Most, if not all, EMS educational programs have faced some type of necessary adjustments due to the COVID-19 crisis. Many have moved to an on-line or education at a distance format to deliver didactic material to their students.
So, what happens next? While the didactic portion imparts the cognitive knowledge to the students and can be accomplished in many formats, psychomotor skills are difficult, if not impossible to effectively conduct at distance.
As the country moves to slowly reopen, colleges and educational facilities will begin to allow students back on campus. The first groups of students will undoubtedly be from public safety and allied health programs.
A Blueprint to Reopen Labs
Psychomotor skills are a cornerstone to EMS programs. The ability to demonstrate skills to the students can take place remotely, actual hands on guided practice and the assessment of competency necessitates meeting with students face-to-face in most cases.
The following are best practices in re-starting the Lab experiences:
- Communicate early and often with college or
- Most college leadership lack the understanding of EMS education and the importance to the community to continue to provide competent entry level providers. Leaders in the academic world come from diverse backgrounds, those who come from other backgrounds besides allied health may not comprehend the importance of lab sessions. This needs to be explained to them early and often to get buy-in from administration.
- Develop a plan to re-open labs, while still maintaining CDC, local and state guidelines.
It goes without saying that EMS providers are necessary employees on the frontline of the battle with COVID-19. Many states have classified EMS education along with other allied health programs as being essential. The following are some best practices to be used during lab experiences.
- Limit the number of students in each lab.
- Lab equipment should be deployed and setup prior to student arrival to prevent bottle necks in storage rooms.
- Students should be divided into groups of 5 or less (groups may have staggered start times to prevent co-mingling between groups).
- Students and faculty should fill out a Covid-19 screening questionnaire and have their temperatures taken prior to participation in lab.
- Students should report to the room assigned and not have interactions with other groups of students or faculty.
- A single instructor should stay with the same group for the entire time period.
- Students should maintain six feet of separation during lab stations.
- Only large classrooms should be used unless it is one-on-one student testing in a simulation area.
- Mannequins should be used for procedure practice and simulations whenever possible.
- All mannequins and equipment will be disinfected between student use.
- Students will wear appropriate PPE including masks and gloves.
- Student groups should take appropriate breaks and meals at different times. The use of community refrigerators and microwaves should be avoided if possible to prevent bottle necks.
Hospital Clinical Rotations
For many EMS programs one of the first adjustments that took place were hospital rotations. Hospitals were faced with uncertainty early in the pandemic and the first reaction was to limit any non-essential provider-patient interactions.
This reaction was two-fold, the first was to limit that possibility of infection of the student, while the second was to maximize the use of available PPE. As the supply of PPE increases over time, hospitals will be become more willing to reintroduce paramedic students. Communication with the education department at the hospital early will open an essential line of communication.
Most EMS educational contacts are located within the Nursing Education Department. Aligning the programs timeline with that of nursing program students into the hospital clinical environment will result in the in a timely re-entry into hospital clinical. Selection of what hospital units to utilize may become an important consideration.
The Emergency Department will be the likely choice for initial re-entry. The staff in the emergency department knows the important roles of paramedics and procedures they can perform. Involving the program medical director may help in this process. Other units that may be more problematic include the operating room and Labor and Delivery.
Nationwide, operating rooms have decreased their procedures on guidance of the American College of Surgeons to help deal with the COVID-19 surge. Currently, only patient requiring critical interventions are being taken to the operating theater. These patients are less likely to be candidates for paramedic students to perform interventions on.
As more elective type surgeries increase in the coming months, the re-introduction of paramedic students will become more likely. Obstetrics and Pediatric units are always difficult placements for paramedic students. These areas may be the last to come back online. The use of high-fidelity simulation may be a substitute in these areas.
Field Internship/Ride Time/Capstone Clinical Experience
This may be one of the most challenging hurdles to overcome. Many internship experiences have been put on hold during the pandemic. Students nearing the end of their program are left wondering when they will be able to complete their education and move on the credentialing phase. Many of the agencies that have suspended student ride-time have done so due to shortages in PPE.
As this becomes more available, agencies will again start to re-engage students. Adjustments in number of the number of hours, patient contacts and procedures may be adjusted per CoAEMS guidelines. Ultimately, the goal of preparing competent entry level EMS providers is still essential. The path that the program takes may vary from the past, but the goal still needs to be maintained even in these times.
During these unprecedented times, we have all come to accept that it’s not business as usual. This also is true with EMS education. The Committee on Accreditation of Educational Programs for Emergency Medical Services Programs (CoAEMSP), The National Registry of EMT’s (NREMT), along with most state level EMS authorities, have allowed modifications to programs. The CoAMSP have provided recommendations and toolkits for programs to utilize as they navigate through the process. These modifications include the use of high-fidelity simulation in the determination of competency during clinical and field portions of the program.
The NREMT has suspended the psychomotor exam at all levels until the resumption of normal operations. This will allow graduates to complete the cognitive examinations, and if passed, be granted a conditional certification until such time as psychomotor exams can resume.
Providers granted this exception would need to complete the psychomotor exam later. Many states have adapted regulations and provided guidance for current and future programs. Prior to implementation of any of these alternative plans, consultation with the program medical director and the advisory committee should be consulted.
Any changes approved should be documented in minutes of the Advisory Committee minutes. Modifications made should be reflected in any measurement tools utilized by the program.
During these turbulent times, while faculty and administration struggle with how to complete the needed EMS education programs, students may be left in a dark abyss. Communication with students on a regular basis is paramount as programs restart. Keep the students informed of how the program is changing to meet their goals.
Some students may feel uncomfortable returning to the clinical environment at this time. Have a re-entry plan for them if this is the path they need to take. Above all be honest and transparent. It’s OK to not have all the answers, be open to suggestions from students and understand their concerns.