The authors implemented a hybrid-model EMT course in South Dakota and say they may have an answer to recruitment and retraining problems.

Abstract

Purpose: We aim to implement a hybrid-model emergency medical technician (EMT) course in South Dakota (SD) high schools. We also aim to identify student and course characteristics which are pertinent to program development to attract a young population into the field of emergency medical services (EMS).

Methods: Numerous high schools in Southeast SD were contacted and students were recruited to participate in this hybrid course. Enrolled students were queried before and after the class with a survey that supplied objective information about students and their opinions on specific course features.

Findings: High-achieving students were found to take the course most often; most students had GPAs of greater than 3.8 and were a part of numerous extracurricular activities. Many students also had family or close friends who were in the healthcare field. Course characteristics most valuable to student’s success was exposure to medical equipment and access to knowledgeable skills lab instructors for hands on activities.

Conclusion: As a result of this project, hybrid EMT training is now accessible to students who attend high school in South Dakota. Because most participants are heavily involved in extracurricular activities, it is important for the leaders of this project to implement targeted recruiting. It is also important to optimize availability of skills session equipment and instructors, which students deem most valuable to their success in the course.

Introduction

The EMT is a trained individual who responds to an array of healthcare emergencies outside of a clinical or hospital setting. They perform essential, life-saving interventions and rapidly assure higher acuity healthcare is obtained.¹

While EMT training has traditionally been in a classroom setting, a hybrid learning model has been employed in some regions of the U.S.²This hybrid learning model combines virtual academic lessons with in-person didactic training. Evaluations take place both virtually as well as in the presence of licensed instructors. In the state of South Dakota, we are aware of only two educational programs that offer a hybrid learning model for EMT certification. Neither of these programs specifically target high school students as potential course-takers. Developing a course targeted at high school students is difficult due to a lack of published material on this population. Additionally, the most valuable components of a hybrid EMT course have not been well characterized within academia.

Related

The purpose of this project was twofold. The first goal was to establish a hybrid EMT certification course which could be utilized by high school students in South Dakota. The second goal was to evaluate the EMT course in two ways. First, common attributes of students taking the course were assessed and second, course characteristics most valuable to student success were determined.

As a result of this project, we hope that EMS training might become more accessible to youth across the state, that recruitment might be more targeted for industry needs, and that individuals may be encouraged to join this profession as student opportunities increase.

Background

In the state of SD, the foundation of the emergency medical is provided by local, volunteer emergency medical response teams. Unfortunately, many communities lack the necessary workforce for emergency medical services.³

Of the 130 services who responded to the 2018 SD EMS Survey, 74% have 15 or less active members on their roster, and 48% of agencies have less than 11 active members.³ Ambulance staffing requires a minimum of two individuals to respond to respond to an emergency call. Because this requirement holds true at all hours of the day, throughout the entire week, this is a substantial time investment for members of small EMS departments, many of whom are maintaining a career while volunteering their time.

When the volunteer EMS agencies were polled in the 2016 SD EMS Survey, 68% stated that they had missed calls due to lack of staff availability, and 71% stated that they had experienced a delayed response as a result of staff unavailability.⁴Unfortunately, in some circumstances, these missed calls and delayed responses can negatively affect patient health and mortality.⁵

In addition to the lack of current EMS providers, the age of active providers in SD has increased in the past two decades. From 2000-2018, the state saw the median EMT age rise from 30 to 40 years old. Likewise, 21% of EMTs statewide were over 40 years of age in 2000, while 52% of EMTs were over 40 years old in 2018.³

The statistics reported above show that there is a need for more EMTs in South Dakota. Young EMTs are urgently needed to replace an aging population of technicians. One response to the need to fill a staffing shortfall is to involve local high school students in the process of becoming an EMT.

Methods

EMT Course Implementation

The hybrid learning platform utilized for this project combined digital resources available through the textbook publisher Jones and Bartlett Learning along with live in-person, hands-on skills lab opportunities. Prior to 2018, this platform had been used one time by Sanford Health for instructional purposes at a high school located in Harrisburg SD. In this project, however, the hybrid learning platform was employed more broadly to communities throughout SD with a primary focus on rural underserved regions.

More than thirty school systems in Southeast South Dakota were contacted by project coordinators to inform high school students and administrators of the opportunity for EMT education. At both the beginning and end of every semester, coordinators contacted school systems through various modalities: in-person conversations, phone calls, e-mails and poster distribution. In some instances, an information and display table would be set up during high school lunch periods or at the end of the school day. Students were then able to stop and personally gather information about the educational opportunity as well as discuss questions. In every instance that a community was contacted, school leaders were provided with a course description, a brochure about FAQs, and a registration packet. Information on scholarship opportunities was also provided to school leaders.

Academic credit for the EMT course varied based on the participating high school or school district. Many high schools awarded elective credit for student participation and completion based on the grade awarded by the EMT course director. College and university credit also varied by awarding institution. A common practice by state and private postsecondary institutions was to award three to four credits when a student presented their National Registry of Emergency Medical Technicians’ (NREMT) certificate to the registrar. Public institutions were more likely to award credit within the science disciplines, while private institutions appeared more likely to award the credits for a general elective.

Early in this project, a relationship was developed with leaders from South Dakota HOSA-Future Health Professionals (SD HOSA). SD HOSA administrators decided to financially support EMT education for high school students by providing scholarship opportunities to current club members who pursued training.

Program Evaluation

A survey was administered to characterize students interested in taking the EMT course and to understand essential components of the hybrid class.

To characterize students interested in EMT education, demographic data including students age, sex, GPA, education and career goals were collected. In addition to demographic data, students were characterized by the frequency of interactions with people in the healthcare field. Finally, students shared their perceived reasons for, and obstacles to, EMT training.

To understand the most important qualities of the hybrid EMT course, survey questions were designed to allow respondents to grade the value of major course components on a 1 to 10 scale. This scale identified a course component with a numerical score of one as “not valuable at all” and ten as “very valuable.”

Data Analysis

Descriptive statistics were visualized with a variety of graphs. Count data was illustrated with bar charts while box and whisker plots describe central tendency and dispersion of perceived value of course components. Analyses were performed in both Microsoft Excel and R with the help of the “tidyverse” collection of R packages.⁶⁷

Results

Dissemination of the hybrid EMT course opportunity was extended to students from more than 30 high schools across the state. Ultimately, sixteen students from nine high schools provided responses in the course survey.

Evaluation of Course: Students Characteristics

Sixteen students completed the survey. Seven students were male, and nine students were female. All were 17-18 years of age. Review of students’ GPA’s indicated that the majority of students had GPA’s of 3.8 and above.

Most students participated in numerous extracurricular activities with the average number of extracurricular activities being five per student. More than half of students had family members who were in the healthcare field (9 of 16), and all had family friends or other connections to the healthcare field. The frequency of interactions with people employed in healthcare, on average, was seven per person in a month. All students taking the EMT course planned to attend college while no one shared plans to go into the workforce or vocational school post-high school graduation.

In the survey, most students gave multiple reasons for participating in the hybrid EMT course. The most common answers included plans to serve as an EMT in the future and the desire to make their resume more competitive. Less common answers included participation in the EMT course for college credit and the hope to learn more about the healthcare field (Figure 1).

Figure 1. Student's Reason for Course Application

Evaluation of barriers to application also yielded common answers. Most students noted that they had two-to-three classmates that desired EMT training but could not attend the course due to various reasons. The most common barrier identified by the students for their classmate’s inability to participate was extracurricular activities (Figure 2).

Evaluation of Course: Course Characteristics

Figure 3 shows a graphical representation of the value that EMT students placed on various course components based on a 1 to 10 scale. The most vital attribute identified by students was the availability of skill session equipment and knowledgeable skills day EMS program faculty (both have a median value of 10). Least valuable to their success was a meeting prior to the course with medical students (median value of 4.5).

Box and Whisker Plots for Vital Components to Course Success

Discussion

The objective of reaching high school students across the southeast South Dakota was accomplished by this project. More than 30 schools were contacted and nine had students who participated. Our team is encouraged because continuous marketing of this opportunity will occur in the future as a result of relationships developed between school administrators and with state educational organizations such as SD HOSA.

In addition to the commitment made by SD HOSA to continue sharing the EMT education opportunity with high school students across the state, the organization states that they will continue awarding EMT scholarships to eligible students enrolled in the organization. Though they do not cover the full cost of the course, the availability of SD HOSA scholarships should help offset some of the financial burden identified by the students as an obstacle to participation.

The goal of discerning common characteristics among hybrid EMT course enrollees was also identified. Investigation showed that high-achieving high school seniors take the course most often whether male or female. This is exhibited by the fact that nearly all students had a GPA greater than 3.4, and the most common GPA was 4.0 or greater. All students planned to go to college, and the average number of extracurricular activities that students participated in was five. Although participating in extracurricular activities was a commonality among students, it was also found to be the most common barrier to course participation. Students noted extracurricular activities as the biggest barrier for both themselves and those considering taking the course. Despite this being the largest barrier, our team plans to refine recruitment methods to target students who are high achieving based on GPA and extracurricular involvement. One way to meet this goal is to reach out to the leaders of high school honor society groups.

Connections to individuals in the healthcare field also proved to be a distinguishing factor in students taking the course. More than half of students had a family member in the healthcare field and the average number of healthcare service members known by students outside of their immediate family averaged 17 per person. It may be that increased exposure to a career field increases likelihood for an individual to be interested in that line of service for future employment. However, we are not aware of the average number of connections to the healthcare field in the general population, so this hypothesis may not be true.

Through examination of the EMT course participants opinions, it was found that the most valuable portion of the course was the availability of skills session equipment for the purpose of practicing and having knowledgeable faculty instruction during skills days. Increasing accessibility to faculty who work directly with the Sanford Health Center for Prehospital Care might be beneficial, therefore, to increase student success in the course. Additionally, since instructors are limited, this team hopes to increase accessibility to skills session equipment by preparing kits for use at a local high school that could be checked out and later returned to the Sanford Health Center for Prehospital Care. An alternative to this option would be to pair the student with local EMS agencies for access to some of their equipment and for coaching.

Since the meeting with medical students prior to course initiation was not deemed vital to success in this training program, our team proposed utilizing medical students in the recruitment process and as skills day volunteer faculty instead. According to the results, elimination of the informal orientation meeting that was held with many of the students would not be a loss with respect to program design.

Limitations in this discussion must be noted. The enrollment in this course was smaller than anticipated likely due to the COVID-19 pandemic. Recruitment was difficult without seeing students in person, and because school schedules were changing frequently, students may not have felt the additional organization and responsibility associated with a hybrid course to be worthwhile. Because of the small sample size, the results are probably most useful as a general impression requiring further exploration rather than certainty. Further survey of EMT course takers will continue to provide information about the value of course components. Small changes in course delivery could be planned, but large changes may not be indicated, especially if there was broad range of opinion among participants.

Conclusions

Although the South Dakota EMS system has experienced recent challenges in recruiting and retaining emergency medical technicians, it is anticipated that a program of this nature will result in promotion of EMT as a career opportunity and increase EMT coverage across the state. Recruitment of young people for EMT education through the hybrid delivery model will continue in a sustainable manner because of partnerships developed during this project, and the EMT course survey developed in this project will be utilized annually to improve course administration. In 2021-2022, our team hopes to improve skills equipment accessibility for students participating in the course from large distances. Our team also hopes that diligence to training young people will result in statewide benefits, as made evident by the South Dakota EMS survey administered through SD Office of Rural Health. We hope to see increasing trends in EMT course enrollment, followed by increasing trends in the number of active EMTs, the utilization of younger EMTs, and improvement in slow response times which are currently plaguing many EMS agencies.

Declarations

Project Funding: Not applicable.

Conflicts of Interest: The authors have no conflict of interest to report.

Ethics Approval: The project was submitted for review by the University of South Dakota IRB, but it was not deemed human subjects research, and therefore IRB approval was deemed unnecessary.

Availability of Data and Material: Data may be made available upon request.

Authors’ Contributions: Each author was instrumental in project design, implementation, and authorship of the manuscript.

Correspondence concerning this article should be addressed to Riley Schaap, University of South Dakota Sanford School of Medicine, Sioux Falls SD, via e-mail at Riley.Schaap@coyotes.usd.edu, or via phone at 605-659-1952.

References

1. National Registry of Emergency Medical Technicians [Internet]. Emergency Medical Technicians (EMT); c2001-2021 [cited 2021 Jul 15]. Available from: https://www.nremt.org/EMT/Certification.

2. Boyer CT, Zielewicz J, Frailey G, Trueman M. Investigating the efficacy of a hybrid EMT course. Journal of Allied Health, 2019 48:4, 298-301.

3. South Dakota Department of Health, EMS Workforce Report 2018.

4. South Dakota Office of Rural Health, EMS Database Community Meeting Material for Oct-Dec 2018.

5. Gonzalez R et al. Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? American Journal of Surgery, 2006 197:1, 30-34.

6. Wickham et al. Welcome to the tidyverse. Journal of Open Source Software, 2019 4:43, 1686.

7. Wickham et al. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria 2019. Available from: https://www.R-project.org/.

Conducting and Evaluating a High School EMT Course