Has the AHA made itself irrelevant to EMS?

[Veneficus]

The real tragedy is the instructors in my opinion.

There are not very many instructors who do the job they should. Frankly, all the AHA requires to be an instructor is a commitment from that person that they will follow the material. They do not need to know anything at all about what they are saying...which is sad..

Unfortunately the videos have made the quality of the instructor moot.

I have had to correct more previous instructor errors committed by the students than I could possibly count. Instructors cut corners, skimp on the material that is ALREADY bare bones, and then do a crap job of teaching what little material is left at the end of their instructor slaughter fest.

One of the best parts of my job where I teach is making sure nonfaculty instructors keep to the program. It improves the quality of the program considerably.

An excellent instructor (which I am fairly sure you are Vene) can fairly easily take the AHA material, present it in a way that is appropriate, and give the students a really great, relevant course.

You are too kind, but the video and our organization determined we would strictly adhere to the letter of the AHA law.

I don't agree with everything AHA says either, and to be honest, some of their science is debatable, but using a bit of Socratic questioning and having a solid foundation of knowledge in order to be able to get your students to think outside of the box goes a long way.

I agree, but those days are gone, at least where I work. The script is unyielding. Otherwise, there is 20 instructors teaching 20 things and failing students complaining.

If you really want to know where I think AHA missed the mark, it is PALS. The PALS material is horrible in my opinion.

I think this is a very interesting statement. I have adult only providers asking to take PALS in order to transpose that knowledge of basic emergencies to adults.

 

[Veneficus]

I say pop an IO and roll.

Whatever you like that gets the job done.

 

[WTEngel]

Interesting points Vene, and I completely agree that without careful monitoring, you can have multiple instructors teaching multiple things, and lose the cohesiveness of the material...students getting inconsistent messages is definitely not a good thing.

We have a "teach to the standard, test to the objective" mentality. We teach to the highest standards, and only require the students to perform to the objective to pass.

For example, in looking over the algorithm for VF/VT, the only antidysrhythmic mentioned is Amiodarone. However, if you look into the Circulation journal article that covers the update, it goes into detail about the other antidysrhythmic options available. During testing, we follow the skills sheets, and don't require anything more from them that the skills sheets state, even though we exposed them to much more knowledge, and possibly held them to higher standards during the training scenarios.

In fact, looking at this in retrospect, almost 100% of our students exit the program thinking the final skills scenario testing is ridiculously easy, and feel like they learned much more at the skills practice stations (where we really put the screws to them, and go deep into the material...)

I agree that I would like to see higher standards for ACLS, but unfortunately the students are barely passing as it is in some programs, and the instructors for the most part can barely wrap their heads around the material in its current form. Present company excluded of course...

 

[Shishkabob]

AHA's ACLS became irrelevant when it let anyone BUT physicians and Paramedics in to it. (You know, the only 2 that will actually be making the decisions while running an ACLS situation with any sense of normalcy)

 

[WTEngel]

In response to my dissatisfaction with the PALS program...

I would have to say one of my biggest frustrations is the multiple "This is HOW NOT to do this skill."

I am a firm believer in always model the right way to the students, and do not ever show them an incorrect way. To be honest, the whole bit about "This is how you are not supposed to notify a family of the death of their child" is a bit insulting to say the least. The students are not idiots, they know the incorrect way to do it...unfortunately most instructors are not better at delivering this type of news, or have little more experience than the students taking the course...

Maybe I am just too down on the instructors, but I have seen so many bad instructors. I am not trying to get on a TC Faculty high horse or anything, but if I had to break down the instructors I have seen at the majority of other programs, by level of competence, it would look like the following:

20% totally useless in regards to knowledge or teaching ability
60% incompetent, or delivering incorrect material
10% competent instructor, not confident in material
10% outstanding...

The number of incompetent instructors in PALS is even worse.

 

[Farmer2DO]

Just a brief story.....

This is a situation I was involved in that highlights the ridiculousness of rigid standards.

At a former agency where I worked, one of our paramedics took a non-AHA class offered by a local cardiologist. One of the scenarios he brought back was the patient in a very rapid SVT (def narrow complex) without palpable pulses. They were trying to get the idea across of "figure out why your patient is dying", rather than "just follow the algorythm". The answer was, of course, to shock and treat as SVT, because likely the heart was beating so fast, the ventricles didn't have time to fill and thus cardiac output was near zero, and if you didn't stop it quickly, you wouldn't have much to work with.

The chief paramedic of the agency got wind of this, and threw an absolute fit, basically pounding his fist on the desk, saying "It's PEA, and needs CPR with epi and atropine, and anyone who doesn't do it that way will have their privileges suspended." Well, you can imagine how that went. The local paramedic class instructor (a VERY bright man who wants his paramedics to think about why they are doing what they are doing) found out and took it to the system medical director. The guy basically lost all credibility in a good size urban/suburban/rural system. He tried to retract his statements, but he was already a laughing stock. Within a year, he was "pursuing other career options". Went back into cooking for a living.

(This was the standard for this guy. He didn't understand the most basic of paramedic level material, but wanted everyone to think he was the smartest thing around.)

 

[EpiEMS]

AHA's ACLS became irrelevant when it let anyone BUT physicians and Paramedics in to it. (You know, the only 2 that will actually be making the decisions while running an ACLS situation with any sense of normalcy)

Wouldn't it just be easier for them to offer, say, ACLS for BLS providers, and teach about what the ACLS provider is doing, but not give the depth or try to teach how to run the code?

 

[Arovetli]

Wouldn't it just be easier for them to offer, say, ACLS for BLS providers, and teach about what the ACLS provider is doing, but not give the depth or try to teach how to run the code?

Well for one there's not a whole lot of depth in standard ACLS classes to begin with...

 

[Veneficus]

20% totally useless in regards to knowledge or teaching ability
60% incompetent, or delivering incorrect material
10% competent instructor, not confident in material
10% outstanding...

The number of incompetent instructors in PALS is even worse.

My experience as a TCF mirrors this very closely.

 

[firecoins]

The videos most certainly are a waste of time.

I took the class with non critical area RNs. Very depressing.

 

[WTEngel]

I think in essence we have pretty much summed up about the only viable solution at this time...

TCF (like yourself and me) have to be vigilant about doing the best job they can, with the current published material. We need to be even more vigilant about making sure corners are not cut, and an already stripped down curriculum is not stripped down even more.

The next step would be to become Regional Faculty (I hope to do this when I have some more time...) and begin to put the screws to the TCs that are not doing justice to their participants. One hour CPR courses, 4 hour ACLS courses, and places that pretty much sell you a card are at the top of my list.

Short of those two, we are saddled with what we have until 2016 at the earliest.

 

[mycrofft]

The teaching and economic aspects

I'd participate in this but my experience is in teaching basic and pro CPR. SO when has that stopped me before...

Working with both ARC itself as a vollie, and paid by two AHA-standard (cloned) companies besides, after the 2010 changes I see the following in common:

1. Shorter class time to cover the material.
2. Insistence upon use of the video to standardize the product (class).
3. Lower quality (cheaper) video.

I attribute these to customer (students' employers') feedback (they want shorter class time away from work to meet some rule they don't agree with) and economic downturns motivating training companies to use cheaper materials. (I miss the Payton Manning video, and other ARC instructors have voiced a desire to bootleg its continued use because it was so much better and more complete than current one).

I will bet there is some study that shows you do not need an experienced EMS person to teach these if you only follow the video. Maybe, but the video had better be perfect and the answers readily accessible, and right now they are not. I use the PAUSE button a lot then make sure my "war stories cupboard" is shut before I open my mouth and sometimes call up a student to elaborate.

Veneficus, you have many many questions and all good ones. They can be applied to everyone's training right now. They also ask the question about how we slice up the pathology pie (by problem types, by problem commonalities, by seriousness, by body system, by intervention types, by efficacy in the prehospital environment) to make manageable classes instead of replicating a medical degree

 

[CANDawg]

I recently decided to get certified as a BLS instructor for AHA. I had no idea that they expect you to actually spend 4 hours teaching CPR, with nothing but their video.

I have only taught one class since being certified, but I only ran the video to show proper technique a couple of times and crack a few jokes to keep people awake.

The Heart and Stroke Foundation of Canada uses the same video for their BLS classes, just overlays their logo over the AHA one.

I've been CPR certified since I was 14, way before I even thought about getting into EMS. So the courses are a tad repetitive for me to say the least, but I was usually able to either learn something new or at minimum relearn something small I had forgot. That said, this last recert was my first experience with the videos, and good God.

Kill. Me. Now.

If the AHA/H&SFC train their instructors so well, why can't they just trust the instructors to teach the course on their own? I didn't know you had to spend $400+ and three days of your life to learn how to press a play button.

Okay, rant over. :glare: