Advanced EMT/EMT Intermediate 2011 curricula

[croaker260]

I am jumping into a teaching a college level summer AEMT course using the new scope of practice, and I have been tasked with schedule development.

As this is a brand new thing in my state, I don't have any thing ready to go based on the new AEMT (our old EMT-advanced was really the EMT-I/85).

Of course our State EMS doesn't have framework to help us either, saying its up to us to develop it.

I am wondering if anyone out there has something I can use as a jumping off point so I dont unnecessarily re-invent the wheel. How many hours, what difficulty you encountered are all important bits of information.

I am also interested in what text book you are using, and your opinion of it.

[chbare]

Croaker, I am currently in the process of teaching one of the first AEMT courses in my area. If all goes well, my students will be taking the NREMT psychomotor exam in May, followed by the CBT. However, if I am able to make changes, the current curriculum will see significant changes. This remains to be seen however.

The national standards are somewhat nebulous, but I can offer a few suggestions about modifications that can be done to a curriculum built upon NREMT-I/85 framework. First, you can check out a book called "Transition Series Topics for the Advanced EMT" by Mistovich et al. It is published by Brady/Pearson. The book does a good job of outlining the content that should be added if you are utilising the 85 curriculum as a backbone for your current programme. The new textbook that we will be using is called Advanced EMT: A Clinical Reasoning Approach 1st Edition by Alexander, M. & Belle, R. You can see it here: http://www.amazon.com/Advanced-EMT-A-Clinical-Reasoning-Approach/dp/0135030439/ref=sr_1_1?ie=UTF8&qid=1333769295&sr=8-1.

I believe you can also get it on Kindle which is a plus for students who have Kindles, iPads and other tablets with Kindle support. It is not a bad textbook and it even coveres a bit of chemistry, a plus in my book, but a text book is not as important as the instructor and the overall course structure.

Next, I would spend some time thinking about how to integrate the medical terminology, anatomy and physiology and pathophysiology into the curriculum. Ideally, I would like to push for formal, stand alone classes with labs, but we will see if this occurs. Currently, I am incorporating rudimentary concepts of chemistry into the existing framework and adding physiology labs. One such lab consists of drawing my blood, citrating it and preparing slides of the blood. Then, under microscopy, we add different solutions of varying tonicity and observe the results. Of course, I work at a college and have worked a few drug deals and obtained a microscope and flex camera along with slides and various other types of equipment for my class. Additionally, I integrate microscopic histology labs into the existing anatomy and physiology lectures. We also have a lambskin condom lab that illustrates the concepts of osmosis and diffusion quite well. Also, acid/base, arterial blood gasses, cellular respiration and general lab values receive more emphasis. Again, this is in part because I receive logistical support for a college. However, if you put in a little leg work and sell your self to a local college and develop a good relationship, you may open doors for enhanced learning opportunities. In addition, be prepared to teach additional pharmacology and pharmacological principles along with IO access.

Additionally, you will need to spend time ensuring your students have a good understanding of what they need to do for the national registry psychomotor exam. There are several stations including a new paediatric respiratory station that must be negotiated by your students. Personally, I hate making people memorise skills sheets and perform scripted events, but it must be done to pass NREMT. Therefore, on lab days, I have the class do two exercises. Half the time focuses on running reality based scenarios where scenrios play out dynamically and the students are often forced to critically think through situations, while the other half focuses on ensuring the students are able to run a scenario and ensure they follow the NREMT skill sheets. Additionally, we have a full day dedicated to running a mock NREMT test site toward the end of the class.

The current NREMT psychomotor stations that must be negotiated include; Trauma Station, Medical Station, IV placement and IV medication bolus station, Alternative Airway Station, Paediatric Respiratory Station, Paediatric IO station, Random Skill Station and Supine Spinal Immobilisation Station. As of next year, student will have to do a Cardiac Arrest/AED station as well. You can find exam coordinator information and skills sheets on the NREMT website.

I may be willing to share the current syllabus for my course, but I am somewhat hesitant considering the anonymous nature of the internet. (No offense.) The length of the course is a little over 200 hours. Around 220 or so. Again, I am pushing for change and would like to see a 500-1,000 hour course, but I highly doubt that will ever happen. Realistically, I hope to push for prerequisite classes and perhaps a core curriculum of around 300 hours, but we will see how that goes.

Please forgive any typos as you are getting an iPhone special.

[croaker260]

The national standards are somewhat nebulous, but I can offer a few suggestions about modifications that can be done to a curriculum built upon NREMT-I/85 framework. First, you can check out a book called "Transition Series Topics for the Advanced EMT" by Mistovich et al. It is published by Brady/Pearson. The book does a good job of outlining the content that should be added if you are utilising the 85 curriculum as a backbone for your current programme. The new textbook that we will be using is called Advanced EMT: A Clinical Reasoning Approach 1st Edition by Alexander, M. & Belle, R. You can see it here: http://www.amazon.co...3769295&sr=8-1.

I believe you can also get it on Kindle which is a plus for students who have Kindles, iPads and other tablets with Kindle support. It is not a bad textbook and it even covers a bit of chemistry, a plus in my book, but a text book is not as important as the instructor and the overall course structure.

Just curious , what text book are you using now? Did you chose this new text over another text, or are the pickings pretty slim out there? This is the book the school wants to use but I am 99% sure it wont work despite the publishers rep swearing its updated for 2012.

http://www.elsevier....ion#description

Next, I would spend some time thinking about how to integrate the medical terminology, anatomy and physiology and pathophysiology into the curriculum. Ideally, I would like to push for formal, stand alone classes with labs, but we will see if this occurs. Currently, I am incorporating rudimentary concepts of chemistry into the existing framework and adding physiology labs. One such lab consists of drawing my blood, citrating it and preparing slides of the blood. Then, under microscopy, we add different solutions of varying tonicity and observe the results. Of course, I work at a college and have worked a few drug deals and obtained a microscope and flex camera along with slides and various other types of equipment for my class. Additionally, I integrate microscopic histology labs into the existing anatomy and physiology lectures. We also have a lambskin condom lab that illustrates the concepts of osmosis and diffusion quite well. Also, acid/base, arterial blood gasses, cellular respiration and general lab values receive more emphasis. Again, this is in part because I receive logistical support for a college. However, if you put in a little leg work and sell your self to a local college and develop a good relationship, you may open doors for enhanced learning opportunities.

I am in a rather odd situation. This endeavor is on behalf of a relatively brand new community college in our area, whose campus is spread out over 6 different sights over at least 2 counties. Ugggh. Apparently they want all the EMS related programs at one location, so we will see what the cross department cooperation will be like. We do have decent facilities though, so that’s a plus. I grew up teaching in Ambulance Bays and under shade trees from time to time, so not having to bring my own screen and projector is a plus J

Also, while the college does require separate A&P and similar courses for the medic level classes, I am not sure they will go for that for the AEMT class. I may have a way around that though. Since we will certainly have more applicants than available slots, I may make it know that preference will be given to those who have their A/P already. Sure , that way I am not REQUIRING it…but it will have the same result. For similar reasons any chemistry is going to be taught by me and my co-instructors in house so to speak. Definitely something we can do, just takes up time I would rather spend going over other topics. Such is life though.

The current NREMT psychomotor stations that must be negotiated include; Trauma Station, Medical Station, IV placement and IV medication bolus station, Alternative Airway Station, Paediatric Respiratory Station, Paediatric IO station, Random Skill Station and Supine Spinal Immobilisation Station. As of next year, student will have to do a Cardiac Arrest/AED station as well. You can find exam coordinator information and skills sheets on the NREMT website.

Fortunately, since we already have a medic program in place, I think we are dialed in there. I guess I should add that I have been teaching EMS for about 13 years myself now at all levels. Its just this new level is new to me, not the cope/breadth of the material itself, and I have fallen into this rather suddenly.

I may be willing to share the current syllabus for my course, but I am somewhat hesitant considering the anonymous nature of the internet. (No offense.) The length of the course is a little over 200 hours. Around 220 or so. Again, I am pushing for change and would like to see a 500-1,000 hour course, but I highly doubt that will ever happen. Realistically, I hope to push for prerequisite classes and perhaps a core curriculum of around 300 hours, but we will see how that goes.

Please forgive any typos as you are getting an iPhone special.

I think we are limited to about 200-250 hours simply because of the summer semester block /reality we are stuck with. No offense taken. I would really appreciate getting a copy of the syllabus to look at. I believe that you and I have hung around here in EMTCITY land and IIRC the old EMSvillage “back in the day” (Is that forum even active anymore?) enough for a little cross internet cooperation, but I understand in any case. Thanks again for any help.

Also, what is your opinion on this book?

http://www.amazon.co...=pd_sim_sbs_b_1

We already use this series for the EMT basic level so it is an easy purchase logistically ..Thoughts welcome.

Edited April 7, 2012 by croaker260

[island emt]

I would question [not you personally Chris or Steve] how you can accomplish all the required curriculum in that few [200-250] hours.

The current EMT-B courses my wife is teaching run into 150 hrs classroom plus field clinical time.

When I took my EMT I-99 course 14 years ago , it was a total of 540 classroom hours and an additional 200 clinical hrs. The clinical hours included ER time=24 hrs ICU time 24 hours, OR time for airway management/ intubation ,minimum of 10 successful inttubations & 12 hrs, ride time on other service 48 hours, community service health projects [flu clinics etc.

Then we have been mandated to complete medication modules, IO module, and other updates along the way.

The whole AEMT philosophy will be to dumb down many of the existing standards to meet a national curriculum .

Using the Peter principle to make it fit the lowest common denominator.

Getting off my soapbox now!

[chbare]

Island, the AEMT is not I-99. In fact, if you look at the curriculum, it is basically I-85 with a few enhancements. Personally, I prefer the limited scope of interventions because I am not convinced that high risk questionable value techniques such as intubation are of much use.

Additionally, as I've stated, I have an ideal curriculum in mind. However, it's taken me three years to build current relationships and to acquire resources and logistical support. Within a year, I may be in a full time, tenure track. This will allow me even more flexibility and allow me to have a direct say on committees.

However, I understand your concerns and I can only say that I am actively pushing for progressive educational change. In reality, it's going to be a few years, but if I could see significant, quantifiable change in my lifetime, I would be reasonably happy.

We are currently using the AAOS Advanced Emergency Care book. The student feedback has been universally negative, hence the change to the book I mentioned. Of course, they may hate this one as well, but we are attempting to find the best fit possible. I agree with your concern over the I-99 textbook. Even if it's a decent book, it looks bad using a textbook to teach an extinct curriculum to students learning a different curriculum. However, as I stated, the real onus is on the instructors and the course structure. I am lucky because I only have six AEMT students and most are well educated people coming from other careers. I even have a biochemist in my class. Therefore, motivation has been high and the students are tearing through the topics with little effort.

PM me your email and I can send the syllabus. It does not include the clinical schedule as that is a different course run by a dedicated clinical instructor.

[island emt]

I understand what your saying Chris: The problem i have is in an effort to make a commonality across the board nationwide they have taken away educational standards and skills + interventions that have been successfully done by the I-99 license level for a long time. a well seasoned and educated Intermediate can handle a large majority of calls, saving the Paramedic level practitioner for those calls that really need a higher level of intervention. We have a system that has a Paramedic level flycar available for backup intercepts when needed.

I don't particularly have a problem with them taking away endotrachael intubation, instead relying on blind insertion devices. We were only intubating in cardiac/ respiratory arrest as it was. Then they gave us the choice of LMA[ Lost my airway} or the King airway/ combitube as devices,

Instead of educating and training on the airway structures and learning the Malapatti scale, they are teaching stick in a blind insertion airway if the pt is not breathing. A case of cookbook medicine: Not breathing ::: do this!

Then they take away the ability to use McGill forceps, basing that decision on the fact that the data weenies figured we weren't using them much anyway.

What is one supposed to do in a FBAO when you know there is an obstruction but you can't reach with a finger sweep?

{I've never been a fan of putting my digits in anyones mouth} Our only course of action will be to insert a blind airway device to force the FB deeper into the trachea? You know as well as i do the Heimlich maneuver doesn't always have the desired effect. [ Yes i know we're not supposed to call it that anymore} abdominal thrusts.

So at that point a FBAO become an arrest caused by the obstruction!

Maybe I'm just old and set in my ways after 40+ years in the business, but it seems to me that the national standard is going backwards.

OR what the powers that be really want is for a Paramedic on every call , no matter how minor.

Too bad they don't want to pay for that to happen. Yes it would be nice to have , but it's not practical in many rural areas.

I wish you well in trying to educate your AEMT's in that few hours.

Edited April 7, 2012 by island emt

[chbare]

I am not aware of a significant base of literature that suggests Magill use is a particularly high yield technique and the role of intubation in cardiac arrest has been de-emphasised. Honestly, spending more time on critical techniques such as properly using airway adjuncts, maintaining a good mask seal and use of a bag valve mask is long overdue IMHO. More time on so called "basic" techniques. I am not sure what the "lost may airway" reference means as it relates to the LMA? The LMA is an effective device with a considerable amount of literature supporting it's use. However, placing and managing the LMA is not as easy as many seem to think. In respiratory school, we spent a fair amount of time in OR working on just using the LMA. It is effective, but is not a "fire and forget" device.

Also, instituting change is not as simple as snapping your fingers and having things magically happen. It is actually a good thing that my state is transitioning to the new model because it gives me more leverage to act as a catalyst or even a direct change agent. As the transition occurs, I continue to gather additional support. This time next year may see a very different course design. As I have already stated, the current EMT-I in my state has had a scope that roughly approximates the AEMT, therefore my battle will never be about expanding the scope of practice. In fact, a rather limited provider who has a significant amount of education is my big push. Perhaps this is a reflection of all my years as an ER nurse where my ability to perform interventions such as intubation and the use of Magill forceps was limited, but my education and ability to assess and appreciate the patient's condition was able to impact patient care and outcome. Again, my push is for prerequisite courses and somewhere around 500-1,000 hours. My guess would place us on the low end of that but there is a good chance that we may end up having prospective students take several prerequisite credits. Of course, there is always a chance I could fail miserably, but I will go down trying in any event.

[island emt]

I am not aware of a significant base of literature that suggests Magill use is a particularly high yield technique and the role of intubation in cardiac arrest has been de-emphasised. Honestly, spending more time on critical techniques such as properly using airway adjuncts, maintaining a good mask seal and use of a bag valve mask is long overdue IMHO. More time on so called "basic" techniques. I am not sure what the "lost may airway" reference means as it relates to the LMA? The LMA is an effective device with a considerable amount of literature supporting it's use. However, placing and managing the LMA is not as easy as many seem to think. In respiratory school, we spent a fair amount of time in OR working on just using the LMA. It is effective, but is not a "fire and forget" device.

The lost my airway refers to once placed properly , it is hard to keep a good seal when bouncing down rural roads for 30 minute to an hour. Yes they work great in the OR setting when the pt is sedated and they have fasted. I learned the use of it from a highly respected gas passer who preferred the LMA to intubation in most procedures.

However when trying to prevent aspiration of beernuts and budweiser, they don't work so well.

Use of McGills is a very handy thing when you need to remove the lobster tail from a tourist esophagus , Ask me how I know.

I agree with you on increased levels of education & knowledge for all levels of licensed prehospital provider.

PM sent

[croaker260]

uhmm, I think this thread has derailed....

[croaker260]

I am jumping into a teaching a college level summer AEMT course using the new scope of practice, and I have been tasked with schedule development.

As this is a brand new thing in my state, I don't have any thing ready to go based on the new AEMT (our old EMT-advanced was really the EMT-I/85).

Of course our State EMS doesn't have framework to help us either, saying its up to us to develop it.

I am wondering if anyone out there has something I can use as a jumping off point so I dont unnecessarily re-invent the wheel. How many hours, what difficulty you encountered are all important bits of information.

I am also interested in what text book you are using, and your opinion of it.

So...anyone else have any help on the original topic ?