FALL 2015 Issue

EU

FALL ‘15

UPDATE

Applying Experiential learning theory to Medical Simulation

by Kelly Lombardi, MS, Paramedic

Is First Aid/Public Use of Oxygen Safe Without Oximetry?

by Pete Goldman, MD

1-877-947-2831

IN THIS ISSUE National Association of EMS Educators 250 Mount Lebanon Boulevard Suite 209 Pittsburgh, PA 15234 Phone: 412-343-4775 Fax: 412-343-4770 www.naemse.org

2015

2015-2016 Board of Directors John Todaro, BA, NRP, RN, TNS, NCEE President Richard Beebe, MS, RN, NRP Vice President John Creech, MEd, LP Treasurer

WHAT’S INSIDE

Rebecca Valentine, BS, NRP, NCEE, I/C Secretary

PAGE 3 NAEMSE NEWS

PAGE 4 Where in the World is NAEMSE?

Linda Abrahamson, MA, ECRN, EMT-P, NCEE James Dinsch, MS, NRP, CCEMTP Lindi Holt, PhD, NRP, NCEE Connie Mattera, MS, RN, EMT-P

by NAEMSE Staff

Mickey Moore, A.A.S., EMT-P

PAGE 5 PAGE 8

Michael Nemeth, AEMCA(f), EMT-P, ICP, MA

2015 NAEMSE Symposium Recap

Christopher Nollette, EdD, NRP, LP

by Brandon Ciampaglia, NAEMSE Staff

Dr. Nerina Stepanovsky, PhD, MSN, CTRN, PM Dr. Walt Alan Stoy, PhD, EMT-P

NAEMSE Committee Corner

National Office Staff

by NAEMSE Staff

Joann Freel, BS, CMP Executive Director, Editor

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Stephen Perdziola, BS Business Manager Brandon Ciampaglia, AS Communications Coordinator

Paying it Forward: Doug Smith Platinum Educational Group

Nora Davidson, BA Membership Coordinator

by Doug Smith - MAT, EMT-P, IC, Medical Educator Tom Gottschalk - EMS I/C., NREMT-P, CCEMT-P, Medical Coordinator, and Jeremy Johnson

Laurie Davin, AS Education Coordinator Larissa Kocelko, BA Administrative Assistant William Raynovich, MPH, NREMT-P, Ed.D Editor, Domain3

PAGE 16 Is First Aid/Public Use of Oxygen Safe Without Oximetry?

Reprinting Information

Interested in reprinting one of the articles you find in this publication? If so, please contact Brandon Ciampaglia via e-mail at brandon.ciampaglia@naemse.org or by phone at (412)343-4775 ext. 29

by Pete Goldman, MD

PAGE 19 CoAEMSP Outcomes Threshold Report Summary 2014

Submission Guidelines

Unsolicited submissions are welcomed. Members of the NAEMSE Publications Committee review Domain3 manuscripts. Acceptance of a manuscript for publication is contingent upon completion of the editing process.

by Patricia L. Tritt, RN, MA

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Manuscripts should be e-mailed to brandon.ciampaglia@ naemse.org. Submit a cover letter with each manuscript indicating: Author name, credentials, title, and affiliation.

A title letter should also be included disclosing any commercial associations that could post a conflict of interest. If you have an idea brewing that you’d like to submit, please contact us. We would be happy to discuss it.

New authors are welcome and encouraged.

NAEMSE NEWS

NAEMSE NEWS

NAEMSE Instructor Courses Continue to Inspire and Motivate EMS Educators from Around the Country The highly influential NAEMSE Instructor Courses have been and continue to make long-lasting impacts on the thousands of instructors who have taken one of the various levels of IC and have applied the info acquired to their respective classrooms. Just take a look at a few of these more recent testimonals: Jason E. Stroud, Virginia Beach, Virginia

INSTRUCTOR COURSE DATES NAEMSE continues to bring its heralded EMS instructor course to all corners of the country.

If you have never attended, you can reserve your spot online. If you’re an instructor, spread the good news to your colleagues in the EMS community.

The following is a complete listing of all upcoming Fall ‘15 & Winter ‘16 courses:

INSTRUCTOR COURSE I Atlantic City, NJ: November 11-13, 2015 Louisville, KY: December 2014 Held in partnership with the 201512-14, New Jersey Held in partnership with Louisville Metro EMS Statewide Conference on EMS Des Moines, IA: November 12-14, 2015 Held in partnership with the 2015 IEMSA Annual Conference Dallas, TX: November 20-22, 2015 Held in partnership with the 2015 Texas EMS Conference

These pictures showcase some of the many new and exciting active learning activities planned at a new BLS Academy, along with new approaches on how they’re doing business, based off of material learned from the Level 1 IC. “Good Morning. I attended the Level 1 NAEMSE instructor course this past weekend in Ventura. It was my absolute favorite class that I have ever attended. When you are in high school and a friend asks you who your favorite teacher is, most people revert back to an elementary grade teacher. If I were asked that question now as an adult, I would say my favorite is Dr. Nollette. I plan on repeating the course every other year, to refresh on skills.” - Kristina Hong, Lancaster, CA “First and foremost, let me say what an amazing and life changing experience this course was. It impacted me in a way that will surely follow me the rest of my life for the better. I cannot thank you enough.

I want to be a part of helping to spread the name and reach of NAEMSE. This is not just a course but I feel a way of life that can help shape the future of this industry. I came expecting just a course on how to be a better instructor but I left feeling touched in a way I cannot even explain. I feel like NAEMSE message will change a lot of the issues we deal with in EMS today. Chris [Nollette] should look into motivational speaking. He not only effectively hooks you with his passion but he blows you away with his charisma and ability to substantiate passion, drive, and energy with information driven by research… and that is a rare combination. I thank you for the rest of my life. I would like to mentor under you guys. Thank you!” - Chino

Onwuka, South Hampton, PA

Have you attended one of our many IC classes and experienced similar results? We would love to hear from you! Please contact Education Coordinator, Laurie Davin (laurie.davin@naemse.org), and we will highlight your comments.

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Colorado Springs, CO: Jan. 8-10, 2016 Held in partnership with the Colorado Springs Fire Dept.

Los Angeles, CA: February 19-21, 2016 Held in partnership with the Los Angeles Fire Dept.

Pearland, TX: February 26-28, 2016 Held in partnership with Pearland Fire

INSTRUCTOR COURSE II Albuquerque, NM: February 5-6, 2016 Held in partnership with the University of New Mexico School of Medicine

CAAHEP Accreditation Update & Evaluating Student Competency Workshops Rosemont, IL: December 3-5, 2015 Held in partnership with CoAEMSP

For more information, please visit

NAEMSE.ORG

WHERE IN THE WORLD IS NAEMSE?

Where in the World is NAEMSE? By: NAEMSE Staff

The month of October found NAEMSE at: Ventura, California, where NAEMSE proudly presented the national Instructor Course Part I. The Ventura College Paramedic Studies Program and Director Tom O’Connor provided a great facility for the course faculty, staff and educator participants. The Ventura College Paramedic Studies Program was established in March 1999 with the first class graduating in 2000.

Graduates from this program will be provided with specific understanding of the paramedic profession, sound theoretical rationale, critical thinking skills and proficiency in practical skills, which will provide the basis for decision-making and success in the workplace. The patch of the Ventura Paramedic program was created with pride and is meant to represent the college, the profession and the city.

Atlanta, Georgia was the site for the NAEMSE Instructor Course Part II at Grady EMS. Host Mr. Jeff Asher, Education Coordinator provided the faculty, staff and educator participants with southern hospitality. The Grady EMS is one of the largest providers of pre-hospital care in the southeast h andling approximately 100000 patients yearly. The Vision Statement of the Training & Education Division states that their division strives “To become the leading EMS Training & Education center nationally by developing entry level, highly motivated, technically skilled, critically thinking, and ethical healthcare professionals”.

Little Rock, Arkansas NAEMSE and CoAEMSP co-presented the workshop “ Evaluating Student Competency” using the CAAHEP Accreditation Standards as it relates to student evaluation. Faculty included David Page, Dennis Edgerly and Michael Miller who presented this important topic to educators from the great state of Arkansas. Thank you to Dr. Daniel Bercher, the Arkansas EMT Association (AEMTA) & the Arkansas Trauma System for supporting this workshop.

Where’s NAEMSE headed next? Take a look at our upcoming Instructor Course dates to find out and register.

We look forward to seeing you in class!

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2015 NAEMSE SYMPOSIUM RECAP: NASHVILLE, TN - AUG. 4-9, 2015 For twenty years NAEMSE has delivered unparalleled educator resources in the form of its Instructor Courses and diverse catalogue of programming, which has successfully trained thousands of educators from around the world.

What better way to celebrate than with the Annual Educator Symposium & Trade Show in Music City!

Over 700 attendees explored session after session, navigating Omni’s expansive floorplan to reach their next learning destination. One after the other, all quickly become aware that there was something extra special about this year’s event. Conversations of how wonderful the agenda had been thus far echoed from one end of the hotel to the other.

Nashville, TN proved to be the best possible spot for getting our celebration rockin’ & rollin’ the right way. The Omni Nashville - home of the 2015 NAEMSE Symposium - was ideally situated and allowed for attendees to take quick jaunts to numerous restaurants, honky tonks, and attractions that showcased the diversity of the city’s landscape and excellent music scene. Needless to say, there was no shortage of walkable entertainment.

As always, the NAEMSE Exhibit Hall saw its own share of traffic and attention, attracting all attendees to take part in various one-on-one discussions with vendors from all over the country. 70+ exhibitors showcased their products and services, handing out business cards and other contact info to maintain a line of communication once the symposium came to a close.

Things officially got underway in Nashville on Tuesday, August 4th, with the various pre-conferences getting things off to a quick start. It was impossible to ignore the booming vocals of Dr. Chris Nollette leading his wide-eyed troop of IC 1 students into the hotel hallways, clapping and cheering the word of the day. Not to be outdone, IC 2, Education Technology, and more filled the various rooms at the Omni with their own brand of enjoyment and erudition. No matter which course was actively ongoing, everyone was finding the experience to be quite rewarding.

Other highlights included the always enjoyable NREMT/ NAEMSE Welcome Reception, the Trading Post evening event, and the NAEMSE Social. Sponsored this year by the Tennessee EMS Education Association (TEMSEA) at the popular Tequila Cowboy Bar & Grill, the social has become THE gathering for good food, good talks, and good times.

It wasn’t long before we reached the main breakouts of the event, with a strong sense of jubilation lingering in the air.

It was palpable. Everyone knew that great things lie ahead over the next 3-days... and they were not disappointed. It all began with Chris Nollette’s Opening Session, which garnered great focus and attention from the large audience that, by the end, were reminded of the importance of the work they do on a daily basis.

We have already begun work on next year’s festivities and have opened up our annual Calls for Presentation. If you are interested in submitting your presentations, you can do so online at the following address (http://naemse. org/?page=2016presentations). The deadline for submissions is midnight, November 16, 2015. Get your ideas in today!

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We cannot thank you enough for making this year’s event so incredibly successful and we look forward to seeing you again in Ft. Worth on August 1-6, 2016 for the next Educator Symposium & Trade Show!

NAEMSE COMMITTEE CORNER

PROGRAM COMMITTEE

Meeting Date: Wednesday, October 14, 2015 Next Meeting: TBD

engaging updates.

Welcome to Committee Corner! This new section of Educator Update will be an ongoing series of updates that will strive to accurately represent that which has been discussed during the most recent round of committee meetings. Here you will be caught up on the constant going’s on of the association and it’s affiliated groups. And who knows! Perhaps you may want to join one of the committees below as a result of their updates. We always welcome and encourage you to become a more active voice for the association!

If interested, please visit: http://naemse.org/members/group_select.asp? type=18354

Under the leadership of Committee Chair, John Todaro and Co-Chair, Jim Dinsch, the Program committee is reviewing the extremely positive evaluations for Symposium 2015 in order to improve Symposium 2016 in Ft. Worth, TX. Thank you to everyone who participated in the review process this year, and we hope to see you in Texas in 2016! Call for Presentations 2016 is currently open, and committee members are eagerly waiting for their chance to review submitted materials In the middle of November.

MEMBERSHIP COMMITTEE

Meeting Date: Tuesday, October 13, 2015 Next Meeting: Tuesday, November 10, 2015 The committee continues their project of contacting new members as a welcoming project under the new committee chair, Linda Abrahamson. A webinar showcasing the features of NAEMSE’s new website is also in development.

The membership survey for 2016 is in development, with plans for an early spring release. The committee also hopes to communicate with training officers and preceptors to find out how NAEMSE can better fit their needs as a membership organization and start taking steps to incorporate those groups.

EDUCATION TECHNOLOGY COMMITTEE Meeting Date: Thursday, October 22, 2015 Next Meeting: Thursday, November 19, 2015

EDUCATION COMMITTEE

Meeting Date: Friday, October 9, 2015 Next Meeting: TBD 1. Connie Mattera, the Chair of the Education Committee, asked for a motion to approve the Education Committee Charter and a motion was made by committee members Nancye Davis and William Wells to approve.

2. A Trading Post Report was given by Education Committee member Stephanie Watson. Stephanie stated that she has 3 groups for this task and that each group will have both a team leader and a co-leader. She has also set up a trading post gmail email address.

Connie Mattera, Committee Chair, stated that we are to use the newsletter to reach out to members.

3. Mickey Moore, NAEMSE Board of Director/Education Committee member, reported on a Technology Web Based program for members and non members. He stated that there would be no cost to members, but non members would pay a fee; we could put packages together or make it ala carte. Also, we could give instructors CE’s for the program/s and those could be around 20-30 mins long. Some suggestions for topics included: IEP, Lesson Plans, Blueprinting, Legal Aspects and Technology.

Furthering the discussion on advancement within EMS Education technology, the committee discussed ways of making their pre-conference session at the NAEMSE Symposium more interactive and engaging. This created a lively discussion that produced a lot of great ideas. Also, the group talked about various collaborative technologies that exist online that can help produce more engagement in the physical and virtual classrooms.

COMMUNUCATIONS COMMITTEE Meeting Date: Friday, October 2, 2015 Next Meeting: TBD

As NAEMSE contiues its pursuit to drive both member and non-member engagement, the committee (led by NAEMSE Vice-President, Richard Beebe) held an in-depth discussion that saw great focus on NAEMSE’s quarterly publication and website thus leading to talks of how to maximize both resources to attract new and retain exising members.

Hoping to expand to a larger audience, NAEMSE’s publication wishes to see fresh & original content submitted by new content writers. Emails are to be sent out very soon seeking said writers for placement in future issues of Educator Update/Domain3.

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DOMAIN SPRING/SUMMER ‘15

Providing a Voice for EMS Educators

3

Official Publication of the National Association of EMS Educators

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Applying Experiential Learning Theory to Medical Simulation by: Kelly Lombardi, MS, Paramedic Colorado State University Masters in Adult Education and Training / Eagle County

Editorial Review Board William Raynovich Les R.Becker Bruce Butterfras Todd Cage Deb Cason

Lynne Dees Kim McKenna Beth Ann McNeill Mike G. Miller Kelly Wanzek

MISSION STATEMENT: To inspire and promote excellence in EMS education and lifelong learning within the global community.

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Educator Update | www.naemse.org

DOMAIN3

To inspire and promote excellence in EMS education and lifelong learning within the global community

Applying Experiential Learning Theory to Medical Simulation By: Kelly Lombardi, MS, Paramedic Colorado State University Masters in Adult Education and Training / Eagle County Paramedic Services Abstract A review of literature on simulation training in healthcare identified feedback, primarily in the form of post-simulation debriefing, is the most important feature of simulation-based education (Issenberg, McGaghie, Petrusa, Gordon, & Scalese, 2005).

However if EMS educators are going to be effective at debriefing, it is important that they understand the theoretical underpinnings that make debriefing an effective teaching method. This article will specifically discuss how experiential learning theory underlies the current techniques used in debriefing a medical simulation. This is achieved through a comparison of experiential learning stages to the currently established stages of debriefing. It also includes a more in-depth discussion of the importance of appreciating the individuality of experience and how that impacts the debriefing process.

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s the term suggests, experiential learning is simply learning from one’s experiences. Benjamin Franklin once said, “Tell me and I forget, teach me and I remember, involve me and I will learn” (University of Waterloo Centre for Teaching Excellence, 2014). In the field of emergency medical services (EMS) education, methodologies such as case studies, skill labs, and medical simulation are integral to learning because they involve providing learners with an experience. However, if EMS educators are going to employ such techniques, it is important that they understand the theoretical underpinnings that make them effective. This article will specifically discuss how experiential learning theory underlies the current techniques used in debriefing a medical simulation. These same principles of debriefing can be generalized to field training instructors following an actual call, or even by a supervisor or manager following a critical incident.

Feedback in the form of debriefing has been found to be the most important feature of simulation-based medical education (Issenberg, et al., 2005), and the perceived skill of the debriefer has the highest independent correlation to the perceived overall quality of the simulation (Wilhelm, 1991). One might ask. “How does an EMS educator conduct an effective debriefing?” The answers can be found by further investigating the tenants of experiential learning theory and comparing them to current practice.

David Kolb formalized experiential learning theory by describing how a learner progresses through four specific learning stages (Kolb, 1984). These phases are depicted in Figure 1.

Figure 1: Kolb’s Four-Stage Learning Cycle (McLeod, 2013)

In Kolb’s first phase, the learner has a concrete experience. Kolb (1984) emphasized that learning occurs when the learner encounters experiences that challenge their preconceived knowledge, beliefs, and attitudes. He explained that learning occurs when the experience challenges the learner’s expectations. If the learner’s internal frame of reference is not challenged, learning will be limited, which has direct implications for designing simulations that are appropriately challenging for the participants. While range of difficulty for learning objectives doesn’t rank as high as providing feedback, it is still considered an important variable in simulation-based medical education (Issenberg, et al., 2005).

In Kolb’s second phase, the learner makes an observation or reflects upon the experience. If the participant of a simulation fails to take the time to reflect or maybe has inadequate metacognitive abilities, their learning will again be limited.

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DOMAIN3

To inspire and promote excellence in EMS education and lifelong learning within the global community

In Kolb’s third stage of experiential learning, observations and reflections are synthesized into new conceptual understandings and interpretations (Kolb, 1984). This stage seems to be the most challenging for the participant and the educator during a debriefing. Since it is so challenging , there is a strong emphasis in the literature on this phase of learning.

Fanning & Gaba (2007) summed up the challenge that, “Not everyone is naturally capable of analyzing, making sense, and assimilating learning experiences on their own, particularly those included in highly dynamic team-based activities. The attempt to bridge the natural gap between experiencing an event and making sense of it led to the evolution of the concept of the ‘post experience analysis’ or debriefing” (p.

116). This phase of learning will be revisited when discussing more specifically how to assist participants in forming these new conceptual understandings and interpretations.

Kolb’s fourth phase of learning occurs when these new understandings and interpretations are applied to guide new and purposeful experiences (Kolb, 1984). Unless the simulation is repeated, the participants will not be able to immediately and directly achieve this phase of learning. Instead, the educator concludes the debriefing by summarizing the lessons learned which leaves the participants with a more organized plan for how they can go forth and apply their new understandings to their clinical practice.

Current practice in debriefing simulation training in healthcare very closely follows Kolb’s phases of experiential learning. For example, in their online Structured and Supported Debriefing Course, the American Heart Association advocates for following the gather, analyze, and summarize (GAS) phases of debriefing (American Heart Association, 2013). During the gather phase, the educator encourages participants to reflect upon their experience by gathering initial reactions. The educator then moves to an analysis phase where they assist the participants in reaching conclusions about their individual and group performance. The debriefing concludes with a summary of the lessons learned that the participants can then take and apply to their practice.

Another very similar approach to debriefing is using the reactions, analyze, and summary phases (Rudolph, Simo, Raemer, & Eppich, 2008).

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Like the gather phase described by the American Heart Association, the reactions phase is a time to gain insight into what the participants believed were the most important or impressionable aspects of the simulation. Kolb might call this the reflection phase of learning. It also gives the educator a chance to formulate a plan on how to incorporate some the of newly discovered participant objectives with the already-established learning objectives (Rudolph, et al., 2008).

The analyze phase closely parallels Kolb’s third phase of experiential learning – abstract conceptualization, or a phase when participants create new ideas or reach conclusions based on reflection. As mentioned previously, this seems to be the most challenging phase for both participants and educators alike. It can be very difficult to take an emotionally charged group of students with disorganized thoughts to a place of mutual respect and agreed upon conclusions. The authors of this method advocate a very specific procedure to assist educators through the analyze phase. The steps are as follows (Rudolph, et al., 2008): 1. Note salient gaps related to the predetermined objectives (these can be performance decrements or increments).

2. Provide feedback on the gap by describing what they observed in a respectful but direct manner.

3. Investigate the basis for the gap by exploring the frames (and sometime emotions) that contributed to the current performance level.

4. Help close (or when the trainees perform above expectations, help the group learn from) the performance gap by discussing principles and skills relevant to performance in the case.

These steps provide educators with a sensible guide that will assist them in navigating the often tumultuous waters of post-analysis debriefing. That which makes this approach particularly noteworthy is that the authors acknowledge the importance of considering the frames from which the participants were acting. Kolb (1984) explained that, “If the education process begins by bringing out the learner’s beliefs and theories, examining and testing them, and then integrating the new, more refined ideas into the person’s belief systems, the learning process will be facilitated” (p. 29).

DOMAIN3

To inspire and promote excellence in EMS education and lifelong learning within the global community

A challenging aspect of debriefing a medical simulation is that the educator and all the participants are operating from their own mental frames. Frames are internal filters that we use to make sense of our external reality; they are like our mental operating systems and are a product of such things as culture, knowledge, emotions, and personal experience (Rudolph, et al., 2006). For example, a paramedic’s field impression is a mental frame from which he or she will base his or her treatment plan. It is formed from the paramedic’s own interpretation of data gathered, knowledge of pathophysiology and protocols, personal attitudes, and past experiences (Dalton, 1996).

The concept of mental frames explains why, despite being given the same patient scenario, paramedics may come up with different field impressions.

If everyone in a debriefing is thinking from their own mental frames, communication can become difficult.

For example, the EMS educator knows the objectives and the actions they want to see during the simulation, but they do not have the benefit of being able to see the mental frame that led the participant to his or her actual actions. Instead, the instructor only sees the actions. Without that understanding, the educator runs the risk of imposing his or her own conclusions on the participants. This of course can leave everyone, except maybe the educator, with a sense of dissatisfaction.

How then can an educator work within the limits of his or her own frames, yet draw out the participant’s frames to better understand how to close the performance gaps? Remember that in the analyze phase of debriefing there were two steps that included the educator providing direct feedback on the performance gap based on observed actions followed by the educator’s genuine investigation into the participant’s frames that led to the performance gap (Rudolph, et al., 2008). It can be said that, “Just as Sherlock Homes used visible clues to uncover crimes, the debriefer works backward from an observed performance gap to discover what frames (assumptions, goals, knowledge base) drove the actions contributing to that gap” (Rudolph, et al., p. 1011).

The next hurdle for the educator is that, even though they may have a clear idea of how the participant’s frame led to the performance gap, they need to be able to communicate it appropriately with the student. If the educator does not, the participants will likely again be left with feelings of dissatisfaction.

Some educators may gravitate toward an authoritative style of communication where they leave little room for the participant’s point of view, and other educators may lean too far toward a non-judgmental style of communication where they fear hurting the participant’s feelings with disapproval (Rudolph, et al., 2006). This only leaves the participants confused trying to guess what the educator is thinking without any real conclusions made.

One suggestion for better communication may be that the educator takes an approach of “debriefing with good judgment” (Rudolph, et al., 2006). In this approach, the educator starts by advocating their own hypothesis of what they observed. This is followed by a genuine inquiry to learn more about the participant’s frame that led them to the observed action. For example, an educator debriefing a simulation for a respiratory case may state, “I saw that you were spending a lot of time obtaining vital signs on your patient, but no one had put them on oxygen. Tell me about how you made that decision.” The educator may find out that the performance gap they observed was due to a communication error instead of a clinical judgment error. Such observations will, of course, have an impact on the conclusions or take-home points that the educator will use to close the debriefing.

True to experiential learning theory, the next step for educators is to take this information and apply it in their practice. Then reflect on how well they were able to move participants through the stages of experiential learning using the methodologies of current practice.

They will then be able to form their own conclusions about that which does and does not work. This may be in the field of medical simulation or be generalized to other areas of experiential learning in EMS education such as field training. The authors cited in this article were publishing their own conclusions, or what Kolb might call abstract conceptualizations, about what they found to work in their experience. There is a need for more EMS educators to do the same in medical simulation or other areas of experiential education in EMS.

Reprinting Information

Interested in reprinting this article? If so, please contact Brandon Ciampaglia via e-mail at brandon.ciampaglia@ naemse.org or by phone at (412) 343-4775 ext. 29

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DOMAIN3

To inspire and promote excellence in EMS education and lifelong learning within the global community

References American Heart Association . (2013) Retrieved from http:// www.heart.org/idc/groups/ahaecc-public/@wcm/@ecc/documents/downloadable/ucm_444052.pdf.

Dalton, A. (1996). Enhancing critical thinking in paramedic continuing education. Journal of Prehospital and Disaster Medicine, 11(4) , 246-253.

Fanning, M.B., & Gaba, D.M. (2007). The role of debriefing in simulation-based learning. Society for Simulation in Healthcare, 2(2), p. 115-125.

Motola, I., Devine, L.A., Chung, H.S., Sullivan, J.E., Issenberg, S.B. (2013). Simulation in healthcare education: A best evidence practical guide. Medical Teacher. 35(10), p. 1511-1530.

Rudolph J.W., Foldy E., Robinson, T., Kendall, S., Taylor, S., Simon, R. (2013). Helping without harming: The instructor’s feedback dilemma in debriefing--A case study. Simulation in Healthcare. 8(5), p. 304-316.

Rudolph J.W., Simon R., Raemer, D.B., Eppich, W. (2008).

Debriefing as formative assessment: closing performance gaps in medical education. Academic Emergency Medicine. 15(11), 110-1116.

Issenberg, S.B., McGaghie, W.C., Petrusa, E.R., Gordon, D.L, Scalese, R.J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher. 27(1), p. 10-28.

Rudolph, J.W., Simon, R.S., Dufresne, R.L., Raemer, D.B. (2006). There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare. 1(1), 49-55. University of Waterloo Centre for Teaching Excellence. (n.d.).

Kolb D.A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall.

Retrieved from https://uwaterloo.ca/centre-for-teaching-excellence/resources/integrative-learning/experiential-learning.

McLeod, S. (2013). Kolb – Learning Styles. Retrieved from http://www.simplypsychology.org/learning-kolb.html.

Wilhelm J. (1991). Crew member and instructor evaluations of line oriented flight training. Proceedings of the 6th international symposium on aviation psychology, 362-367.

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PAYING IT FORWARD: DOUG SMITH To inspire and promote excellence in EMS education and lifelong learning within the global community

PAYING IT FORWARD: Doug Smith, Platinum Educational Group By: Doug Smith - MAT, EMT-P, IC, Medical Educator, Tom Gottschalk - EMS I/C., NREMT-P, CCEMT-P, Medical Coordinator, and Jeremy Johnson

In honor of NAEMSE’s 20th Anniversary, this ongoing series will focus on and recognize those members who have made it all possible through their committment towards and excellence in EMS education.

Then three events occurred that caused him to change course. The first was a motorcycle accident at a lake where a student of his collided with a tree. As he was a teacher, onlookers incorrectly assumed Doug would know what to do at the scene. The student had a towel on his face and Doug foolishly asking him to remove the towel. After seeing his face, and nearly passing out, Doug had the student replace the towel and then obtained an ambulance. The second event was a single roll-over accident in front of their family home involving the parent of a high school student. Doug managed through that as well.

The final event (calling) was when Doug’s son, David (Platinum Educational Groups Customer Service Manager), swallowed the pop-out of an outlet box when he was just 1½ years old. David turned blue and was unable to breath, but because of the CPR course Doug had taken, he was able to clear David’s airway and save his life. At the time, the nearest phone was many minutes away with an ambulance response much further than that. So Doug’s first save in EMS was his oldest son and the journey into EMS began as both a passion as well as a debt to repay.

While his path into the EMS profession was unique, his progression to the highest levels was very similar.

Doug obtained his EMT license in 1981, his instructor in 1982, taught and took his specialist in 1986. In 1989 Doug earned his Master’s degree in Education and Mathematics and then retired from teaching and became a regional coordinator for the State of Michigan and obtained his paramedic license in 1991.

Partnership with Tom Gottschalk/Forming Platinum Educational Group

Doug Smith’s Journey into EMS Doug’s journey into EMS was a rough one in which he entered very reluctantly. He had just moved to Paradise, Michigan, a town with a population around 300 and became the math and physical education instructor for the high school. One day, a colleague came in to the phys. Ed. class to teach CPR and convinced Doug that he should take this class as a great role model for the students. She was also the director of the volunteer ambulance service that was staffed by mostly teachers from the school. Doug took the class but failed the written true-false test, not getting one question correct! He passed all of the practical portions but did not want to work on the service.

Prior to 2002, Paramedics Tom Gottschalk and Doug Smith worked at the Medical Education and Research Center (MERC) in Grand Rapids, Michigan. The MERC vision was to help the healers to heal. When that vision changed, the duo formed Platinum Educational Group. Since then, they have grown, developed, and thrived along with the EMS Industry and specifically education. Unlike others, Platinum’s mission and vision has never wavered-- helping the educators to educate.

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PAYING IT FORWARD: DOUG SMITH Getting Personal with Doug Smith

On the Road Again—Travels with Doug

Participation with NAEMSE: How did you originally get involved?

Our sales and marketing staff, including myself, work tirelessly in the pursuit of educational greatness.

When we are not attending one of the many great EMS and Allied Health expo’s or conferences, then we are out “pounding the pavement’ providing our own educational community workshops. It is our mission to deliver valid and reliable testing, scheduling, skills tracking, and reporting solutions to every EMS, Nursing, and Allied Health programs worldwide.

And with that mission comes a lot of travel!

I attended the original NAEMSE symposium held in San Antonio and became a charter member with the encouragement of Linda Honeycutt. At the first symposium, it was great to meet with other EMS Educators from around the country. It was as if I had finally been rescued from a deserted island. The ability to share information, communicate new ideas, and network with others has been an invaluable reward of being a NAEMSE member.

Continued Participation I was Chairman of the Endorsement Committee during its tenure of NAEMSE. While being the Chair, I had the honor of working with the finest educators in EMS. I have also had the honor of teaching/presenting at several different NAEMSE symposiums over the years.

When the opportunity arose to co-sponsor the opening remarks at the 2015 NAEMSE Symposium in Nashville, we knew it was a no-brainer. The message of THE SPARTAN WARRIORS: ARE YOU ONE OF THE 300? coincides with our company’s philosophy of always striving to be the very best and applying excellence in educational standards. In the end, we must all answer one question: What are we willing to sacrifice to become great educators?

When not traveling (home life) When not focusing on Platinum Educational Group, I like to spend time with my wife, five grandchildren, and my dog. I enjoy watching movies, cooking steaks on the grill, and Big Ten football. Go Michigan State!

Know of someone who should be recognized for his or her dedication to EMS Education?

We would love to hear from you!

I have been to every symposium with the exception of one. I did not make it to the Orlando Conference (the one with the hurricane) as I was training physicians in Albania and experienced my first earthquake!

Current Status Our company started off as two dudes who hoped to help people write more valid test questions for their programs. We now employ a staff of 18 with full-time programmers, customer service representatives, marketing professionals, an accounting department, an internal and external sales staff, and educators. Our product started out as paper tests but expanded into online testing and skills tracking software products that cater to EMS, Nursing, and Allied Health administrations, educators, and students throughout the United States and beyond. It’s been a long journey, but we can proudly say we are the testing, scheduling, & skills tracking experts!

EducatorUpdate Update| |www.naemse.org www.naemse.org 1516| |Educator

Send an email to: brandon.ciampaglia@naemse.org brandon.ciampaglia@naemse.org and tell us how this educator has impacted the classroom and maintained high levels of NOTE: This individual must be a NAEMSE member.

IS FIRST AID/PUBLIC USE OF OXYGEN SAFE WITHOUT OXIMETRY?

Is First Aid/Public Use of Oxygen Safe Without Oximetry?

By: Pete Goldman, MD

Editor’s note: This guest commentary from Pete Goldman MD, a consultant for Lif-O-Gen Automated First Aid Oxygen and an ED physician who’s been an innovator in public involvement in emergency care delivery for decades, presents an interesting dialogue on the public’s use of oxygen for people with respiratoryc ompromise and in need of emergency care, often in tandem with AEDs. NAEMSE is re-printing this opinion piece because many EMS agencies are now implementing training programs for school teachers, school security police and the public for use of tourniquets, Epi pens and other treatment modalities in addition to AEDs, and we felt EMS agencies should be aware of this position on the use and impact of oxygen even though the American Heart Association guidelines call for EMS use of oxygen by titration to pulse oximetry readings.

Introduction Over the past few years there’s been much emphasis on the need for EMS to carefully titrate oxygen administration using pulse oximetry to avoid worse outcomes attributed to hyperoxia.

Indeed, the new Pennsylvania Department of Health, Bureau of EMS 2015 Statewide BLS Protocols now requires all BLS ambulance and squad vehicles to “carry pulse oximetry for use by the agency’s EMTs.”1 Other states also require the titration of oxygen based upon American Heart Association recommendation.

Since EMS personnel are often called upon by members of the community for safety recommendations, it’s important they know the difference between their “EMS/fire/police unit oxygen” and “public/first aid oxygen” usage.

The intent of this position paper by a public oxygen unit manufacturer is to present some facts that show that there’s probably no harm or limited risk in the public use of medium concentration oxygen on patients who are suffering from a medical emergency.

Why the Concern?

The American Heart Association has recommended that first responders and EMS crews titrate oxygen based upon pulse oximetry readings in order to keep the patient in the 95–99% range.

Since this recommendation, the concern in the EMS community has been whether the public is potentially doing harm by administering oxygen to patients suffering from a medical emergency, particularly those who are experiencing respiratory compromise or respiratory or cardiac arrest.

In addition, the AVOID study—the most recent in a line of studies to support the “too much oxygen” concern—showed patients with evolving myocardial infarction who received supplemental oxygen had worse outcomes than those who were otherwise normoxic (SpO2 > 94%) without it.2 The author of the AVOID study commented that “as little as 15 minutes of oxygen can cause hyperoxia” leading to negative consequences. But hypoxia for 15 minutes can have negative consequences too, as emphasized in most EMS protocols.

It’s important to note that the AVOID study used a flow rate of 8 liters per minute (Lpm) provided by non-rebreather mask—a relatively high concentration of oxygen. The added damage (increase in infarct size) was therefore assumed to be caused by oxygen free radicals in the plasma at arterial oxygen partial pressures (PaO2) over 300 mmHg, the threshold of plasma hyperoxia, as defined.3 Also in terms of partial pressures, plasma normoxia is defined from 60 to 300 mmHg PaO2, and hypoxia below 60 mmHg.3 These are arterial blood gas derived numbers done in the hospital, and not normally used by EMS. For patients with a pulse, by limiting the SpO2 with pulse oximetry guided titration to no higher than 95–99%, EMS avoids causing plasma PaO2s in excess of 300 mmHg. This therefore avoids hyperoxia.

So, what about first aid oxygen units that are used by lay responders who don’t have access to pulse oximetry?

Estimated PaO2 Calculation of First Aid Oxygen Units FDA-approved first aid oxygen units marketed for the general lay public in the United States are required to have a minimum flow rate of 6 Lpm and a minimum endurance capacity of 15 minutes.4 Lay responders are required to be trained in “oxygen deficiency and resuscitation.”5 All stock units sold to the lay public use a pocket mask or close variant, or a simple rebreather mask as the delivery device, and most have continuous flow rates from 6–7 Lpm, with one manufacturer offering an optional 12 Lpm. A pocket mask, when used for a breathing patient, is effectively equivalent to a medium concentration simple rebreather mask that, for quiet breathing patients with flow rates of 5–10 Lpm, presents oxygen concentrations of approximately 35–70%, respectively.

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IS FIRST AID/PUBLIC USE OF OXYGEN SAFE WITHOUT OXIMETRY? PaO2 Likely Lower Than Calculation Estimate There are also several other points that EMS and first responder agencies should consider about the oxygen being delivered by oxygen units deployed by the general public:

•

Therefore, with a good seal, quiet breathing of oxygen in a healthy individual would provide the highest concentration per given flow rate to calculate PaO2.

Conclusion

•

Hyperventilation (tachypnea and/or hyperpnea) also lowers the oxygen concentration in the mask because the oxygen source is a continuous flow. In terms of oxygen concentration, this creates an underestimate of actual oxygen delivered over time.

•

Rescue breathing provides a lowering of oxygen concentration in the mask due to the approximately 5% lower oxygen concentration of the provider’s breath (16% compared to ambient 21% oxygen) that mixes with the source oxygen inside the mask. And, the underlying condition requiring rescue breathing likely further reduces any resultant PaO2. The above estimated numbers are based on a healthy individual with no leakage around the mask rim, which would also reduce concentration.

This information is presented to you in the event that industries or members of the general public approach your agency to ask for advice or your opinion about the deployment and use of citizen oxygen units.

Unhealthy individuals, particularly those with pulmonary deficit, and those with decreased perfusion, would necessarily have lower PaO2s with the same concentrations. In addition, the mask seal in lay first aid response is often imperfect.

*Originally printed on Fri, Aug 21, 2015 through the Journal of Emergency Medical Services (JEMS) - http://www. jems.com/articles/2015/08/is-first-aid-publicuse-of-oxygen-safe-without-oximetry.html

•

The point of this position paper is that it’s unlikely that FDA-approved stock first aid oxygen units, with flow rates of 6–7 Lpm, produce hyperoxia, as defined, and are probably safe to use without pulse oximetry.

As with other areas that impact EMS, your department administration and medical director should be consulted before advising the public about the use of oxygen in advance of the arrival of EMS, fire or police professionals.

References

About the Author:

1. Pennsylvania Department of Health, Bureau of EMS. (July 1, 2015.) Statewide Basic Life Support Protocols, section 202.

Retrieved Aug. 21, 2015, from www.pehsc.org/wp-content/ uploads/2014/05/Statewide_BLS_Protocols_Final_020915. pdf.

2. Jeffrey S. (Nov. 21, 2014.) AVOID oxygen? Evidence of harm in MI. Medscape. Retrieved Aug. 21, 2015, from www.medscape.com/viewarticle/835297.

3. Kochanek PM, Bayir H. Titrating oxygen during and after cardiopulmonary resuscitation. JAMA. 2010;303(21):2190–2191.

4. Food and Drug Administration. FDA Compliance Policy Guide 7124.10. Chapter 24: Devices, oxygen equipment, emergency and OTC use. FDA: Silver Spring, Md., 1987.

5. Food and Drug Administration. Human Drug CGMP Notes.

FDA: Silver Spring, Md., 1996.

6. Safar P. Pocket mask for emergency artificial ventilation and oxygen inhalation. Crit Care Med. 1974;2(5):273–276.

7. White K: Oxygenation. In Fast facts for critical care. Kathy White Learning Systems: Mobile, Ala., p. Resp 3, 1996.

Pete Goldman, MD, is a consultant to Allied Healthcare Products Inc.’s Lif-O-Gen First Aid Oxygen division, a manufacturer of public use oxygen systems. He’s a former director of emergency services at Malcolm Grow U.S. Air Force (USAF) Medical Center at Andrews Air Force Base and was the first medical director of the American Safety & Health Institute. He held staff privileges at Lehigh Valley Hospital in Allentown, Pa., for 24 years in ED and inpatient care. He served as a lieutenant colonel in the USAF Reserves and is a former USAF and Air National Guard flight surgeon in the 334th and 121st Tactical Fighter Squadrons,

Author breathing from pictured Lif-O-Gen Automated First Aid Oxygen unit, no leaks around mask. Arterial blood gases (PaO2) drawn at end of 5 minutes of quiet breathing, unit still running. PaO2 was 222.0 mmHg, well below the 300 mmHg threshold of hyperoxia.

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IS FIRST AID/PUBLIC USE OF OXYGEN SAFE WITHOUT OXIMETRY? Supporting Data Study Notes: Dr. Goldman, 6/22/15

Test Equipment Timemeter Calibration Analyzer Model # RT 200: I measured the flow output of the Lif-­O-­Gen Automated first aid oxygen unit at 6.8 LPM. Maxtec Oxygen Analyzer Model # OM-­25AE: Calibrated with a new Oxygen Cell, I measured the oxygen % under the mask to be in the range of 35-45%.

Our Test results: At 6.8 LPM the oxygen concentration while running, w/ mask well secured on subject’s face, was measured at a range of 35-­45% under the mask, varying with respiratory cycle.

Wally Smith Lehigh Valley Health Network Respiratory Department Technical Service Manager 1200 S. Cedar Crest Blvd Allentown, Pa 18103

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CoAEMSP - OUTCOMES THRESHOLD REPORT SUMMARY 2014

Outcomes Threshold Report Summary 2014 By: Patricia L. Tritt, RN, MA

The CoAEMSP Quality Improvement Committee recently reviewed the analysis of the outcomes data from the 2014 CAAAHEP/CoAEMSP Annual Reports. As a review, the following minimum thresholds are identified:

OUTCOME

Threshold

Written National or State Credentialing Examinations

70%

Programmatic Retention

70%

Job (Positive) Placement

70%

In the past, the outcomes data were reviewed, but actions were not required by programs when a threshold was not met. However, beginning with the 2012 annual reports, covering the 2009 - 2011 graduate reporting period, programs that did not meet the threshold for Written National or State Credentialing Examinations were required to submit a detailed analysis and action plan in a Standardized Progress Report (SPR) format. Outcomes data are analyzed based on a three-year rolling average.

Since Annual Reports are due in December each year and some programs do not have complete data for that previous 12 months, the 3-year “review window” always omits the calendar year of the report submission.

The 2013 annual reports (review window of the 2010 2012 graduates) added an analysis of Programmatic Retention, and programs were required to submit a detailed analysis and action plan if this outcome was below 70%. The 2014 annual reports (review window of the 2011 - 2013 graduates) added the third threshold of Job or Positive Placement.

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The process of review, analysis, and standardized reporting continues to evolve. Now, instead of waiting for a letter from the CoAEMSP requesting the appropriate SPR(s), those tools (a separate one for each outcome) are available on the CoAEMSP website in a SurveyMonkey® format and programs are instructed to complete and submit at the time of submission of the Annual Report. Those SPR(s) are then reviewed by the CoAEMSP Quality Improvement Committee and programs are provided feedback: the report is accepted as satisfactory analysis and action plan, or the program is asked to resubmit providing additional information as to how that program intends to improve that outcome.

Further streamlining is being evaluated to incorporate the responses into future Annual Reports.

Results for the 2014 Annual Reports are as follows: A total of 91 programs were required to submit one or more SPRs for falling below the three-year average on the threshold of one or more outcomes (21% of all reporting programs). Seventy-nine programs were required to submit an SPR for 1 outcome, 11 for two outcomes, and 1 for three outcomes.

Written National or State Credentialing Examinations Outcome: •

430 programs submitted Annual Reports

•

10 fell below the 70% passing threshold (2% of reporting programs)

•

100% of the Standardized Progress Reports were accepted by the Quality Improvement Committee as delineating an adequate analysis of the reasons for poor passing scores and providing a satisfactory action plan

•

0 programs received letters identifying the need for further analysis and implementation of corrective actions

CoAEMSP - OUTCOMES THRESHOLD REPORT SUMMARY 2014 Programmatic Retention Outcome: •

430 programs submitted Annual Reports

•

72 fell below the 70% retention threshold (17% of reporting programs)

•

Retention appears to be the current most challenging outcome and some suggestions can be found in the CoAEMSP October 2014 eNewsletter on the page: http://coaemsp.org/ publications.htm.

• Small student cohorts continue to be a challenge 70 of the Standardized Progress Reports were accepted for some programs for the written exam and by the Quality Improvement Committee as delineating retention thresholds. an adequate analysis of the reasons for poor retention scores and providing a satisfactory action plan Establishing thresholds in key areas is part of the focus on an outcomes oriented approach in education. And outcomes are very important to our • 2 programs received letters identifying the need for further analysis and implementation of corrective students. CoAEMSP works with programs to identify actions barriers to achieving thresholds and ways to address improving certifying examination results, retention, Job (Positive) Placement Outcome: and positive placement as needed. Paramedic programs are unique and face various challenges; • 430 programs submitted Annual Reports however, the collective goal is to provide a sound educational experience for the student and to graduate • 22 fell below the 70% placement threshold (5% of competent entry level providers. reporting programs) As the process for review and analysis of outcomes • 20 of the Standardized Progress Reports were continues, the dialogue between the program and accepted by the Quality Improvement Committee as the CoAEMSP will escalate if the rolling three year delineating an adequate analysis of the reasons for averages continue to be below thresholds and a range poor job placement and providing a satisfactory action of actions may occur. Programs will be evaluated on plan a variety of factors including the actual percentage in the category, trends (improving, declining, static), • 2 programs received letters identifying the need for and other significant factors. The third consecutive further analysis and implementation of corrective year of not meeting a threshold may result in a actions citation originated by the CoAEMSP QI Committee, which will then follow the process of CoAEMSP/ Some themes or lessons from the review of the SPRs CAAHEP action, as appropriate. Potential actions included: could include: required Progress Report or a site visit. At some point of not a meeting threshold(s), a • Program Directors need a better understanding of how negative accreditation action, such as probationary to complete the Annual Report. The CoAEMSP may result. website includes an FAQ sheet and webinar on preparing the Annual Report: www.coaemsp.org/weThere is also good news for programs. Most agree binars.htm. that feedback from Graduate and Employer Surveys provides valuable information but we all know how • Programs can choose the date/method of when they hard it can be to even get the threshold 50% return take the official count of students in the Paramedic rate. CoAEMSP is strongly committed to continuing program: for example , end of add-drop, IPEDS the Graduate and Employer survey process, but the reported number, assignment of the major code by Board has decided to drop the required 50% the Registrar, or other reasonable method. The threshold for return rate. Instead, programs will be methodology chosen by the program must be accountable for the number/percent of consistent from year to year. surveys sent, which must be 100%. Programs will still report the number/percent received and • Programs in colleges should be aware of the placement report on the analysis of results. So yes, programs resources/center within their institution and access must continue to send surveys and make a good faith those services. effort to solicit returns, and analyze the results.

•

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CoAEMSP - OUTCOMES THRESHOLD REPORT SUMMARY 2014 As mentioned previously, accurate completion of the Annual Report continues to be a challenge. This reporting year only 55% of the ARs were submitted correctly the first time. However, there is a lot of assistance available. Visit the CoAEMSP Annual Report webpage at http://coaemsp.org/Annual_Reports.htm.

Review the Annual Report information: • • •

FAQ sheet Slides Webinar

You can also contact Lynn Caruthers at lynn@coaemsp. org or 214-703-8445, x115.

CAAHEP has also mandated that ALL CoA’s must require programs to report on at least one Outcome Threshold that will be viewable by prospective students as well as the public. The CoAEMSP Board of Directors has voted to require that ALL CAAHEP accredited programs will make the following results available by December 31, 2015: Written National or State Credentialing Examinations Outcome, Programmatic Retention Outcome, & Job (Positive) Placement Outcome The CoAEMSP will require that CAAHEP accredited programs provide evidence of a web link to these results with submission of the 2015 Annual Report due

by December 31, 2015. Please look for additional details to follow in the near future.

Congratulations to the many programs who met all the outcomes thresholds for this reporting year! Let us know what your program is doing well – what are your best practices – and we will share that information with other programs. ###

ROSEMONT, IL

December 3-5, 2015 Accreditation Workshop - This workshop is designed to bring the new paramedic program director and others in on the CAAHEP accreditation process including self study, site visit, and on-going issues.

Evaluating Student Competency Workshop - This 2-day workshop is designed to assist instructors in appropriately evaluating students in all domains as well as complying with CAAHEP accreditation Standards related to student evaluation.

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