- Email: [email protected]
Development of selection criteria for advanced EMT trainees
ORIGINAL CONTRIBUTIONS
Development of Selection Criteria for Advanced EMT Trainees Lewis M. Flint, Jr, MD* Robert Brown, PhD** Carol Latimer, RN** Max S. Rittenbury, MD*** Charleston, South Carolina
T h e r e s u l t s o f a s t a n d a r d p s y c h o l o g i c a l p r o f i l e a n d test o f a w a r e n e s s , in c o n j u n c t i o n w i t h b i o g r a p h i c a l d a t a a n d p e r s o n a l i n t e r v i e w s , are u s e d to s e l e c t 21 p e r s o n s f r o m 142 c a n d i d a t e s to a t t e n d a n a d v a n c e d e m e r g e n c y m e d i c a l t e c h n i c i a n c o u r s e . A l l 21 c o m p l e t e d t h e 2 8 0 - h o u r c o u r s e a n d e x a m i n a t i o n . O f a s e c o n d g r o u p o f 21 s t u d e n t s , w i t h l e s s p r o m i s i n g test s c o r e s , 8 f a i l e d to c o m p l e t e t h e c o u r s e r e q u i r e m e n t s . T h e d a t a s u g g e s t t h a t s t a n d a r d p s y c h o l o g i c a l t e s t s m a y b e v a l u a b l e a d j u n c t s to b i o g r a p h i c a l d a t a a n d i n t e r v i e w i n g for s e l e c t i o n o f s t u d e n t s for A d v - E M T t r a i n i n g .
Flint LM Jr, Brown R, Latimer C, et al: Development of selection criteria for advanced EMT trainees. JACEP 4:536-538, November/December 1975. EMT,
training; EMS, personnel. INTRODUCTION Advanced Emergency Medical Technicians (Adv-EMT) are presently functioning in m a n y communities. The t r a i n i n g they have received varies according to their role in each medical community. Adv-EMT training courses r e q u i r e s u b s t a n t i a l i n v e s t m e n t s in time by physicians, nurses and t r a i n e e s as well as s i g n i f i c a n t *Department of Surgery, University of Louisville, Health Science Center. **South Carolina Hospital Association, Columbia. ***Department of Surgery, Medical University of South Carolina, Charleston. Presented at the Fifth Annual Meeting of UA/EMS in Vancouver, British Columbia, Canada, May 1975. Address for reprints: Lewis M. Flint, Jr, MD, Department of Surgery, University of Louisville, Health Science Center, Louisville, Kentucky, 40208
Page 536 Volume 4 Number 6
financial support from f u n d i n g agencies. If methods for selecting trainees who can and will complete Adv-EMT courses, and m a i n t a i n acceptable levl els of performance, were developed, savings in time and money could result. Our s t u d y explored precourse t e s t i n g to predict performance.
Evaluation of EMT Training The concept of prehospital care for c r i t i c a l l y ill p a t i e n t s is widely accepted and n u m e r o u s p r o g r a m s for t r a i n i n g personnel to provide this care have been developed. The allocation of c e r t a i n h e a l t h professionals to this area r e m a i n s controversial. Nurses, physicians a s s i s t a n t s and a m b u l a n c e personnel might-perform successfully 1 b u t the available i n f o r m a t i o n indicates t h a t the existing pool of trained, basic EMTs provides most of the trainees for advanced prehospital care techniques. 2
I n f o r m a t i o n d o c u m e n t i n g the effec. tiveness of advanced t r a i n i n g for basic EMTs is scanty. F u r t h e r m o r e , there is no precise m e a s u r e of long term success as a n Adv-EMT nor any detailed description of the Adv-EMT's job_ a There is general agreement, however, t h a t the Adv-EMT should be thoroughly schooled i n advanced life support t e c h n i q u e s and prepared to b e g i n t r e a t m e n t at the scene of an emergency, u n d e r a physician's direct supervision. Although the money and time committed to Adv-EMT training courses vary, the expense is significant. C u r r e n t l y , the cost of offering a single A d v - E M T course in Sour], C a r o l i n a exceeds $10,000, approxi-i mately $500 per student. Therefore, there should be a way t0~ assure t h a t t r a i n e e s selected for AdvEMT courses are suited for their jobs and will s u c c e s s f u l l y complete the t r a i n i n g . We will describe one approach to selection of Adv-EMT trainees u s i n g t r a d i t i o n a l methods supplem e n t e d by s t a n d a r d psychological testing, i
METHOD Description of Training Program The South C a r o l i n a Hospital ASS0" ciation provides the stat'ewide Adv" EMT t r a i n i n g p r o g r a m (Figure I)' E a c h course is monitored b y a loJ
November/December 1975" --J~P
EMT-ADVANCED T R A I N I N G IN SOUTH CAROLINA I. Statewide steering committee I1. Psychologic testing and consultation Ill. Local steering committee IV. Course coordinator
~'ig. l. O r g a n i z a t i o n a l structure o f ~outh Carolina A d v - E M T training.
EMT-ADVANCED SELECTION CRITERIA I. Completion of basic EMT training II. Demonstration of interest III. Advanced learning capabilities IV. Desirable behavioral profile 1. Adequate independence level 2. Satisfactory anxiety level V. Not overqualified VI. Employer recommendation
iteering committee composed of physi/inns, h e a l t h professionals, a m b u Ii~nce s e r v i c e m a n a g e r s a n d c o n iturners and coordinated by a regislered nurse. Approximately 256 hours if instruction are given in prehospital i0ronary care, life support techniques iLnd m i s c e l l a n e o u s topics in emerllencymedicine (Figure 2). The faculty •/~compose d of surgeons, pediatricians, !:ardiologists, anesthesiologists, emer~ney physicians, psychologists and ~urses from anesthesia, coronary care ~ndsurgery_ Over 60% of the didactic ,struction is provided by physicians. he nurse coordinator accompanies inees d u r i n g t h e i r frequent field ercises.
t
Student progress is m e a s u r e d by iodic multiple choice e x a m i n a t i o n s practical exercises. Successful i~mpletion of a final multiple choice iritten e x a m i n a t i o n , a practical demInstration, and a n oral quiz by a panel ifphysicians leads to certification by
ti'l.
EMT-ADVANCED COURSE S U M M A R Y Prehespital coronary care A. Arrhythmia detection B. Drug therapy C. Management of ventricular fibrillation D. Transportation of patients with cardiac disease
Fig. 3. A d v - E M T course results. the S o u t h C a r o l i n a D e p a r t m e n t of" H e a l t h and E n v i r o n m e n t a l Control.
Student Selection A t o t a l of 142 students have been s c r e e n e d ( F i g u r e 3) a n d 63 h a v e
e n t e r e d t r a i n i n g . I n t e l l i g e n c e level and a psychological profile were obt a i n e d by h a v i n g each p o t e n t i a l t r a i n e e undergo a test of' awareness and a s t a n d a r d 16 P F test (Institute for P e r s o n a l i t y and Ability Testing, C h a m p a i g n , Illinois). The test of a w a r e n e s s (developed by co-author Robert Brown, PhD) prim a r i l y m e a s u r e s r e a s o n i n g by analogy, thnd of general infbrmation, and n u m b e r reasoning. The 16 PF provides information concerning such variables as a n x i e t y levels, independence and a b i l i t y to f u n c t i o n u n d e r s t r e s s , termed alert-poise. Prior to the i n i t i a l s t u d e n t selection, the steering committee listed behav-
A. Intravenous therapy B. Airway management C. Cardiopulmonary resuscitation Ill. Trauma care
After s e l e c t i o n of' the i n i l i a l 21 students who were judged most suitable, a comparison o£ psychological test scores was made between those selected and not selected. S t u d e n t s T Test was used as a test of significance. A second group of 21 t r a i n e e s was selected from those candidates w i t h less desirable test scores and their performance in the EMT course evaluated. A third class of 21 with h i g h e r t e s t scores was chosen for another EMT course.
RESULTS Significant differences existed b e t w e e n t e s t of a w a r e n e s s scores ( P < 0 . 0 1 ) a n d levels of a l e r t - p o i s e ( P < 0 . 0 5 ) , w h e n selected a n d nons e l e c t e d s t u d e n t s were c o m p a r e d (Table 1). All 21 students successfully completed the first t r a i n i n g course. L o w e r m e a n t e s t of a w a r e n e s s scores (101_6 + 13.6) characterized the second class of students (N - 21). E i g h t of the 21 s t u d e n t s failed to complete the course satisfactorily. In the t h i r d class (N = 21) s t u d e n t s with higher intelligence levels were selected (mean - 111.4 + 9.5) and there were no failures (Table 2).
Table 1 EMT-ADVANCED STUDENT TEST SCORES
Intelligence
I1. Life support
ioral criteria necessary fbr satisfactory A d v - E M T p e r f o r m a n c e . T h e y included above average intelligence, s a t i s f a c t o r y levels of a n x i e t y a n d a v e r a g e l e v e l s of i n d e p e n d e n c e . D e m o n s t r a t e d excellence in b a s i c EMT t r a i n i n g and adequate job performance as evidenced by employer r e c o m m e n d a t i o n s were also required.
Alert Poise
(P < 0.05) (P < 0.01)
Selected
Not Selected
112.6 + 8.7 58.7 + 7.3
104.1 + 13.5 54.2 + 8.3
Table 2 EMT-ADVANCED SUCCESSFUL C O M P L E T I O N OF T R A I N I N G COURSE
,IV. Perinatalemergencies and neonatal transport
V. Psychiatric emergencies VI. Poisoning and drug abuse VII. Pediatric emergencies
Class 1
till Management of mass casualties
Class 2 Class 3
No. Starting
Completion
21 21 21
21 13 21
!g.2. A d v - E M T course outline.
•
]
•
P
N o v e m b e r / D e c e m b e r 1975
V o l u m e 4 N u m b e r 6 Page 537
DISCUSSION A t t r i t i o n r a t e s in excess of 40% h a v e been r e p o r t e d for basic E M T training. 4 Well-defined selection crit eri a could assure m i n i m a l attrition for A d v - E M T trainees. Our data suggest t h a t s t a n d a r d psychological testing is a w o r t h w h i l e adjunct to the selection process. Our data support a method of selecting i n d i v i d u a l s able to complete AdvE M T t rai n i n g . However, the equally i m p o r t a n t question of long t e r m performance as an A d v - E M T has yet to be a d d r e s s e d . C a r e f u l l y d e v e l o p e d prospective studies may provide n e e d e d i n f o r m a t i o n . Of p a r t i c u l a r importance is a detailed description of t h e A d v - E M T ' s job in th e community.
Page 538 Volume 4 Number 6
The question of'~over qualification" for A d v - E M T t r a i n i n g is important. The ~too-bright" trainee, as judged by i n t e l l i g e n c e testing, m i g h t not perform well in the long run. ~ However, f u r t h e r study m a y r e v e a l t h a t exclusion on the basis of over qualification deprives t h e profession of v a l u a b l e manpower. T h e s t a n d a r d i z a t i o n of role definition and t r a i n i n g for Adv-EMTs on a n a t i o n w i d e basis has been suggested. 6 Provision for screening, t e s t i n g and long t e r m observation of the A d v - E M T career would be an i m p o r t a n t addition to such standards.
REFERENCES 1. Wasserberger J: The EMT; his training and future, in Findeiss J (ed): Emergency
Medical Care, New York, Intercontinental Medical Corporation, 1974. 2. Boyd DR, Romano TI, Sparacino S, etal: New health professionals in an emergency medical system. Southern Medicine, 1974. 3. Brown R: Ambulance work: a profes. sion? a trade? a hobby? Internatmnal Res. cuer, 1968. 4. Campbell P: Community training o[ ambulance attendants. Northwest Medi. cine 67:1084-1086, 1968. 5. Brown R: Selection and evaluation of advanced EMT trainees in Expanded Con. cepts of Emergency Medical Servtces: A report to the W K Kellogg Foundati0n, Columbia, South Carolina, 1975, South. Carolina Hospital Association Research and Education Foundation. 6. Collins MC: State laws for ambulance attendants and advanced emergency medi. cal technicians. Journal of the American College of Emergency Physicians 3:161. 167, 1974.
November/December 1975,, ~ P
Development of Selection Criteria for Advanced EMT Trainees Lewis M. Flint, Jr, MD* Robert Brown, PhD** Carol Latimer, RN** Max S. Rittenbury, MD*** Charleston, South Carolina
T h e r e s u l t s o f a s t a n d a r d p s y c h o l o g i c a l p r o f i l e a n d test o f a w a r e n e s s , in c o n j u n c t i o n w i t h b i o g r a p h i c a l d a t a a n d p e r s o n a l i n t e r v i e w s , are u s e d to s e l e c t 21 p e r s o n s f r o m 142 c a n d i d a t e s to a t t e n d a n a d v a n c e d e m e r g e n c y m e d i c a l t e c h n i c i a n c o u r s e . A l l 21 c o m p l e t e d t h e 2 8 0 - h o u r c o u r s e a n d e x a m i n a t i o n . O f a s e c o n d g r o u p o f 21 s t u d e n t s , w i t h l e s s p r o m i s i n g test s c o r e s , 8 f a i l e d to c o m p l e t e t h e c o u r s e r e q u i r e m e n t s . T h e d a t a s u g g e s t t h a t s t a n d a r d p s y c h o l o g i c a l t e s t s m a y b e v a l u a b l e a d j u n c t s to b i o g r a p h i c a l d a t a a n d i n t e r v i e w i n g for s e l e c t i o n o f s t u d e n t s for A d v - E M T t r a i n i n g .
Flint LM Jr, Brown R, Latimer C, et al: Development of selection criteria for advanced EMT trainees. JACEP 4:536-538, November/December 1975. EMT,
training; EMS, personnel. INTRODUCTION Advanced Emergency Medical Technicians (Adv-EMT) are presently functioning in m a n y communities. The t r a i n i n g they have received varies according to their role in each medical community. Adv-EMT training courses r e q u i r e s u b s t a n t i a l i n v e s t m e n t s in time by physicians, nurses and t r a i n e e s as well as s i g n i f i c a n t *Department of Surgery, University of Louisville, Health Science Center. **South Carolina Hospital Association, Columbia. ***Department of Surgery, Medical University of South Carolina, Charleston. Presented at the Fifth Annual Meeting of UA/EMS in Vancouver, British Columbia, Canada, May 1975. Address for reprints: Lewis M. Flint, Jr, MD, Department of Surgery, University of Louisville, Health Science Center, Louisville, Kentucky, 40208
Page 536 Volume 4 Number 6
financial support from f u n d i n g agencies. If methods for selecting trainees who can and will complete Adv-EMT courses, and m a i n t a i n acceptable levl els of performance, were developed, savings in time and money could result. Our s t u d y explored precourse t e s t i n g to predict performance.
Evaluation of EMT Training The concept of prehospital care for c r i t i c a l l y ill p a t i e n t s is widely accepted and n u m e r o u s p r o g r a m s for t r a i n i n g personnel to provide this care have been developed. The allocation of c e r t a i n h e a l t h professionals to this area r e m a i n s controversial. Nurses, physicians a s s i s t a n t s and a m b u l a n c e personnel might-perform successfully 1 b u t the available i n f o r m a t i o n indicates t h a t the existing pool of trained, basic EMTs provides most of the trainees for advanced prehospital care techniques. 2
I n f o r m a t i o n d o c u m e n t i n g the effec. tiveness of advanced t r a i n i n g for basic EMTs is scanty. F u r t h e r m o r e , there is no precise m e a s u r e of long term success as a n Adv-EMT nor any detailed description of the Adv-EMT's job_ a There is general agreement, however, t h a t the Adv-EMT should be thoroughly schooled i n advanced life support t e c h n i q u e s and prepared to b e g i n t r e a t m e n t at the scene of an emergency, u n d e r a physician's direct supervision. Although the money and time committed to Adv-EMT training courses vary, the expense is significant. C u r r e n t l y , the cost of offering a single A d v - E M T course in Sour], C a r o l i n a exceeds $10,000, approxi-i mately $500 per student. Therefore, there should be a way t0~ assure t h a t t r a i n e e s selected for AdvEMT courses are suited for their jobs and will s u c c e s s f u l l y complete the t r a i n i n g . We will describe one approach to selection of Adv-EMT trainees u s i n g t r a d i t i o n a l methods supplem e n t e d by s t a n d a r d psychological testing, i
METHOD Description of Training Program The South C a r o l i n a Hospital ASS0" ciation provides the stat'ewide Adv" EMT t r a i n i n g p r o g r a m (Figure I)' E a c h course is monitored b y a loJ
November/December 1975" --J~P
EMT-ADVANCED T R A I N I N G IN SOUTH CAROLINA I. Statewide steering committee I1. Psychologic testing and consultation Ill. Local steering committee IV. Course coordinator
~'ig. l. O r g a n i z a t i o n a l structure o f ~outh Carolina A d v - E M T training.
EMT-ADVANCED SELECTION CRITERIA I. Completion of basic EMT training II. Demonstration of interest III. Advanced learning capabilities IV. Desirable behavioral profile 1. Adequate independence level 2. Satisfactory anxiety level V. Not overqualified VI. Employer recommendation
iteering committee composed of physi/inns, h e a l t h professionals, a m b u Ii~nce s e r v i c e m a n a g e r s a n d c o n iturners and coordinated by a regislered nurse. Approximately 256 hours if instruction are given in prehospital i0ronary care, life support techniques iLnd m i s c e l l a n e o u s topics in emerllencymedicine (Figure 2). The faculty •/~compose d of surgeons, pediatricians, !:ardiologists, anesthesiologists, emer~ney physicians, psychologists and ~urses from anesthesia, coronary care ~ndsurgery_ Over 60% of the didactic ,struction is provided by physicians. he nurse coordinator accompanies inees d u r i n g t h e i r frequent field ercises.
t
Student progress is m e a s u r e d by iodic multiple choice e x a m i n a t i o n s practical exercises. Successful i~mpletion of a final multiple choice iritten e x a m i n a t i o n , a practical demInstration, and a n oral quiz by a panel ifphysicians leads to certification by
ti'l.
EMT-ADVANCED COURSE S U M M A R Y Prehespital coronary care A. Arrhythmia detection B. Drug therapy C. Management of ventricular fibrillation D. Transportation of patients with cardiac disease
Fig. 3. A d v - E M T course results. the S o u t h C a r o l i n a D e p a r t m e n t of" H e a l t h and E n v i r o n m e n t a l Control.
Student Selection A t o t a l of 142 students have been s c r e e n e d ( F i g u r e 3) a n d 63 h a v e
e n t e r e d t r a i n i n g . I n t e l l i g e n c e level and a psychological profile were obt a i n e d by h a v i n g each p o t e n t i a l t r a i n e e undergo a test of' awareness and a s t a n d a r d 16 P F test (Institute for P e r s o n a l i t y and Ability Testing, C h a m p a i g n , Illinois). The test of a w a r e n e s s (developed by co-author Robert Brown, PhD) prim a r i l y m e a s u r e s r e a s o n i n g by analogy, thnd of general infbrmation, and n u m b e r reasoning. The 16 PF provides information concerning such variables as a n x i e t y levels, independence and a b i l i t y to f u n c t i o n u n d e r s t r e s s , termed alert-poise. Prior to the i n i t i a l s t u d e n t selection, the steering committee listed behav-
A. Intravenous therapy B. Airway management C. Cardiopulmonary resuscitation Ill. Trauma care
After s e l e c t i o n of' the i n i l i a l 21 students who were judged most suitable, a comparison o£ psychological test scores was made between those selected and not selected. S t u d e n t s T Test was used as a test of significance. A second group of 21 t r a i n e e s was selected from those candidates w i t h less desirable test scores and their performance in the EMT course evaluated. A third class of 21 with h i g h e r t e s t scores was chosen for another EMT course.
RESULTS Significant differences existed b e t w e e n t e s t of a w a r e n e s s scores ( P < 0 . 0 1 ) a n d levels of a l e r t - p o i s e ( P < 0 . 0 5 ) , w h e n selected a n d nons e l e c t e d s t u d e n t s were c o m p a r e d (Table 1). All 21 students successfully completed the first t r a i n i n g course. L o w e r m e a n t e s t of a w a r e n e s s scores (101_6 + 13.6) characterized the second class of students (N - 21). E i g h t of the 21 s t u d e n t s failed to complete the course satisfactorily. In the t h i r d class (N = 21) s t u d e n t s with higher intelligence levels were selected (mean - 111.4 + 9.5) and there were no failures (Table 2).
Table 1 EMT-ADVANCED STUDENT TEST SCORES
Intelligence
I1. Life support
ioral criteria necessary fbr satisfactory A d v - E M T p e r f o r m a n c e . T h e y included above average intelligence, s a t i s f a c t o r y levels of a n x i e t y a n d a v e r a g e l e v e l s of i n d e p e n d e n c e . D e m o n s t r a t e d excellence in b a s i c EMT t r a i n i n g and adequate job performance as evidenced by employer r e c o m m e n d a t i o n s were also required.
Alert Poise
(P < 0.05) (P < 0.01)
Selected
Not Selected
112.6 + 8.7 58.7 + 7.3
104.1 + 13.5 54.2 + 8.3
Table 2 EMT-ADVANCED SUCCESSFUL C O M P L E T I O N OF T R A I N I N G COURSE
,IV. Perinatalemergencies and neonatal transport
V. Psychiatric emergencies VI. Poisoning and drug abuse VII. Pediatric emergencies
Class 1
till Management of mass casualties
Class 2 Class 3
No. Starting
Completion
21 21 21
21 13 21
!g.2. A d v - E M T course outline.
•
]
•
P
N o v e m b e r / D e c e m b e r 1975
V o l u m e 4 N u m b e r 6 Page 537
DISCUSSION A t t r i t i o n r a t e s in excess of 40% h a v e been r e p o r t e d for basic E M T training. 4 Well-defined selection crit eri a could assure m i n i m a l attrition for A d v - E M T trainees. Our data suggest t h a t s t a n d a r d psychological testing is a w o r t h w h i l e adjunct to the selection process. Our data support a method of selecting i n d i v i d u a l s able to complete AdvE M T t rai n i n g . However, the equally i m p o r t a n t question of long t e r m performance as an A d v - E M T has yet to be a d d r e s s e d . C a r e f u l l y d e v e l o p e d prospective studies may provide n e e d e d i n f o r m a t i o n . Of p a r t i c u l a r importance is a detailed description of t h e A d v - E M T ' s job in th e community.
Page 538 Volume 4 Number 6
The question of'~over qualification" for A d v - E M T t r a i n i n g is important. The ~too-bright" trainee, as judged by i n t e l l i g e n c e testing, m i g h t not perform well in the long run. ~ However, f u r t h e r study m a y r e v e a l t h a t exclusion on the basis of over qualification deprives t h e profession of v a l u a b l e manpower. T h e s t a n d a r d i z a t i o n of role definition and t r a i n i n g for Adv-EMTs on a n a t i o n w i d e basis has been suggested. 6 Provision for screening, t e s t i n g and long t e r m observation of the A d v - E M T career would be an i m p o r t a n t addition to such standards.
REFERENCES 1. Wasserberger J: The EMT; his training and future, in Findeiss J (ed): Emergency
Medical Care, New York, Intercontinental Medical Corporation, 1974. 2. Boyd DR, Romano TI, Sparacino S, etal: New health professionals in an emergency medical system. Southern Medicine, 1974. 3. Brown R: Ambulance work: a profes. sion? a trade? a hobby? Internatmnal Res. cuer, 1968. 4. Campbell P: Community training o[ ambulance attendants. Northwest Medi. cine 67:1084-1086, 1968. 5. Brown R: Selection and evaluation of advanced EMT trainees in Expanded Con. cepts of Emergency Medical Servtces: A report to the W K Kellogg Foundati0n, Columbia, South Carolina, 1975, South. Carolina Hospital Association Research and Education Foundation. 6. Collins MC: State laws for ambulance attendants and advanced emergency medi. cal technicians. Journal of the American College of Emergency Physicians 3:161. 167, 1974.
November/December 1975,, ~ P