One key goal of all EMS systems is to provide quality education to staff; however, the recent economic recession and continuing recovery has led many EMS systems to make financial adjustments. Unfortunately, this often includes significantly reducing training and educational budgets and, in many agencies, eliminating staff educational allowances and/or reimbursement for EMS-related seminars and conferences.
Though many services looked at and/or moved to online education that could be done by staff members while on shift to significantly reduce costs, this does not adequately address the educational needs of kinesthetic (hands-on) learners. It also is not the best method of reviewing many of the psychomotor skills used by providers at all levels. Many of these skills and interventions (see Prehospital Skills sidebar) require not only practice, but also development of mind-muscle connections for high-demand, low-use interventions like endotracheal intubation, needle chest decompression and surgical airways, to name a few. These psychomotor skills and interventions cannot be practiced online and the mind-muscle connection will not be developed, which may lead to less than optimal performance in high-stress environments like pediatric cardiac arrest, patients requiring medication-assisted airway management and trauma.
This is not to say that online education does not have its place. Online training and education, balanced with kinesthetic training and education, along with face-to-face (f2f) medical direction involvement, is beginning to emerge as the training and educational model of the future. This will not only lead to financial savings, but will also allow EMS education directors to maintain an aggressive, educational, cutting edge and interesting training schedule for the system's staff. An example of a cost-effective kinesthetic training and education in-service is a two-hour advanced life support (ALS) airway management review that can be easily adapted to BLS or air/ground critical care transport providers.
The first step in developing any educational offering is to determine the overall goal, or macro-objective, of the in-service. This can be accomplished through reviewing recent 9-1-1 responses, or, even better, determining what type of patients and/or skills staff has not seen or used recently. Choose a selected area from the National Registry of EMT-Paramedic or other provider level core requirements, from discussions with staff, or develop an ABC monthly rotation (see Training Plan Development sidebar). The macro-objective for Adult Airway Management for the Experienced Provider was identified by discussing with EMS Director B.J. Jungmann of the Maplewood (MN) Fire Department what he ultimately wanted to accomplish. He wanted a challenging two-hour f2f airway management review for his paramedics. This was a perfect macro-objective that not only defined what he wanted, but was easily adapted to meet state and national recertification requirements for all levels of providers, could be conducted f2f, and could also be easily modified to a blended online/f2f in-service.
Next, you need to establish micro-objectives by identifying current resources like PowerPoint, dry-erase boards, or an apparatus bay with large Post-its on the wall. The key to developing and presenting an effective in-service is not the technology/media used, but what individual staff members learn and, ultimately, if what they learn enhances and/or improves their individual or team performance on real-world responses. For the Adult Airway Management review, three comprehension (review), two psychomotor (kinesthetic or hands-on) and one synthesis (formulate a plan in a simulation) micro-objectives were chosen (see Micro-objectives sidebar), intending to have the didactic portion last no more than 30 minutes and the kinesthetic portion make up the other 90 minutes with a short break in between. PowerPoint was chosen for the didactic portion and now needed to be fully developed.