awaiting additional EMS response
• Skills Oxygen, BVM, suction, oral airways, AED

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Emergency Medical Technician

• Very similar to todays EMT-Basic
• Focus basic emergency medical care and
  transportation for critical and emergent patients
  
• Skills pulse ox, assisted meds, oral glucose,
  ASA
• Blood glucose analysis not included

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Advanced EMT

• Focus basic and limited advanced care and
  transportation for critical and emergent patients
  
• Skills Combitube, IV/IO, NTG, Epi 11000,
  glucagon, D50, ß2 agonists, narcan, Nitrous oxide

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Paramedic

• Very similar to todays EMT-Paramedic
• Focus advanced emergency medical care and
  transportation for critical and emergent patients
  
• Skills CPAP, capnography, 12 Lead interp,
  thrombolytics, etc.

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• Education Agenda for the Future A Systems
  Approach, June, 2000

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What are Education Standards?

• the document which provides minimal terminal
  objectives for each provider level.

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Education Standards

• guide program personnel in making appropriate
  decisions about what material to cover in class
• used by publishers to develop instructional
  material

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Education Standards

• With ES, educational institutions are held more
  accountable for content and quality of
  instruction

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EDUCATION STANDARDS

• Designed to increase EMS education program
  flexibility
• Encourage creativity
• Improve and facilitate alternative delivery
  methods

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Education Standards

• Will replace NSC

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Whats wrong with NSC?

• They have been essential to the development of
  EMS education programs!
• Community reliance on NSC has
• - decreased education program flexibility
• - limited creativity
• - impaired development of alternative
  delivery methods

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Education Standards

• Are broad
• Identify the necessary
• depth of content

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ANDInstructional Guidelines (IG)

• Companion document to Education Standards
• More specific with elaboration of content
• Will need frequent update
• Provide short-term guidance
• Not intended to be part of standards

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A word about process OPEN

• Stakeholders selected format to use (May 06)
• Drafts (3 versions) have been on website
• Comments have been welcome from states,
  organizations and individuals
• Comments drive changes
• Stakeholders met Feb 08 to id changes for draft
  3.0

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So how are the EDUCATION STANDARDS organized?

• For each provider level, a list of
• COMPETENCIES
• Knowledge required
• Clinical behavior and judgment

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Content Sections

• Preparatory
• Airway
• Assessment
• Resuscitation
• Cardiology

• Trauma
• Medical
• Special pts
• Ops
• Educational Infrastructure

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E.S. KNOWLEDGE TERMS

• DEPTH BREADTH
• simple simple
• fundamental foundational
• complex comprehensive

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KNOWEDGE APPLICATION

• Increasing level of cognition in competencies
• Recognizes
• Uses
• Applies
• Integrates

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COMPETENCY example

• EMR, Preparatory Uses a simple understanding of
  the EMS system, safety/well being of the EMR,
  medical/legal issues at the scene of an emergency
  while awaiting a higher level of care.

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KNOWLEDGE REQUIRED

• EMR under Preparatory, WORKFORCE SAFETY
  WELLNESS
• Simple depth, simple breadth
• Standard safety precautions
• P.P.E.
• Stress
• Prevention of response-related injuries
• Lifting and moving pts
• Dealing with death dying

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CLINICAL BEHAVIOR JUDGEMENT

• Assessment
• Therapeutic communication cultural competency
• Professionalism
• Decision Making
• Record Keeping
• Scene Leadership
• etc

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GLOSSARY ISSUE

• EMT is specific to that provider level, NOT
  generic!
• EMS Personnel or EMS Professional is the
  generic term

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Education Standards are NOT

• Instructions on
• Class sequence
• Recommended class sessions
• How to teach a class
• What to teach in a certain class

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For example When should I teach AP?

• OPTIONS
• 1. Make it a prerequisite
• 2. Front load all AP
• 3. Specific relevant anatomy
• during the trauma medical
• 4. Otheryour way

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• Education Standards do NOT require the
  completion of the previous level before moving to
  the next. (but states might!)

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So whats in the Education Standards?

• Use of traditional assessment terminology
• (primary and secondary
• survey)
• Skills added/changed
• More pathophysiology and understanding required
  of EMTs

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• Patient contacts required for EMT and above
• ED or alternative
• Field

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• Medical direction for
• ALL levels
• Student evaluation in all domains, all levels
• Course Length competency based

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CLASSES

• NOT necessarily all seat time
• OKAY to have prerequisites or co-requisites or
  just verify competency (CPR, NIMS, HAZMAT
  awareness YOUR choice)

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EMR

• 48-52 hrs
• Added skills
• Added info on airway/breathing, anaphylaxis,
  shock

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EMT

• APPROXIMATELY 150 190 hrs
• ADDED SKILLS
• pulse ox, automated BP, pt med assist
• ADDED KNOWLEDGE
• whys, airway mgmt, respiration, artificial
  ventilation, shock, acute coronary syndrome,
  anaphylaxis
• ADDED Clinical/field

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EMT CLINICAL FIELD

• Observe in ED (enough to appreciate continuum of
  care)
• 10 patient assessments (flexible location)
• Patient contacts on ambulance (approved by med
  dir and program dir)

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AEMT

• ESTIMATED 150-250 additional hrs over EMT
• More knowledge and depth related to background
  for skills
• Requires patient contacts

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AEMT clinical

• MUST DEMONSTRATE
• Med admin (15)
• Vascular access (25)
• Assessment/mgmt of pts
• chest pain, resp distress, altered m.s.,
  pedi, adult and geriatric

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AEMT clinical field

• SHOULD DEMONSTRATE
• Ventilation of unintubated pts (20)
• MUST PARTICIPATE team leader in internship
  approved by med and program director

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PARAMEDIC

• Ed Infrastructure references CoAEMSP standards
  for paramedic level

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CoAEMSP.org

• Program director full time, bachelors degree
  (or working on one)
• Sponsorship academic institution must
  participate
• Curriculum approx 1000-1300 hrs
• Adequate clinical resources

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TIME LINE

• Sept 07 Feb 08 receive input on 2nd draft
• Feb 08 Stakeholders met

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• TIME LINE
• April 08 Draft 3.0 on line
• May 30, 08 End of comments
• Summer, 08 IG done
• Aug 08 Deliver to NHTSA

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WEB SITE

• www.NEMSES.org
• National EMS Ed Standards

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Did I mention this is a

DRAFT
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Debra.cason_at_UTSouthwestern.edu

QUESTIONS?