Emergency Medical Technician Training Research Articles

Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation*

To compare cardiopulmonary resuscitation (CPR) with a compression to ventilation (C:V) ratio of 15:2 vs. 30:2, with and without use of an impedance threshold device (ITD). Prospective randomized animal and manikin study. Animal laboratory and emergency medical technician training facilities. Twenty female pigs and 20 Basic Life Support (BLS)-certified rescuers. Acid-base status, cerebral, and cardiovascular hemodynamics were evaluated in 18 pigs in cardiac arrest randomized to a C:V ratio of 15:2 or 30:2. After 6 mins of cardiac arrest and 6 mins of CPR, an ITD was added. Compared to 15:2, 30:2 significantly increased diastolic blood pressure (20 +/- 1 to 26 +/- 1; p < .01); coronary perfusion pressure (18 +/- 1 to 25 +/- 2; p = .04); cerebral perfusion pressure (16 +/- 3 to 18 +/- 3; p = .07); common carotid blood flow (48 +/- 5 to 82 +/- 5 mL/min; p < .001); end-tidal CO2 (7.7 +/- 0.9 to 15.7 +/- 2.4; p < .0001); and mixed venous oxygen saturation (26 +/- 5 to 36 +/- 5, p < .05). Hemodynamics improved further with the ITD. Oxygenation and arterial pH were similar. Only one of nine pigs had return of spontaneous circulation with 15:2, vs. six of nine with 30:2 (p < 0.03). HUMANS: Fatigue and quality of CPR performance were evaluated in 20 BLS-certified rescuers randomized to perform CPR for 5 mins at 15:2 or 30:2 on a recording CPR manikin. There were no significant differences in the quality of CPR performance or measurement of fatigue. Significantly more compressions per minute were delivered with 30:2 in both the animal and human studies. These data strongly support the contention that a ratio of 30:2 is superior to 15:2 during manual CPR and that the ITD further enhances circulation with both C:V ratios.

Public Health Department Training of Emergency Medical Technicians for Bioterrorism and Public Health Emergencies

The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%-14.9%). State health departments provided even less training (6.3%-17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approach to disasters and other public health emergencies.

Improving Combat Medic Learning Using a Personal Computer-Based Virtual Training Simulator

The new military occupational specialty for combat medics, the 91W, requires that all medics successfully pass the National Registry of Emergency Medical Technicians examination. The objective of this study was to supplement standard emergency medical technician training with a three-dimensional, computer-based, virtual training simulator and to assess whether scores and pass rates could be increased. Combat medics (N=167) were selected for training through the usual noncommissioned officer unit selection process and were randomized by cohort to the training simulator. Results showed no significant differences in National Registry of Emergency Medical Technicians examination scores (t = 1.019, df = 153, p = 0.745, one-tailed) or pass rates (chi2 = 1.575, df = 1, p = 0.209). The findings, however, were used to construct two models of combat medic characteristics that can be used to assist in initial selection for emergency medical technician courses and subsequent counseling of soldiers on course completion. With further research, these models could be refined for Army-wide use to increase the cost-effectiveness of combat medic recruitment, training, and testing.

Successful Development and Implementation of a Tactical Emergency Medical Technician Training Program for United States Federal Agents

The emerging need for tactical operations in law enforcement often places personnel involved at risk. Tactical operations often are carried out in environments in which access to emergency care is limited. With the war against terrorism expanding, special operations involving United States federal agents are occurring worldwide. Currently, there are very few tactical medicine curricula training traditional emergency medical services (EMS) providers to operate in these high-risk missions. Trainees in existing programs must have previous EMS experience, and are selected from a wide range of backgrounds. The goal of this study is to examine a Special Agent Emergency Medical Technician (SAEMT) training curriculum developed specifically for federal special agents with prior experience in tactical operations, but without previous medical training. An analysis of the SAEMT Program given to federal agents of the Drug Enforcement Administration (DEA) in Quantico, Virginia between July 2000 and April 2002 was performed. The SAEMT curriculum provided enrolled agents 181.5 hours of training in tactical emergency topics, including medical mission planning, logistics, operations, evacuation, and weapons training. In addition, SAEMT concurrently provides emergency medical technician (EMT) training. All of the participants were DEA agents with no previous medical training. Upon completion of the course, all participants took the National Registry of EMT-Basic examination. Measured endpoints included course completion rate and performance on certifying examinations. Ninety-five agents were enrolled and successfully completed the SAEMT course between July 2000 and April 2002. Of the agents enrolled, 84 (88%) passed the National Registry of EMTs-Basic examination within two attempts. The SAEMT Program provides basic emergency medical training to federal special agents with no previous medical experience. The design of this program provides a useful template to meet the expanding demand for tactical emergency medical personnel.

Increasing cardiopulmonary resuscitation between countershocks during use of automated external defibrillators in out-of-hospital cardiac arrest

Study objectives: Prompt cardiopulmonary resuscitation (CPR) and electrical defibrillation are the most important determinants of successful resuscitation in out-of-hospital ventricular fibrillation cardiac arrest (OHCA). Evidence supports that increasing the balance of CPR compared with hands-off CPR may improve survival in OHCA. We assess whether emergency medical technician training and automated external defibrillator (AED) reconfiguration are associated with an increase in the amount of CPR delivered between countershocks. Methods: The study was a cohort study of 301 persons who experienced OHCA and were treated with at least 2 AED countershocks by the emergency medical services (EMS) first-tier responders in the study community. In January 2003, first-tier EMS providers were retrained as to the importance of hands-on CPR between countershocks. In addition, a subset of AEDs (models using biphasic waveform) was reconfigured to remove continuous fibrillation detection and its associated voice prompts for the first 2 minutes after the each defibrillatory shock to be comparable with the other AED models. AED electronic recordings and EMS reports were reviewed to assess the amount of CPR. The main outcome was the density of CPR assessed as the time spent performing hands-on CPR divided by the total time between the first and second countershock. The density of CPR was compared for the cohort of cases before and after the training and reconfiguration intervention. Results: Two hundred sixty-one cases were treated in the preintervention period and 40 in the postintervention period. CPR density was 0.42±0.20 in the preintervention period compared with 0.50±0.17 in the postintervention period ( P =.03). The difference in CPR density was greatest for the biphasic waveform AED for which EMS was retrained and the AED reconfigured (0.35±0.21 versus 0.51±0.16, P =.001). There was a smaller increase for the other AED models for which EMS was retrained, but no reconfiguration was necessary (0.43±0.19 versus 0.50±0.18, P =.30). Survival to hospital discharge was 24.5% for the preintervention period compared with 26.3% in the postintervention period ( P =.81). Among patients treated with biphasic waveform AEDs, survival to hospital discharge was 16.7% in the preintervention period compared with 25.9% for the postintervention period ( P =.30). Conclusion: Training interventions and AED reconfiguration may increase the proportion of time spent performing hands-on CPR between countershocks in ventricular fibrillation cardiac arrest. Whether this increase improves outcomes including survival requires additional study.

Emergency medical technicians' disaster training by tabletop exercise

The objective of this study was to assess the attitudes of emergency medical technicians (EMTs) toward tabletop drills to determine the effect of tabletop simulation on the EMT student perception of disaster preparedness and management. In November 1998 and April 1999, 59 firefighters underwent 260 hours of EMT intermediate level training at the National Cheng Kung University Hospital in Tainan, Taiwan. All participants had experience in field disaster exercise training before they attended this EMT training course. The EMT courses included a disaster and mass-casuality incident program. A 9-item questionnaire was completed by the 59 EMTs before (for field exercise) and after undergoing the tabletop drills. The results of the survey revealed that the field operation exercise could not provide adequate provisions to link the results of disaster exercises to appropriate changes in terms of training, equipment, supplies, and plans. Field operation failed to show the ability of others to fill in during the absence of key officials. Tabletop drilling provided better performance for these 2 issues. Tabletop exercise also provided a better chance than field exercise to evaluate the response without the use of telephones, which are not always reliable in real emergency situation. For disaster exercises, limitations of field operation drills such as communications, coordination, assignment of responsibilities, and postevent mitigation priorities were noted, and tabletop drills provided additional benefits for these settings. Large-scale effect evaluation of different drills may be necessary to design future disaster preparedness programs.

Executive summary: Developing objectives, content, and competencies for the training of Emergency Medical Technicians, Emergency Physicians, and Emergency Nurses to care for casualties resulting from Nuclear, Biological, or Chemical (NBC) incidents

Study objective: The task force assessed the needs, demands, feasibility, and content of training for US civilian emergency medical responders (paramedics, nurses, and physicians) for nuclear/biological/chemical (NBC) terrorism. Methods: A task force representing key professional organizations, stakeholders, and disciplines involved in emergency medical response conducted an iterated instructional-design analysis on the feasibility and content of such training with input from educational professionals. We then analyzed 6 previously developed training courses for their congruence with our recommendations. Results: The task force produced descriptions of learning groups, content and learning objectives, and barriers and challenges to NBC education. Access to training and sustainment of learning (retention of knowledge) represent the significant barriers. The courses analyzed by the task force did not meet all objectives and challenges addressed. Conclusion: The task force recommends training programs and materials need to be developed to overcome the identified barriers and challenges to learning for these audiences. Furthermore, the task force recommends incorporating NBC training into standard training programs for emergency medical professionals. [Waeckerle JF, Seamans S, Whiteside M, Pons PT, White S, Burstein JL, Murray R, on behalf of the Task Force of Health Care and Emergency Services Professionals on Preparedness for Nuclear, Biological, and Chemical Incidents. Executive summary: developing objectives, content, and competencies for the training of emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from nuclear, biological, or chemical (NBC) incidents. Ann Emerg Med. June 2001;37:587-601.]

Altitude-related illness in two California national parks.

High-altitude illness encompasses a spectrum of disorders related to the hypoxia experienced by individuals at elevation. Altitude-related illness has been well described in the United States, but there are no studies published in the medical literature looking at the occurrence of high-altitude illness within the US National Parks system. The purpose of this study is to describe the incidence, treatment, and outcomes of visitors to Sequoia and Kings Canyon National Parks who presented to emergency medical services (EMS) personnel with signs and symptoms consistent with high-altitude illness. We conducted a retrospective review of all EMS patient care records (PCRs) from Sequoia and Kings Canyon National Parks during the study period of June 1992 to August 1995. There were 23 cases of altitude-related illness identified by EMS personnel in the parks during the 38-month study period, including five cases of high-altitude pulmonary edema and 19 cases of acute mountain sickness. One patient died, nine patients were transported to local hospitals, nine patients were assisted in their descent and then released from medical care, and four patients were treated and then allowed to continue their travels. There was an average of 5.9 cases per year of high-altitude illness and an incidence of one case per 27 EMS contacts. We conclude that altitude-related illness does occur in Sequoia and Kings Canyon National Parks and, although high-altitude illness accounts for only 4% of EMS contacts, caring for these patients uses a significant amount of national park resources. We suggest continued training of emergency medical technicians and park medics in the recognition and treatment of these disorders. We also support education of hikers to reduce or prevent the morbidity associated with altitude-related illness.

An evaluation of automated defibrillation and manual defibrillation by emergency medical technicians in a rural setting

We show that automated external defibrillation training of emergency medical technicians (EMTs) is less time consuming than manual defibrillation training, and hypothesize that both improve survival from sudden cardiac death. Data on 91 cardiac arrests over 27 months among five basic life support services was collected before EMT-defibrillation (EMT-D) training. Subsequently, seven BLS services were trained in EMT-D using either manual defibrillation or automated external defibrillation technology, and 55 sudden cardiac death patients were entered after training. Manual defibrillation required 11 more hours per student in initial training. Survival to hospital discharge improved from two of 91 patients (2.2%) in the series before EMT-D training to nine of 55 patients (16.4%) after EMT-D training ( P = .001). Improved survival was correlated with shorter prehospital defibrillation times, 8.84 minutes, when EMTs performed defibrillation versus 16.3 minutes before training when EMTs awalted advanced life support defibrillation ( P < .001). To enhance equipment famillarity we allowed EMTs to apply three-lead electrode monitors to all medical/cardiac patients during transport (surveillance). There were six emergency medical service-witnessed “surveillance” arrests and three arrests survived to hospital discharge (50% survival). This group represented 33% of all survivors in the series. We recommend automated external defibrillation training for EMTs. Improved survival in sudden cardiac death cases in well-run emergency medical service systems should result from EMT-D training. Finally, we recommend that routine “surveillance” of high-risk patients during transport by defibrillation-capable EMTs be considered in EMT-D programs, rather than limiting EMT-D only to units capable of rapid “man-down” response.

Resuscitation decision making by New Mexico emergency medical technicians

The extent to which Emergency Medical Service personnel are placed in situations in which difficult cardiopulmonary resuscitation decisions must be made has been poorly explored. Further, it is not known whether this kind of decision making is troubling to emergency medical technicians. Although it is likely that emergency medical service systems handle with-holding cardiopulmonary resuscitation in a variety of ways, the authors chose to examine a cross-section of New Mexico emergency medical technicians. Using a survey instrument, emergency medical technicians of all tralning levels, representing several emergency medical service systems around the state were asked how many times in their career they had been in a situation in which cardiopulmonary resuscitation had been withheld without a direct physician order. Of 310 individuals surveyed, 211 (66.8%) responded that this had occurred at least once. When asked whether they had been troubled by one of these situations, 86 of 211 (41%) individuals responded “yes.” When a variety of demographic factors were evaluated, only training to the paramedic level was identified as being an independent predictor of those who were troubled ( P = .019). Emergency medical technician training, protocols, and do not resuscitate programs may need to be expanded to give furthe guidance to prehospital personnel when making difficult resuscitation decisions.

Survey of Emergency Medical Technicians' Ability to Cope with the Deaths of Patients During Prehospital Care

AbstractHypothesis:Emergency medical technicians (EMTs) find that the death of patients in their care is stressful.Population:Random sample of certified EMTs in one state (Levels I–IV).Methods:A blinded, self-administered survey was sent to a random sample of 2,500 EMTs. Demographic data obtained were: level of training; hours worked each month; population of area served; age; gender; number of deaths per year; training for coping prehospital deaths; and availability of protocols and on-line medical advice for out-of-hospital deaths. A five-point, Likert scale was used to rate the frequency of perceived stress experienced by EMTs in specific situations and the routine practice for notification of survivors. Univariable analysis was performed using Spearman's Rank correlation, Kruskal-Wallis test, and Mann-Whitney U-test. Multivariable correlations were performed using forward and backward step-wise logistic regression analysis. A significance level of 0.05 was used throughout.Results:There were 654 respondents with a mean age of 35.5±8.3 yr; 83% were men. Their highest level of training was: 4% EMT-I, 43% EMT-II, 18% EMT-III, 33% EMT-IV. They saw an average of 9.6 deaths/year and spent an average of 20±17 minutes with survivors. 62 % found treatment of a patient that was dying or died in their care was commonly a stressful experience. Factors that made notification of the family about the prehospital death emotionally difficult included: fewer hours worked/month; working in a smaller community; lower level of EMT training; female gender; and fewer deaths seen during the previous year. The same factors were associated with general emotional difficulty in treatment of a patient who died during prehospital care. Online [direct] medical direction by physicians was common (73%), but did not lessen the difficulty of notification. It did reduce the emotional difficulty for specific clinical situations. Written protocols for not attempting resuscitation were common (66%), but only 44% had protocols for termination of resuscitation. Resuscitation of the clearly dead for the benefit of the family (10%) or for the EMT (5%) was practiced infrequently. Most (67%) respondents had some formal training in dealing with death and the dying patient. Such training did not correlate with less difficulty in notification of survivors or in coping with the deaths of patients in their care.Conclusion:EMTs perceive they have emotional difficulty when prehospital deaths occur and survivors must be notified. Less experience and a lower level of EMT training correlate with more difficulty in coping with patient death. Protocols and on-line [direct] medical control can provide support for the EMT in coping with out-of-hospital deaths. Most notification of survivors is handled by EMTs with formal training to cope with patients that are dying or who die during prehospital care.

Should semi-automatic defibrillators be used by emergency medical technicians in Belgium? The Belgian Cerebral Resuscitation Study Group.

Early external defibrillation is the single most effective intervention in patients with out-of-hospital cardiac arrest. Literature data indicate that instructing emergency medical technicians (EMTs) to use defibrillators is beneficial, provided the local emergency medical system is well organized. We tried to estimate the potential benefit of early defibrillation in some centres in Belgium by retrospectively analyzing the data from the Belgian Cardio-Pulmonary-Cerebral Resuscitation Registry collected between 1983 and 1987 in Belgian centres with a Mobile Intensive Care Unit (MICU). The data show that 2310 out of 3371 patients (69%) were first attended by the EMTs; on subsequent arrival of the MICU-teams, 584 of these 2310 patients i.e. 17% of the whole study population, presented with ventricular fibrillation. Analysis of estimated time factors in these 2310 patients revealed that the median time interval between collapse and start of resuscitation by EMTs was 8 min; the median time interval between collapse and start of MICU-resuscitation attempts was 16 min. The duration of EMT-resuscitation before MICU-arrival was probably more than 5 min and 10 min in 58% and 23% of the cases respectively. It is concluded that EMTs can be expected to reach a substantial number of ventricular fibrillation victims within a few minutes after the collapse and many minutes before arrival of the MICU. Therefore, training of EMTs in the use of semi-automatic defibrillators seems worthwhile in MICU-served regions in Belgium.

Smokejumper wilderness rescue missions: experience of the North Cascade Smokejumper Base, 1957–1988

Wilderness emergencies present unique problems in rescuer access and medical evacuation. An innovative prehospital care system utilizing United States Forest Service smokejumpers has evolved in north central Washington state. Trained primarily as airborne forest firefighters, smokejumpers have unique talents in rough terrain parachuting. Coordination between the North Cascades Smokejumper Base, a local primary care physician, and the nearby county sheriffs office has made the access, initial treatment and evacuation of wilderness patients possible. Utilizing data from the United States Forest Service Logbooks and personal records of the base manager, the rescue mission experience of North Cascades Smokejumper Base between 1957 and 1988 is presented. The urgency of patients rescued was high, with 18% being in the critical or fatal outcome category, and 67.5% of patients being classified as urgent. The majority of rescues (80.5%) were for trauma patients. An average of four smokejumpers per rescue was utilized. Medical evacuation was predominantly by helicopter; horseback, litter carry, hiking and ground ambulances were also used. Medical training of smokejumpers has improved since 1973 with Emergency Medical Technician training of selected smokejumpers.

Psychological training of emergency medical technicians: an evaluation.

American Journal of Community PsychologyVolume 12, Issue 1 p. 127-131 Brief Report Psychological training of emergency medical technicians: An evaluation Michael A. Hoge, Michael A. Hoge Department of Psychology, Kent State University, 44242 Kent, OhioSearch for more papers by this authorRichard Hirschman, Corresponding Author Richard Hirschman Department of Psychology, Kent State University, 44242 Kent, OhioSearch for more papers by this author Michael A. Hoge, Michael A. Hoge Department of Psychology, Kent State University, 44242 Kent, OhioSearch for more papers by this authorRichard Hirschman, Corresponding Author Richard Hirschman Department of Psychology, Kent State University, 44242 Kent, OhioSearch for more papers by this author First published: 01 February 1984 https://doi.org/10.1007/BF00896932Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume12, Issue1February 1984Pages 127-131 RelatedInformation

The training of emergency medical technicians

The training of emergency medical technicians

Management of Popliteal Artery Injuries

In a series of seven popliteal artery injuries including two concomitant popliteal vein injuries and three knee dislocations, only one failure occurred. With appropriate training of emergency medical technicians and adequate supportive services such as blood banking and arteriography, the vascular surgeon in a small hospital setting can manage peripheral vascular trauma with acceptable results.

Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning

Several time-related variables involving resuscitation from out-of-hospital cardiac arrest were studied. Short time intervals from collapse to initiation of cardiopulmonary resuscitation (CPR) and to provision of definitive care were significantly associated with survival from cardiac arrest. The two times were jointly related, and one short time without the other was unlikely to result in survival. If CPR was initiated within four minutes and if definitive care was provided within eight minutes, 43% of patients survived. If either time was exceeded, the changes of survival fell dramatically. The time to initiation of CPR and definitive care are factors directly influenced by emergency medical service program decisions. A realistic option to improve time to initiation of CPR is widespread citizen CPR training. A possible option to improve the time to definitive care is the training of emergency medical technicians in defibrillation.

Hospital Care of the Trauma Patient

SINCE THE landmark white paper,<i>Trauma, Accidental Death and Disability, the Neglected Disease of Modern Society</i>, published by the National Academy of Sciences in 1966,¹dramatic changes have occurred in the prehospital care of the acutely ill and injured in many areas of the United States. These changes, wrought by physicians and laymen educated in the needs of the trauma patient, were encouraged, catalyzed, and often augmented by financial assistance from a private foundation (Robert Wood Johnson) and the federal government (Department of Transportation and Department of Health, Education, and Welfare). Improved prehospital emergency medical services bring more salvageable patients to the hospital now than ten to 15 years ago. This is due to improved access to emergency medical services, training of emergency medical technicians, development of central dispatch, and radio communications between emergency medical technicians and hospital physicians. However, during the same ten to 15 years, hospital care

Statewide approach to emergency medical training

In Kansas, an instructor/coordinator approach is used to train emergency medical technicians (EMTs) through two ten-day sessions at the University of Kansas. The students are trained in various aspects of the Department of Transportation (DOT) Dunlop course, in the use of audiovisual aids and in basic teaching and testing theory. Then, they return to their communities and offer EMT training programs as the need arises. There are 82 instructor/coordinators throughout the state. Law enforcement officers, frequently the first on the scene in rural Kansas, receive training in crash injury management through a 70-hour plus course developed through the Kansas Highway Patrol. Also, 110 advanced paramedics, or emergency mobile intensive care technicians, have been trained through 600 to 1500 hour courses at the Kansas University Medical Center.

The Field Exercise: An Invaluable Adjunct in the Training of Emergency Medical Technicians

The Field Exercise: An Invaluable Adjunct in the Training of Emergency Medical Technicians