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Emergency Medical Specialists
PREFACE
I. Application
for Education Program Approval
Education programs
must be formally approved by the Michigan Department of
Public Health (MDPH)
prior to initiation of a course. Each education program
must have a sponsor,
as defined in the administrative rules.
The education
program sponsor, in conjunction with the physician director
and/or the
Instructor-Coordinator, shall be responsible for the following:
A. Curriculum
development, including clinical coordination.
B. Ensure that
clinical contracts are current and on file, and that quality
assurance measures
are in place, including patient confidentiality.
C. Evaluation and
selection of instructors.
D. Student
evaluation (for basic literacy and math skills, at a minimum) for
admission into the
program.
E. Clear and
detailed requirements for one to meet in order to complete the
program
successfully. These are to include grievance policies, P.A. 179
of 1990, rules and
regulations, and the instructional objectives.
F. Maintain and
assure the availability of adequate and functioning
equipment, including
training aids, classrooms, and a resource library.
G. Ensure that
practical examinations maintain an adequate student to
instructor ratio, to
allow for close observation of student activities, and are
in compliance with
the task analyses, which is part of this document.
H. Periodically
review student performance, and assist students, as
appropriate.
I. Maintain student
performance records, for a minimum of 5 years. At a
minimum, performance
records must include terminal event evaluation
tools.
J. Provide MDPH,
within 30 calendar days of the completion of a course
(classroom and
clinical sections), the names of students who have
successfully
completed the education program course.
K. Assuring student
competency of knowledge and skills at the EMT level.
L. Issue each
graduate proof of successful course completion.
General Provisions
Each education
program course shall:
A. Utilize clearly
stated behavioral objectives and performance criteria for
the didactic,
practical, and clinical activities.
B. Provide clinical
training in a hospital and a limited advanced, or advanced
life support agency.
Each clinical site shall be capable of meeting the
clinical educational
objectives developed by the Instructor-Coordinator.
Students who
complete an unapproved program course will not be eligible for
licensure.
An education program
approval shall remain in effect unless otherwise denied or
revoked by the
department as prescribed in the administrative rules. If a program
sponsor does not
offer a course for three consecutive years, the sponsor will
have to submit an
initial application for program approval.
Course Approval
Requirements
The application for
Approval to Conduct an Education Program (J-135), must be
completed with the
assistance of an Emergency Medical Services Instructor-
Coordinator (EMS
I-C). Required documentation must be included and
submitted to the
appropriate Regional Coordinator at least sixty (60) days prior
to the first class
session. Following review, the Regional Coordinator will
resolve with the
program sponsor (it's designee) any issues which may arise
concerning the
application. Programs meeting established criteria are submitted
to MDPH by the
Regional Coordinator for approval action.
The Education
Program Sponsor (or it's designee) will be formally notified by the
department, or it's
designee, of approval or disapproval. Program approval
affords the sponsor
authorization to conduct an education program at that level,
and approval to
conduct the first course.
Once a course has
been approved, the EMS I-C is responsible to provide each
student with, or
make available for their review and study, the following
information:
A. A copy of the
MDPH course approval
B. Specialist
program objectives
C. A copy of the
current EMS legislation; P.A. 179 of 1990 and
administrative rules
D. The requirements
which must be achieved to successfully complete the
course shall be in
writing, and provided to each student.
The education
program sponsor is responsible for notifying the Regional
Coordinator of any
modifications to their program schedule on the Addendum for
Approval to Conduct
an Education Program (J-135A). As Regional Coordinators
conduct periodic
on-site visits to evaluate courses, any changes to an approved
education program
must be reported.
Subsequent Course(s)
Requirements
An education program
sponsor may provide subsequent courses at any time
following initial
approval, by submitting an Addendum for Approval to Conduct an
Education Program
(J-135A). This form is to be completed with assistance of an
I-C and submitted
with a revised course schedule and a listing of the
current
clinical
contracts
to the appropriate Regional Coordinator at least thirty
(30)
days prior to the
first class session. Programs which continue to meet minimum
criteria shall be
submitted to MDPH by the Regional Coordinator for approval
action.
II. Program
Admission Prerequisites
The minimum
requirements for admission to a Specialist course is successful
completion of an
Emergency Medical Technician (EMT) course. However,
individuals wishing
to participate in the Specialist examination for licensure must
provide proof of
current or past Michigan licensure at the EMT level. Education
program sponsors are
expected to establish written admission policies and have
them available for
prospective students.
All eligible
candidates for licensure must be at least 18 years of age, at the time
of application to
MDPH.
III. Program
Staff
Emergency Medical
Services Instructor-Coordinator (EMS I-C)
The I-C for the
program must be licensed by MDPH and possess dual licensure
as a Specialist or
Paramedic. The I-C is the liaison between the class,
instructional staff,
program sponsor, physician director and MDPH or it's
designee. In concert
with the education program sponsor, the I-C is responsible
for completing the
application(s) for program approval and providing any
supportive
documentation required by the department.
Physician Director
Each education
program must have a physician director (PD), who possesses
current licensure in
accordance with department rules. Responsibilities of the
PD include provision
of medical expertise and assurance that current standards
of emergency care
are being presented in each course. Further responsibilities
are outlined in the
administrative rules.
Instructors
Course instructors
are to be selected by the I-C and PD. Each instructor shall
possess expertise
and background in the topic area(s) which they address.
Instructors are to
be provided with the appropriate lesson outline and objectives
in advance of the
presentation, and are to be thoroughly versed on the content
and limitations of
the topic they are to present. The Instructor-Coordinator and
program sponsor are
responsible to assure all program requirements are met.
IV. Licensure
Examination
Students who
successfully complete an approved course are eligible to
participate in the
examination for licensure, provided that they are in compliance
with the current
statute and administrative rules.
Following course
completion, the I-C must submit to the department a list of the
names of the
students who successfully completed the course. This information
must be submitted on
the Notification of Students Completing an Education
Program Course form
(J-122). This form must be signed by the I-C. I-Cs may
expedite the
licensure process by including with this form, completed student
examination/licensure applications, the appropriate supportive
documentation
outlined in the
application, and the respective fees. Those students who wish to
submit their
application directly to the department must include a copy of their
course completion
certificate along with the aforementioned documents.
Only those students
whose completed examination/licensure applications have
been received and
approved by the department on or before the first working
day of the month
that they wish to take the examination will be scheduled for
examination during
that month. Each I-C shall contact the appropriate Regional
Coordinator to
arrange for the licensure examination. Approximately two weeks
prior to the
examination, the Regional Coordinator will contact, by mail, each
applicant with the
examination date, time and place, unless specific
arrangements have
been made between the I-C and the Regional Coordinator.
Questions regarding
these requirements should be directed to your Regional
Coordinator.
V. Course Length
and Organization
The initial course
must comprise a minimum of 100 clock hours. This includes
didactic
presentations, practical demonstrations, skills practice and clinical
experience. The
sequence in which lessons are presented is left to the
discretion of the
I-C. It is expected, however, that Topic 1 (Introduction,
Roles/Responsibilities of the Specialist, Medical/Legal
Considerations, EMS
Systems Operations)
will be presented first. The student is
responsible for all
information in
the current EMT Objectives.
VI. Lesson
Outlines and Objective Format
The information
included, in conjunction with the EMT objectives, is required in
order to meet the
established educational objectives for a Specialist education
program. I-Cs and
other instructors shall use this minimum required material in
their education
programs, as the licensure examination is based on these
objectives.
Note: The
enclosed material is a supplement to the EMT Lesson Outline
and Objectives
and should not be used without them.
Text
The choice of text
and/or handout material is left to the discretion of the program
sponsor and I-C.
To allow flexibility
in choosing a preferred text, program objectives were
developed to ensure
consistent minimum education standards, in conjunction
with the educational
objectives for the EMT, and are to serve as the foundation
for course
development. The following have been utilized in the development of
the educational
objectives:
Cardiopulmonary
Resuscitation: American Heart Association
American Red Cross
Pediatrics:
Pediatric Emergency Management
Curriculum-
MDPH/EMS-C Project
Trauma: Basic Trauma
Life Support/Advanced -
Brady
Pre-Hospital Trauma
Life Support -
Mosby
Other Specialist
Topics: Advanced Emergency Care for
Paramedic Practice -
Lippincott
Emergency Care in
the Streets
Fourth Edition -
Little, Brown
Paramedic Emergency
Care
Second Edition -
Brady
Mosby's Paramedic
Textbook - Mosby
Task Analysis:
The skills that the
Specialist will minimally be able to perform are broken down
into an abbreviated
task analysis format for the instructor and student. The
instructor may
modify the format as needed for practice and testing purposes.
The skills are
identified in this manner instead of a psychomotor objective
format.
The student is responsible for all EMT skills as well
as specific
advanced level
skills. The specific advanced level skills (from the
Paramedic
Objectives) are included in this curriculum for convenience in
duplication of
this document.
VII. Curriculum
Format
The Specialist
Objectives include specific topic areas that are a review of the
EMT level topics or
are new material from the Paramedic curriculum. The
instructor is
responsible to identify for the student that all patients should have
consideration for
vascular access, fluid volume management and advanced
airway management,
as appropriate. Objectives, specific for Specialist level
practice, have not
been written for all topic areas to illustrate that point.
Topic Format
See Example Page
Following
#1
Title:
Each topic is titled
listing the major subjects included in the topic. The first page
of each topic
includes the publishing date. As topics are updated, a new date for
the topic will be
posted in the upper right corner. The page numbers at the
bottom of each page
include the topic number and page number within the topic.
#2
Opening
Statement:
Each topic has an
opening statement that is similar. This statement identifies the
expected performance
of the student. Multiple performance verbs are used
since the student
will have their performance evaluated at many different
learning levels.
#3
Related
Information:
Each topic
identifies what related topic areas and task analysis should be
referenced when
covering that topic.
#4
Definitions:
New terms are
defined at the beginning of the topic. The exception is when a
term is defined
within an objective statement, if it is more appropriate within the
flow of the outlined
material.
#5
Outline and
Objectives:
The topic is
outlined with subject headings identified by bold print. Most
often
the topic heading is
followed by objective statements. These objectives are
numbered by the
topic number followed by the objective number.
#6
Outline Only
When a outlined
subject heading is given with no objective statements following,
it indicates the
objective information is covered in the EMT Lesson Outlines and
Objectives, or
elsewhere in the Specialist document.
EXAMPLE TOPIC
PAGE ONE
7/1/95
#1 Specialist
6: FLUIDS AND ELECTROLYTES,IV THERAPY, SHOCK
#2 LESSON OUTLINE
AND PERFORMANCE OBJECTIVES:
According to
Specialist lecture presentations, assigned readings, practical lab and
clinical
assignments, the student will be able to state, describe, choose,
demonstrate,
analyze, prescribe, evaluate, etc., the following, including
information
addressed in:
#3 EMT
Objectives: IV Maintenance, Shock
Anatomy and
Physiology
Patient
Assessment
EMT Task
Analysis: PASG: Application/ Inflation
Paramedic Task
Analysis: Airway Management, Oxygen Therapy, Ventilation
Drug and Fluid
Volume Calculations
Peripheral
Intravenous Lines
#4 Definitions:
To meet the
objectives of this part, each student must be able to define and
understand
related terminology.
The student is responsible for all EMT terminology in related
sections.
The following terms
are not intended to be all-inclusive.
1. Anion: An ion
with a negative charge.
2. Cation: An ion
with a positive charge.
OUTLINE AND
OBJECTIVES
#5 I. Fluids and
Electrolytes
A. Water
Distribution
6.1 The two (2)
compartments of total body water (TBW) are:
a. Intracellular
fluid
b. Extracellular
fluid
#6 B. Movement of
Water, Solutes
1. Osmosis
2. Diffusion
6-1
SPECIALIST
EDUCATION PROGRAM
TOPIC AREAS
TOPIC TITLE
REQUIRED
MINIMUM HOURS
1 INTRODUCTION,
ROLES/RESPONSIBILITIES OF THE SPECIALIST, 2
MEDICAL/LEGAL
CONSIDERATIONS, EMS SYSTEMS OPERATIONS
2 TELEMETRY/
COMMUNICATIONS
2
3 PATIENT ASSESSMENT
4 TRIAGE 10
5 RESPIRATORY
EMERGENCIES, CHEST INJURIES
ACID-BASE BALANCE
AIRWAY MANAGEMENT,
OXYGEN THERAPY 24
6 FLUIDS AND
ELECTROLYTES, IV THERAPY, SHOCK
20
7 INTRODUCTION TO
PHARMACOLOGY
2
8 CARDIOVASCULAR
SYSTEM
2
9 CENTRAL NERVOUS
SYSTEM
10 OTHER TRAUMATIC
INJURIES:
BLEEDING & SOFT
TISSUE INJURIES, 2
MUSCULOSKELETAL
INJURIES,
FACIAL INJURIES,
ABDOMINAL INJURIES, BURNS
11 ACUTE ABDOMEN
12 DIABETES 2
13 COMMUNICABLE
DISEASES
0
14 BEHAVIORAL
EMERGENCIES
0
15 POISONS,
SUBSTANCE ABUSE 0
16 THE GERIATRIC
PATIENT
1
17 OBSTETRICAL/
GYNECOLOGICAL EMERGENCIES
0
18 PEDIATRICS
2
19 ENVIRONMENTAL
EMERGENCIES
1
20 HAZARDOUS
MATERIALS
0
21 STRESS MANAGEMENT
IN EMS
0
MINIMUM REQUIRED
TOTAL CLASSROOM HOURS =
70
CLINICAL HOURS =
30
______
MINIMUM TOTAL
REQUIRED PROGRAM HOURS =
100
NOTE:
Many
topics overlap and hours may be distributed over various lecture and
practical sessions.
Time for comprehensive final student evaluation is not included in
total required
program hours. It is mandatory to evaluate student performance
throughout the
course, including comprehensive final didactic and practical
examinations.
All Specialist
programs must have the minimum required 70 classroom hours
and 30 additional
clinical hours. The minimum total required program hours, to
receive course
approval, are 100 hours.
At least 30 of
the 70 classroom hours is to be used for introduction and practice
of skills.
Specialist
CLINICAL OBJECTIVES
At a minimum, the
Specialist student shall complete 30 hours of clinical experience. The
clinical
experience shall
include the Emergency Department (minimum 8 hours) and Limited
Advanced or
Advanced Life
Support Vehicle (minimum 8 hours) rotations. Although other clinical
areas, such as
Operating Room,
Intensive Care Unit, Phlebotomy Team, Intravenous Team, Geriatrics,
Pediatrics,
Labor and Delivery,
Psychiatric Unit,and Respiratory Therapy are desirable and strongly
encouraged, they may
not be practical in some medical facilities.
The
Instructor-Coordinator should develop a list of clinical objectives to
be demonstrated, observed
or discussed by the
Specialist student during this portion of the program. These
objectives should
be specific to the
clinical area. Minimum objectives for clinical rotations in the
Emergency
Department and
Limited Advanced or Advanced Life Support Unit are listed below.
These are a
supplement to
the clinical objectives in the EMT curriculum.
Upon completion of
the clinical section of the education program, the Specialist student
will have
demonstrated,
observed, or discussed:
1. The appropriate
method for maintaining a patent airway, including esophageal
obturation,
endotracheal
intubation and esophageal double lumen airway.
2. The proper
technique for starting an IV, maintaining patency and rate, and
discontinuing the
IV, while
maintaining sterile technique.
11
SPECIALIST
REFRESHER PROGRAM
TOPIC AREAS
TOPIC TITLE
REQUIRED
MINIMUM HOURS
1 INTRODUCTION,
ROLES/RESPONSIBILITIES OF THE SPECIALIST, 1
MEDICAL/LEGAL
CONSIDERATIONS,
EMS SYSTEMS
OPERATIONS
2 TELEMETRY/
COMMUNICATIONS 1
3 PATIENT ASSESSMENT
4 TRIAGE 6
5 RESPIRATORY
EMERGENCIES, CHEST INJURIES
ACID-BASE BALANCE,
AIRWAY MANAGEMENT,
OXYGEN THERAPY 15
6 FLUIDS AND
ELECTROLYTES, IV THERAPY, SHOCK 11
7 INTRODUCTION TO
PHARMACOLOGY
1
8 CARDIOVASCULAR
SYSTEM 1
9 CENTRAL NERVOUS
SYSTEM
10 OTHER TRAUMATIC
INJURIES:
BLEEDING & SOFT
TISSUE INJURIES, 1
MUSCULOSKELETAL
INJURIES,
FACIAL INJURIES,
ABDOMINAL INJURIES, BURNS
11 ACUTE ABDOMEN
12 DIABETES 1
13 COMMUNICABLE
DISEASES Opt
14 BEHAVIORAL
EMERGENCIES Opt
15 POISONS,
SUBSTANCE ABUSE Opt
12
16 THE GERIATRIC
PATIENT 1
17 OBSTETRICAL/
GYNECOLOGICAL EMERGENCIES Opt
18 PEDIATRICS 1
19 ENVIRONMENTAL
EMERGENCIES 1
20 HAZARDOUS
MATERIALS Opt
21 STRESS MANAGEMENT
IN EMS Opt
MINIMUM
REQUIRED TOTAL CLASSROOM HOURS = 44*
CLINICAL
HOURS = Opt
* Includes 41 hours
from required topic areas minimally, and 3 hours from optional topic
areas.
Those optional topic
areas not covered in the Initial Specialist curriculum would utilize
the EMT
Objectives for
review purposes. Time for in-class testing and final testing are not
included in the
minimum required
hours.
Specialist
1: INTRODUCTION 7/1/95
ROLES/RESPONSIBILITIES OF THE SPECIALIST
MEDICAL/LEGAL
CONSIDERATIONS
EMS SYSTEMS
OPERATIONS
LESSON OUTLINE
AND PERFORMANCE OBJECTIVES:
According to
Specialist lecture presentations, assigned readings, practical lab
and clinical
assignments, the student will be able to state, describe, choose,
demonstrate,
analyze, prescribe, evaluate, etc., the following, including
information
addressed in:
EMT Objectives:
Introduction
Roles/Responsibilities of the EMT
Medical Legal
Considerations
EMS Systems
Operations
OUTLINE AND
OBJECTIVES
I. Introduction
and Orientation
A. Course
Administration
1. Course Format
2. Policies and
Procedures
3. Student
Requirements
4. MDPH
Performance Objectives
II. Roles and
Responsibilities
A. Roles
B.
Responsibilities
III.
Medical/Legal Considerations
B.
Legal/Documentation Considerations
C. Current
Michigan Statutes that Apply to EMS
D. Michigan
Continuing Education Requirements for Relicensure
IV. EMS Systems
Operations
A. Components
B. Systems
Operation Under Medical Control Authority
Specialist
2: TELEMETRY/COMMUNICATIONS 7/1/95
LESSON OUTLINE
AND PERFORMANCE OBJECTIVES:
According to
Specialist lecture presentations, assigned readings, practical lab
and clinical
assignments, the student will be able to state, describe, choose,
demonstrate,
analyze, prescribe, evaluate, etc., the following, including
information
addressed in:
EMT Objectives:
Communications
OUTLINE AND
OBJECTIVES
I. Communications
A. Medcom
B. Documentation
C. Interpersonal
Communication
1. Patient
(Psychological and Emotional Support)
2. Family and
Friends (Psychological and Emotional Support)
3. Other Medical
Personnel
Specialist
3: PATIENT ASSESSMENT 7/1/95
LESSON OUTLINE
AND PERFORMANCE OBJECTIVES:
According to
Specialist lecture presentations, assigned readings, practical lab
and clinical
assignments, the student will be able to state, describe, choose,
demonstrate,
analyze, prescribe, evaluate, etc., the following, including
information
addressed in:
EMT Objectives:
Anatomy and Physiology
Patient
Assessment
EMT Task
Analysis: All Assessment Skills
Patient
Management-Trauma Scenario
Patient
Management-Medical Scenario
Specialist
Objectives: Fluids, IV Therapy, Shock
Respiratory
Emergencies
Paramedic Task
Analysis: Airway Management, Oxygen Therapy,
Ventilation
Drug and Fluid
Volume Calculations
Intraosseous
Infusion
IV
Discontinuation
Peripheral
Intravenous Lines
OUTLINE AND
OBJECTIVES
I. Patient
Assessment
A. Review
Dispatch Information
B. Overview the
Scene
1. Hazards/Safety
2. Mechanism of
Injury
3. Patient
Information
4. Additional
Resources
C. Identify
Yourself and Team
D. Perform
Prioritized Patient Assessment
E.
Determine/Acknowledge Primary Complaint
1. Transport
Priority Decisions Made
F. Complete
Assessment is Finished, Repeated as Necessary
1. Examination
Skills/Specialized Assessment Areas
a. Enhancing
Communication Skills
1) Patient
Interviewing Skills
2) Past Medical
History
3) History of
Present Illness/Injury
4) Communicating
to Other Health Professionals
b.
Inspection-Visual
1) Head, Facial,
Neck Areas
2) Chest and
Abdominal/Pelvic Area
c. Palpation
1)
Chest/Abdominal Area
2) Skin
d. Auscultation
1) Chest/Neck
Area
e. Percussion
f. Olfaction
(Smell)
2. Types of
Physical Exams
a. Trauma Patient
Assessment
1) Primary
Assessment
2) Secondary
Assessment
3) Continuous
Re-evaluation
4) Serial Vital
Signs
b. Medical
Patient Assessment
1)
Communication/Interviewing Skills
2) Complete
Primary and Secondary Assessments
3) Serial Vital
Signs
3. Diagnostic
Signs to Evaluate During Assessment
a. Airway
b. Breathing
c. Circulation
d. Neurological
Exam
e. Glucose
Determination
3.1 Blood glucose
evaluation should occur on patients with risk
of hypoglycemia or
unexplained altered mental status.
f. Pulse Oximetry
3.2 Pulse oximetry
is helpful to determine oxygen saturation
levels in patients
who may have respiratory or
cardiovascular
compromise, or anyone who may be at risk of
hypoxia.
3.3 Pulse oximetry
may not be accurate for patients with
decreased peripheral
perfusion, CO toxicity, hypothermia,
cyanide poisoning or
methyl alcohol poisoning.
g. Peak
Expiratory Flow Rate
3.4 Peak Expiratory
Flow Rates (PEFR) may be measured
during evaluation of
patients in respiratory distress,
especially before
and after medication management.
4. Additional
Physical Exam Information
II. Documentation
of Patient Assessment
III. Additional
Information for Trauma Assessment and General Management
A. Mechanism of
Injury
B. Priority Needs
of the Trauma Patient
Specialist
4: TRIAGE 7/1/95
LESSON OUTLINE
AND PERFORMANCE OBJECTIVES:
According to
Specialist lecture presentations, assigned readings, practical lab
and clinical
assignments, the student will be able to state, describe, choose,
demonstrate,
analyze, prescribe, evaluate, etc., the following, including
information
addressed in:
EMT Objectives:
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