Knowledge and Skill Measures of Emergency Medical Technicians

Abstract

The role of the ambulance attendant in the emergency medical care delivery system has changed considerably over the past ten years. The major emphasis has changed from transportation to on-scene and in-vehicle care well beyond the traditional first aid level. A nationally established 81 hour curriculum is now the basic minimum requirement in many states and many thousands of Emergency Medical Technicians (EMTs) have completed this course since 1970. Measurement of the effectiveness of this training through improved survival rates is difficult to measure because of simultaneous changes in equipment and organization within the system, and hence training effectiveness measures are needed. Currently, methods have been devised for measuring knowledge using a 300 item multiple choice questionnaire and measuring skill using physician - observers in emergency departments to rate appropriateness of diagnosis and treatment by the EMT. This research represents the first simultaneous use of these two measures on the same sample. It was found that knowledge in the EMT community tested was high in relation to other areas and well distributed, with no company, age or sex related differences reaching significance. Ratings of performance were high but did not correlate significantly with knowledge - in fact a small negative correlation was found. It was found however that knowledge correlated significantly with supervisory ratings. Measures of inter and intra - rater reliability among the physician observers showed that lack of perfect reliability was one major explanation of the lack of relationship between knowledge and skill. Recommendations for improvements in the training program content and organization are given as well as a critique of currently available evaluation tools.