“Did you know that the number
of medication errors made by fire service EMTs in the US is twice
the rate of non-fire service providers?”
Imagine the look of awe and surprise from
the firefighters sitting in the group. Of course, the statement
was fabricated and not accurate and could have been used for any
EMS subgroup, but for me and my students it brought up an
important point. Do you believe everything you read and hear? Are
the skills and information you are presenting to your students
sound and based in research? Are you relying solely on your texts
and related instructor materials to instruct? If you are, you are
also likely teaching information from the way you were taught
that may no longer be accurate. In fact, few question the reasons
behind why and how we do the things we do.
For example, I recently sat in on an
advanced airway class where the instructor stated “Hold your
breath [when intubating]-when you feel the need for air,
your patient needs air too.” He went on to explain that the
time limit for intubation was 30 seconds. Had that instructor
reviewed more current research, he would have taught his students
that if properly pre-oxygenated, they have longer than 30 seconds.
He also would have taught that holding one’s breath during a
procedure doesn’t really contribute to performing that
procedure correctly, and actually increases the provider’s
anxiety.
Evidenced based practice has gained
popularity over the last several years, driven in part by
national organizations such as the American Heart Association who
are determined to assure that the skills being taught and
performed are reasonable and safe. In EMS, a majority of our
skills have been adopted from hospital settings. As we all know,
care provided in a controlled hospital environment is quite
different from that in the prehospital setting. Traditionally,
the researchers for much of the data used in EMS have been
physicians, and not necessarily providers who are performing the
skills regularly. As more and more EMTs participate in controlled
research studies, we will be able to provide better and better
care. The major goal of evidenced based practice is to advance
the standard of care and to improve patient outcomes. As
instructors, we should be committed to not just teaching current,
contemporary practice, but rather to elevate the quality of the
profession’s practice. (After all, current practice may not
be correct!)
There are several ways to integrate
evidenced based research into your teaching. One of the
techniques I have used in my classes is to actually ask the
students to “prove,” through a literature review, a
certain EMS skill. For example, I might say, “Provide me
with three research articles that show that the use of a KED unit
improves outcomes in spinal cord injured patients,” or
“Find three articles that indicate that prehospital patients
do better with non-rebreather oxygen as compared to patients
oxygenated with cannula,” or “Find a research study
that demonstrates that patients cared for by EMTs from rural,
volunteer services (or fire services or critical care services)
have better outcomes than the national average.” Students
quickly discover that much of the research does support the
skills we do, but occasionally are actually refuted by sound
research. They also discover that there is very little research
available on many of the skills we do regularly. Requiring
students to do this literature review allows students to focus
their care on outcomes, as compared to the national averages.
Another neat thing that has occurred from this exercise is that
students learn that even people from Maine do research and
publish articles. One of the perks for me is that I also learn
about the newest and latest research being done.
The second way to assure that you are
teaching up-to-date material is to do your own research review
prior to a class and to commit to sharing one piece of research
on the current topic for each class. For example, last week I was
teaching IV therapy. I did a quick search on the effectiveness of
drawing blood through the IV catheter for use by the ED and
learned that hemolysis rates are higher using some brands of IV
catheters. The article I brought into class supported the text,
and I was able to be a role model for the students on the
importance of using current data to improve patient care.
Finally, it is important to note that
evidenced based research doesn’t mean that we have to
completely change the way we practice. A lot of what we do is
already accepted as the standard. Rather, evidenced based
teaching simply involves a critical analysis of what we are doing
to assure that we are teaching is contemporary, accurate, and
based on sound research. As faculty, we are accustomed to
performing outcomes assessments. The regional coordinators track
our National Registry pass rates, we monitor attrition and
retention for our programs, and we are continually striving to
improve our teaching. Utilizing research should be just one more
step in assuring quality instruction.
For more information on research and
evidence based practice in EMS, try these web sites:
© 2004 by Jacqueline B. Vaniotis and Daryl Boucher