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emtbasicnsc

     Emergency Medical

     Technician-Basic:

     National Standard

     Curriculum

    EMT-Basic: National Standard Curriculum

    Instructor's Course Guide

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     EMT-BASIC: NATIONAL STANDARD CURRICULUM

     PROJECT DIRECTOR

     David J. Samuels, MBA

     System Director

     Samaritan AirEvac/Emergency Medical Services

     Samaritan Health System

     Phoenix, AZ

     CO-MEDICAL DIRECTORS

     Henry C. Bock, MD, FACEP

     Emergency Physician

     Methodist Hospital of Indiana, Inc.

     Indianapolis, IN

     Kimball I. Maull, MD, FACS

     Director

     R Adams Cowley Shock Trauma Center

     Baltimore, MD

     PRINCIPAL INVESTIGATOR

     Walt A. Stoy, Ph.D., EMT-P

     Director of Educational Programs

     Center for Emergency Medicine

     Research Assistant Professor of Medicine

     University of Pittsburgh School of Medicine

     Pittsburgh, PA

     Contract Number DTNH22-90-C-05189

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    i United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum

    EMT-Basic: National Standard Curriculum

    Instructor's Course Guide

    ?????????????????????????????????????

    CURRICULUM DEVELOPMENT GROUP

    James Bothwell, EMT-P Susan McHenry

    National Flight Paramedics National Association of State EMS Association Directors

William Brown, RN, NREMT-P William Metcalf, EMT-P

    National Registry of Emergency American College of Emergency Medical Technicians Physicians

Ricky Davidson Mary Beth Michos

    International Association of Fire International Association of Fire

    Chiefs Chiefs

Karla Holmes, RN Joe Taylor, RN, Ph.D.

    National Council of State EMS Emergency Nurses Association

    Training Coordinators

     Katherine West, RN, MS

    Richard Judd, Ph.D., EMSI Infection Control Expert

    National Association of Emergency

    Medical Technicians Roger White, MD

     American Heart Association

    Kathryn Lewis, RN, Ph.D.

    Phoenix College, Education Robert Worsing, Jr., MD

    Design Expert American Academy of Orthopaedic

     Surgeons

    Paul Maniscalco

    National Association of Emergency

    Medical Technicians

     MEDICAL OVERSIGHT COMMITTEE

    Robert Baron, MD, FACEP Kathleen Handal, MD, FACEP

    Emergency Physician Emergency Physician

Nicholas Benson, MD, FACEP James Heckman, MD, FAAOS

    National Association of EMS American Academy of Orthopaedic Physicians Surgeons

    Society for Academic Emergency

    Medicine William Roush, MD, FACEP

     Joint Review Commission

    George Foltin, MD, FACEP

    American Academy of Pediatrics

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    ii United States Department of Transportation

    National Highway Traffic Safety Administration

    EMT-Nasic: National Standard Curriculum

    EMT-Basic: National Standard Curriculum

    Instructor's Course Guide

    ?????????????????????????????????????

Preface

The National Highway Traffic Safety Administration (NHTSA) has assumed

    responsibility for the development of training courses that are responsive to the standards established by the Highway Safety Act of 1966 (amended). Since these training courses are designed to provide national guidelines for training, it is NHTSA's intention that they be of the highest quality and be maintained in a current and up-to-date status from the point of view of both technical content and instructional strategy. To this end, NHTSA supported the current project which involved revision of the 1984 Emergency Medical Technician-Ambulance: National Standard Curriculum, deemed of

    high value to the states in carrying out their annual training programs. This course is one of a series of courses making up a National EMS training program for prehospital care. The curriculum, Emergency Medical Technician-Basic: National Standard

    Curriculum, is the cornerstone of EMS prehospital training. In addition, the new curriculum parallels the recommendations of the National EMS Education and Practice

    Blueprint.

    The EMT-Basic curriculum is a core curriculum of minimum required information, to be presented within a 110-hour training program. It is recognized that there is additional specific education that will be required of EMT-Basics who operate in the field, i.e. ambulance driver training, heavy and light rescue, basic extrication, special needs, and so on. It is also recognized that this information might differ from locality to locality, and that each training program, or system should identify and provide special training requirements. This curriculum is intended to prepare a medically competent EMT-Basic to operate in the field. Enrichment programs and continuing education will help fulfill other specific needs for the EMT-Basic's education.

Acknowledgement

    From the very beginning of this revision project, the Department of Transportation relied on the knowledge, attitudes, and skills from hundreds of experts. These individuals sought their own level of involvement and contribution toward accomplishing the goals of this project. These contributions varied from individual to individual, and regardless of the level of involvement, everyone played a significant role in the development of the curriculum. It is essential that those who have assisted with the achievement of this worthy educational endeavor be recognized for their efforts. For every person named, there are 50 or more individuals that should be identified for their contributions. For all who have contributed, named and unnamed, thank you for sharing your vision. Your efforts have helped assure that the educational/training

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    iii United States Department of Transportation

    National Highway Traffic Safety Administration

    EMT-Basic: National Standard Curriculum

EMT-Basic: National Standard Curriculum

    Instructor's Course Guide

    ?????????????????????????????????????

needs of EMT-Basics are met so that they can provide appropriate and effective patient

    care.

Special thanks for the knowledge, expertise, and dedication given to this project by the

    Project Director, Principal Investigator, Co-Medical Directors, and all the members of

    the Curriculum Development Group and Medical Oversight Committee.

NHTSA would also like to recognize the following individuals and/or organizations for

    their significant contributions to this project:

National Organizations

    National Council of State EMS Training Coordinators

    Michael O'Keefe, EMT

    National Registry of EMTs

    William Brown, RN

    Phil Dickison, REMT-P

Individuals

    Robert Waters, PhD

    Joseph Mistovich, MS, REMT-P

    Michael Tunik, MD

Montana Pilot Test Site

    Marc Racicot, Governor

    Albert E. Goke, Director, Highway Traffic Safety Division

    Drew Dawson, Chief, EMS Bureau

    Ken Threet, State Training Coordinator

    Dane Castelberry, Course Coordinator

    Dayle Derrin, Assistant State Training Coordinator

    Jim Upchurch, MD, REMT-B, Billings, Montana, Indian Health Service,

     Medical Director for the Pilot Program

Pennsylvania Pilot Test Site

    Kum Ham, PhD, State EMS Director

    Gail Dubs, EMT, State Training Coordinator

    Dennis Wargo, M.Div., EMT-P, Regional Training Coordinator

    Scott Everitt, EMT-P, Lead Instructor

    Tom Platt, NREMT-P, Course Coordinator

    Ron Roth, MD, Medical Director for the Pilot Program

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    iv United States Department of Transportation

    National Highway Traffic Safety Administration

    EMT-Nasic: National Standard Curriculum

    EMT-Basic: National Standard Curriculum

    Instructor's Course Guide

    ?????????????????????????????????????

Center for Emergency Medicine

    Walt Stoy, PhD, EMT-P, Principal Investigator

    Tom Platt, NREMT-P, Coordinator of EMS Education

    Gregg Margolis, BS, EMT-P, Associate Director of Education

    Debra Barclay, EMT-P, Coordinator of Medical Education

    Paul Paris, MD, FACEP, Chief Medical Director

    Donald Goodman, MBA, Chief Financial Officer

    Amy Tremel, BS, EMT-P

    Division of Emergency Medicine

    Attending Physicians, University of Pittsburgh

    Affiliated Residency in Emergency Medicine, University of

     Pittsburgh

Samaritan Health System

    EMS Division

    Cindy Ruthem

    Georgia Snover

    Thanks to the many outside reviewers who provided diverse knowledge and skills from across the country. They contributed to the content and shared their ideas and visions about the new curriculum.

    NHTSA would also like to thank two other Federal agencies that supported the pilot testing of the new curriculum: The Maternal and Child Health Bureau and the Office of Rural Health Policy, both within the Department of Health and Human Services.

Process

    The content of this curriculum was established by a Curriculum Development Group consisting of emergency medical and educational experts. These individuals met periodically to review, edit, and critique the development of the curriculum. The Medical Oversight Committee developed the medical/clinical component of the curriculum. A six-member writing group and Principal Investigator actually "put pen to paper", once the objectives and format were approved by the Curriculum Development Group and Medical Oversight Committee. The co-medical directors dealt with difficult and controversial issues and sought to achieve consensus with the Curriculum Development Group and Medical Oversight Committee.

    The National Council of State EMS Training Coordinators made a significant contribution to the overall design, development, and content of the curriculum

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    v United States Department of Transportation

    National Highway Traffic Safety Administration

    EMT-Basic: National Standard Curriculum

EMT-Basic: National Standard Curriculum

    Instructor's Course Guide

    ?????????????????????????????????????

    throughout the project. More importantly, this organization has assumed the responsibility for implementing the curriculum in the coming years.

    Two pilot tests were conducted in Ekalaka, Montana (representing the rural/frontier EMT-Basic), and Pittsburgh, Pennsylvania (representing the urban/metropolitan EMT-Basic). Seven students participated in the Montana pilot, and twenty-three students participated in the Pennsylvania pilot. The project team gained valuable insight into the implementation of the new EMT-Basic, and modifications were made to the final curriculum document.

    The National Registry of EMTs contributed to the design and development of the examinations and final evaluation tools that were used in the pilot program, as well as the tabulation and evaluation of scores. The National Registry also contributed significantly to the design and development of the skill sheets that are contained within this curriculum.

Medical Direction Statement

    Medical direction of the EMT-Basic is an essential component of prehospital training, and thus is included in this revised EMT-B curriculum. Physician involvement should be in place for all aspects of EMS training programs, specifically for every ambulance service/rescue squad. On-line and/or off-line medical direction must be in place to allow for EMT-Basics to carry and assist with the administration of medications to patients.

    Quality improvement is also a required component of EMS training. The role of medical direction is paramount in assuring the provision of highest quality prehospital care. Medical Directors should work with individuals and systems to review prehospital cases and strive to achieve a sound method of continuous quality improvement.

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    vi United States Department of Transportation

    National Highway Traffic Safety Administration

    EMT-Nasic: National Standard Curriculum

    EMT-Basic: National Standard Curriculum

    Instructor's Course Guide

    ?????????????????????????????????????

Curriculum

History

    The last revision of the EMT-Ambulance: National Standard Curriculum occurred in the early 1980s with a completed course published in 1984. The current revision came about as a result of the National Highway Traffic Safety Administration's (NHTSA) January 1990 Consensus Workshop on Emergency Medical Services Training

    Programs. Participants discussed the national training curricula needs of Emergency Medical Service (EMS) providers. Using a nominal group process, the participants identified the top priority needs for EMS training in the United States. The top priorities identified at that meeting led to issuance of a Request for Proposals (RFP) by NHTSA to revise the EMT-Ambulance Curriculum based upon the input provided by many national EMS organizations and representatives at the consensus workshop. The following priorities from the 1990 consensus workshop recommendations played a directing role in the revision of this EMT-Basic Curriculum:

    ; Review and development of a blueprint/model and core curriculum for each

    provider level, based upon task analysis focusing on field impact (evaluating

    positive/negative outcomes) and the most utilized knowledge and skill areas.

    Identify "need to know" versus "nice to know" content. Conduct an analysis of

    interventions and outcomes for both the patient and the care provider. (What

    are we really doing in EMS? What's making a difference? Define what we want

    to do).

    ; Establish a Physician Board to review and approve all medical curriculum

    content.

    ; Emphasize an assessment-based format rather than a diagnostic-based format

    for all levels and all ages.

    ; Ensure that there is adequate focus on primary skills of assessment and ABCs in

    all provider levels (with emphasis on airway).

    ; Include an objective assessment of all published studies in peer journals when

    revising curricula.

    ; Emphasize rescuer and patient safety components, including infection control, in

    all curricula.

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    1 United States Department of Transportation

    National Highway Traffic Safety Administration

    EMT-Basic: National Standard Curriculum

EMT-Basic: National Standard Curriculum

    Instructor's Course Guide

    ?????????????????????????????????????

    ; Ensure that prehospital providers have adequate skills to care for children and

    infants by integrating information throughout the curricula at all levels, within the

    established course items.

    ; Build in clearly defined medical control for all levels, not just EMT-Paramedic.

    ; Utilize measurable educational objectives (knowledge, skills, judgement) to

    determine individuals' learning needs and duration of training program.

    ; Develop a nationally acceptable core curriculum for each provider level, with a

    mechanism for customizing for local needs.

    ; Place curriculum revision emphasis on EMT-A and First Responder courses.

; Revise basic course to be no more than 110 hours in length.

    ; Add automated defibrillation (fully automatic and semi-automatic) for CPR by

    EMTs and First Responders.

    ; Develop an integrated/situational (real-world) approach for EMT training.

    ; Develop a mechanism for consensus on EMS education among national groups.

; Evaluate delivery methods of training.

    ; Include sufficient information in basic EMT-A curriculum to comply with

    hazardous materials (HAZMAT) worker protection standard.

    ; Include more on medical emergencies as opposed to trauma (including airway).

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    2 United States Department of Transportation

    National Highway Traffic Safety Administration

    EMT-Nasic: National Standard Curriculum

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