Extended Abstract
Using Remote Instruction to Improve Knowledge and Skills
Jeri Pullum, MS
D. Breck Rushton, RN, MPH
This pilot test was designed to improve the pediatric airway management and positioning knowledge and skills for emergency medical technicians working in a rural ambulance service. Problems with pediatric airway management and positioning are well documented in the literature. Rural EMTs typically receive some training in pediatric care, but low call volumes, especially in rural areas, provide few opportunities to practice their skills or use their knowledge.1,2 Knowledge and skill deterioration is well documented in EMS.3,4,5 Although training is often advocated to retain knowledge and skills,6,7,8, 9 high-quality local training is not always available.
The Pediatric Emergency distance learning program included self-study materials contained on an Internet World Wide Web site, in published textbooks, and on interactive CD-ROM programs. The training was conducted by an instructor in Salt Lake City, UT, who communicated with 9 prehospital providers, aged 20-59, in Fort Benton, MT, using E-mail and desktop video conferencing. The instructor reviewed and critiqued videotapes of the ambulance crew members’ performance skills taped before the training began. The performance skill required participants to assess and provide care for a pediatric trauma patient in a simulated emergency.
The providers took a written test, filled out a questionnaire to measure self-confidence, and completed the performance test before and after the training.
Quantitative data showed statistically significant improvement in performance but no change in either written knowledge or self-confidence.
During a focus group meeting and personal interviews, the ambulance crew members identified the chance to review their own performance on videotape and to have access to an expert instructor as the most valuable components of the training program. The lack of improvement on the written test may have been because ambulance crew members concentrated on the performance test, making little use of the self-study materials.
The pilot program shows promise for making high quality training, including performance skills training, available to all prehospital providers, regardless of their location.
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3. Skelton MB, McSwain NE. A study of cognitive and technical skill deterioration among trained paramedics. Journal of the American College of Emergency Physicians 1977;6:436-438.
4. Latman NS, Wooley K. Knowledge and skill retention of emergency care attendants, EMT-As, and EMT-Ps. Annals of Emergency Medicine 1980;9:183-189.
5. Zautcke JL, Lee RW, Ethington NA. Paramedic skill decay. Journal of Emergency Medicine 1987;5:505-512.
6. Eichelberger MR, Stossel-Pratsch G, Mangubat EA. A pediatric emergencies training program for emergency medical services. Pediatric Emergency Care 1985;1:177-179.
7. Hobbs GD, Moshinskie JF, Roden SK, Jarvis JL. A comparison of classroom and distance learning techniques for rural EMT-I instruction. Prehospital Emergency Care 1998;2:189-191.
8. Larmon B, Schriger DL, Snelling R, Morgan MT. Results of a 4-hour endotracheal intubation class for EMT-basics. Annals of Emergency Medicine 1998;31:224-7.
9. Stewart RD, Paris PM, Pelton GH, Garretson D. Effect of varied training techniques on field endotracheal intubation success rates. Annals of Emergency Medicine 1984;13:1032-1036.
Contact: Jeri PullumCritical Illness and Trauma Foundation
2125 1st Ave. South, Great Falls MT 59401
406.761.2692
/ Contact: D. Breck Rushton
Utah Bureau of EMS
P.O. Box 142004 Salt Lake City, UT 84116-2004
(801) 538-6719