CONCEPTS, COMPONENTS AND CONFIGURATIONS
Emergency Medical Technician (EMT-A) Instruction of Medical Students Robert R. Harrison, BA, REMT* Kimball I. Maull, MD, FACSt C. Paul Boyan, MD*
In 1977 the Department of Anesthesiology of the Medical College of Virginia coordinated a compulsory 72-hour course for first-year medical students fulfilling all requirements of the Department of Transportation and leading to eligibility for certification of the medical student as an Emergency Medical Technician (EMT-A). We describe the methodology and content of this course, as well as problems encountered and lessons learned. This sound foundation in emergency care concepts will enable the medical student to develop greater competence in critical skills during the clinical years. Harrison RR, Maull KI, Boyan CP: Emergency medical technician (EMT-A) instruction of medical students, JACEP 8:513-514, December 1979.
education, graduate; training, emergency medical technician, medical students
I NTRODUCTIO N The teaching of emergency care in A m e r i c a n medical schools is i n a d e q u a t e at the present time. In 1976 a survey by the Association of A m e r i c a n Medical Colleges disclosed that i n s t r u c t i o n in emergency care of a n y kind was required by less t h a n 10% of medical schools. 1 Although 80% of medical schools offered some form of elective emergency care experience, most were i n a d e q u a t e to provide the student with the expertise to function i n d e p e n d e n t l y in a situation req u i r i n g basic life support. As a result of the great increase in the sophistication a n d effectiveness of paramedical prehospital care, it has become a p p a r e n t t h a t medical schools are producing physicians who are not capable of properly handling an emergency situation outside the hospital. 2 This deficiency, although recognized, has not led to appropriate changes in the medical school curriculum. I n 1976 the U n d e r g r a d u a t e Education Committee of the A m e r i c a n College of Emergency Physicians, in conjunction with the Medical Education Committee of the U n i v e r s i t y Association for Emergency Medicine, recommended t h a t medical schools require 60 to 80 hours of didactic and practical i n s t r u c t i o n d u r i n g the f r e s h m a n year leading to state certification as an Emergency Medical Technician (EMT-A). z In 1977, the D e p a r t m e n t of Anesthesiology of the Medical College of V i r g i n i a coordinated a n i n n o v a t i v e 72-hour course exceeding those standards. This report will describe the methodology and content of this course, as well as the problems encountered and lessons learned. . From the Departments of Anesthesiology* and Surgery,t Medical College of Virginia, Richmond, Virginia. Presented at the University Association for Emergency Medicine Annual Meeting in Orlando, Florida, May 1979. Address for reprints: Kimball I. Maull, MD, Medical College of Virginia Station, Box 893, Richmond, Virginia 23298. 8:1 2 (December) 1979
JACEP
513/25
CURRICULUM Course m a t e r i a l was based on the s t a n d a r d textbook recommended by the A m e r i c a n A c a d e m y of Orthopaedic Surgeons, 4 and included 34 hours of didactic lectures presented by 22 faculty m e m b e r s with expertise i n their respective clinical areas. This didactic i n s t r u c t i o n commenced i n A u g u s t 1977 and continued weekly for a n i n e - m o n t h period ending the following April. Lectures were supplemented by 38 hours of practical t r a i n i n g generally t a u g h t d u r i n g scheduled e v e n i n g sessions (Table 1). Of this 38-hour block, 22 hours of teaching involved basic skills, such as splinting, bandaging, and p a t i e n t transfer (Table 2). Eight hours corresponded closely to t h e b a s i c c a r d i a c life s u p p o r t g u i d e l i n e s of the A m e r i c a n H e a r t Association. All practical aspects of the course were t a u g h t by a registered EMT instructor. Although the D e p a r t m e n t of T r a n s p o r t a t i o n guidelines call for s t u d e n t exposure in the emergency d e p a r t m e n t , the class was c o m p o s e d of p h y s i c i a n s - t o - b e a n d thus the students were assigned ins t e a d to r e s c u e s q u a d s for a m i n i m u m of eight hours. This was rapidly confirmed as an i n v a l u a b l e addition to the program. Assessment of s t u d e n t p e r f o r m a n c e was b a s e d solely on the state EMT certification e x a m i n a t i o n , w h i c h 168 s t u d e n t s (100%) passed.
Problems As t h e c o u r s e p l a n was implemented, three major problems were readily identified. The first concerned the teaching faculty and the a p p l i c a b i l i t y of lecture m a t e r i a l to basic emergency care. Many faculty members had little recent ~hands-on" experience a n d lacked i n s i g h t into the p r e h o s p i t a l care setting. T h e i r lectures were often off the mark, inappropriate, or too sophisticated for the first-year medical student. This problem occurred despite the timely distribution of copies of each chapter of the basic text to each lecturer. The scheduling of evening classes necessary to fulfill the practical r e q u i r e m e n t s became a problem for students because the classes often interfered with p r e p a r a t i o n for basic science courses, and overall created some s t u d e n t r e s e n t m e n t . The students felt that, if the course was to be t a k e n seriously, it should be t a u g h t d u r i n g the day. Scheduling of evening sessions r e m a i n e d a problem throughout the academic year.
26/514
Table 1 BASIC COMPONENTS OF EMERGENCY CARE COURSE
Didactic lectures Cardiopulmonary resuscitation Emergency skills Rescue squad experience Total
34 hours 8 hours
Determination of vital signs Bandaging Splinting Spine board techniques Patient transfer
22 hours 8 hours 72 hours
The t h i r d deficiency involved assessment of strident performance and s t i m u l a t i n g the i n d i v i d u a l s t u d e n t to keep up w i t h course m a t e r i a l . Although the course was compulsory, it was not counted as part of the overall grade for the first year. Also, because only a s i n g l e e x a m i n a t i o n was required at the end of the year, students tended to let the course material slip, only to cram at the end for the certifying examination.
Recommendations I n response to these problems, s e v e r a l m a j o r i m p r o v e m e n t s were made the following year. The faculty was reduced to three lecturers, all of whom were re-exposed to the prehos pital setting by passing a n instructor-level course i n vehicle crash rescue. This core faculty was made up of a n anesthesiologist, a t r a u m a surgeon, and a n EMT .instructor. The l e c t u r e topics were condensed, restructured, a n d shifted i n sequence to i n t r o d u c e t h e b a s i c life supp o r t c o n c e p t s e a r l y i n t h e course (Table 3). A l t h o u g h scheduled with diffic u l t y , all p r a c t i c a l s e s s i o n s were t a u g h t in afternoon time slots. In addition, the EMT-A course gained a status equal with other first-year courses by h a v i n g its own i n t e r i m e x a m i n a t i o n s and c o n s t i t u t i n g a cert a i n overall percentage of the firstyear grade. The e x p e r i e n c e w i t h a n E M T course for medical s t u d e n t s at the Medical College of V i r g i n i a confirms its acceptance a n d feasibility. It is our s t r o n g b e l i e f t h a t care of the a c u t e l y ill a n d i n j u r e d deserves a higher priority in the c u r r i c u l u m of most medical schools.
REFERENCES 1. Association of American Medical Colleges: A A M C Curriculum Directory,
JACEP
Table 2 BASIC EMERGENCY SKILLS
Table 3 REVISED SCHEDULE OF DIDACTIC L E C T U R E S
Orientation to emergency medical care Interpretation of diagnostic signs Basic life support I & II Bites, stings, anaphylaxis Management of aquatic injuries Emergency burn management Shock Automotive medicine and highway safety Heat and cold exposure Oxygen administration Fractures I & II Head trauma and the unconscious patient Injury to the spine Soft tissue, injuries Forensic aspects of emergency care Poisoning Acute drug abuse Emergency childbirth Radiation emergencies Abdominal trauma Genitourinary trauma Injuries to the chest Cardiovascular emergencies Cerebrovascular emergencies Respiratory emergencies Rescue and extrication Emergency care integration
Washington, DC, 19~6. 2. Carden TS: Emergency medical services: the bottom line. J A M A 241:19311932, 1979. 3. American College of Emergency Physicians and University Association for Emergency Medicine: Recommended undergraduate medical school curriculum for emergency medicine and services. JACEP 5:377, 1976. 4. Committee on Allied Health, American Academy of Orthopaedic Surgeons: Emergency Care and Transportation of the Sick and Injured, ed 2. Menasha, Wisconsin, George Banton Co, 1977.
8:12 (December) 1979
Emergency Medical Technician (EMT-A) Instruction of Medical Students Robert R. Harrison, BA, REMT* Kimball I. Maull, MD, FACSt C. Paul Boyan, MD*
In 1977 the Department of Anesthesiology of the Medical College of Virginia coordinated a compulsory 72-hour course for first-year medical students fulfilling all requirements of the Department of Transportation and leading to eligibility for certification of the medical student as an Emergency Medical Technician (EMT-A). We describe the methodology and content of this course, as well as problems encountered and lessons learned. This sound foundation in emergency care concepts will enable the medical student to develop greater competence in critical skills during the clinical years. Harrison RR, Maull KI, Boyan CP: Emergency medical technician (EMT-A) instruction of medical students, JACEP 8:513-514, December 1979.
education, graduate; training, emergency medical technician, medical students
I NTRODUCTIO N The teaching of emergency care in A m e r i c a n medical schools is i n a d e q u a t e at the present time. In 1976 a survey by the Association of A m e r i c a n Medical Colleges disclosed that i n s t r u c t i o n in emergency care of a n y kind was required by less t h a n 10% of medical schools. 1 Although 80% of medical schools offered some form of elective emergency care experience, most were i n a d e q u a t e to provide the student with the expertise to function i n d e p e n d e n t l y in a situation req u i r i n g basic life support. As a result of the great increase in the sophistication a n d effectiveness of paramedical prehospital care, it has become a p p a r e n t t h a t medical schools are producing physicians who are not capable of properly handling an emergency situation outside the hospital. 2 This deficiency, although recognized, has not led to appropriate changes in the medical school curriculum. I n 1976 the U n d e r g r a d u a t e Education Committee of the A m e r i c a n College of Emergency Physicians, in conjunction with the Medical Education Committee of the U n i v e r s i t y Association for Emergency Medicine, recommended t h a t medical schools require 60 to 80 hours of didactic and practical i n s t r u c t i o n d u r i n g the f r e s h m a n year leading to state certification as an Emergency Medical Technician (EMT-A). z In 1977, the D e p a r t m e n t of Anesthesiology of the Medical College of V i r g i n i a coordinated a n i n n o v a t i v e 72-hour course exceeding those standards. This report will describe the methodology and content of this course, as well as the problems encountered and lessons learned. . From the Departments of Anesthesiology* and Surgery,t Medical College of Virginia, Richmond, Virginia. Presented at the University Association for Emergency Medicine Annual Meeting in Orlando, Florida, May 1979. Address for reprints: Kimball I. Maull, MD, Medical College of Virginia Station, Box 893, Richmond, Virginia 23298. 8:1 2 (December) 1979
JACEP
513/25
CURRICULUM Course m a t e r i a l was based on the s t a n d a r d textbook recommended by the A m e r i c a n A c a d e m y of Orthopaedic Surgeons, 4 and included 34 hours of didactic lectures presented by 22 faculty m e m b e r s with expertise i n their respective clinical areas. This didactic i n s t r u c t i o n commenced i n A u g u s t 1977 and continued weekly for a n i n e - m o n t h period ending the following April. Lectures were supplemented by 38 hours of practical t r a i n i n g generally t a u g h t d u r i n g scheduled e v e n i n g sessions (Table 1). Of this 38-hour block, 22 hours of teaching involved basic skills, such as splinting, bandaging, and p a t i e n t transfer (Table 2). Eight hours corresponded closely to t h e b a s i c c a r d i a c life s u p p o r t g u i d e l i n e s of the A m e r i c a n H e a r t Association. All practical aspects of the course were t a u g h t by a registered EMT instructor. Although the D e p a r t m e n t of T r a n s p o r t a t i o n guidelines call for s t u d e n t exposure in the emergency d e p a r t m e n t , the class was c o m p o s e d of p h y s i c i a n s - t o - b e a n d thus the students were assigned ins t e a d to r e s c u e s q u a d s for a m i n i m u m of eight hours. This was rapidly confirmed as an i n v a l u a b l e addition to the program. Assessment of s t u d e n t p e r f o r m a n c e was b a s e d solely on the state EMT certification e x a m i n a t i o n , w h i c h 168 s t u d e n t s (100%) passed.
Problems As t h e c o u r s e p l a n was implemented, three major problems were readily identified. The first concerned the teaching faculty and the a p p l i c a b i l i t y of lecture m a t e r i a l to basic emergency care. Many faculty members had little recent ~hands-on" experience a n d lacked i n s i g h t into the p r e h o s p i t a l care setting. T h e i r lectures were often off the mark, inappropriate, or too sophisticated for the first-year medical student. This problem occurred despite the timely distribution of copies of each chapter of the basic text to each lecturer. The scheduling of evening classes necessary to fulfill the practical r e q u i r e m e n t s became a problem for students because the classes often interfered with p r e p a r a t i o n for basic science courses, and overall created some s t u d e n t r e s e n t m e n t . The students felt that, if the course was to be t a k e n seriously, it should be t a u g h t d u r i n g the day. Scheduling of evening sessions r e m a i n e d a problem throughout the academic year.
26/514
Table 1 BASIC COMPONENTS OF EMERGENCY CARE COURSE
Didactic lectures Cardiopulmonary resuscitation Emergency skills Rescue squad experience Total
34 hours 8 hours
Determination of vital signs Bandaging Splinting Spine board techniques Patient transfer
22 hours 8 hours 72 hours
The t h i r d deficiency involved assessment of strident performance and s t i m u l a t i n g the i n d i v i d u a l s t u d e n t to keep up w i t h course m a t e r i a l . Although the course was compulsory, it was not counted as part of the overall grade for the first year. Also, because only a s i n g l e e x a m i n a t i o n was required at the end of the year, students tended to let the course material slip, only to cram at the end for the certifying examination.
Recommendations I n response to these problems, s e v e r a l m a j o r i m p r o v e m e n t s were made the following year. The faculty was reduced to three lecturers, all of whom were re-exposed to the prehos pital setting by passing a n instructor-level course i n vehicle crash rescue. This core faculty was made up of a n anesthesiologist, a t r a u m a surgeon, and a n EMT .instructor. The l e c t u r e topics were condensed, restructured, a n d shifted i n sequence to i n t r o d u c e t h e b a s i c life supp o r t c o n c e p t s e a r l y i n t h e course (Table 3). A l t h o u g h scheduled with diffic u l t y , all p r a c t i c a l s e s s i o n s were t a u g h t in afternoon time slots. In addition, the EMT-A course gained a status equal with other first-year courses by h a v i n g its own i n t e r i m e x a m i n a t i o n s and c o n s t i t u t i n g a cert a i n overall percentage of the firstyear grade. The e x p e r i e n c e w i t h a n E M T course for medical s t u d e n t s at the Medical College of V i r g i n i a confirms its acceptance a n d feasibility. It is our s t r o n g b e l i e f t h a t care of the a c u t e l y ill a n d i n j u r e d deserves a higher priority in the c u r r i c u l u m of most medical schools.
REFERENCES 1. Association of American Medical Colleges: A A M C Curriculum Directory,
JACEP
Table 2 BASIC EMERGENCY SKILLS
Table 3 REVISED SCHEDULE OF DIDACTIC L E C T U R E S
Orientation to emergency medical care Interpretation of diagnostic signs Basic life support I & II Bites, stings, anaphylaxis Management of aquatic injuries Emergency burn management Shock Automotive medicine and highway safety Heat and cold exposure Oxygen administration Fractures I & II Head trauma and the unconscious patient Injury to the spine Soft tissue, injuries Forensic aspects of emergency care Poisoning Acute drug abuse Emergency childbirth Radiation emergencies Abdominal trauma Genitourinary trauma Injuries to the chest Cardiovascular emergencies Cerebrovascular emergencies Respiratory emergencies Rescue and extrication Emergency care integration
Washington, DC, 19~6. 2. Carden TS: Emergency medical services: the bottom line. J A M A 241:19311932, 1979. 3. American College of Emergency Physicians and University Association for Emergency Medicine: Recommended undergraduate medical school curriculum for emergency medicine and services. JACEP 5:377, 1976. 4. Committee on Allied Health, American Academy of Orthopaedic Surgeons: Emergency Care and Transportation of the Sick and Injured, ed 2. Menasha, Wisconsin, George Banton Co, 1977.
8:12 (December) 1979
