Airway & Respiratory, Columns, Patient Care

Are You Graduating Competent Problem-Solvers?

EMTs and paramedics must be good problem-solvers to make sound clinical decisions in the complex, ambiguous prehospital setting. Seasoned paramedics solve problems by drawing on their accumulated knowledge and past experiences. Novice EMS personnel often cope with “textbook” calls, but struggle when faced with a messy, ill-defined situations.

So, how can you prepare students to solve tough issues? Problem-solving exercises in your classroom can include many activities. One example is to give students a standard problem with an algorithm. Then, vary the scenario so that the algorithm doesn’t quite fit and see how they manage the situation. Another way to help them develop their problem-solving skills is to use video-based products to present your students with situations that may be somewhat ill-defined and challenging to solve. For example, show a case from Mosby’s Virtual Patient Encounters and have them solve the standard case that is presented. Then ask them a “what if” question such as, “what if you knew this patient had a history of renal failure and had missed dialysis for several days before having this cardiac arrest?” Then have them solve the case with this new knowledge to see how they would resolve the problem.

Review selected calls after student clinical to see how problems were managed. Ask the class to identify whether other solutions were possible.

Chris Le Baudour of Sonoma, Calif. taught me a great problem-solving exercise I use in my EMS classroom. Student squads of three to four people have designated “on-call” class days. At some point during a class, they are “dispatched” by radio to a simulated emergency call. The squads deal with such problems as unsafe scenes, complex illness or injuries, equipment failures, pets and uncooperative patients. The exercise allows them to makes mistakes in a safe setting, yet the situations are real enough to cause flushed faces and shaking hands.

On one call they re presented with a patient (often one or our medics or past students) who is reluctant to communicate, but has a very helpful slightly intoxicated friend. If the squad manages the situation appropriately and moves the friend to another room, they re able to discover that the patient is suicidal. If they fail to check for the presence of hazards before they put the patient in the ambulance, they miss the large, fake knife hidden on the patient. After the call, we discuss the good and not so good communication skills the squad used. We always invite the patient to our debriefing. The patient models offer great feedback about how they felt in the situation. In this case, if the squad has not discovered it, we have the patient reach down and pull out the knife — it s definitely a lesson they don t forget.

When we teach prehospital care skills such as splinting and airway management, we have clearly defined criteria to follow. Training our students to effectively solve problems is often more difficult to do — but it’s essential so they will be prepared to practice in the complex world of EMS.

Do you have a particular exercise or strategy that you use in your classroom? Please let us know! Send us an e-mail.