Warning: I guess I was bored.. this is long, but I think it is valuable!
Very good points, application of the knowledge as in clinical skills is essential. Without the knowledge though, one is just "performing" or "acting" without really knowing the reason why and accepts everything as face value.
Agreed
This is why so many EMT's & medics are hesitant for any changes. For example trendelenburg to even CISD, even though both have been repeated in several hundred studies and years of research, not to work, we continue.
Here I disagree. "This is why": unsubstantiated cause and effect argument. Sure, change may be met with some degree of resistance, but I find that many EMT's and medics accept change quite well. Yes, at least in NYC and NYS, my observations give me the impression that many times change only happens after it is long overdue. The responsibility for that doesn't lie with the street level EMT's and medics, it has to do much more with the politicians (those who write the protocols, the policies, the medical directors, the upper level administrators).
I remember reading an abstract of a published study in JEMS evaluating the efficacy of prehospital intubation for APE patients a few years ago. They compared the eventual outcomes of APE patients intubated in-field with APE patients intubated immediately on arrival at the ED. There was convincing evidence that prehospital intubation for APE patients was harmful.
So, now I am armed with a piece of knowledge. But, even to this day, daring to apply that knowledge means risking my certification and the ability to support myself and my family.
Since then CPAP has been added as an "option" in our protocols. I don't use it, not because of my hesitance to change, but because none of my employers have even considered providing either the equipment or the training. I guess that option must be expensive.
When I was in medic school (96-97), there were drastic changes implemented to the citywide protocols. Calcium was removed from the cardiac arrest protocol. Versed was added as a sedation option for pacing and intubation. Ativan was also added as an option for stat-ep. ASA was added to the MI protocol, and the use of NTG (SL and paste) was emphasized while morphine was de-emphasized. Transcutaneous pacing and 12 lead EKG's were all added to the protocols. The medic trucks I was riding on carried all the new drugs, and they were all equipped with new lifepak 12's capable of the new technology. The training was provided by their employer.
Were the "old-time medics" I worked with hesitant to the change? HELL NO! They WELCOMED it! I observed every one of these new implementations during my "observer tours"... except for the Versed and Ativan. See, it wasn't the medics that were hesitant, telemetry absolutely refused to acknowledge that we even carried the option.
EMT-B's can now carry and administer albuterol, ASA, even epi-pens under certain strict circumstances. Although required on the 911 units, the commercial service I work for doesn't equip BLS units with these options. As far as the albuterol, they went as far as offering the training and preparing the equipment for distribution to all the units. The medical director refused. Do you really believe that the EMTs would be unwelcome to these new changes?
Without the knowledge, all we have is performing personnel. Not really knowing the "full picture" can be detrimental. My question is why not give the full picture?
Yes, without knowledge, all we have is performing personnel. I can't see any harm in giving the full picture. But I question how "not really knowing the full picture can be detrimental". Do you have a basis to support this?
For example I always taught the full hemodynamic lecture to basic when explaining blood pressures. It proved to be less confusing to learn something right the first time, than to go back to school later and re-learn something. Ironically, basic always had a higher score than most advanced students, because they did not already have preconceived ideas.
Hmmm... not sure I get this. "It proved to be less confusing to learn something right the first time" as opposed to "relearning it later". Are you saying that those paramedic students who had previously attended your hemodynamic lecture during EMT-B training had better test scores (for this area of knowledge) than already practicing medics who lacked receiving an equivalent lesson during their EMT-B training?
Since I'm playing devil's advocate, I'll refrain from forming an opinion to the "because they did not already have preconceived ideas." Cause and effect statements are tricky to evaluate.
The difference between good medics and half arse ones is the desire and "want" to learn. Instead of stopping at your basic book, maybe if you had researched and looked past, you would had found the answer. Again, we must stop the traditional mentality of describing that everything is found in the basic course and texts. In actuality it is a very poor, poor representation of emergency medicine. You see my Basic EMT book had the pathophysiology of right failure and left, again we did "dumb down" the EMT curriculum in 1993. This was met by resistance of many educators that knew the potential effects that we are now seeing.
Yes, I agree! I'll reword it though since I don't think it is "THE" difference, but I think that you are on to something here.
One (of several) important qualities necessary to be a good medic is the desire to learn.
Later on, I actually did ask some more experienced EMTs about the difference between left/right sided heart failure, but none of them knew the answer either. Nowadays, I could have easily googled the answer in seconds. For this reason, I feel it is necessary to teach EMTs about evaluating sources of information. Back then, I would have been too intimidated to just stop a doctor in the ED and ask. This was enforced by the medic's rant (I wouldn't dare want to give off the impression I was incompetent for not knowing what a peer felt was "basic knowledge"). Maybe more needs to be done with promoting a good relationship between EMS (especially new EMTs) and the staff of their regional EDs.
Yes, CME needs to be encouraged. But, motivation cannot be forced.
We expect our basics to have the knowledge and skills, but we are not teaching, nor providing avenues to meet those expectations. Yet, again how many instructors are informing students that they must go outside their comfort zone and read other educational materials and demand such? Yes, the basic text is needed as one of the required books, but NOT the sole text.
Hopefully, with the proposed new curriculum we will see the EMT length increase by 20-30%, requiring more in-depth education.
R/r 911
Every CME I have attended has welcomed EMTs, but there has never been a requirement for EMT-Bs in NY. Even most medics will attend the bare minimum, or even look for ways around attending CMEs. Again, motivation cannot be forced, and this lack of motivation is sad indeed. It's a spiraling effect too. Why should an employer spend their resources organizing CMEs when their personnel lack the interest of attending.
So more avenues to increase knowledge and skills need to be provided, yes. But maybe incentive needs to be provided since natural desire lacks. Some larger organizations may offer compensation (paid time or even $) for attending CME, but good luck encouraging this expensive option to administrators. Actually union shop stewards for non-profit agencies should find out about government education and training grants. They can secure the resources to provide all sorts of training programs, including wage compensation, at no cost to the agency.
Encourage competition! As humans, we love to compete! Instead of compensating every employee for every CME hour they attend, you could probably get better response for offering some sort of periodic competition with prizes going to the top few. It can end up promoting a better social working environment as well.
Say, you offer a CME for pediatric trauma. All those in attendance are allowed to take a written test. The top 1 or 2 scores can be awarded a gift certificate to a restaurant, an extra personal day, tickets to a local sporting event. All sorts of options that are certainly cheaper than paying out hourly wages... and I suspect the turnout would be better. Inter-agency and regional competitions should be promoted as well.
