Ohio Hospital Educates Medics Through Competition

Editor’s note: This article originally appeared at www.emra.org/emresident/article/ems-education/.

The most effective medical education is designed with specific learners in mind. Using that as a guiding principle, the emergency medicine faculty and residents at OhioHealth Doctors Hospital in Columbus came up with an engaging approach to EMS training.

Healthcare providers are attracted to their specialties for a variety of reasons. Like EM residents, EMS providers don’t particularly enjoy learning via hours of PowerPoint lecture. EM residents did not choose the busy and chaotic practice environments of the ED or the back of an ambulance because we enjoy warming chairs. To understand how to create educational and fun events in residency, it is important to understand the training process of EMS providers.

Background of EMS Education

EMS education requirements were first laid out in 1993 with a document called the National EMS Education and Practice Blueprint and further delineated in 2005 with the EMS Education Agenda for the Future. This consensus document itemizes the five tenets of EMS education, their associated goals, and a plan for achieving them. These tenets include core content, scope of practice, education standards, education program accreditation, and EMS certification. We now have a national credentialing body, the National Registry of Emergency Medical Technicians (NREMT), and a national scope of practice model that defines different types of providers (EMT, advanced EMT, and paramedic).

EMT, AEMT, and paramedic training courses are typically sequential, with increasing hour requirements ranging from 100–1,300 hours of classroom, clinical, and simulation time. Additionally, providers must pass their state or NREMT exam for their respective level of certification. Recertification is typically completed every two years, and requirements can be met with courses, conferences, research, and online resources.

As there is significant state and local variation in the educational methods used and the requirements themselves, identifying exactly what teaching modalities are most commonly used would be quite difficult. For example, the Seattle Fire Department requires considerably more classroom, simulation, and actually cadaver lab and operating room (OR) time for intubations than the national guidelines.¹ This extra education, as well as the department’s greater-than-average number of intubations per year, may contribute to its higher intubation success rates.¹

There are undeniable similarities in the education and practice of EMS providers and EM residents. Airway management is one such critical clinical skill shared by both sets of providers. Intubations performed in the field or the ED are often challenging for a variety of reasons: austere environments, trauma, critically ill patients, or the recent ingestion of a cheeseburger, to name a few.

Historically EM resident involvement in EMS education has been limited to going on ride-alongs and possibly giving lectures. Only 89% of residencies in a recent survey had a designated EMS rotation, and only 64% noted a requirement for education of EMS providers by residents.² Conversely, 92% had a requirement for direct medical control.²

Airway Competition

After learning all this (and more), Doctors Hospital leaders decided to shake up their learning process with an event meant to be both fun and educational: an airway competition. This contest consisted of sequential stations simulating different difficult-airway scenarios. The 23 competing EMS providers from several local agencies performed the challenges in a head-to-head timed race.

Seeking to repair potentially bruised relationships caused by the individual competition, we then paired providers for a team-based challenge in which they literally had to be each other’s eyes and hands to intubate a “victim” trapped in a building collapse.

The EM residents involved either served as race officiators or performed a debriefing with the EMS providers after their competition, with discussion of difficult-airway techniques, equipment, indications, and troubleshooting.

Overall, participating EMS providers said they enjoyed the competition and found the debriefing sessions valuable. We aim to continue pioneering future educational ventures and plan to put more than bragging rights on the table next time.

This event not only helped EM residents gain insight into how EMS education is structured but additionally improved our camaraderie and relationships with the EMS providers from whom we take sign-outs each shift. Resident instruction of our EMS and prehospital colleagues can be a valuable experience for both parties and helps to strengthen the acute care team.

References

1. Warner K, Carlborn D, Cooke C, et al. Paramedic training for proficient prehospital endotracheal intubation. Prehosp Emerg Care, 2010; 14(1): 103–8.

2. Katzer R, Cabanas JG, Martin-Gill C. Emergency medical services education in emergency medicine residency programs: A national survey. Acad Emerg Med, 2012; 19(2): 174–9.

Geoff Comp, DO, FAWM, is a resident at OhioHealth Doctors Hospital and ex-officio board member with the Emergency Medicine Residents’ Association (EMRA).

Rachel Munn, DO, is a resident at OhioHealth Doctors Hospital.

Vishnu Mudrakola, MD, is a resident at OhioHealth Doctors Hospital.

Eric Cortez, MD, FACEP, is a clinical assistant professor of emergency medicine at OhioHealth Doctors Hospital and associate medical director for the Columbus Division of Fire.