Letters to the Editor
121
affordable and effective instruction. An additional student WM conference was also hosted in 2011 and 2012 in the mid-Atlantic region using a similar model. The conference remains affordable as all of the instructors are volunteers and are not financially compensated for their participation. The conference allows new educators, such as residents, an opportunity to teach and become more involved with WM. Student travel costs are minimized as the conference is designed as a regional event and typically moves within the region annually. Student organizers also are able to gather local sponsorships, which offset associated conference costs. Meals and t-shirt options are carefully reviewed to ensure the costs remain low. Before and after conference surveys were administered at the Fifth Annual Southeastern Conference to evaluate students’ perceived comfort levels with general WM subjects. The categories included identifying snakes, treating snake envenomations, treating mammal bites, treating heat stroke, treating hypothermia, treating frostbite, treating lightning victims, taking lightning precautions, treating common dislocations, building litters and transporting patients, performing a trauma assessment, maintaining C-spine precautions, recognizing possible myocardial infarctions, treating anaphylaxis, and hypoglycemia management. There was a statistically significant difference between the before and after conference survey comfort levels in all categories. It was concluded that attendees had a significant improvement in their perceived comfort levels, which is a marker of the conference’s success. Each year the student attendance at the conference has steadily increased. Registration has increased from 120 students in the first year to 232 students in the fifth year, which is yet another marker of success. Although this regional conference model has been successful in the southeast, there remains great opportunity to replicate this model in other regions. We hope this conference will serve as a model to other organizations throughout the nation for providing affordable and effective WM training for students. The keys to this model’s efficacy are the low cost and regional locations, which allow medical students easy and affordable access. By increasing access to WM training, we can build a safer and more rewarding community among outdoor enthusiasts. Stephanie A. Lareau, MD Carilion Clinic Dept of Emergency Medicine Roanoke, VA Georgia Regents University Dept of Emergency Medicine Augusta, GA
Patrick E. Robinson, BS Sean S. Wentworth, BS Henderson D. McGinnis, MD Wake Forest Baptist Health Dept of Emergency Medicine Winston-Salem, NC
References 1. Lischke V, Byhahn P, Westphaul K, Kessler P. Mountaineering accidents in the European Alps: have the numbers increased in recent years? Wilderness Environ Med. 2001;12:74–80. 2. Simon RB. Making a case for wilderness medicine. Nursing. 2012;42:32–35. 3. Lemery J, Sacco D, Kulkarni A, Francis L. Wilderness medicine within global health: a strategy for less risk and more reward. Wilderness Environ Med. 2012;23:84–88. 4. Fielding CM. Introducing medical students to wilderness medicine. Wilderness Environ Med. 2011;22:91–93. 5. Hawkins SC, McGinnis H, Visser P. Organizing wilderness medicine on a regional scale. Wilderness Environ Med. 2008;19:305–309.
Comparing Student Outcomes of Hybrid and Conventional Wilderness Emergency Medical Technician Programs To the Editor: International, remote, and wilderness travel has significantly increased over the past few decades. The ability of the sojourner to care for oneself and cohorts while traveling is a primary concern. The most common cause of mortality, while traveling, is attributable to motor vehicle accidents.1 Other health conditions that frequently afflict the traveler include upper respiratory infections and gastrointestinal infections.2 Although pretravel education and training is indicated for remote and wilderness excursions, many travelers are unable devote 30 days to attend a full face-to-face Wilderness Emergency Medical Technician (WEMT) course owing to financial and time constraints. The focus of this study was to explore the impact and assess outcomes of combining a blended online precourse component (hybridization) to the conventional WEMT 30-day conventional face-to-face program to shorten the onsite portion of the course and, therefore, decrease costs and increase availability. The study assessed outcomes of hybridized or blended learning and conventional WEMT students based on satisfaction levels after course completion and National Registry of Emergency Medical Technician’s (NREMT) certification. Furthermore, satisfaction levels were
122 assessed by online survey to determine the participant’s perception of ability to adequately care for others while traveling. This was believed to be the first study solely focused on the implementation of blended or hybridized learning as related to the WEMT curriculum. Approval was obtained before implementation of the study by the institutional review board at the researcher’s university. It was deemed that the study was exempt from institutional review board review under US Department of Health and Human Services regulations at 45 CFR 46.101 (b)(2). Data were collected and analyzed for relevance and significance using SAS software (SAS Inc, Cary, NC) and Fisher’s exact test (the FREQ procedure in SAS; version 9.3). Differences between groups were deemed to be statistically significant if the probability value was less than .05. A retrospective quantitative analysis was conducted with 65 course participants who completed either a hybrid or conventional face-to-face WEMT or an advanced WEMT course. A purposive sample was obtained from both groups. An online survey of 25 questions was used for data collection related to postcourse satisfaction, perceived knowledge, and NREMT certification pass rates. A total of 26 respondents completed the survey (response rate of 40%). The only statistically significant result was related to the hybrid format being more flexible (Figure; P ¼ .03). The hybrid format may also be associated with convenience and increased NREMT pass rates; however, further research is needed. All of the respondents stated they were satisfied with their WEMT course. Interestingly, although 69.2% of respondents passed their NREMT certification examination, 26.9% never attempted the certification examination. The most significant limitation to this study was the sample size. Numerous attempts were made to encourage participants who completed a WEMT course, either hybrid or conventional, between January 1, 2011, and
Letters to the Editor December 31, 2012, to complete the online survey. The initial survey was sent to the participants on January 1, 2013, with reminder e-mails sent on January 14, 2013, and January 21, 2013. There were a total of 65 participants available for query of which 26 participants responded, with 1 declining to participate for unknown reasons. Threats to internal validity included limited number of course participants and a relatively homogeneous study population, as well as a survey instrument that was not validated. Threats to external validity included the inability to generalize this study to a larger population and that the principal investigator works at the vendor for the 12-day hybrid WEMT and advanced WEMT programs. Overall, the results revealed similar outcomes between hybrid or blended learning WEMT courses and conventional face-to-face WEMT courses. Wilderness EMT programs, which have traditionally been taught for 30 days, can be taught effectively over a shortened duration in a hybrid or blended learning format with the same, if not better, satisfaction levels, perceived knowledge levels, and NREMT pass rates. This shortened on-site course format may be more appealing to the increasing number of international travelers to remote areas. Both conventional and hybrid participants reported that they were taught effectively and prepared to respond to emergencies abroad. When course participants were queried on whether they felt confident that they could assess, diagnose, and treat the most common medical emergencies while abroad, to include cardiovascular, upper respiratory, gastrointestinal, and traumatic injuries, both groups stated that they felt prepared. Also, both groups described the content and curriculum as being clearly defined with requirements outlined in a manner that was understandable. Joshua D. Martin, DNP, WEMT-P Sound Physicians & Northern Cairn LLC Petoskey, MI
References 1. Jong EC, Sanford CA. The Travel and Tropical Medicine Manual. 4th ed Philadelphia, PA: Saunders; 2009. 2. Brunette GW, ed. CDC Health Information for International Travel 2012: The Yellow Book New York, NY: Oxford University Press; 2011.
Hornet Stings Presenting to a Primary Care Hospital in Anuradhapura District, Sri Lanka
Figure. Flexibility of the hybrid Wilderness Emergency Medical Technician course (P ¼ .03).
To the Editor: Hymenopterid stings and consequent allergic reactions are common indications for emergency medical
121
affordable and effective instruction. An additional student WM conference was also hosted in 2011 and 2012 in the mid-Atlantic region using a similar model. The conference remains affordable as all of the instructors are volunteers and are not financially compensated for their participation. The conference allows new educators, such as residents, an opportunity to teach and become more involved with WM. Student travel costs are minimized as the conference is designed as a regional event and typically moves within the region annually. Student organizers also are able to gather local sponsorships, which offset associated conference costs. Meals and t-shirt options are carefully reviewed to ensure the costs remain low. Before and after conference surveys were administered at the Fifth Annual Southeastern Conference to evaluate students’ perceived comfort levels with general WM subjects. The categories included identifying snakes, treating snake envenomations, treating mammal bites, treating heat stroke, treating hypothermia, treating frostbite, treating lightning victims, taking lightning precautions, treating common dislocations, building litters and transporting patients, performing a trauma assessment, maintaining C-spine precautions, recognizing possible myocardial infarctions, treating anaphylaxis, and hypoglycemia management. There was a statistically significant difference between the before and after conference survey comfort levels in all categories. It was concluded that attendees had a significant improvement in their perceived comfort levels, which is a marker of the conference’s success. Each year the student attendance at the conference has steadily increased. Registration has increased from 120 students in the first year to 232 students in the fifth year, which is yet another marker of success. Although this regional conference model has been successful in the southeast, there remains great opportunity to replicate this model in other regions. We hope this conference will serve as a model to other organizations throughout the nation for providing affordable and effective WM training for students. The keys to this model’s efficacy are the low cost and regional locations, which allow medical students easy and affordable access. By increasing access to WM training, we can build a safer and more rewarding community among outdoor enthusiasts. Stephanie A. Lareau, MD Carilion Clinic Dept of Emergency Medicine Roanoke, VA Georgia Regents University Dept of Emergency Medicine Augusta, GA
Patrick E. Robinson, BS Sean S. Wentworth, BS Henderson D. McGinnis, MD Wake Forest Baptist Health Dept of Emergency Medicine Winston-Salem, NC
References 1. Lischke V, Byhahn P, Westphaul K, Kessler P. Mountaineering accidents in the European Alps: have the numbers increased in recent years? Wilderness Environ Med. 2001;12:74–80. 2. Simon RB. Making a case for wilderness medicine. Nursing. 2012;42:32–35. 3. Lemery J, Sacco D, Kulkarni A, Francis L. Wilderness medicine within global health: a strategy for less risk and more reward. Wilderness Environ Med. 2012;23:84–88. 4. Fielding CM. Introducing medical students to wilderness medicine. Wilderness Environ Med. 2011;22:91–93. 5. Hawkins SC, McGinnis H, Visser P. Organizing wilderness medicine on a regional scale. Wilderness Environ Med. 2008;19:305–309.
Comparing Student Outcomes of Hybrid and Conventional Wilderness Emergency Medical Technician Programs To the Editor: International, remote, and wilderness travel has significantly increased over the past few decades. The ability of the sojourner to care for oneself and cohorts while traveling is a primary concern. The most common cause of mortality, while traveling, is attributable to motor vehicle accidents.1 Other health conditions that frequently afflict the traveler include upper respiratory infections and gastrointestinal infections.2 Although pretravel education and training is indicated for remote and wilderness excursions, many travelers are unable devote 30 days to attend a full face-to-face Wilderness Emergency Medical Technician (WEMT) course owing to financial and time constraints. The focus of this study was to explore the impact and assess outcomes of combining a blended online precourse component (hybridization) to the conventional WEMT 30-day conventional face-to-face program to shorten the onsite portion of the course and, therefore, decrease costs and increase availability. The study assessed outcomes of hybridized or blended learning and conventional WEMT students based on satisfaction levels after course completion and National Registry of Emergency Medical Technician’s (NREMT) certification. Furthermore, satisfaction levels were
122 assessed by online survey to determine the participant’s perception of ability to adequately care for others while traveling. This was believed to be the first study solely focused on the implementation of blended or hybridized learning as related to the WEMT curriculum. Approval was obtained before implementation of the study by the institutional review board at the researcher’s university. It was deemed that the study was exempt from institutional review board review under US Department of Health and Human Services regulations at 45 CFR 46.101 (b)(2). Data were collected and analyzed for relevance and significance using SAS software (SAS Inc, Cary, NC) and Fisher’s exact test (the FREQ procedure in SAS; version 9.3). Differences between groups were deemed to be statistically significant if the probability value was less than .05. A retrospective quantitative analysis was conducted with 65 course participants who completed either a hybrid or conventional face-to-face WEMT or an advanced WEMT course. A purposive sample was obtained from both groups. An online survey of 25 questions was used for data collection related to postcourse satisfaction, perceived knowledge, and NREMT certification pass rates. A total of 26 respondents completed the survey (response rate of 40%). The only statistically significant result was related to the hybrid format being more flexible (Figure; P ¼ .03). The hybrid format may also be associated with convenience and increased NREMT pass rates; however, further research is needed. All of the respondents stated they were satisfied with their WEMT course. Interestingly, although 69.2% of respondents passed their NREMT certification examination, 26.9% never attempted the certification examination. The most significant limitation to this study was the sample size. Numerous attempts were made to encourage participants who completed a WEMT course, either hybrid or conventional, between January 1, 2011, and
Letters to the Editor December 31, 2012, to complete the online survey. The initial survey was sent to the participants on January 1, 2013, with reminder e-mails sent on January 14, 2013, and January 21, 2013. There were a total of 65 participants available for query of which 26 participants responded, with 1 declining to participate for unknown reasons. Threats to internal validity included limited number of course participants and a relatively homogeneous study population, as well as a survey instrument that was not validated. Threats to external validity included the inability to generalize this study to a larger population and that the principal investigator works at the vendor for the 12-day hybrid WEMT and advanced WEMT programs. Overall, the results revealed similar outcomes between hybrid or blended learning WEMT courses and conventional face-to-face WEMT courses. Wilderness EMT programs, which have traditionally been taught for 30 days, can be taught effectively over a shortened duration in a hybrid or blended learning format with the same, if not better, satisfaction levels, perceived knowledge levels, and NREMT pass rates. This shortened on-site course format may be more appealing to the increasing number of international travelers to remote areas. Both conventional and hybrid participants reported that they were taught effectively and prepared to respond to emergencies abroad. When course participants were queried on whether they felt confident that they could assess, diagnose, and treat the most common medical emergencies while abroad, to include cardiovascular, upper respiratory, gastrointestinal, and traumatic injuries, both groups stated that they felt prepared. Also, both groups described the content and curriculum as being clearly defined with requirements outlined in a manner that was understandable. Joshua D. Martin, DNP, WEMT-P Sound Physicians & Northern Cairn LLC Petoskey, MI
References 1. Jong EC, Sanford CA. The Travel and Tropical Medicine Manual. 4th ed Philadelphia, PA: Saunders; 2009. 2. Brunette GW, ed. CDC Health Information for International Travel 2012: The Yellow Book New York, NY: Oxford University Press; 2011.
Hornet Stings Presenting to a Primary Care Hospital in Anuradhapura District, Sri Lanka
Figure. Flexibility of the hybrid Wilderness Emergency Medical Technician course (P ¼ .03).
To the Editor: Hymenopterid stings and consequent allergic reactions are common indications for emergency medical
