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The EMT training problem is a lot bigger than just the 200 people who didn't take refresher courses
By adamg on Wed, 06/23/2010 - 8:05am
Ray Vaillancourt, who has paramedic training himself, writes the entire refresher system is something of a failure:
... The fact that hundreds of EMT's blowing off the classes had no apparent effect on patient care is evidence of the irrelevance of the training. Very few EMT's statewide received meaningful refresher training, whether they spent the time in the classroom or not.
Those who signed off on no-show refreshers ought to be disciplined, but we shouldn’t stop there. This scandal is not just an ethics problem; it is a sign of a systemic education problem. The answer is not to crack down on attendance and ensure that every EMT serves every moment of their refresher "sentence"; the answer is to ensure that the refresher better serves each EMT so each EMT can better serve the community. Spending an arbitrary amount of time in a classroom covering material the students already know is not an effective use of resources. ...
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Comments
I was thinking along the same lines.
Most working EMTs (especially in larger cities) do actual live CPR a couple hundred times a year on the job. Then EMT legal requirements have regulations that say every EMT, paramedic, etc have to do a yearly 4-12 hour "refresher" course that is pretty much a waste of time and money for many EMT's involved. It is kind of like making high school English teachers have to do a 8 hour training session in the summer explaining to them the difference between there, their and they're.
The EMTs get paid for the training, but the training itself is useless for those EMT's that already know the stuff. It isn't really an excuse to skip the training and get paid for it, but I see what this guy is saying.
Aren't CPR techniques
Aren't CPR techniques reviewed and updated with some regularity? Do these refresher courses not provide information on new techniques, or are they provided through some other program? If it has been found some new technique saves 1 more person out of a hundred, isn't learning the new technique worth it?
New techinques.
If the new technique is real important, the EMT's learn it right away. They do this because they don't want working EMT's using outdated techinques while the training is going on. There are usually no new tecniques learned in these classes anyway and the changes they do make usually aren't that significant (for example some doctors think 20 chest compressions are the same as 30 chest compressions so if EMTs do either one they aren't recklessely hurting the patient in anyway).
The new techniques
The new CPR recommendation is to always do chest compressions even if the person has a pulse. They simplified it so that you always do 20 compressions and 2 breaths or something, no matter what the situation is. Research found that for the average person, they're going to perform better if they only have one set of instructions to remember, so it's better to err on the side of doing chest compressions and messing up a beating heart than not doing them on a non-beating heart and having the person up and die.
But of course people who can readily pull up their understanding of physiology aren't going to do chest compressions on someone with a pulse, so, no, I'm pretty sure this "new" recommendation isn't being taught to EMTs.
I didn't mean to imply that it was a new tecnique.
just wanted to point out that the quantity of compressions/breaths per minute isn't an exact science. Sometimes the recommended number changes with things like this. But it's better to do some than none in almost any case.
Both the American Red Cross
Both the American Red Cross and American Heart Association offer two categories of CPR training: one for healthcare providers/professional rescuers (like the EMTs involved in this issue), and one for the general public. As you suspected, the courses for providers/rescuers still include checking for pulse and choosing techniques based on presence or absence thereof.
"Most working EMTs... do
WHAT?!? That's absolutely insane. You're talking multiple CPR calls, every working day. That just doesn't happen except on TV. Even when I was working full-time for an EMS service handling 911 calls, I never did CPR more than 4 or 5 times in a month. I recently spent a week with a St. Louis Fire Department EMS crew (EMT + Paramedic). They were plenty busy that week, but no CPR.
Sure, there are busy EMS systems like Boston which see significant numbers of CPR calls, but what about EMTs working in small towns and/or at private ambulance services doing mostly non-emergent calls? There are also EMT certified Fire Fighters and Police Officers whose primary duty is not EMS. These people need to have refresher training to keep the skills current.
I would imagine the majority of EMTs in Massachusetts have done CPR no more than a few times, and many have never done it at all. I'd be surprised if you could find an EMT who has done CPR more than a hundred times in the past 12 months.
No, this rarely happens. CPR techniques are reviewed and updated regularly, but the changes aren't implemented immediately in the field. Certified providers generally don't learn the changes until their next refresher class, and there is always an overlap where both the old and new techniques are being used. That doesn't mean the change is unimportant, but at the same time, it doesn't render the old standard unsafe or ineffective.
Many updates to the refresher course for providers aren't actually changes in technique as much as putting emphasis on knowledge that was determined to be lacking. For example, instead of just checking for presence of breathing, they now discuss what breathing is adequate. Also, the cutoff between the child and adult algorithms went from a fixed age to the onset of puberty.
I agree that refresher training for both CPR and EMT programs isn't always the most enriching, but there are some basic skills that don't get used very often and need to be reviewed on a regular basis. As we can all agree, that the quality of the training needs improvement isn't an excuse to falsify training records.
You are right.
What I should have said is that EMT's in larger cities go to hundreds of calls a year where the basic elements of CPR are used and that learning to how to check a pulse in these classes isn't that beneficial to these EMT's, especially when there are no other required classes that may further the education of the EMT's. EMT's and first responders from areas where there isn't a high volume of these calls should benefit from these classes (or should if they are run the right way)
And when I said "significant changes", I meant cases where an immediate change needed to occur before the EMT's hit the streets again (new/faulty defibs, dosage changes in paramedic kits, etc). Like you said, most changes are made where the old tecnique is just as efficient. And it is usually efficient enough to wait until next years training class to implement it.
But you kind of summed it up. You basically have to suck it up and listen to all the small stuff during these classes, even if you already know it.
correlation is not causation
The fact that hundreds of EMT's blowing off the classes had no apparent effect on patient care is evidence of the irrelevance of the training.
No, it's not. Maybe EMTs (and Paramedics) are largely irrelevant? Oh ho, did you see what I did there?
First off, the state (which has been annoyingly ambivalent about the whole thing) claimed patient care wasn't impacted. We really have no clue whether or not patient care was impacted. Why do we have no clue? Because the dozens of EMTs and Paramedics have probably treated thousands of patients each. Do we all think that the state went to the trouble to get medical records (if they even can in the first place), read through them, interview doctors, and determine whether patients received the best care possible?
Second...let's give the state the benefit of the doubt, ok? Just because they didn't find any "effect" doesn't mean that was because the training was irrelevant. And "no training had no effect" does not mean "training has no effect".
Exactly
If I decide not to do my continuing ed this year, am I suddenly going to do egregious things like "hey, really obviously acutely psychotic guy, go ahead and walk home and I'll see you next week!"? No, of course not. But will I be a less effective clinician if over time I stop caring about networking and hearing about new research and fresh ways of thinking and finding opportunities to have my insights vetted by other professionals? Absolutely. I'm basically competent, so nothing I do with or without continuing ed is going to put the public at zomgrisk. But the people who depend on my services and other services deserve better than basic competence, and they especially deserve someone who's invested in the profession and doesn't see furthering one's skills and furthering the field as just a nuisance.
I think that was the guys point eeka.
The current "training" isn't really training at all. It is usually just a rehash of the basics and you aren't responsible for knowing the information anyway. Even if you did go to the class they "pass" you regardless. You need to take a test and they always give you the answers to them (if you don't happen to know them)
If the classes were about furthering one's skills and the field then it would be a good thing. But these classes don't do that.