PMA News
Professional Medical Associates would like to take this opportunity to thank all the service directors, hospital managers, assistant instructors and preceptors for their assistance in the past few years. As PMA moves into its fourth year, we look forward to continuing to work with all of you. On behalf of our students ..... THANK YOU AGAIN !!!!WHAT'S NEW IN THIS ISSUE??
Starting with this issue, hyper links have been added to make it a little easier to navigate around the newsletter. Again, thank you for the feedback and suggestions - we look forward to your comments.NEWSLETTER CONTENTS
EMT-Paramedic Update/Refresher
Professional Medical Associates is pleased to add another accomplishment to the list of firsts for our students and practicum partners - the EMT-Paramedic Refresher Program. The need for it that has been voiced for a long period of time. The refresher program is targeted to current ALS providers to ensure skills and knowledge are current. The program is offered in a modular format, consistent with our commitment to flexible delivery of all of our programs.The program has recently been submitted to the Alberta College of Paramedics for review, and results will be announced as soon as they are received.
The program parallels the extremely successful PMA EMT-P program and presents the program in a body system-based approach so information can be reinforced and assimilated more easily. The program includes components such as ACLS and BTLS, but focuses on the range of patient populations and conditions the EMT-P is faced with. The refresher program is an attractive alternative to completing an entire year of education and is targeted to the specific needs of participants. Pre-course exams and assessments allow the program to concentrate on any identified weaknesses.
The program has been utilized in a pilot format recently as a portion of the preceptor appreciation program in partnership with one of our ambulance service practicum sites.
PMA Continues To Answer Student Needs with Unprecedented Success
PMA EMT-Paramedic Program
The EMT-Paramedic Completer Program formed the final link in the seamless curriculum from EMR through to the EMT-P level, first available from Professional Medical Associates. The focus was simple - meet the needs of practitioners and the ambulance profession to streamline the education and training of students so they can continue their employment and remain in their communities. It is also of note that all programs from Professional Medical Associates rely solely on our students and partnership arrangements with our ambulance services and hospitals. Unlike other training organizations, Professional Medical Associates, nor our students, receive base funding from the government. While this may cause the programs to be more expensive, it also forces the Professional Medical Associates' team to ensure the needs of the students are met. One of the cornerstone strengths of the program, aside from the total length, is the ability of the students to maintain current employment while upgrading their education.Program faculty possess a wide range of educational experience including experience as former instructors with other post-secondary institutions in Alberta. The program's strength relies on small instructor to student ratios to maximize practical experience, and ensure instructors are readily available should questions arise. In initial programs, student to instructor ratios of 2 to 1 or 3 to 1 produces graduates that have been well received by practicum sites. Students with extensive experience as EMT-A practitioners removes much of the need to review EMT-A information and produces EMT-Paramedic graduates well suited to the changing face of EMS in Alberta.
Program feedback from students, graduates, our preceptors and practicum partners allows Professional Medical Associates to maintain our "Commitment to Educational Excellence" and reports regarding the EMT-P program and the results have been extremely positive.
In response to the needs of our students, Professional Medical Associates has finalized the site for the next PMA EMT-P program; the program will run out of St. Albert. The initial plan was to offer the program in a Southern Alberta site, though the vast majority of applications where from more northern communities. The Southern Alberta site will be attempted for the next program, but will be dictated by the needs of our students. Information on the next program, likely centered out of Southern Alberta is available through the office or email - registrar@promedics.org.
EMT-A Partnerships Continue to Grow
Medicine Hat and High River
PMA is pleased to announce the successful completion of the didactic potions of the latest EMT-A Completer partnership programs - Medicine Hat and High River. With the great assistance of the respective ambulance services, Medicine Hat Ambulance Service and Highwood EMS, the courses provided local students the opportunity to advance their EMS careers. At the time of printing, the students were eagerly beginning their hospital and ambulance practicums. Professional Medical Associates would like to extend our appreciation, on behalf of our students, to all the ambulance services and practitioners that worked to make the programs successful. Our appreciation goes out to our primary instructors Lynn Long for the High River EMT-A completer program and Krista Bailey, Scott Mullen, Sepah Mazhloun and Kevin Walcer for the Medicine Hat EMT-A Completer program.We would also like to take this opportunity to once again thank those ambulance services and hospital sites that have graciously allowed our students to gain valuable practical experience within their respective organizations. The support for our programs, and for our Preceptor Appreciation initiatives continues to grow and is greatly appreciated.
New Partnership Initiatives - Vermilion and Fort McMurray
The latest partnership initiatives to be finalized include an EMT-A completer Program in partnership with Syncrude Canada in Fort McMurray and the second program in conjunction with the Vermilion Valley Ambulance Service.Both programs will offer local students the opportunity to continue their EMS careers, and the ability to partner with the two organizations to provide instructional space, instructional resources and assistant instructors. Partnerships such as these two offer some significant benefits for the students as well - utilization of local assisting instructors helps to contain costs which are then passed on to the students.
Progress reports on the Vermilion and Fort McMurray programs will be available in future editions of the newsletter as well as regular updates on progress of the programs is available on the Professional Medical Associates' web site at www.promedics.org. Stop by and comment on the site.
EMT-A Update
Final site selection is based on the number of applicants from areas sponsoring the program to maximize employability. Negotiations are currently underway with a number of rural ambulance service partners regarding assisting in hosting the program, and the obvious benefit to the EMR practitioners that reside in the communities. The next EMT-A program has started in St. Albert, and the partnership programs are set to start during the last week of February.The selection process involves completion of a multiple choice examination, completion of a scenario, and a personal interview for each applicant. Applicants must also supply a copy of their APPA EMR registration, BCLS - Level C within the previous 6 months, and resume detailing work and educational experience. Other supporting documentation includes letters from EMS related employers and other registered practitioners. To date, the selection process has been extremely successful. In fact over 95% of our students complete the program and all grads have been successful on the APPA Provincial Registration Examination.
Program Feedback
PMA continues to send our feedback surveys to our preceptors and Service Directors. The surveys form a portion of the Quality Improvement Program of Professional Medical Associates. This ensures our graduates meet the needs of the ambulance profession, and they are prepared for their hospital and ambulance rotations.The results are extremely positive, and we would like to thank the preceptors for taking the time to assist us in improving our programs even further. With the assistance of our preceptors and our Quality Improvement Program, PMA can continue to work to improve upon the success of our graduates on the Provincial Registration Examinations. Even though over 95% of our graduates are successful on the EMT-A Provincial Registration Examination, there is still some work to be done to reach complete success. Our Commitment to Excellence and the assistance of our preceptors and our practicum partners allow us to continue to improve and continue to strive for 100% success in the next few examinations.
Survey Responses
The following is a sample of the responses we have received on our program surveys for EMT-A and EMT-P: | "very kind and professional with all patients and families. Very supportive and understanding. Easy to work with as part of the team. Will make a good EMT-A." |
| "the delivery method ... very much hands-on as opposed to only the ++++ book work of other programs" |
| " very well done" |
| " above average - overall preparedness of your student was good" |
| "overall student readiness was strong with strongest points being anatomy and physiology as well as pathophysiology" |
| "Of all the students that I have had the pleasure to be their preceptors, I will always remember ... that stood out superior to any other student. I also think this program (EMT-P) has excellent instructors and course objectives." |
EMT-A Competency Assessment and Maintenance Program
The final changes have been made to the pilot competency assessment program for EMT-A practitioners. Following a few trial sessions, the program is ready to be delivered to existing practitioners through our preceptor appreciation program. The program has two goals. The first, from the services perspective, is to have a third party assessment completed of the staff, and second, to identify areas that would benefit from continuing education of competency maintenance sessions.The process involves completion of an extensive multiple-choice examination, as well as a practical scenario and skills stations on a variety of BLS skills. Upon completion, reports are generated that identify individual members' strengths and areas for improvements. The process is based on the most recent competency document through APPA. The program includes Section 12(1) skill knowledge, though this can be removed from the process as required.
The competency assessment program is another of the exciting and practical initiatives that has been developed in response to the request of our ambulance service partners throughout the province. In addition, the program can be attended by current EMT-A practitioners that are curious to discover how their competency compares to other practitioners. The program has served as an excellent tool for service directors to review the continuing education needs of their department and practitioners. Empowered with this knowledge, PMA can assist in developing education programs to target specific needs or issues.
EMR and EMT Refresher
The EMR and EMT-A refresher programs have been well received by students and service directors alike. The programs can be offered either on site or our offices, depending on the need. The next program is starting in March 1998. Contact the office for specific information, or call the 24 hour support line at (800) 571-5355.Preceptor Awards - Better for '98
The draw date for the latest award was December 30, 1997, and is a complimentary spot on our Preceptor Appreciation Program for our next ski trip. The ski trip has been planned for April 10th to the 13th, 1998. We were looking at a number of potential spots including Whitefish, Montana and either Panorama Resort or Big White in Kimberly, BC.With the shape of the Canadian dollar, we have decided to look at BC, and we are expecting an even better trip than last year's excursion to Whitefish. At this point, Panorama is a 99 % certainty, though we want to get the best package price for our students and preceptors. By the time the newsletter is delivered, final details will be available on our web site by calling the office anytime.
With the level of support that we have received from ambulance and hospital preceptors as well as ambulance service directors and hospital site managers, the preceptor appreciation program has been expanded. Professional Medical Associates on behalf of our students, is now drawing for 4 spots on our next ski trip, 2 for ambulance preceptors and 2 for hospital preceptors.
Our congratulations to the latest winners of the ambulance preceptors appreciation award goes to Chris McIntosh of the City of Calgary EMS Department and Bruce Wade of Wetaskiwin EMS Limited. Our winners of the two spots for the hospital preceptors are Charlene Descalchuk of the Wetaskiwin Regional Health Center and Marilyn Gusa of the Stony Plain Health Center.
Our preceptors add an extremely valuable perspective for the students . We are extremely proud of our preceptor appreciation and partnership programs. The PMA commitment to our preceptors is to ensure the preceptors have all required support, where and when they need it. PMA continues to improve on our appreciation and support program that benefits all three parties, the service, the preceptors, and most importantly, our students. As a reminder, you can reach the on-call practicum facilitator 24 hours a day at 1(800) 571-5355 or you can send email - james@promedics.org.
Spring Appreciation Ski Trip
The next preceptor event is our annual ski trip, and it looks like the destination is Panorama with its on-hill accommodation and fantastic choice of runs for all levels of skiers. There is even enough to do to keep the non-skier busy from April 10th to the 13th, 1998. The package includes 3 nights accommodation at your choice of hotel or private condo on the hill. The trip also includes return transportation from both Calgary or Edmonton as well as transfers around the area and a 2 day lift ticket. Additional days skiing or night skiing packages are also available, as well as the special non-skier package for those that just want to get a way for a few days in the beauty of the BC Interior.Prices start at $215.00 per person for the Pine Inn
Hotel and $235.00 per person for the Horsethief Condos, based on quad occupancy.
The prices do not include the preceptor appreciation subsidy, preceptor
pricing is available from the office. By the time the newsletter is delivered,
all prices will be finalized, though there is a remote chance there may
be some changes. For more information, please contact the office or check
out all the details for the ski trip. Availability is limited so make you reservations today, toll-free at (800)
665-6836.
| HOTEL | ROOM | PACKAGE PRICE |
| PINE INN | ||
| Double Occupancy | Standard Room | $ 265.00 per person |
| Quad Occupancy | Standard Room | $ 215.00 per person |
| HORSETHIEF CONDOS | ||
| Double Occupancy | 1 bedroom unit | $ 340.00 per person |
| Quad Occupancy | 1 bedroom unit | $ 235.00 per person |
| Six Person Occupancy | 2 bedroom unit | $ 240.00 per person |
| Eight Person Occupancy | 3 bedroom unit | $ 230.00 per person |
Continuing Education
You are called to a residential neighborhood where a local youth has telephoned 911 because there is a person passed out in the alley. While you are responding, you request more information from dispatch. Dispatch tells you that they were unable to obtain any further information regarding the patient or the situation but they are able to tell you that the caller thought that the patient was unconscious but breathing. Based on the information available, you request police assistance, and they are dispatched and should be there on your arrival.As you arrive, you are met by the police. The scene is safe, though you have parked the ambulance in such a manner that the scene lights are not illuminating the scene. You notice a young male in his 20's, lying supine in the alley. As you approach, you note that the patient is unresponsive to all stimuli and is breathing at 8 per minute with snoring respirations.
EMR
1. Your first action should be:
a) NRB at 15 LPM
b) size and insert NPA
c) assure adequate airway, insert OPA
d) take vitals
2. You should next assess:
a) circulation at radial and carotid
b) listen for heart sounds
c) circulation at carotid and brachial
d) ventilation rate and assist with ventilations
You have an OPA in place as well as assisting ventilations at a rate of 15 per minute with 100% oxygen. The next step in the assessment has also been completed and you find the patient to have a strong pulse, of 56 per minute at both the radial and the carotid.
3. The next step in the assessment is to:
a) remove wallet for ID
b) do a rapid primary assessment
c) do a focused history d) check
pedal pulses
The remainder of the primary survey reveals little more information regarding your patient. The only obvious abnormalities are scars to the patient's wrists and arms along with recent track marks and pinpoint pupils. With this information the mnemonic, AEIOU TIPS flashes through your mind.
4. Based on AEIOU TIPS, the possible problem is most
likely related to:
a) alcohol b) insulin
c) overdose d) underdose
Based on the presentation of the patient, you have
already called for ALS backup which is now pulling up on scene. Now that
the primary survey has been completed and you have performed all critical
interventions, you move to begin the next phase of the assessment and your
partner continues to question bystanders and others to gain any history
that is available regarding the patient.
5. Your next step while continuing care should be
to:
a) patch to hospital b) stop ventilations
c) obtain vitals
d) congratulate the other crew for such a rapid response
EMT-A 12-1
As EMT-A's with the above information, you start
an IV of normal saline 1000 ml TKVO as a medication route for the paramedics
and take a blood glucose level from the needle.
6. A sample taken from the intravenous needle is
the best and most accurate source of blood for a blood glucose level.
a) true b) false
While awaiting ALS to have their equipment ready to take over patient care you continue to assess and mange the patient. Once vitals and interventions are performed, your partner attaches the cardiac monitor and obtains a Lead 2 tracing identified in Figure 1.
7. The rhythm identified in Figure 1 is:
a) sinus rhythm
b) first degree block
c) sinus bradycardia
d) junctional bradycardia
Upon confirming your interpretation of the cardiac
monitor tracing with the ALS crew you note that it is now time to read
the glucose reading taken earlier. The patient presents with a blood glucose
level of 2.1 mmol/l. Your partner also finds a medical alert card in the
patient's wallet that indicates the patient is an insulin dependent diabetic.
There is an additional card that indicates other pertinent history that
includes a history of psychiatric disorders as well as a bottle of Tylenol
#4 in his jacket pocket that is empty. You believe he may have taken up
to 40 tablets.
8. What is the normal range of blood glucose level for the typical male patient?
a) 4 - 6 mmol/dl
b) 4 - 8 mg/dl
c) 4 - 6 mmol/l
d) 4 - 8 mmol/ml
Since the patient has a history of diabetes and is presenting with a decreased level of consciousness and a low blood sugar level it is decided to manage the hypoglycemia.
9. To manage the hypolycemia, what is the dose of
D50W that you will administer?
a) 0.5 mg/kg SIVP
b) 25.0 mg SIVP
c) 25.0 g SIVP
d) 1.0 mg/kg to a maximum of 25 mg SIVP
ALS
10. Based on the suspected ingestion of a large
number of Tylenol #4, while of the following is most consistent with an
overdose on the medication?
a) dilated pupils
b) tachycardia
c) constricted pupils
d) hypertensive crisis
It is decided that it would be in the patient's
best interest to administer naloxone IVP, unfortunately as you were transferring
the patient to the cot someone stepped on the IV tubing which was then
removed from patient's arm.
11. What dose of Narcan would have been administered
assuming a patent IV?
a) 0.4 mg
b) 4.0 mg
c) 2.0 mg/kg
d) 2.0 micrograms
e) 0.1 mg/kg to max of 3.0 mg
12. Assuming that IVP is no longer a viable route
as there is considerable difficulty on starting another intravenous, naloxone
could next be administered in which of the following manners?
a) sublingual
b) intraoccular
c) direct arterial injection
d) intramuscular injection
13. The patient responds as you might expect but
after approximately 5 minutes his respirations and LOC decrease and patient
becomes more obtunded, another dose of Naloxone could be given. You now
have a patent IV line up and your dose may be:
a) 4.0 mg IVP
b) 0.4 mg - 2.0 mg
c) 0.1 mg/kg to a maximum of 2.0 mg
d) 1 g SIVP
14. Rapid administration of large or inappropriate
doses of naloxone may precipitate which of the following conditions in
a patient with a known drug history?
a) seizures
b) respiratory arrest
c) withdrawal symptoms
d) VT
e) a and d
15. How much codeine is present in each Tylenol #4
tablet?
a) 8 mg
b) 15 mg
c) 30 mg
d) 60 mg
Answer Key
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EMR course update
PMA is pleased to announce the conclusion of our latest programs, and assisting a number of smaller communities to set up initial response organizations. Programs currently running, or about to start, include those in St. Albert and Calgary as well as our continuing focus on rural needs with programs being finalized for northern and eastern regions in the spring. We are also gearing up to commence the next EMR programs in Calgary and St. Albert starting the latter part of April. Contact the office for specific details, or try the 24 hour support line at (800) 571-5335.
Alumni news
With graduates stretching from one end of the province
to the other, there is always something happening with our graduates. Got
something to share with everyone else? We'd be pleased to pass on the good
news - got a new career, promotion - had an interesting call? Let us know
and we'll try to include it in a future issue. To contact any of us, call
the office at 1-800-665-6836, facsimile at (403) 460-8277, or via e-mail
- james@promedics.org. We are always interested in what our students think
of our programs. If there is anything else you have thought of since you
completed the post-course questionnaire, feel free to let us know.
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