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was present. The analysis assessed time of arrival to completion of vitals and departure from scene. The mean, median, and frequency were determined using SPSS analysis software (Chicago, IL). Results: Five hundred fifty calls were included and reviewed in this study. There were no sig- nificant differences in the total number or types of procedures performed for either group. The mean time for arrival on- scene to assessment of patient vitals for EMS crews with no students was 6 minutes 18 seconds (378 sec). For EMS crews with students, arrival on-scene to assessment of patient vitals was 6 minutes 48 seconds (408 seconds), an 8% increase in time (p = 0.254). The mean for total scene time for EMS crews with no students was 14 minutes 47 seconds. EMS crews with students had a mean total scene time of 14 minutes 45 seconds. Conclusion: The clinical phase of paramedic training is an essential element in the paramedic students’ medical training. The presence of paramedic students in the prehospital clinical setting, despite a small increase in total scene time, does not represent a significant negative impact. 03 WHAT IS THE LEARNING STYLE OF THE PARAMEDIC STUDENT? Janice Dorey, RN, BS, Advocate Christ Medical Center, Oak Lawn, Illinois Introduction: Many recent educational studies have been conducted regarding the learning styles of college students; a University of Minnesota study indicated that 80% are visual learners. This restrospective study of entry-level paramedic students identifies their learning styles. Hypothesis: Adult learners in college entry-level classes are visual learners, therefore, entry-level paramedic students are visual learners. Method: The survey tool used was the HOBET (Health Occupation Basic Entrance Test), which is a diagnostic indicator of student aptitude in health occupation programs. The tool identifies the learning style of students by asking 45 questions. This testing tool indicates that students are generally a blend of all learning approaches; however, most have very distinctive preferences. Knowing the learning styles can help instructors adjust their teaching styles to the individual student as well as to entire class learning style. Results: The HOBET was administered in the first month of the paramedic course. In a retrospective study, conducted over a three-year period, 207 students completed the testing. The results are as follows: Forty-six percent of the students are auditory learners. This student learns from hearing words spoken, therefore lectures are effective. Sixty-five percent of the students are visual learners. This student learns from seeing words in books, chalkboards, videos, or PowerPoint presentations. Forty-nine percent of the students are writing- dependent learners. This student can write fluent essays and care plans. Sixty-nine percent of the students are oral- dependent learners. This student speaks fluently and can present orally. Sixty-five percent of the students are solitary learners. This student gets more done alone and thinks best and remembers more when learning alone. Sixty-eight percent of the students are social learners. This student strives to study with at least one other student, because group interaction increases learning. Conclusion: This study reveals that paramedic students are visual learners but are signifi- cantly oral-dependent and social learners. The instructor can use this information to blend presentations by using visual aides, group activities, and student oral presentations to better instruct these people effectively. 04 ELECTROCARDIOGRAPHY:ASTUDY OF PARAMEDICS’LEARNING METHODOLOGIES Madeleine O’Donnell, BNg, BEd, MEdS, Flinders University of South Australia, Adelaide, South Australia, Australia Introduction: There is no emergency medical services (EMS) literature that describes how student paramedics learn to read an electrocardiogram (ECG). Understanding how stu- dents learn helps instructors modify teaching practices to optimize student learning. The aim of this study was to record cognitive functions that paramedics describe when they are learning to read an ECG. The study is posited in the qualitative paradigm. Research Question: What strategies and cognitive elements do paramedics describe when they are learning to read ECGs? ‘‘Elements’’ are defined as those mental activities that students are progressively thinking. Elements refer to a range of approaches, systems, concepts, or methodologies through which individuals say they learn. Methods: Twelve participants were selected at random and interviewed using a semistructured technique. This format allowed probing and prompting questions to extrapolate meaning. Data were coded into six themes with 63 sub- categories. QSR N6 software processed the data. Content analysis was concerned with description, induction, genera- tion, and construction in terms of commonality in how ECG learning occurred. Results: From the interviews, 63% of the transcripts contained descriptions of students’ learning. Six themes emerged and are defined as: 1) Learning Activities—elementary skills derived from listening to in- struction, reading, writing, calculating, and classifying. 2) Transformation of Information Processes—comprehension originating from elementary skills, emphasizing 3-D visual- izations and mental imagery. 3) Learning Interactions— events external to the classroom setting; initiating, listening to, and participating in conversation. Context of Learning— informal activities through clarification with selected peers. Self-Regulatory Learning Events—students taking responsi- bility for their own learning. 6) Affective Learning—how students think and feel about their learning. Conclusion: Instructors need to adopt teaching methodology that comple- ments students’ learning. This can be achieved through de- tailed attention to explaining the meaning of every component of the ECG, incorporating 3-D visualizations, and providing dynamic skills labs. 05 EMERGENCY MEDICAL SERVICES AND A PEDIATRIC SUBACUTE FACILITY :DEVELOPMENT OF SEAMLESS INTERACTION Daved van Stralen, MD, Totally Kids Specialty Healthcare, Loma Linda, California. Coauthors: Patricia King RN, BSHCS, Racquel Calderon, RCP, RRT, BS, Margarita Gil, RN, Larry Meissner, BA, Matt Fratus, Div. Chief, Bruce Barton, EMT-P, Doug Padgett, BS, NHA Ravindra Rao, MBBS Introduction: Because of the different treatment methods and goals of emergency medical services (EMS) and nursing facility staff, conflicts can develop. These conflicts will interfere with both resuscitation of patients and care for the noncritically ill patient. We addressed these conflicts in 493 PREHOSPITAL CARE RESEARCH FORUM/NAEMSE ABSTRACTS
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was present. The analysis assessed time of arrival tocompletion of vitals and departure from scene. The mean,median, and frequency were determined using SPSS analysissoftware (Chicago, IL). Results: Five hundred fifty calls wereincluded and reviewed in this study. There were no sig-nificant differences in the total number or types of proceduresperformed for either group. The mean time for arrival on-scene to assessment of patient vitals for EMS crews with nostudents was 6 minutes 18 seconds (378 sec). For EMS crewswith students, arrival on-scene to assessment of patient vitalswas 6 minutes 48 seconds (408 seconds), an 8% increase intime (p = 0.254). The mean for total scene time for EMS crewswith no students was 14 minutes 47 seconds. EMS crews withstudents had a mean total scene time of 14 minutes 45seconds. Conclusion: The clinical phase of paramedictraining is an essential element in the paramedic students’medical training. The presence of paramedic students in theprehospital clinical setting, despite a small increase in totalscene time, does not represent a significant negative impact.
03 WHAT IS THE LEARNING STYLE OF THE PARAMEDIC STUDENT?Janice Dorey, RN, BS, Advocate Christ Medical Center, OakLawn, Illinois
Introduction: Many recent educational studies have beenconducted regarding the learning styles of college students;a University of Minnesota study indicated that 80% are visuallearners. This restrospective study of entry-level paramedicstudents identifies their learning styles. Hypothesis: Adultlearners in college entry-level classes are visual learners,therefore, entry-level paramedic students are visual learners.Method: The survey tool used was the HOBET (HealthOccupation Basic Entrance Test), which is a diagnosticindicator of student aptitude in health occupation programs.The tool identifies the learning style of students by asking45 questions. This testing tool indicates that students aregenerally a blend of all learning approaches; however, mosthave very distinctive preferences. Knowing the learningstyles can help instructors adjust their teaching styles to theindividual student as well as to entire class learning style.Results: The HOBET was administered in the first month ofthe paramedic course. In a retrospective study, conductedover a three-year period, 207 students completed the testing.The results are as follows: Forty-six percent of the students areauditory learners. This student learns from hearing wordsspoken, therefore lectures are effective. Sixty-five percent ofthe students are visual learners. This student learns fromseeing words in books, chalkboards, videos, or PowerPointpresentations. Forty-nine percent of the students are writing-dependent learners. This student can write fluent essays andcare plans. Sixty-nine percent of the students are oral-dependent learners. This student speaks fluently and canpresent orally. Sixty-five percent of the students are solitarylearners. This student gets more done alone and thinks bestand remembers more when learning alone. Sixty-eightpercent of the students are social learners. This studentstrives to study with at least one other student, because groupinteraction increases learning. Conclusion: This study revealsthat paramedic students are visual learners but are signifi-cantly oral-dependent and social learners. The instructor canuse this information to blend presentations by using visual
aides, group activities, and student oral presentations tobetter instruct these people effectively.
04 ELECTROCARDIOGRAPHY: A STUDY OF PARAMEDICS’ LEARNING
METHODOLOGIES Madeleine O’Donnell, BNg, BEd, MEdS,Flinders University of South Australia, Adelaide, South Australia,Australia
Introduction: There is no emergency medical services (EMS)literature that describes how student paramedics learn toread an electrocardiogram (ECG). Understanding how stu-dents learn helps instructors modify teaching practices tooptimize student learning. The aim of this study was torecord cognitive functions that paramedics describe whenthey are learning to read an ECG. The study is posited in thequalitative paradigm. Research Question: What strategiesand cognitive elements do paramedics describe when theyare learning to read ECGs? ‘‘Elements’’ are defined as thosemental activities that students are progressively thinking.Elements refer to a range of approaches, systems, concepts, ormethodologies through which individuals say they learn.Methods: Twelve participants were selected at random andinterviewed using a semistructured technique. This formatallowed probing and prompting questions to extrapolatemeaning. Data were coded into six themes with 63 sub-categories. QSR N6 software processed the data. Contentanalysis was concerned with description, induction, genera-tion, and construction in terms of commonality in how ECGlearning occurred. Results: From the interviews, 63% ofthe transcripts contained descriptions of students’ learning.Six themes emerged and are defined as: 1) LearningActivities—elementary skills derived from listening to in-struction, reading, writing, calculating, and classifying. 2)Transformation of Information Processes—comprehensionoriginating from elementary skills, emphasizing 3-D visual-izations and mental imagery. 3) Learning Interactions—events external to the classroom setting; initiating, listeningto, and participating in conversation. Context of Learning—informal activities through clarification with selected peers.Self-Regulatory Learning Events—students taking responsi-bility for their own learning. 6) Affective Learning—howstudents think and feel about their learning. Conclusion:Instructors need to adopt teaching methodology that comple-ments students’ learning. This can be achieved through de-tailed attention to explaining themeaning of every componentof the ECG, incorporating 3-D visualizations, and providingdynamic skills labs.
493PREHOSPITAL CARE RESEARCH FORUM/NAEMSE ABSTRACTS
05 EMERGENCY MEDICAL SERVICES AND A PEDIATRIC SUBACUTE
FACILITY: DEVELOPMENT OF SEAMLESS INTERACTION Daved vanStralen, MD, Totally Kids Specialty Healthcare, Loma Linda,California. Coauthors: Patricia King RN, BSHCS, RacquelCalderon, RCP, RRT, BS, Margarita Gil, RN, LarryMeissner, BA, Matt Fratus, Div. Chief, Bruce Barton,EMT-P, Doug Padgett, BS, NHA Ravindra Rao, MBBS
Introduction: Because of the different treatment methods andgoals of emergency medical services (EMS) and nursingfacility staff, conflicts can develop. These conflicts willinterfere with both resuscitation of patients and care for thenoncritically ill patient. We addressed these conflicts in
dependent children. Methods: This is a descriptive, retro-spective study in a 50-bed freestanding, pediatric subacutefacility. Ventilator settings came from a register maintainedweekly. The number of 911 responses and staffing wereobtained from facility transfer logs, fire department records,and ambulance response records. Hand-ventilation tech-niques for chronic ventilator settings were identified fromdiscussion with bedside RCPs. Results: There were 57recorded ambulance transfers of ventilator-dependent chil-dren to acute hospital settings within a 12-month period.Ambulance staffing consisted of one emergency medicaltechnician I as driver, an ambulance paramedic, and a firedepartment paramedic, to provide patient care and handventilation. Bedside RCP demonstrated a hand-ventilationtechnique necessary for the individual child to the para-medics on scene. In each case, paramedics assumed care ofthe child and transported without RCP accompaniment oradverse events. The authors identified three chronic con-ditions that require bedside education: 1) accommodation oflarge air leaks that result from small tracheostomy tube inrelation to tracheal diameter; 2) positive end expiratorypressures (PEEP) of 4 to 8 cm of water pressure; and 3) longerexpiratory time constants requiring slower rates of ventila-tion. Conclusion: Paramedics efficiently learn bag–tracheos-tomy ventilation techniques to manage large air leaks, PEEPto 8 cm of water pressure, and higher time constants.
07 RESULTS OF THE NATIONAL REGISTRY EMT-B EXAM AFTER
CONVERSION TO THE 91W COMBAT MEDIC CURRICULUM MajGeorge N. Appenzeller, MD, 91W Initial Entry Training,Department of Combat Medic Training, Fort Sam Houston, Texas.Coauthors: James A. Morgan, MD, James B. Miller,NREMTP
Introduction: On October 15, 2001, the new 91W Combat
494 PREHOSPITAL EMERGENCY CARE OCTOBER / DECEMBER 2003 VOLUME 7 / NUMBER 4
a program of education and participation between EMSproviders and nursing facility staff. Hypothesis: Conflictsbetween subacute caregivers and EMS personnel can beresolved through effective communication. Methods: Theauthors recognized that 1) all caregivers had the best interestof the patient in mind; 2) conflict came from different viewsof the same problem but with different resources; and 3)open and aggressive communication was necessary until allcaregivers were in agreement. The authors conducted a re-view of interactions among a nursing facility, fire service EMSprovider, and private ambulance EMS provider. Activitieswere directed at identifying goals in common and goals thatdiffer. The nursing facility is a 50-bed, freestanding, pediatricsubacute facility in which patients include ventilator-dependent children. The fire service provides paramedics onall engine companies. The private ambulance providerresponds with a paramedic and an emergency medicaltechnician. Results: Conflicts were discussed openly withthe assumption that all parties were correct. Interactions werekept ongoing as long as conflicts occurred. Interactionsincluded 1) meetings between supervisory staff; 2) tours ofthe facility; 3) attendance on ventilator management rounds;4) ongoing communication with supervisory EMS officers;and 5) positive feedback to EMS caregivers in the form ofletters to their supervisor and the city’s mayor. Beliefs of EMScaregivers fell into three categories: ethics of care for theseclients, level of care at the facility, and the use of the 911response system. Facility staff believed EMS caregivers weredisinterested and found EMS confusing. After intervention,EMS providers appreciated the level of care in the facilityand evaluation of complex chronically ill patients. Facilitystaff developed close interactions with EMS. Conclusion:Identification of the similarities between EMS and subacutecare acts as a catalyst for closer interactions. This benefits thepatient and all caregivers by providing a smooth transitionfrom subacute facility to the emergency department.
06 ON-SCENE EDUCATION FOR HAND VENTILATION OF THE
VENTILATOR-DEPENDENT CHILD Daved van Stralen, MD, TotallyKids Specialty Healthcare, Loma Linda, California. Coauthors:James Arden, RCP Calderon, RCP Racquel, RRT, BS, LarryMeissner, BA, Bruce Barton, EMT-P, Matt Fratus, Div.Chief, Patricia King, RN, BHSCS
Introduction: It has become more common for childrendependent on long-term mechanical ventilation to be caredfor in the home or in a long-term care facility. When thesechildren need transfer to an acute-care hospital, it is highlyunlikely that they will be maintained on mechanical venti-lation during transport. During these transfers, a paramedicwill need to hand-ventilate the patient, whomay have chronicdiseases that require a variety of ventilation patterns. Hypo-thesis: Paramedics can rapidly assimilate education fromthe bedside respiratory care practitioner (RCPs) to performhand-ventilation techniques specific to individual ventilator-
Medic training curriculum went into effect. One of the newrequirements was mandatory EMT-B certification. The pro-gram of instruction (POI) underwent significant revisionregarding EMT training. These included a dedicated EMTcurriculum, coordinating staff and educational materials. Toevaluate these changes, National Registry Exam pass rateswere compared from before and after POI changes, and withcivilian and sister service pass rates. Methods: Overall passrates for combat medic trainees on the National Registry EMTexamination were compared between those before and afterimplementation of the revised curriculum. All examinationsgiven at the Ft. Sam Houston Department of Combat MedicTraining were used. Results: Overall, pass rates for thecombat medic training at Ft Sam Houston increased from32.7% to 97% with an odds ratio of 2.9687 (95% confidenceinterval-2.71–3.25). Conclusions: From the test results itis clear there has been an improvement in the level of train-ing received by the combat medics before release to theirunits.
