Preface. David M. LaCombe, EMT-P President Florida Association of Emergency Medical Services Educators

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1 Preface This Summit on EMS Education and Training marks an unprecedented assembly of over 60 professionals representing undoubtedly all domains of human resource development in Emergency Medical Services. The information contained in these proceedings is the result of the combined efforts and knowledge of all summit participants. The primary purpose of this summit was to allow stakeholders and interested parties to voice their opinions and concerns on a myriad of issues. The facilitated discussions enabled free exchange of information. The discussion of some issues resulted in reaching consensus while other discussions ended in many differences of opinions. In each case, participants felt that the open discussion of these issues was healthy. A valuable byproduct of this meeting was the opportunity for networking. The information learned from this summit will assist the Florida Association of EMS Educators (FAEMSE) in developing specific objectives for our broad goals (see page ii). These proceedings should be viewed as a summary of over 60 opinions and not as a consensus document. Future meetings will be called to reach accord on some of the issues discovered during this summit. A little over one year ago, with the invaluable assistance of Jaime Greene, John Todaro, Dick Clinchy, Nabil El Sanadi, Marcie Fisher, and myself, FAEMSE was formed. Our goal was, and remains today, to foster an environment of free communication amongst Florida s EMS Education and training communities. The journey has been well worth the effort. This summit is a testimonial of our constituent s desire to belong and contribute to an organization of its peers. Together, we will join in the ceaseless pursuit of excellence in EMS education. We are indebted to the group of dedicated professionals who gave their time and energy to discuss their experiences and opinions that represent the current day and future of Florida s EMS educational resources. David M. LaCombe, EMT-P President Florida Association of Emergency Medical Services Educators i

2 About FAEMSE The Florida Association of Emergency Medical Services Educators (FAEMSE) was founded on the principle that our organization needs to serve the broad interests of everyone involved in teaching EMS. Our members include primary educators, continuing education instructors, training officers and preceptors, administrators, and researchers. Mission FAEMSE s mission is to provide resources to individuals and organizations that will foster excellence in EMS education and training. Vision The vision of FAEMSE is to be the foremost resource within Florida s EMS educational community. Goals Leadership. FAEMSE will develop and support standards of excellence improving learning and workplace performance. Information. FAEMSE will be the leading source of information on EMS education and training. Our organization will promote the worldwide exchange of information. Research. FAEMSE will support the development, investigation, evaluation, and publication of innovative and effective educational methods. Networking and Partnerships. FAEMSE will promote professional networking and form partnerships with individuals and organizations resulting in improved learning and workplace performance. Development. FAEMSE will create opportunities for continual learning and professional development for itself as an organization, its members and all individuals involved in EMS education and training throughout the State of Florida. ii

3 Attendees Christine Argo St. Augustine Technical Center William Azzinaro Miami Beach Fire Rescue Ellen Bedu Miami Children s Hospital Marjorie Bowers Indian River Community College Pam Bromley Seminole Community College Cliff Chapman Alachua county Fire Rescue Steve Collins Palm Beach County Fire Rescue Judy Conlin Florida Department of Education Bill Corso Hillsborough Community College Stephen Cramer Valencia Community College Antonia Crimi Nova Southeastern University Dave Crum Century Ambulance Thomas Dibernardo Sunrise Fire Rescue Kim Dickerson Edison Community College Darrel Donato Riviera Beach Fire Rescue Steven Eggnatz Oakland Park Fire Rescue Alan Espinosa Lake City Community College Eric Feld Delray Ocean Rescue Marcie Fisher Florida Community College George Fox Jacksonville Fire Rescue David French St. Lucie County Fire Rescue Vicki Garlock Pensacola Junior College Ralph Goven Broward Community College Fred Greene Tampa Fire Rescue Jaime Greene Palm Beach County Schools William Gulbrandson Boynton Beach Fire Rescue Joel Harris Broward Community College Rick Hatton St. Augustine Technical Center Michael Hohl Pembroke Pines Fire Rescue Rob Holborn Seminole Community College Donald James Miami Dade Fire Rescue Elizabeth Jordan Broward Community College iii

4 Gordy Kokx Central Florida Community College Brett Lea Boca Raton Fire Rescue Nicil Locicero Tampa Fire Rescue Mike McMurrer Central Florida Community College Lisa Moore Coastal Health Fred Neff Air Ambulance Debra Nielsen Able Aviation Kevin Nugent Nova Southeastern University Warren Panen Edison Community College Michael Pcolar Lee County EMS Henry Preston Orange County Fire Rescue Clinton Randolph Liberty Ambulance Laurie Romig, MD St. Petersburg Junior College Donald Rosenberg, MD Miami Dade Fire Rescue Thomas Sheridan Office of Medical Director Dr. Lee Sharon Snyder Broward County Fire Rescue Bob Staples James Terry Tamerac Fire Rescue Dave Tranchard Division of Community Colleges Freida Travis Florida Bureau of EMS Gerry Vandervelde Broward Community College Dino Villani Florida Bureau of EMS Toni Vineyard Pasco Hernando Community College Tom Whitley Les Williams Brevard Community College Bruce Willms Lake City Community College Michael Yoder Miami Dade Community College James Yun Coastal Care ALS Debbie Sacks University of Miami iv

5 Acknowledgments We gratefully acknowledge the contributions of the following sponsors of this summit. Without their assistance, this event would not have taken place. Florida Association of EMS Educators Research, planning, finance, and implementation Florida Department of Health Bureau of EMS Mailing services City of Pompano Beach Donation of meeting facility American College of Prehospital Medicine Continental breakfast We wish to thank the following individuals for their support and input in the production of the summit and these proceedings. Their contributions this project is very much appreciated. First, the FAEMSE Board of Directors deserves accolades for the planning and implementation of this summit: David LaCombe, President, Jaime Green, Vice-President, John Todaro, Secretary, Richard Clinchy, Ph.D., Nabil El Sanadi, MD, Marcie Fischer, and Gail Stewart. Special thanks to George Minnich of the Pompano Beach Fire-Rescue Department for arranging the donation of the meeting space at the City s Civic Center. We also thank Dino Villani, Freida Travis, and Al Herndon of the Florida Bureau of Health for their input. They supported the concept of this event from the very beginning. Sincere thanks to Debbie Sacks and Marcie Fisher who were volunteered to keep us on time and document this event. Your ability to adapt to this uninvited challenge is very much appreciated! On a final note, compiling and editing these proceedings was a tedious task. We gratefully thank our families for their patience, support, and understanding for the many weekend and evening hours spent away from them locked up in the office. Regretfully, our eagerness to publish these proceedings may have left someone unrecognized. Your name may have been overlooked but your participation and contribution is still very much appreciated. v

6 Primary Education Issues Topic RFP for EMT and paramedic exam Change current rule to allow Florida educators to develop test questions. Historically, Florida educators were not allowed to be involved in the process of writing or reviewing questions for the EMT and paramedic certification exams. The EMS Advisory Council Education Subcommittee, with input from FAEMSE, is recommending changes in its report to the Bureau of EMS. Florida educators should be involved in test development process. Should educators from each institution be required to submit questions? Should educators be compensated for their time developing questions? If each institution submitted X number of questions, no one institution, or its students, would have access to the full examination. FAEMSE to develop addendum to original position paper supporting above dialog. Topic RFP for EMT and paramedic exam Addition of 9 th category of Florida specific questions The current paramedic examination is composed of eight categories. The Advisory Council Subcommittee is proposing that a ninth category be added that contains Florida specific questions such a laws, trauma triage criteria, etc. What would be considered as a Florida specific question? Possible content includes recertification criteria, trauma triage and trauma alert criteria. Should concentrate in information that is essential and not how many 4 X 4s should be on a vehicle. Concise objectives should be developed for educators and test writers to avoid having to teach entire contents of 401 and 64E. How would out of state applicants prepare for this part of evaluation? Develop a study guide to reduce cost of having to duplicate 401. Who should develop study guide? Students in some Florida training centers are given 401 to study. Out of state applicants should have this document also. Instead of making each candidate know how many 4 x 4s are required on a vehicle they should know what document covers this issue and how to obtain that document. If 9 th category is adopted, FAEMSE will offer to publish a study guide for out of state applicants to prepare for examination. 1

7 Topic RFP for EMT and paramedic exam Switch to a non-compensatory examination scoring model Currently, the certification examination uses a compensatory model. This model permits a candidate who scores low in one domain to pass the examination by attaining higher scores in other content domains. The RFP for the new examination calls for a non-compensatory examination. In essence, candidates who score strong in one area cannot make up for weaknesses in other areas. An informational report presented on April 8, 1997 by Schroeder Measurement Technologies, Inc. reveals that the pass rate will initially fall when a non-compensatory model is utilized. What % will be selected as the minimum passing score for each category? Using data from previous exams the following hypothetical outcome could occur: - Paramedic 80% for each domain = overall pass rate 10%, from 57% - Paramedic 70% for each domain = overall pass rate 40%, from 57% - EMT 70% for each domain = overall pass rate 33%, from 89% - EMT 60% for each domain = overall pass rate 70%, from 89% Would candidates have to retake just the part of examination that they failed or the entire examination? - Passionate debate over this question. - Participates divided. Some favor retaking the entire test while others favor retake of section failed. - If candidate passes a section once they should be able to pass the section again. - Are candidates being penalized for failing one section by having to take all sections again? How will the contract holder handle students who would be required to take only one section of the examination? Why would only 10% of the candidates pass the examination? What is wrong with our educational process? Community colleges could be negatively impacted if their pass rates fall. Educators should do a better job of educating their students. Is there proof that a non-compensatory exam is more favorable? Consider having a phase in period where data would be shared with each training center to identify weakness in their teaching. FAEMSE to develop position paper supporting non-compensatory examination model. FAEMSE to send letter to state requesting more detailed reporting of examination results to training centers. FAEMSE to promote continuous quality improvement principles amongst training centers. 2

8 Topic AS degree Should an AS degree be the minimum standard for entry-level EMS providers? This issue provoked some of the more passionate discussion during the summit. Participants presented compelling arguments for and against the pursuance of the AS degree as an entry level standard. Limited data exists that either supports or rejects this issue as efficacious. Why? Show me proof that an AS degree makes you a better paramedic. All the paramedic competencies are already in the paramedic curriculum. High school is supposed to develop English and Math skills. If we want our profession to move forward and be considered true professionals we need degrees. Aren t we already considered professionals now, degree or no degree? Money follows credentials and education. If we move to an AS degree as an entry level standard there should be a phase-in time so that this standard is not just dropped on the community. If we are going to support this AS degree issue then let s support it for the right reasons. Not only should the degree increase basic competencies but consider advancement issues and self respect. We are not here to tell the community what they need but to do what the community wants. Survey them. Survey the medical directors. We can assure competency without a degree or we can t say we have competent paramedics now. Upon completing EMT and paramedic school, the candidate only needs 20 additional credit hours to be awarded the degree. Most of these courses are the same as the ones used for the Fire Science degree. Informal vote amongst 27 participants: Should we support AS degree as an entry level standard: Yes=22, No=1, Abstain=4. Why those in favor voted yes: - Education increases critical thinking skills - Move forward as a profession - Investment in learner s future. - Raise the bar for other competencies other than clinical ones. - Will serve as a screening tool to identify the most committed applicants. - Students surveyed at Broward Community College reported that the AS degree improved their communication and documentation skills. FAEMSE to review available literature to determine efficacy of AS degree as an entry-level requirement. Consideration should also be given to financial impact. FAEMSE to develop and distribute a survey to determine opinions of all stakeholders (medical directors, providers, students, educators, etc.). Survey other states as well. After analysis of all available data, FAEMSE will develop an informational paper on this issue. A position paper will likely follow. 3

9 Topic New national standard paramedic curriculum Roll-out (learning to implement new curriculum) This new program represents a significant change in the depth and breadth of paramedic education in the United States. Developed with the participation of 500 EMS educators nationwide, the new curriculum is designed to provide a more "solid" foundation for the paramedic. It will also present some challenges for EMS educators across the country. This Rollout is designed to assist program directors and faculty members in developing meaningful implementation strategies to increase the effectiveness of paramedic education. Roll-out should held more than once and in more than one location in Florida. Determine if roll-out can be professionally video taped. Roll-out should be held as early as possible to allow educators as much time as possible to digest information. Time is also a factor for schools that must submit course descriptions and course numbers to curriculum planning committees. Consider co-presentation of new curriculum by national experts and educators from Santa Fe Community College. FAEMSE to consult with Bureau of EMS to develop action plan aimed at holding Roll-out around April Critical criteria include: - Central location - Minimize cost to individuals and centers (corporate sponsorship) - Date of Roll-out must not conflict with other education related events. Topic Instructor qualifications Should EMS educators and instructors be required to attain certification? The entry-level qualifications for EMS educators are limited and those that do exist are vague. There is no standardized curriculum or experiences required in this state. Much data exists on this topic for Florida educators to benchmark from. The FAEMSE Board of Directors has discussed in strategic planning sessions about possibly developing a voluntary training and certification process for instructors and educators. Instructors should have at least the level of training and education that students are pursuing, including AS degree if applicable. Should complete coursework specific to task. Should instructors be licensed by state or FAEMSE certification? Consumers of education should have assurance that instructor has met minimum standards. FAEMSE to charge committee with task of researching implementation of voluntary training and certification of entry-level educators. - Survey stakeholders for input. - Survey other states. Determine criteria for each specialty (utilize job task analysis) including lab instructors, clinical instructors, classroom instructors, and preceptors. FAEMSE Board of Directors to make presentation to general membership before calling question for a vote to proceed with development of curriculum and certification program. 4

10 Topic Accreditation of paramedic training centers Are training centers satisfied with the current accreditation process? The Committee on Allied Health Education and Accreditation (CAHEA) grants accreditation to programs for the Emergency Medical technician- Paramedic upon the recommendation of the Joint Review Committee on Educational Programs for the EMT-P (JRCEMT-P). The JRCEMT-P essentials and guidelines are the minimum standards of quality to be used for the development, evaluation, and self-analysis of paramedic training programs. A needs assessment should be conducted before any additional programs are licensed to teach EMT or paramedic. We currently have training centers with additional centers currently in the application process. Accreditation is essential to maintain quality standards. Students and providers must be informed about advantages of attending an accredited program. Some accredited sites have had problems with JRC being arbitrary in their enforcement. Despite the problems with JRC, they remain the industry standard. Perhaps we should try to help fix whatever is wrong with their process. Get a Florida representative involved in the JRC process. Minimally, FAEMSE should conduct a poll of all the training centers to determine specifically what problems we are experiencing with JRC. Topic EMS Research What are potential projects that could ignite Florida educators to become more involved in research? The scanty nature of research, particularly in the field of EMS education, is alarming. The importance of peer reviewed, scientific research cannot be overstated. Leaders in the field suspect that the principle factor inhibiting the performance of research is that potential researchers lack knowledge and experience in this area. Experienced researchers must remain committed to the education and development of potential cohorts. FAEMSE is committed to the development, investigation, evaluation, and publication of innovative and effective educational methods. Evaluation of training programs (Levels I IV). Effectiveness of Computer Based Training. How do we best teach the skills and knowledge required to become an EMS provider? Evaluation of evaluation tools. Live intubations vs. manikin training (already published, but could be interesting to repeat study locally). Conduct training to teach basic principles of research. EMS educators should develop professional relations with experienced researchers at academic centers. 5

11 Continuing Education Issues Topic EMT & Paramedic Recertification What should the requirements be for EMTs and Paramedics to maintain their state certification? Current recertification requirements : EMT: Current BLS card, 2 hours of HIV/AIDS training and one of the following, 30 hour EMT-B refresher or successfully pass the state EMT-B exam in one attempt or 30 hours of EMT-B work-related continuing education approved by a medical director or completion of the first semester of Paramedic school. Paramedic: Current ACLS card, 2 hours HIV/AIDS training and one of the following, 30 hour Paramedic refresher or successfully pass the state Paramedic exam in one attempt or 30 hours of Paramedic work-related continuing education approved by a medical director or completion of the first semester of Paramedic school. Should recertification be continuing education or refresher education based? Expansion of the EMT & Paramedic knowledge base alone does not provide for assurance of understanding and application of the basics. Refreshing of standard curriculum leaves little to no time for new information and/or skills Development of an education process which expands the EMT & Paramedic knowledge base using the standard curriculum as its cornerstone. Building on known information and skills to expand and enhance performance. Should the recertification requirements be a set time frame (30 hours) or menu driven (specific topics inclusive of the required hours)? Avoidance of prescribed hours or topics by special interest groups. Allowance for provider specific educational needs. Medical Director approval of education based on set guidelines and utilization of agency QA/QI data. How many hours is enough? every two years? Method of recertification should allow for integration of agency quality assurance/improvement data into the education process FAEMSE in cooperation with the state office will develop a survey to be distributed to all provider levels and Medical Directors statewide. After the survey is compiled a workshop should be held to develop a consensus paper utilizing the survey data. 6

12 Topic Instructor Qualifications There are no requirements for continuing education/refresher instructors in Florida at this time. Should there be? If so what should the requirements be? Each organization providing these programs have their own idea of what qualifies an instructor. Setting minimum requirements Certification at or above the level being taught Years of experience on the job Knowledge of subject matter Ability to teach Methods and Techniques of Instruction course Presentation courses etc Understanding/utilization of Quality assurance/improvement principles. Need for a special subject matter exception to minimum requirements. Need to develop statewide instructor resources. Grandfather process for those presently employed as instructors. Should instructors be licensed/certified by the state or through FAEMSE? Development of a statewide standard continuing education/refresher instructor process. FAEMSE to charge committee with task of researching implementation of voluntary training and certification of continuing education/refresher instructors. FAEMSE Board of Directors to make presentation to general membership before calling question for a vote to proceed with development of continuing education/refresher instructor curriculum and certification program Topic Education Quality Assurance/Improvement Utilization of the QA/QI process in continuing education/refresher training. At the present time utilization of the QA/QI process in continuing education/refresher training is not uniformly used throughout the state. Competency based skills education and assessment Utilization of agency/system outcome and sentinel event data for continuing education/refresher program development. Integration of field and hospital QA/QI data into continuing education/refresher program development. State-wide QA/QI education program NREMT s current research project on QA/QI in EMS Develop and implement a state-wide QA/QI education program Support the development and implementation of competency based skills testing process for continuing education/refresher training 7

13 Topic Technology and Resources How technology and other available resources could be utilized to expand and improve continuing education/refresher training? At the present time there are no standard processes to help agencies or schools to utilize available or develop new technology and resources for continuing education/refresher instruction. High tech resources Cable TV Web education Computer-based training (CBT) CD-ROM technology Satellite systems Regionalized mobile training system Patient simulators Skills labs Funding possibilities EMS grant monies Low-tech resources Case studies live and multimedia Grand rounds live and multimedia Utilization of games Develop directory of resources available State EMS Clearing house Distance Education System- state community colleges FAEMSE NAEMSE Research funding sources for regional mobile training system EMS grants Workforce development monies Joint ventures and partnerships Topic Volunteer continuing education/refresher funding How to fund continuing education/refresher training for volunteers There is presently no means of funding continuing education/refresher training for volunteer services and personnel. EMS grants program Workforce development monies Provider/volunteer cooperative programs Create a state-wide taskforce to research this issue and bring recommendations to the State Office and FAEMSE 8