Paramedic TRIPP teaching resource of instructor in prehospital pediatrics for paramedics

Inouye Editors and Contributors Getting Started Introduction How to Use This Resource Background and Educational Resources 1 Emergency Medical Services for Children 2 Accreditation and R

Contents: Paramedic TRIPP

(Teaching Resource for Instructors in Prehospital Pediatrics for Paramedics)

Cover

Registration Form

Forward by Senator Daniel K Inouye

Editors and Contributors

Getting Started

Introduction

How to Use This Resource

Background and Educational Resources

1 Emergency Medical Services for Children

2 Accreditation and Registration

21 Pain Management and Sedation

22 Medication Administration and Vascular Access

Special Problems

23 Newborn Resuscitation

24 Sudden Infant Death Syndrome/Death

of a Child

25 Child Abuse and Neglect

26 Children with Special Health Care Needs Environmental

27 Thermal Emergencies

28 Near-Drowning

29 Poisonings Psychological

30 Behavioral Emergencies

31 Post Traumatic Stress in Children

32 Critical Incident Stress Management for Paramedics

33 Family Reaction to Pediatric Emergencies Growth and Development

34 Developmental Considerations

35 Adolescents Additional Issues for Paramedics

36 Pediatric Injury Prevention

37 Medicolegal Issues in Pediatric Care

38 Safe Transport of Children

39 Disasters and Multi-Casualty Incidents

It was my pleasure to write the Foreword for the Teaching Resource for Instructors in Prehospital

Pediatrics (TRIPP), which was the 1999 national award-winner for Innovative EMSC Product of the Year.

It is gratifying that it has found a place in prehospital training programs across the United States, as well as

43 countries around the world

Following this unprecedented success, the Paramedic TRIPP has been highly anticipated This updated

version expands upon the knowledge and scope of practice from basic to advanced life support for

prehospital providers This joint endeavor represents the best from our nation’s medical community whoadvocate for children This book constitutes a logical continuation in our mission to provide children withthe same high quality emergency medical services that are available to adults

Legislation was initially introduced in 1984 to address the gap between the quality of emergency servicesavailable to adults and those available to children In the intervening years, members of Congress havestrongly supported continuing legislation to reauthorize this momentous health care initiative The

American Academy of Pediatrics has played an invaluable role in the development and continuation of thisprogram as well

I am proud to note that the Emergency Medical Services for Children program has grown steadily, with allfifty states and six territories now receiving EMSC funding This is a significant accomplishment, but there

is much work yet to be done There are many rural, underserved areas where ill and injured children still donot receive the best possible treatment We must diligently continue our work to ensure that every child inevery state and region of our country receives appropriate care Our country’s heroes, EMS and Fire

personnel deserve the best possible tools to do their job This Resource is one of those tools

To all who have contributed tirelessly to this important resource, I express my sincere appreciation Icongratulate you on this enormous accomplishment and encourage you to continue your efforts to keepEmergency Medical Services for Children in the forefront of health care for the twenty-first century andbeyond

Aloha,

DANIEL K INOUYEUnited States Senator

Editors and Contributors

Columbia Univ College of Physicians & Surgeons

David Markenson, MD, EMT-P

Columbia Univ College of Physicians & Surgeons

Marsha Treiber, MPS

New York University School of Medicine

Andrew Skomorowsky, MFA, NREMT-P

New York University School of Medicine

Primary Medical Editor:

University of Colorado School of Medicine

William R Brown, Jr., NREMT-P

National Registry of EMTs

Richard Cantor, MD

Syracuse University Hospital

John C Clappin, BA, EMT-P

Fire Department of New York, Bureau of Training

Kathryn D Clark, MD

Childrens Hospital of Denver

Charles Coren, MD

Winthrop University Medical Center

Philip Dickison, NREMT-P

National Registry of EMTs

New York University School of Medicine

Ann Fitton, BS, EMT-P

Fire Department of New York, Bureau of Training

Glenn Fredenburg, EMT-CC, GN

Chazy NY Volunteer Fire Department EMS

Columbia Univ College of Physicians & Surgeons

Deborah Parkman Henderson, RN, PhD

UCLA School of Medicine

Gary Mark Horewitz, JD, NREMT-P

International Association of Fire Chiefs

Children’s Hospital & Medical Center of Seattle

Maimonides Medical Center

Paul F Marmen, M.Ed, NREMT-B

University of Oklahoma College of Medicine

Gene McDaniel, EMT-P

Phoenix College

Jeffrey T Mitchell, PhD

International Critical Incident Stress Foundation

Karen McCloskey, MD

University of Texas Southwestern Medical Center

Connie Monahan, BA, EMT

University of New Mexico

James H Moorehead, BS, NREMT-P

Utah EMSC, Primary Childrens Medical Center

Jeff Rusteen, EMT-P

Fire Department of San Franscisco

Baylor School of Medicine

Andrew W Stern, MPA, MA(PS), NREMT-P

NYS Department of Health Office of Managed Care

Oregon Health Sciences University

Robert van Amerongen, MD

New York Methodist Hospital

Elise W van der Jagt, MD, MPH

Univ of Rochester School of Medicine and Dentistry

Daved van Stralen, MD

Loma Linda University School of Medicine

Phillip A von der Heydt, MEd, RRT, EMT

Education Management and Accreditation Consulting

American Academy of Pediatrics Committee on

Pediatric Emergency Medicine

Susan M Fuchs, MD

American Heart Association

Lisa Carlson, RN, MS

William Hardwick, MD

Committee on Accreditation of Educational Programs

for the EMS Professions

Daniel L Storer, MD, FACEP

EMSC National Resource Center

Jane Ball, PhD, RN

Robert Waddell, EMT-P

Emergency Nursing Association

Linda Manley, RN

National Association of EMS Educators

Jose Salazar, MPH, NREMT-P

National Association of EMTs

Tommy Loyacano, EMT-P

National Association of State EMS Directors

Michael Armacost, MA, NREMT-P

National Council of State EMS Training Coordinators

Edgar W Batsford

National Registry of EMTs

Charles O’Neal, NREMT-P

A Movement for Change

For many years, our emergency medical services systems focused primarily on adult care, givinglittle attention to the special needs of critically ill and injured children As this shortcoming

became more evident, a new movement gave rise to numerous programs that have worked to

close the gap between adult and pediatric care One of the cornerstones of this movement lies inthe training we provide to emergency medical technicians and paramedics, who deliver the bulk

of the prehospital emergency care in this country

With few exceptions, these EMTs and paramedics received their certification after completing

the National Standard Curriculum for EMT Basics or Paramedics The material covered in these

curriculae equips them to handle a wide range of medical emergencies However, neither

furnishes the detailed information EMTs and paramedics need to provide high-quality care to

children While greatly improved and expanded, the newest incarnations of the NSC curriculae

do not provide instructors with enough background information to answer students’ questions or

to provide in-depth training in the area of prehospital care

Bridging the Knowledge Gap

We have developed the Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP) to

help bridge the knowledge gap that still exists in the specialized field of prehospital pediatric

care Neither a course nor a curriculum, the TRIPP serves as an encyclopedic resource manual for instructors who teach the pediatric sections of the revised EMT-Paramedic: National Standard Curriculum It will furnish you with fundamental background knowledge about assessing and

treating critically ill and injured children so that you can provide more effective teaching to yourparamedic students You’ll also find student handouts, task analyses, and case scenarios that willhelp paramedics apply the information to actual practice

It is critical that paramedics receive appropriate teaching Since emergencies involving childrenmake up a minority of the ambulance runs in any given district, paramedics have fewer

opportunities to develop and practice their skills in pediatric care—and there are many unique

aspects in providing emergency care to children that they must know about Children experience

a different range of medical problems and injuries than adults, and their bodies react differently

to medical emergencies The TRIPP will help you teach paramedics about these specific

differences and how to manage them

We have presented information geared specifically to meet the objectives of the National

Standard Curriculum, with a wealth of information that goes beyond what is required there It is

also consistent with the latest American Heart Association emergency cardiac care guidelines Inaddition, we have included material that will help you prepare paramedics to cope with the

immense emotional impact of caring for sick or injured children, and to communicate more

effectively with young patients and their families

By absorbing this information and passing it on to your paramedics, you have the opportunity tomake a significant difference in the outcome of emergencies involving children

The Development of the Resource

The TRIPP was developed as a project for Emergency Medical Services for Children (EMSC).

The project was initiated by the Center for Pediatric Emergency Medicine, New York City,

which is made up of physicians and other health professionals on staff at New York UniversityMedical Center/Bellevue Hospital and Columbia University Medical Center/Harlem Hospital

We developed the TRIPP with the assistance of health professionals from around the country

working in pediatrics, pediatric surgery, emergency medicine, emergency medical services, andemergency nursing, as well as professional educators specializing in teaching prehospital

providers

We began by creating a content outline, which was agreed on by this authoritative group We

then located content experts in each subject area covered, who drafted the individual chapters

After reviewing and reorganizing the draft chapters, we took them to regional and developmentalworkshops around the country so that we could gather input from the people who will be usingthe resource—the paramedic instructors

Since we wanted to ensure that the material would be equally useful in any environmental

situation, we gave the chapters to paramedic instructors working in urban, suburban, and rural

settings We asked them to comment on the ease of use, practicality, approach, organization, andcontent, and we received many valuable suggestions, which we have incorporated into revisions

To ensure the accuracy of the information, a final evaluation was provided by educational

consultants and a review board consisting of representatives from national organizations who

have special expertise in emergency medical services

How to Use This Resource

We understand that the Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP)

contains much more information than you could reasonably expect to incorporate into a basic

paramedic curriculum However, the TRIPP is not intended to function as an adjunct course or a supplemental curriculum Rather, it is a resource that will help you strengthen the pediatric

content throughout the new National Standard Curriculum (NSC) We hope that you will

integrate relevant material from this resource as you teach the NSC Eventually, you may

consider using the TRIPP as a basis for much-needed continuing education courses in prehospital

pediatrics

With that in mind, the following discussion will help you get the best use out of the informationcontained within these pages

Get to Know the Content

We suggest that you begin by studying the contents to familiarize yourself with the scope of

material covered Then read through the opening chapters, which discuss educational principlesand barriers to learning These sections will give you background information designed to helpyou prepare effective lesson plans and present the material efficiently

The heart and soul of prehospital pediatric care is contained in the core sections covering

assessment, respiratory emergencies, shock, trauma, and cardiopulmonary failure These chaptersprovide information that will help paramedics identify critically ill or injured pediatric patientsand initiate lifesaving interventions This is the primary material you should present in depth toyour students

Other assessment and management issues unique to pediatric emergency care are covered in themedical/trauma sections Content ranges from seizures to SIDS, from child abuse to resuscitation

of the newly born, as well as children with special health care needs All of these topics are part

of the National Standard Curriculum and are essential to paramedic training To make the most

efficient use of your pediatric course time, we suggest that you familiarize yourself with these

chapters so that you can focus on key material as you work through the NSC You can add

selected tables and handouts from these chapters to your course presentation Some sections willcontain information that is particularly relevant to care of children in your region, and you mayelect to present these sections in more depth

The final sections cover important content you may wish to use based on time available and

regional requirements These chapters address injury prevention and medicolegal matters;

psychological issues, including critical incident stress; and additional topics not covered

elsewhere

At the end of the book, you’ll find appendices containing

• case scenarios for each of the core and medical/trauma chapters, emphasizing an interactiveapproach to learning that will help your students apply the knowledge they’ve acquired

• detailed task analyses, giving step-by-step instructions to help paramedics develop practicalskills, such as placing airway adjuncts or providing bag-mask ventilation

• information on developmental considerations that figure prominently in providing care for

children of varying ages

• figures that illustrate selected techniques and procedures described the text

• a master glossary list providing definitions for specialized terms used throughout the resourceChapter Organization

Each chapter opens with

• a glossary that reviews the specialized terms used in the discussion that follows

• a set of measurable learning objectives

• a list of key points for paramedics that correspond to the learning objectives

• a list of NSC objectives, where applicable, that correspond to chapter content

Clinical information makes up the bulk of the chapter This is the essential information you

need to get across to your students Included here under assessment and treatment are first

impression, initial assessment (including airway, breathing, circulation, mental status), focusedhistory, detailed physical exam, further treatment, reassessment and transport, and

documentation

Each chapter also includes a detailed overview/explanatory text, which will help you

understand the reasons and mechanisms behind the actions paramedics must take in caring for

children This material includes pathophysiology and anatomy, how children are different, and

information on differential diagnoses This will give you the background knowledge you need toanswer your students’ questions and will help you and your students see why the information isimportant

Rounding out the chapter is a list of selected references for further reading as well as non-text

resources such as videotapes and slides

At the end of each chapter, we’ve provided student handouts that were specifically requested by

the paramedic instructors who evaluated draft versions of the resource The handouts include

summaries of the key points covered in the chapter content, assessment tables, and other practicalinformation for paramedics

We urge you to photocopy the handouts and distribute them to your students Make sure they

understand that they are not required to memorize these materials, but should carry them for

onsite reference during emergency calls Even seasoned prehospital providers rely on pocket

cards, charts, protocols, and mnemonics for certain information, and your students should do so

as well

Planning Your Lessons

When you’re ready to plan a lesson, select a chapter and then:

• read the learning objectives and key points

• study the clinical information and explanatory text

• consult references as appropriate

• create a lesson plan based on this information, incorporating the handouts at the end of the

• develop test questions based on the key points, so you can evaluate your students’

understanding of the material

Feel free to adapt the information as needed We have chosen to present this resource in a format

that allows you to customize your copy of the TRIPP by adding other material that will be useful

to you We encourage you to modify student handouts, case scenarios, and task analyses to suitprotocols and conditions in your area In the future, we hope to offer updated portions of the

resource, so that the information will always be as current as possible.

Teaching Practical Skills

The task analyses included in the appendix provide detailed descriptions of important treatmentskills You’ll find task analyses for each skill considered essential to pediatric resuscitation

When planning your lesson, you should allow adequate time for your students to master

associated treatment skills Reinforce this learning by asking students to describe appropriate

skills during case scenarios

Conducting Case Scenarios

Case scenarios provide an active group exercise that will help your students understand how toapply information covered in each chapter Use the scenarios to talk your students through

simulated encounters with pediatric patients so that students can practice making assessment andmanagement decisions Playing out these scenarios will also help students feel more comfortableabout interacting with children and families

The appendix includes case scenarios for essential clinical chapters You can present these

scenarios to the group as a whole, but the experience will be more effective if students divide

into small teams such as you would send on an actual ambulance run

Each scenario is made up of a series of short descriptive passages, which you will read to the

students, followed by question and answer sessions, in which the students ask you for additionalinformation and draw conclusions based on what you tell them The exercise will lead studentsthrough their first impression and initial assessment, focused history and detailed physical

examination (when appropriate), and patient transport During the exercise, students may find ithelpful to refer to the Pediatric Assessment Triangle as well as vital sign handouts included at the

end of the Patient Assessment chapter.

At the end of the scenario, discuss the case with your students, pointing out critical steps and

answering questions Encourage them to explain how they used the information you gave them tomake their management decisions This will help you evaluate how well they base their reasoning

on the material in the chapter

A Note About Strategy

We believe that your students will absorb, understand, and retain information better if you

reinforce your lectures with role-playing sessions and hands-on practice In fact, fully half the

time you spend with your students should be devoted to acting out case scenarios and

honing practical skills We hope you’ll make full use of the supplementary materials included

throughout the resource on which you can base your exercises

A Note About Terms

We appreciate that a child’s primary caregiver may be someone whose relationship with the child

does not fit the traditional definition of parent For the sake of simplicity, however, we have used the term parents in this resource to refer to anyone who functions in this role Much of the

information directed toward parents or caregivers applies to other family members as well

For further resources

We strongly urge you to obtain a list of the products available through the EMSC Program of theNational Maternal and Child Health Clearinghouse Contact information appears in the

Updates

Updates to the material covered in the Paramedic TRIPP, including controversies and changes in

medical practice, may be found on our website, www.cpem.org The CPEM Bear Facts: A

Quarterly Newsletter from the Center for Pediatric Emergency Medicine is published

electronically If you register on our website, you will be notified when the newest edition is

available Our registration list is confidential and is never shared with any other group.

The Emergency Medical Services for Children Program

What You’ll Cover

• Why children need a special emphasis in EMS

• How the EMSC Program was implemented

• The kinds of EMSC funding that is available

• The purpose of the EMSC Program

• The state-of-the-art pediatric emergency care

• The integration of pediatric emergency care into EMS and trauma systems

• The importance of the continuum of care system for children

• How an integrated EMSC system can improve patient outcome

Introduction

The Emergency Medical Services for Children (EMSC) Program is a national initiative designed

to reduce child and youth disability and death due to severe illness or injury This program was

first authorized and funded by the U.S Congress in 1984 as a demonstration program

Administration of the EMSC program is jointly shared by the Health Resources and Services

Administration’s Maternal and Child Health Bureau (MCHB) and the Department of

Transportation’s National Highway Traffic Safety Administration (NHTSA)

The emergency medical services system development of the 1970's initially focused on providingrapid intervention for sudden cardiac arrest in adults and rapid transport for motor vehicle crash

victims The medical community planning the EMS system did not initially recognize that

children’s needs were different when experiencing a medical emergency Recognition of the

need for the EMSC Program occurred in the early 1980's by children’s advocates Even as the

EMSC program was authorized and funded, many states were still trying to get statewide EMS

systems established to provide services to their population

• Emergency medicine was a new medical specialty

• Pediatric emergency medicine as a medical specialty was just emerging

• The earliest research about pediatric emergency issues was focused on the educational needs

of prehospital providers, equipment available for the emergency care of infants and children,

and the readiness of hospital emergency departments to care for children

Dr Calvin Sia, a pediatrician and president of the Hawaii Medical Association in the late 1970's

laid the groundwork for the EMSC Program He urged members of the American Academy of

Pediatrics to develop multifaceted EMS programs that would decrease morbidity and death in

children Dr Sia worked with Senator Daniel Inouye (D-HI) and his staff assistant, Patrick

DeLeon, Ph.D., to write legislation for a pediatric emergency medical services effort

In 1983, a particular incident demonstrated the need for these services One of Senator Inouye’s

senior staff members had an infant daughter who became critically ill Her treatment showed theserious shortcomings of an average emergency department when caring for a child in crisis A

year later, Senators Orrin Hatch (R-UT) and Lowell Weicker (R-CT), backed by staff members

with disturbing experiences of their own, joined Senator Inouye in sponsoring the first EMSC

legislation The federal EMSC Program was established in 1984

Why Children Need a Special Emphasis in EMS

Children need a special focus in emergency medical management for several reasons

Children grow constantly from infancy through adolescence, and therefore need correctly sized

equipment (bags and masks, endotracheal tubes, IV catheters) to manage their emergency

condition

• A child’s physiologic response to a critical illness or injury is different from an adult’s for

such conditions as shock and prolonged respiratory distress Prehospital providers must be

able to recognize the signs that indicate a child’s condition is becoming potentially

life-threatening

• Children are also developing mentally and behaviorally They often fear strangers and dislikebeing restrained Children are dependent upon their parents for security, and often are more

cooperative when the parent is present

• Infants and young children cannot tell you what the problem is or where it hurts Parents

must often be the interpreter of information about the child’s condition

• Children account for such a small number of the total patients treated by prehospital

providers Therefore, there is insufficient practice in pediatric assessment and life saving

skills Frequent practice sessions and refresher training are extremely important to keep skillsoptimal

How the EMSC Program was Implemented

Initial funding from the EMSC Program supported four state demonstration projects (California,

Alabama, Oregon, and New York) These state projects developed some of the first strategies foraddressing important pediatric emergency care issues, such as disseminating educational

programs for prehospital and hospital-based providers, establishing data collection processes to

identify significant pediatric issues in the EMS system, and developing tools for assessing

critically ill and injured children In later years, other states were funded to develop other

strategies and to implement programs developed by their predecessors

One of the first tenets of the EMSC Program was “Knowledge, Transfer, and Utilization” (KTU),the expectation that a state or program with EMSC funding would share any ideas or products

developed with other interested states Many states adopted a neighboring state and assisted withthat state’s EMSC Program development After several years, a mechanism was needed to makethese ideas and products more easily accessible to interested states In 1991, two national

resource centers were funded to provide technical assistance to states and to manage the

dissemination of information and EMSC products

At about the same time, members of Congress requested information that justified continued

funding of the EMSC Program The Institute of Medicine (IOM) of the National Academy of

Sciences was commissioned in 1991 to conduct a study of the status of pediatric emergency

medicine in the nation A panel of experts was convened to review existing data, model systems

of care, and to make recommendations as appropriate The findings from this national study

revealed continuing deficiencies in pediatric emergency care for many areas of the country and

listed 22 recommendations for the improvement of pediatric emergency care nationwide These

recommendations fell into the following categories:

• Education and Training, Equipment and Supplies

• Categorization and Regionalization of Hospital Resources

• Communication and 9-1-1 Systems

goals and 48 objectives Each objective had a specific plan with national needs, suggested

activities, mechanisms to achieve the objective, and potential partners were identified In 1998,

the plan was updated with baseline data, refined objectives, and the progress in completing

activities

A new 5 year plan was published in 2001 as a national agenda for the launching the EMSC

program into the new century The national agenda, titled EMSC 5 Year Plan 2001-2005

outlines roles for the federal program and its partnering national professional organizations and

community organizations This plan has 11 goals and 45 objectives Achievement of the goals

and objectives requires collaboration and participation of many partners A major new focus of

the plan is an emphasis on information systems, research, and evaluation

With continuing support in the U.S Congress, the EMSC Program has had a modest, but slow

increase in funding, starting with $2 million in 1985 to $19 million in 2001 Key landmarks of

the program are listed in Table 1

Table 1 EMSC Program Landmarks

1984 Congress passes initial authorizing legislation

1985 First 4 states receive demonstration grants

1991 2 national resource centers funded

1993 EMSC Institute of Medicine study published

1995 EMSC 5 Year Plan published

1997 Partnership for Children Consortium formed

1998 All 50 states, the District of Columbia, and 5

territories have received an EMSC grant

2001 The EMSC research network was funded

Why We Still Need a Special EMSC Program

In the five years since the IOM study was published, much progress has been made in addressingpediatric emergency care deficiencies All states have received some type of EMSC funding,

however, many states are in very early stages of program development that will address their

system deficiencies Many other states had funding during early years of the EMSC Program,

and then no continuous funding As a result, many changes initiated in these states were not

sustained Partnership grants are a mechanism for these states to reassess the needs for program

development and to identify a mechanism for sustaining system changes benefiting children

Baseline data collected for the EMSC 5 Year Plan Midcourse Review revealed some disturbing

figures Hundreds of thousands of children are transported in ambulances by emergency medicaltechnicians each year Yet only two states require all the pediatric equipment recommended for

basic life support ambulances, and only five states require all essential pediatric equipment for

advanced life support ambulances

Over 30 million children and adolescents go to emergency departments every year, and children

under 3 years comprise the largest proportion of injury and medically-related visits of all

pediatric and adolescent age groups However, two in five hospitals do not have a pediatrician

available in house or on call Among hospitals with pediatric intensive care units, only 30%

have agreements to cut red tape and speed patient transfers when necessary

These statistics are only a clue to the challenges that remain in addressing pediatric emergency

care issues in the nation

The Kinds of EMSC Funding Available

The majority of grants are made to states to improve the way that children receive emergency

care Most EMSC projects can now be funded for three years with a possible extension of one

year to complete project work Different opportunities for EMSC funding have developed over

the years as the program interests and funding have expanded Table 2 lists current grant

opportunities

Table 2 Types of EMSC Funding (2001-2002)

STATE SYSTEM GRANTS

Implementation A 3-year grant is awarded to states for the purpose of initiating the

development of a special pediatric focus within the state’s EMS system The state identifies specific objectives for the grant funding States are encouraged

to use resources and strategies developed by other states while addressing specific challenges in their state States are eligible for only one

implementation grant.

Partnership A 3-year grant is awarded to states have completed an implementation grant

The purpose is to help states sustain the significant system changes that had been accomplished with EMSC funding States may apply for consecutive grants.

OTHER GRANTS

Targeted Issues Some issues related to EMSC have a regional or national scope and cannot be

adequately addressed by a state system grant This 2-3 year grant is awarded

to states or medical schools to develop and evaluate a model program or strategy with regional or national significance In most cases the grant is responsive to a special need identified by the EMSC program staff

Regional Symposia

Grants

Many issues for improving an EMS system for children require collaboration between states This grant supplement is awarded to a state partnership grant recipient to organize a regional workshop or meeting to promote the exchange

of knowledge and information Issues to be addressed may include emergency medical services for children needs in such areas as sharing new technologies, problem-solving with special populations, network-building, and implementation of public policy.

To receive grant funding, interested professionals must apply for funding by proposing a project

that conforms to the EMSC program application guidelines (grant guidance) This guidance

describes the specific requirements for all sections of the project proposal, including the problemstatement, goals and objectives, methodology, evaluation, project management, and budget

An independent review panel of EMS, EMSC, and maternal and child health experts evaluates

the applications and recommends those that are good enough to receive funding The federal

staff of the EMSC program awards grant funding only to those projects recommended by the

review panel

The Purpose of the EMSC Program

The EMSC program has 11 major goals as described in the 5 year plan They can be found in

Table 3

Table 3 Goals of the 5-Year Plan

• Include pediatric issues in all aspects of clinical care

• Improve and expand pediatric emergency care education systems

• Promote and strengthen pediatric EMS research and evaluation

• Enhance EMS human resource development

• Include pediatric components in development of EMS information

systems

• Ensure that integration of health services meets children's needs

• Promote institutionalization of EMSC through legislation and

regulation

• Include pediatric protocols in medical direction for all EMS

agencies

• Develop broad-based support for prevention activities

• Ensure universal public access to the emergency care system for

all children and their families

• Improve pediatric emergency medical services through public

education.

In summary, these goals can be boiled down to 3 major points The first is to ensure that

state-of-the-art emergency medical care is available for all ill and injured infants, children, and

adolescents Once that level of care is identified, it is important to assure that pediatric

emergency care is provided in a well-planned manner within the state’s EMS and trauma

systems Then the continuum of care needed by any child must be addressed, including primary

prevention of illness and injury, bystander care, prehospital care, hospital-based care (emergencydepartment, critical care, inpatient care), rehabilitation (inpatient facility and community

outpatient services), and the primary care provider

The State-of-the-Art in Pediatric Emergency Care

Optimal pediatric emergency care can only be provided when standards of care are evaluated by

examining patient outcomes

Does equipment work in the way it was designed? For example, pneumatic antishock garments

(PASG) were thought to help manage shock and pediatric PASG were carried on many

ambulances Subsequent research revealed that the only children who benefited from PASG

were those with long bone lower extremity fractures and unstable pelvic fractures Therefore,

PASG had limited treatment value for children Thus the state-of-the-art in pediatric emergency

care changed, and PASG are no longer recommended

Does the child receiving treatment for an injury do as well as a similar child receiving a

different treatment for the same injury? For example, peripheral intravenous access was state of

the art care for an acutely ill or injured toddler, when it could be accomplished, until intraosseousaccess was proposed Research revealed that rapid access by intraosseous infusion could be

accomplished with few complications, and the outcome for infants and toddlers in shock was

greatly improved The state of the art in pediatric emergency care was then changed to make

intraosseous access a standard of care for critically ill or injured young children

The state of the art of emergency care is constantly changing as emergency care professionals

look at challenges in delivery of care to acutely ill and injured children and try to determine whatcould improve care Research on equipment function, system design, treatment choices, and

patient outcomes continue to advance the state of the art Such research is encouraged and

sometimes supported by the EMSC Program

How to Assure that Pediatric Emergency Care is Provided Within a Well Planned EMS

and Trauma System

Once the state of the art in pediatric emergency care is identified, then it is important to integratethat change uniformly throughout the country New standards of care must be developed so all

children benefit from state-of-the-art care These standards need to be implemented in all states

Elements of a Well Planned EMS and Trauma System for Children

• Hospitals make a commitment to have appropriate equipment and trained personnel to give

optimal pediatric emergency care for the level of care they can provide

• Prehospital provider destination guidelines for pediatric patients recognize hospitals with a

pediatric commitment

• Agreements exist between hospitals to transfer children in need of more specialized

emergency or critical care when that care cannot be provided in the local hospital

• Medical direction guidelines for the management of pediatric patients exist for BLS and ALSprehospital providers, either through protocols or on-line medical direction

• Pediatric prehospital education is an integral part of refresher and recertification training so

that skills are maintained

• Data collection from patient records is used to monitor the quality of care provided, so that

the need for system changes and refresher education is identified

Why the Continuum of Care System is Important for Children

While the name Emergency Medical Services for Children gives an emphasis on emergency, the

EMSC program is much broader in its scope Examining the specific needs of children who

experience an acute illness or injury means looking at the larger health care system The system

of care needs to be continuous or seamless so that children have access to all important services Only when there are no gaps in services will there be the best chance of preventing a childhood

emergency or for a full recovery when an emergency happens The optimal continuum of care

model follows

• Prevention of illness and injury is important to reduce the number of emergencies that occur

in children Families, day care providers, and schools look for potential risk factors in the

setting and try to eliminate them, thus potentially reducing the number of injuries

• A nationwide uniform emergency number enables any parent or child to quickly access

emergency care no matter where they may move or travel

• Bystander care knowledge of CPR and first aid helps keep the condition of an acutely ill or

injured child from getting worse when an emergency occurs

• Prehospital provider education, medical direction, and pediatric equipment on the ambulanceincrease the likelihood that optimal emergency care will be provided en route to the

emergency department

• Emergency departments and hospitals acknowledge their capability in providing pediatric

emergency care They commit to providing treatment that conforms to the recognized level

of care with appropriate equipment, trained personnel, patient care guidelines, and an

organized system of care response

• Agreements exist between hospitals to transfer children who need more specialized care to a

hospital with the recognized level of commitment This ensures the smooth and rapid

transition of children to needed care

• Children who experience a major complication or disability as a result of their illness or

injury are linked to rehabilitation services as early as possible so the optimal outcome for thatchild is possible

• Children with chronic conditions or requiring medical technology to survive have an

emergency care plan so that information about the most appropriate emergency care is

available to prehospital and other emergency care providers

• All children have a designated primary care provider for preventive health services and

management of health care conditions before they become emergencies These primary care

providers are prepared to manage potential emergencies in their office setting until

prehospital providers are able to respond This is becoming increasingly important in a

managed care environment when families are discouraged from using the emergency

department

From the prehospital provider perspective, each child is important, and each ill or injured child

should receive treatment in accordance with the recognized standard of emergency care The

EMSC Program works to assure that prehospital providers in every state and EMS agency have

the resources to provide the same quality of care to all children nationwide The EMSC Programcannot equip every ambulance and train every provider, but it can work with EMS systems to

make needed changes, whether that EMS agency is in a large city or very rural region of a state

These characteristics of the EMSC Program are what makes it a public health program

How the EMSC Program Achieves its Goals

EMSC grant funding provides a state with access to materials developed by other states, nationalorganizations, and experts in order to meet its goals for improvement of pediatric care in the

EMS system Various resources are available to help states make change

The EMSC National Resource Center (NRC) collects and catalogs products developed by EMSCgrantees and other organizations These products are available through its clearinghouse In

addition, staff of the NRC have the following areas of expertise to share with grantees:

• strategic planning and problem solving

• project development, management and evaluation

• collaborating with community-based organizations

• working with the media

• finding alternative funding sources

• identifying injury prevention program resources

• identifying resources to address children with special health care needs

• developing an EMSC political agenda for the state

• understanding managed care challenges in the state

• developing quality improvement projects

• developing research projects

Consultation is available by phone, e-mail, meetings, and technical assistance visits The NRC

can be reached as follows:

EMSC National Resource Center EMSC Program

111 Michigan Ave., NW 2070 Chain Bridge Road, Suite 450

Another resource center, the National EMSC Data Analysis Resource Center (NEDARC),

provides technical support to the EMS community in identifying data sets that exist, promoting

collaboration between agencies to share data, providing assistance in linking existing data sets,

data management, data error analysis, and statistical analysis The purpose is to enable states to

examine data to assess system quality of care and to study outcomes of care The NEDARC alsoprovides educational programs to help grantees and state health officials learn more about data

collection, management, and analysis The NEDARC can be reached as follows:

National EMSC Data Analysis Resource Center

The University of Utah

615 Arapeen Drive, Suite 202

Salt Lake City, UT 84108-1226

(801) 581-6410 voice

(801) 581-8686 fax

http://nedarc.med.utah.edu

How An Integrated Emsc System Can Improve Patient Outcome

The EMSC Program can only achieve its goals for an effective EMS system for all children in the

nation by working collaboratively with national and state organizations, interested professionals

and families, policy makers, and grantees Almost every goal requires a change in awareness,

attitude, behavior, and policy There are many competing priorities for a policymaker’s time andeffort, however, the program’s planned benefit to children often helps stimulate more interest in

the topic Policy makers in this case may be agency directors, state EMS directors, hospital

administrators, as well as elected state and national officials By collaborating, individuals and

organizations can more effectively foster the practice, system, and policy changes that will

benefit children within the EMS system Listed below are examples of how the EMSC programhas used collaboration to address key issues, sometimes at the state level, but more often at the

national level

Education

The EMSC Program worked with national organizations and the National Highway Traffic

Safety Administration to integrate the most appropriate pediatric emergency information into thenational standard curricula for EMT-Bs, EMT-Is, and EMT-Ps A national task force, sponsored

by the EMSC Program, developed a list of major topics and skills for inclusion in pediatric

curricula for prehospital providers Findings of this task force were considered in the final

development of the EMT-P national standard curriculum National efforts such as those

described help assure that consensus is reached about core content of educational programs for

health care providers

Continuing education and refresher training in psychomotor skills is also important as evaluation

of educational efforts have identified the problem of skill performance deterioration after a few

months This likely occurs because providers have so few pediatric calls in contrast to adults

Many psychomotor skills are not performed with enough frequency to keep skills at an optimal

level The EMSC Program works with state EMS offices to encourage the integration of some

pediatric information into all recertification programs

Equipment Standards

The EMSC Program supported task forces composed of representatives from key national

organizations to develop a consensus about the pediatric emergency equipment needed on BLS

and ALS ambulances, as well as in emergency departments State EMS systems are encouraged

to recommend this list of equipment as standards for their EMS agencies The NHTSA

recommends that ambulance manufacturers use the consensus statement as the minimum

standard for stocking all new ambulances

System Development

Collaborative effort involves working to strengthen existing systems or to build bridges between

existing programs EMSC is ineffective if the EMS system does not function well In some

cases the system must be strengthened for the entire population before a child specific focus can

be enhanced For example, a major deficiency of most state EMS systems is the lack of a well

structured data collection and analysis process Some states are challenged to identify the most

effective way to collect uniform EMS patient care information in an electronic (computerized)

format However, a computerized data collection system makes it easier to analyze the

frequency, characteristics, and quality of EMS care provided The National EMSC Data AnalysisResource Center provides technical assistance to EMS state agencies to improve the overall

system Another example is a state trauma system Guidelines need to be developed for the

entire population, and then children need to have their own special needs addressed Addressing

children’s needs cannot precede the overall trauma system development, but should be integrated

as the overall system is developed

Public Education

Public access to emergency care must be uniform for the entire population, not just for children

However, parents need to know when it is appropriate to call EMS to obtain emergency care and

transportation for their child The EMSC program works to enhance public education already

provided by NHTSA about appropriate calls for emergency care A message about the special

considerations for children can then be added Children are sometimes the target for the public

education message, so they will know how to get help for parents or other children At other

times parents or caregivers are the target so they are able to make appropriate decisions about

when to activate EMS for a pediatric emergency

Partnerships

Some objectives of the EMSC program involve activities on a national scale and cannot be

adequately addressed by individual states National health professional organizations are

important for their advocacy and advisory roles, but a formalized partnership has made it

possible to enlist the help of organizations in addressing specific issues Fourteen national

organizations representing physicians, nurses, prehospital providers, state EMS directors,

psychologists, social workers, children’s hospitals, and poison control centers are members of thePartnership for Children Consortium Each partner organization has a contract and a specific set

of activities to perform that are related to the EMSC goals and objectives They also inform the

membership about EMSC issues Examples of PFC projects are listed in Table 4

Table 4 Partnership for Children 2001-2002 Projects

National Association of EMTs Develop and disseminate national guidelines on providing

family-centered care during out-of-hospital care and transport.

National Association of State EMS

to certificate/license renewal requirements.

Emergency Nurses Association Conduct a secondary analysis of pediatric data from prior

research projects to make recommendations for improving the delivery of health care to children in medical emergencies.

American Trauma Society Develop and disseminate a program called Second Trauma that

is designed to provide support to families and survivors of major trauma

National Association of EMS

Physicians

Review literature of pediatric and adolescent mental health emergencies by type and occurrence, and of mental health emergency practices in out-of-hospital and emergency department settings

American College of Emergency

Physicians and American

Advocacy

Advocates are needed to foster the needed changes in attitudes, behaviors, and policy Advocatescan be anyone who is interested in making sure children get good care within the EMS system

You can be an advocate by setting a good example for your colleagues Volunteer and support

EMS involvement in community childhood injury prevention programs Make sure you and all

your colleagues have regular training updates in pediatric emergency care Serve on local EMS

agency committees that set policies regarding equipment purchases, protocol development, and

continuing education so that children are well represented

Committee on Ambulance Equipment and Supplies, National Emergency Medical Services for

Children Resource Alliance (1996) Guidelines for pediatric equipment and supplies for basic

and advanced life support ambulances, Annals of Emergency Medicine, 28(6):699-701.

Committee on Pediatric Equipment and Supplies for Emergency Departments, National

Emergency Medical Services for Children Resource Alliance (1998) Guidelines for pediatric

equipment and supplies for emergency departments, Annals of Emergency Medicine, 31(1):54-57 Durch, J.S., and Lohr, K.N (1993) Emergency medical services for children Washington, DC:

National Academy Press

Eichelberger, M.R., Stossel-Pratsch, G., Mangubat, E.A (1985) A pediatric emergencies training

program for emergency medical services Pediatric Emergency Care, 1:177-179.

Gausche, M., Henderson, D.P., Brownstein, D., Foltin, G.L for the Pediatric Education Task

Force (1998) Education of out-of-hospital emergency medical personnel in pediatrics: Report

of a national task force Annals of Emergency Medicine, 31:58-64.

Haller, J.A., Shorter, N., Miller, D., et al (1983) Organization and function of a regional

pediatric trauma center: Does a system of management improve outcome? Journal of Trauma,

23:691-696

Ramenofsky, M.L., Luterman, A., Quindlen, E., Riddick, L., and Currier, P.W (1984) Maximum

survival in pediatric trauma: The ideal system Journal of Trauma, 24:818-823.

Seidel, J.S., Hornbein, M., Yoshiyama, K., et al (1984) EMS and the pediatric patient: Ar the

needs being met? Pediatrics, 73:769-772.

Seidel, J.S (1986) EMS and the pediatric patient: Are the needs being met? II Training and

equipping EMS providers for pediatric emergencies Pediatrics, 78:808-812.

Solloway, M., Gotschall, C.S., Barta, L.J., and Avery, A (1996) Emergency Medical Services

for Children: An evaluation of sustainability in seven states Washington, D.C.: Center for HealthPolicy and Research, George Washington University

Unpublished data, special study conducted by the Consumer Product Safety Commission

National Electronic Injury Surveillance System commissioned by the EMSC Program, 1998

U.S Congress, Public Law 98-555

U.S Department of Health and Human Services, Health Resources and Services Administration,

Maternal and Child Health Bureau (1995) 5 Year Plan: Emergency Medical Services for

Children, 1995-2000 Washington, DC: Emergency Medical Services for Children National

Resource Center

U.S Department of Health and Human Services, Health Resources and Services Administration,

Maternal and Child Health Bureau (1998) 5 Year Plan: Midcourse Review, Emergency Medical Services for Children, 1995-2000 Washington, DC: Emergency Medical Services for Children

National Resource Center

U.S Department of Health and Human Services, Health Resources and Services Administration,

Maternal and Child Health Bureau (2000) 5 Year Plan: Emergency Medical Services for

Children, 2001-2005 Washington, DC: Emergency Medical Services for Children National

Resource Center

Weiss, H.B., Mathers, L.J., Forjuoh, S.N., Kinnane, J.M., and Coben, J.H (1997) Child and

adolescent emergency department visit databook Pittsburgh, PA: Center for Violence and InjuryControl, Allegheny University of the Health Sciences

n HANDOUT

Table 1 EMSC Program Landmarks

1984 Congress passes initial authorizing legislation

1985 First 4 states receive demonstration grants

1991 2 national resource centers funded

1993 EMSC Institute of Medicine study published

1995 EMSC 5 Year Plan published

1997 Partnership for Children Consortium formed

1999 All 50 states, the District of Columbia, and 5

territories have received an EMSC grant

2001 The EMSC research network was funded

Table 2 Types of EMSC Funding (2001-2002)

STATE SYSTEM GRANTS

Implementation A 3-year grant is awarded to states for the purpose of initiating the

development of a special pediatric focus within the state’s EMS system The state identifies specific objectives for the grant funding States are encouraged

to use resources and strategies developed by other states while addressing specific challenges in their state States are eligible for only one

implementation grant.

Partnership A 3-year grant is awarded to states have completed an implementation grant

The purpose is to help states sustain the significant system changes that had been accomplished with EMSC funding States may apply for consecutive grants.

OTHER GRANTS

Targeted Issues Some issues related to EMSC have a regional or national scope and cannot be

adequately addressed by a state system grant This 2-3 year grant is awarded

to states or medical schools to develop and evaluate a model program or strategy with regional or national significance In most cases the grant is responsive to a special need identified by the EMSC program staff

Regional Symposia

Grants

Many issues for improving an EMS system for children require collaboration between states This grant supplement is awarded to a state partnership grant recipient to organize a regional workshop or meeting to promote the exchange

of knowledge and information Issues to be addressed may include emergency medical services for children needs in such areas as sharing new technologies, problem-solving with special populations, network-building, and implementation of public policy.

n HANDOUT

Table 3 Goals of the 5-Year Plan

• Include pediatric issues in all aspects of clinical care

• Improve and expand pediatric emergency care education systems

• Promote and strengthen pediatric EMS research and evaluation

• Enhance EMS human resource development

• Include pediatric components in development of EMS information

systems

• Ensure that integration of health services meets children's needs

• Promote institutionalization of EMSC through legislation and

regulation

• Include pediatric protocols in medical direction for all EMS

agencies

• Develop broad-based support for prevention activities

• Ensure universal public access to the emergency care system for

all children and their families

• Improve pediatric emergency medical services through public

education.

Accreditation and Registration

What You’ll Cover

• How EMS educational programs benefits from accreditation

• How programs become accredited

• How to become listed in the national registry

Accreditation of Paramedic Educational Programs

The Advantages of Accreditation

Accreditation helps to guarantee a formal systematic review that will support educational

programs in their adherence to a certain level of performance, integrity, and quality In the UnitedStates, accreditation for post-secondary education—that is, education beyond the high schoollevel—is usually administered through regionally based independent programs rather than

government agencies, making it essentially self-regulated

EMS programs are generally nationally accredited through a specialized agency that works

closely with the organization to ensure that accreditation requirements are relevant to prehospitalpractice At the beginning of 2001, there were approximately 150 accredited educational

programs for paramedics in the United States

The potential advantages of accreditation include eligibility for government funding and privatescholarship programs as well as public recognition that the program meets accepted standards ofeducational quality Since the accreditation process requires an institution or program to examineits goals, objectives, activities, and achievements, it becomes an opportunity for ongoing self-evaluation and improvement through periodic accreditation reviews For EMS professionals,

accreditation provides an avenue for participation in setting program requirements

History of Accreditation in Paramedic Practice

In 1975, the American Medical Association (AMA) recognized paramedic-level practice as anallied health occupation, paving the way for development of program accreditation standards thefollowing year During the ensuing period, several professional organizations collaborated withthe AMA to adopt a set of standards and to sponsor formation of the Joint Review Committee onEducational Programs for the EMT-Paramedic (JRCEMT-P) The JRCEMT-P changed its name

to the Committee on Accreditation of Educational Programs for the EMS Professions

(CoAEMSP) in 2001

Today, the CoAEMSP is one of 18 Committees on Accreditation (CoA) reporting to the

Commission on Accreditation of Allied Health Education Programs (CAAHEP); one of the

largest specialized accrediting agencies in the country CoAEMSP committee members assessapplicant programs to ensure that they will adequately prepare graduates for entry level

competency into the paramedic profession The CoAEMSP is currently sponsored by the

• American Academy of Pediatrics

• American College of Cardiology

• American College of Emergency Physicians

• American College of Surgeons

• American Society of Anesthesiologists

• National Association of EMS Educators

• National Association of Emergency Medical Technicians

• National Association of State EMS Directors

• National Registry of Emergency Medical Technicians

Sponsoring organizations help to support the CoAEMSP through annual dues, and in return areentitled to appoint 2 members who participate in the committee’s activities

Steps in the Accreditation Process

The following paragraphs summarize the process through which a paramedic program achievesCAAHEP accreditation

Application for accreditation

The program’s sponsoring institution submits a written request for accreditation

Self-study

The program faculty and staff perform a structured self-study report analyzing a program’s

sponsorship, curriculum, committed resources, operations, student policies and practices, and anyplanned enhancements to address areas in which the program falls short of accreditation

standards This report is submitted to the CoAEMSP

Program referee

On receipt of the self-study report, the CoAEMSP assigns a referee to usher the program through

the remaining stages of accreditation The referee works with the programs to help identify

potential opportunities for self-improvement and notifies the CoAEMSP when the program isready for an onsite visit

Onsite evaluation

The onsite team, consisting of a program director and an EMS physician familiar with paramediceducational programs, is selected and the visit is scheduled Table 1 summarizes typical activitiesduring the 2-day site visit

Table 1 CoAEMSP Site Visit Activities

• current and former students

• program advisory committee

Tour facilities

Review student records

Visit clinical and field internship sites Meet with preceptors

Meet with the program director to clarify issues

Complete the site report Meet with program officials for final comments

After the site visit, the team’s report is sent to the program for correction of factual errors and anopportunity for the program to respond to the report The report is then forwarded to CoAEMSPfor consideration by the program referee

CoAEMSP recommendations

At its next full committee meeting, the CoAEMSP evaluates the institution’s program

application, its self-study report, the onsite evaluation report, the program’s responses to the

report, and other pertinent documentation The committee’s recommendations are forwarded toCAAHEP

CAAHEP accreditation

CAAHEP examines the CoAEMSP’s recommendations to ensure that they follow due processand contain no conflicts of interest CAAHEP’s president then sends a notification letter to theinstitution explaining the commission’s accreditation determination Finally, a certificate is sent

to those programs that are awarded accreditation

Future Directions for Program Accreditation

In a number of medical and allied health fields, graduation from an accredited program is

required before candidates are permitted to sit for their specialty’s licensing, registry, or

credentialing examination This is not yet the case for EMS professionals

The CoAEMSP is currently working toward such a requirement, in keeping with

recommendations outlined in the US Department of Transportation’s EMS Agenda for the

Future Released in 1996, this document states that all EMS educational programs should seek

accreditation by recognized agencies, and public funds for education, including state and federalfinancial aid programs for students, should be directed preferentially toward accredited programs.Shortly after the report was issued, the National Highway Traffic Safety Administration

convened an EMS educational conference to identify logical steps toward achieving the Agenda’s

goals A task force formed in 1998 recommended that EMS develop a new educational systemincorporating

• a national EMS core education content

• core curriculum for all levels of EMS professional education

• a Practice Blueprint defining levels of function among EMS professionals

• required accreditation of EMS educational programs at all levels

• national EMS education standards

• national EMS scope of practice model

• achievement of national certification as a requirement for state licensure

The CoAEMSP is investigating methods for attaining these goals

Program accreditation remains an important step in setting performance standards for

paramedics, as it will help to ensure that all patients receive appropriate prehospital emergencycare delivered by uniformly trained professionals

National Registration of Paramedics

The National Registry of Emergency Medical Technicians (NREMT) is an independent, profit organization that registers EMS providers across the United States Since its inception in

not-for-1970, the registry has examined more than a million rescuers at all levels of practice, from firstresponder to paramedic Approximately 155 000 rescuers are registered at this time

The NREMT is not an association and does not have members in the traditional sense; rather, itprovides national certification to registrants who meet and maintain certain standards of safe andeffective practice Candidates for the registry examination must be at least 18 years old with norecord of felony crimes Successful completion of a CPR course is the minimum EMS

educational requirement Those who attain satisfactory scores in both written and performanceexaminations are entered in the registry Applications must be renewed on a biannual basis;

reregistration is contingent on the candidate’s continued ability to meet the NREMT’s

requirements in education and experience

While the NREMT is best known for developing and administering its registry examinations, theorganization’s activities have also included

• sponsoring research into EMT qualifications and competency

• conducting functional job analyses for EMTs at the basic and paramedic levels

• sponsoring the EMS Education and Practice Blueprint

• conducting research on prehospital provider attitudes, knowledge and skills

• developing an approved felony review process

NREMT members attend national meetings and actively participate in the growth and recognition

of EMS in the United States The organization is represented on the Committee on Accreditation

of Educational Programs for the EMS Professions Members of the NREMT’s board of directorsbelong to national EMS organizations or have special expertise in EMS systems Board membersmeet twice a year to discuss policies, procedures, and methods

For EMTs in 43 states, the NREMT’s registration services are required as part of the licensureprocess Examinations are administered after candidates have completed an approved EMS

educational program Those who reside in states that do not require registration may contact theNREMT if they wish to apply NREMT registration is a valuable asset for those seeking

employment or reciprocity in another state

References

Core

Fauser, J Accreditation In Allied Health Education: Concepts, Organization, and

Administration Farber N., McTernan E., Hawkins R., eds Springfield, IL:Charles C Thomas.

1989 125–141

Emergency Medical Services Agenda for the Future (August 1996)

National Highway Traffic Safety Administration (NHTSA)

US Department of Transportation

EMSC Resources

none

Non-Text Resources

Commission on Accreditation of Allied Health Education Programs (CAAHEP)

35 East Wacker Drive, Suite 1970

Educational Methods

What You’ll Cover

• Special considerations for teaching adult learners

• Methods for effective classroom preparation and delivery

• Techniques for motivating and evaluating your students

Glossary

The following specialized terms are used in this chapter:

affective–relating to feelings or emotions

cognitive–relating to thought processes through which knowledge is attained

psychomotor–relating to movement or muscle activity

reliability–in testing, describes how well a test delivers scores that are consistent with other

measures of performance

self-efficacy–belief in one’s ability to produce a desired effect

validity–in testing, describes how well a test focuses on its intended purpose

Introduction

Teaching prehospital pediatric care is a tremendous responsibility When your teaching is done,your students must apply their learning to the care of young patients whose lives may depend onthe product of your efforts

This chapter reviews the fundamentals of successful teaching and successful learning You’ll

examine basic educational concepts and your role as class leader You’ll also cover effective

ways to

• set clear goals for students

• motivate students to succeed

• deliver course material

• evaluate and test students

Reviewing these elements before you prepare for your first class will save you time and effort inachieving your teaching goals

Setting Goals and Objectives

Every educational activity must begin with a set of clearly stated goals and objectives Writtengoals keep educational endeavors on track by stating the purpose and desired outcome of the

educational program, while written objectives outline the steps necessary to reach the goal Thisgives administrators, teachers, and students a means to shape their expectations, focus clearly oncontent, and measure success

Your course goal for teaching paramedics about pediatric care might be stated:

On completing the course, the student will be competent in all pediatric tasks and modalities

consistent with the paramedic scope of practice.

An objective to reach this goal might be stated:

Students will complete hands-on practice sessions to develop competence in specialized

techniques for pediatric prehospital care.

Whether you use the examples above or devise your own goals and objectives, make sure youhave satisfactory written statements before proceeding

Learning Objectives

After you’ve determined the goal and objective statements for the course as a whole, you needspecific learning objectives for each class Learning objectives help you focus the content of yourlectures, labs, and other classroom activities (such as case scenarios and tests) on the key pointsyou want your students to absorb

Learning objectives are precise statements of what the student is expected to know and be able to

do following instruction Effective learning objectives begin with a phrase like “After completingthis lesson, the student will be able to…” followed by an active verb and a description of the taskthe student will perform correctly when the objective is accomplished; for example:

• state 2 indications for gastric intubation of a pediatric patient

• describe 5 assessment findings that indicate an unstable tachydysrhythmia in an infant

• demonstrate the procedure for obtaining intraosseous access in a pediatric trauma patient

Each clinical chapter of this manual furnishes you with a list of associated learning objectives

Since the Paramedic TRIPP is designed to support the National Standard Curriculum (NSC) for paramedics, you’ll also find a list of NSC objectives that are closely aligned with chapter content.

Categories of learning

Educators often sort learning objectives into 3 categories (or domains) according to the type of

learning described in the objective Each of these categories requires a different type of test todetermine whether students have successfully mastered the learning objective The categories are

• Knowledge (sometimes called the cognitive domain)—objectives relating to facts and

concepts, usually measured with written or oral examinations; for example, “On completion

of the lesson, the student will be able to list 3 indications for intraosseous access in the

pediatric patient.”

• Skills (sometimes called the psychomotor domain)—objectives relating to tasks or

procedures, usually tested by having the student perform the task; for example, “On

completion of the lesson, the student will be able to perform defibrillation on the pediatricpatient according to AHA guidelines.”

• Behavior (sometimes called the affective domain)—objectives relating to the student’s

professional manner and conduct, including communication skills, empathy, self-confidence,and appearance, usually measured through observation; for example, “On completion of thelesson, the student will successfully use active listening and distraction techniques to gaincooperation from a distraught child.”

While practice sessions give students a chance to perform skill objectives, it can be challenging

to devise classroom activities that require students to demonstrate knowledge and behaviorialobjectives These objectives are often simply explained by the instructor, leaving written and oraltests to measure how well students understand them To improve the learning experience, try tocreate an opportunity for every student to practice the activities described in every category oflearning

Motivation

Perhaps your most important task as instructor is to motivate your students Motivation is

essential to effective learning Most successful students can name instructors whose motivationalefforts had a positive influence on their academic careers

If students are unmotivated, the best classroom presentations will fail The opposite is also true,however; a motivated student can excel even under less-than-ideal learning conditions

Developing effective motivational techniques is an art, and any artist’s works will please somecritics while leaving others unmoved Similarly, you will find that different students respond todifferent types of encouragement, and you must draw on a wide range of techniques to maximize

classroom enthusiasm Come prepared to adapt your techniques from one day to the next and

from one student to another

Understanding a few fundamental concepts can help you motivate the typical paramedic student:

• This student is an adult with a great deal of personal pride and a highly developed self-image.Avoid using negative motivational techniques that challenge this self-image

• While testing is necessary to measure each student’s progress toward mastery of the material,

it is not an appropriate motivator in the adult learning environment Adult learners disliketesting and find the process intimidating

• Adult learners want to participate in planning their studies Help them feel that you have

considered their needs in planning course schedules and activities

• Adult learners want to feel that they positively influence their class’s overall success Youcan promote this by complimenting them often on their contributions and participation

Express your appreciation for their presence, efforts, skills, and shared experiences

Do your best to motivate each of your students as an individual The sooner you start this

process, the easier it will be

• Prepare yourself to present the content

Preparation is the hallmark of excellent teaching, and students deserve a well-prepared classsession If you find that you lack expertise in a particular subject area, use your preparationtime to remedy this

• Motivate

Include some form of motivational activity in your class preparation, and watch for

spontaneous motivational opportunities during the session Try to address each student’s

motivational needs

• Evaluate existing knowledge

Begin with an exercise, such as a brief question-and-answer session, a self-graded quiz, or agame, to help students evaluate their existing knowledge This also gives you an indication ofyour students’ progress in meeting the learning objectives

• Identify important objectives

Start your lecture by clearly state the purpose of the lesson Identify important points and

objectives at the beginning of the class and again as they are covered This will help studentsdistinguish essential clinical knowledge from explanatory information and rationale

• Illustrate the major objectives

Anecdotes and enrichment activities can enliven a lecture and focus students’ attention onkey information Draw on your own experiences in the trenches to illustrate major objectives,but be careful not to overuse this technique Keep the lecture moving at a brisk pace

• Clarify the most important points

Use multimedia resources to clarify important points These materials should be simple toread, easy to see, and clearly focused on the topic Again, do not allow audiovisual

presentations to dominate the lecture or they’ll lose impact

• Review the objectives

Review the learning objectives at the end of the class session, stressing essential information.This will help students focus their study time It also gives them an opportunity to check theirnotes and make sure they have covered each main point

• Motivate the students again

End each class with a final effort to fire up your students’ enthusiasm This measure can helpkeep students’ energy levels high until the next meeting Stress the importance of their

contribution to the health care team and restate the community’s need for their expertise

Remember that it is virtually impossible to provide too much motivation

While effective lecture delivery is important, it is not as critical as effective motivation and

evaluation, so be sure to balance your preparation time among these activities Also keep in mindthat students retain information better through active learning experiences Plan to limit your

lectures to no more than half the allotted classroom time, reserving the other half for skills

practice sessions and case scenarios More information appears in Teaching Pediatric Skills.

Self-Efficacy

This is a key concept in approaching adult learners Self-efficacy refers to how your students