EMT in the High School

What are EMTs?

• Emergency Medical Technicians– Provide basic medical care and transportation

between scene and hospital– Nationally recognized certification

• Required for application to most fire departments / fire protection districts

• Highly recommended to have when applying for law enforcement positions

• Also found working in emergency rooms, 9-1-1 dispatch centers, and FEMA / Homeland Security

Levels of EMS Service

First Responder80-hour course taught to most police officers and commercialsafety officers that usually includes some components of CPR, first aid and emergency/disaster response.

Emergency Medical Technician (EMT-B)Minimum 110-hour didactic and 10-hour clinical course to teach basic life support procedures (CPR and AED use, spinal immobilization, basic medication administration, etc.) and emergency care and transport.

Paramedic (EMT-P)Minimum 630-hour didactic and 480-hour clinical course to teach advanced life support procedures (manual cardiac defibrillation, endotracheal intubation and advanced airways, IV and pre-hospital medications, etc.)

National Job Outlook

• “Employment of emergency medical technicians and paramedics is expected to grow by 19 percent between 2006 and 2016, which is faster than the average for all occupations.”

• Full-time paid EMTs and paramedics will be needed to replace unpaid volunteers because of the amount of training and the large time commitment these positions require.

• “Furthermore, as a large segment of the population—aging members of the baby boom generation—becomes more likely to have medical emergencies, demand will increase for EMTs and paramedics.”

• Continued demand for part-time, volunteer EMTs and paramedics in rural areas and smaller metropolitan areas.

Source: Occupational Outlook Handbook; US Dept of Labor; Bureau of Labor Statistics (2006).

National Curriculum

• Governed by the National Highway Traffic and Safety Administration

• Minimum of 110 hours didactic and 10 hours of clinical experience

• Allows state EMS agencies to develop emergency treatment and transport protocols for all levels of first responders

AVUHSD EMT Program

• Started through the Antelope Valley ROP for students 18 years of age and older

• Sought accreditation through LA County EMS Agency in the high school in 2007

• Allow students more employment opportunities after high school

• EMT profession is expected to grow by 34.5% in Los Angeles County from 2004-2014 (www.labormarketinfo.edd.ca.gov)

Accreditation

• Currently 23 approved EMT I schools in Los Angeles County

• Accreditation process– Differs from county to county

• Requires that all NHTSA guidelines are followed• May have specific requirements or certification

procedures for each individual countyLos Angeles County EMS requires additional 8 hours of

education on county-specific protocols and procedures for any EMT training to certify or work in LA County.

Palmdale High School

• Antelope Valley • Title I School• Student Population of 3,700• Ethnic Breakdown

63% Hispanic18% African American12% White, Non-Hispanic 7% Other

Health Careers Academy

• 4 year comprehensive program

• 450 students

• Job shadowing during their junior year and internship during their senior year

• Option for Sports Medicine their Junior year

• Joint effort between ROP and Palmdale High School

Palmdale HCA Prerequisites

• Senior level - Health Career Academy

• Students must have a current American Heart Association CPR for the Health Care Provider certificate

• Anatomy and physiology

• Approval to enroll from the Program Director

EMT Course Credit Hours

• NTHSA minimum requirement is 110 didactic hours and 10 clinical hours– Many universities and community colleges

offer courses that run 130 – 200 hrs in length.• AVROP EMT course for high school is 180 hours

based on a 16-week semesterRoughly three didactic hours and two laboratory hours per week.

Clinical rotations are the student’s responsibility to perform outside of class / school hours

EMT Student ExpectationsDefining Adulthood

Many young EMS students may still be in high school or have recently graduated from high school.

• Students in transition– Life roles and responsibilities are not those normally

considered to be fully adult– Students do not have experiences necessary to achieve

adulthood, and it may be reflected in their conduct

But because of the considerable responsibility that comes with being EMS providers, they must be held accountable as adults.

EMT Student ExpectationsSensitive Subjects

Maturity of the student and must be constantly monitored

• Particularly important when discussing emergency care and treatment for:

– Obstetrics and Emergency Childbirth– Sexual Assault– HIV / AIDS and communicable disease patients

• Remove emotion from course subject matter – Personal attacks on the rescuer / first responder– Child / Elder Abuse– Sudden (Traumatic) Death / Suicide– Death of a child or infant

Student Evaluations

• EMS Education is in transition from objective-based learning to competency-based learning– EMT Educational Standards

• Meeting the core content for each nationally recognized level of practice.

– Most EMS textbooks and support materials are written directly from the content of the EMT National Standard Curricula.

• But hands-on skills are equally as important in developing the EMT student’s learning.

Competency-based Education

“CBE focused on preparing students to perform the prescribed competencies of a profession under real-life conditions at a level or proficiency required for workers on the job,” (Alexander, 120)

Equipment, supplies and teaching scenarios need to reflect real-world applications.

National Registry of EMTs

• National Registry exam required for EMT certification in CaliforniaComputer-based testing

• Six key areas of knowledge are tested– Airway– Cardiology– Trauma– Medical Emergencies– OB / Pediatrics– EMS Operations

• Computer-adaptive testing

Students must pass each key area with a score of 75% or better

Effects of Culture and Gender

EMS was traditionally thought of as a “man’s job”.Today 75% of all EMS professionals are male, but trends are showing more females entering EMS than at any other time.

In 2005, there were 1,347 women on 136 CA fire departments (896 women in CA Dept of Forestry, San Francisco, Los Angeles City & San Diego FDs), 115 engineers (70 on CDF), 10 lieutenants, 60 captains, 15 chiefs, 7 chiefs of department.

(Status Report, 2005; Women in the Fire Service, Inc.)

Cultural biasEMS is a helping profession. The instructor must be

culturally aware and promote an atmosphere of cultural

understanding.• Be aware and respectful of social and religious customs

• Men’s and women’s roles in culture and EMS

• Care of patients by the opposite sex

• Non-native English speaking students

• Body language

NHTSA Guidelines for EMS Instructors

10 professional skills sets and professional attributes for EMS instructors– Understands essential concepts and tools for each of

the EMS levels and their individual content areas.– Understands adult learning and use the knowledge to

support student development– Understands learning styles and be able to adapt

learning experiences to the student– Promotes higher-thinking and problem-solving

strategies.– Utilizes knowledge of individual and group motivation

and dynamics to create a positive learning environment

NHTSA Guidelines for EMS Instructors

10 professional skills sets and professional attributes for EMS instructors– Uses effective verbal and nonverbal communication

to encourage student inquiry and interaction – Competently plans instruction drawing upon

knowledge of subject matter, principles of learning and curriculum objectives

– Uses effective formative and summative evaluation criteria in all facets of the program

– Is a reflective practitioner who consistently uses self-evaluation to seek opportunities for professional growth and development

– Cultivates professional relationships with colleagues to improve instruction.

Field and Clinical Rotations

• Each approved EMT-Basic training program shall have written agreements with one or more general acute hospitals and/or operational ambulance provider(s) or rescue vehicle provider(s) for the clinical portion of the course (CA Title XXII).

• No more than 3 students per 1 qualified supervisor and students must assess a minimum of 5 patients with adequate documentation

Program Director

Also known as the Course Coordinator – Education and experience in methods, materials and

evaluation of instruction which shall be documented by at least 40 hours of teaching methodology (CA Title XXII)

– Current certification as an EMT-Basic or higher – Responsible for course planning, operation, and

evaluation – National Registry preparation and tracking – Approval of all clinical and field activities

Clinical Director

Also known as the Medical Director – Currently licensed physician, nurse, physician

assistant, or paramedic with 2 years of academic or administrative ED experience

– Acts as the ultimate medical authority regarding course content, procedures, and protocols.

– Should provide input on all examinations

Principal Instructor / Primary Instructor

As Defined by Title 22:– May be the program clinical coordinator or program

director; or – Be a physician, registered nurse, physician assistant,

or paramedic currently licensed in California; – Be an EMT-I who is currently certified in California; – Have at least two (2) years of academic or clinical

experience in the practice of emergency medicine or prehospital care in the last five (5) years;

– Be approved by the program director in coordination with the program clinical coordinator as qualified to teach the topics to which s/he is assigned.

Secondary Instructor

“Teaching Assistant”“...qualified by training and experience to

assist with teaching of the course.”

40 Hour Education

• Forty hour teaching methodology course– California State Fire Marshal, “Fire Instructor

1A and 1B”– National Fire Academy’s “Fire Service

Instructional Methodology Course”– EMS Educator Course (NAEMSE) – Any other coursework that meets the US

DOT/NHTSA 2002 Guidelines for EMS Instructors

The mission of The National Association of EMS Educators is to inspire excellence in EMS education and lifelong learning.

The NAEMSE Educator Course represents the didactic component and practical application of the beginning education process to become an EMS instructor.

Course has been designed to provide a basic introduction of concepts for the beginning EMS educator.

Instructor education is crafted to develop professional EMS educators using NAEMSE developed modules that follow the curriculum objectives of the DOT/NHTSA 2002 National Guidelines for Educating EMS Instructors.

3 day course, 8-9 hours per day$275.00 for members

$370.00 for non-members www.naemse.org

Supplies

Well-Being of the EMT-Basic Eye protection, gowns, gloves, masks, formsThe Human BodyAnatomy modelsVital SignsStethoscopes, blood pressure cuffs (adult, child,

infant), penlights. Ratio 1:6Lifting and Moving PatientsStair chair, scoop stretcher, flexible stretcher,

gurney, long and short backboards, bed

Supplies

Airway

Pocket mask, bag-valve-mask, flow restricted oxygen powered ventilation device, oral airways, nasal airways, suction units, suction catheters, oxygen tank, regulator, nonrebreather mask, nasal cannula, tongue blade, lubricant, combi-tube, ET tube

Supplies

Cardiac Emergencies

CPR manikins, artificial ventilation manikins, automated external defibrillator

General pharmacology

Epinephrine auto-injector trainers, activated charcoal, glucose, nitroglycerin, inhaler

Behavioral

Restraints, stretcher

Supplies

Obstetrics

Childbirth kit, OB manikin

Trauma

Dressings, 4x4 gauze, occlusive dressings, pneumatic anti-shock garment, triangular bandage, roller bandages, air splints, traction splints, rigid splints, cervical collars, blankets, burn sheets, ladder splint

Estimated start-up costs

Paperwork Filing FeesDependent county to county

Durable Equipment$10 – 20k (including gurney)

Medical Supplies$3 – 8k

EMT Text$60 - $90 per textbook

Can use any text that supports DOT/NHTSA guidelines.

Available from Mosby/JEMS, Brady/Pearson-Prentice Hall,

Elsevier publishers

EMTA V ROPTRAINED. TESTED. COMPETENT. CONFIDENT.

DON’T BOTHER CALLING 9-1-1. I’M ALREADY HERE.

Contact

Tim Klein, MPH, NREMT

tklein@avhsd.org

661 273-3181 ext 333