The education of out-of-hospital emergency medical personnel in pediatrics: Report of a national task force

Abstract

In the last ten years there has been considerable interest in the development of curricula in pediatric emergency care for out-of-hospital emergency medical personnel.^1-4 At the same time, there has been notable controversy in regard to the design and content of the curricula. Traditionally paramedic instruction has been diagnosis-driven: emergency medical services (EMS) educators had instructed out-of-hospital providers by modifying the “medical school” approach and incorporating information based on the scope of practice of the out-of-hospital provider. Although there are few data evaluating current educational methods, many instructors and students have found the diagnosis-based approach impractical for providers in the out-of-hospital setting when implemented in the field setting. The reasons for this are multifactorial and may include the following: 1) establishing a diagnosis in the field is problematic because physical assessment may be hampered by the unpredictable ambient conditions (poor lighting, increased noise, and inclement weather) and safety issues (gunfire or criminal activity); 2) few cost-effective, portable diagnostic resources are available for field use; and 3) the provider spends a limited time with the patient. The solution to this educational dilemma has been the development of the educational strategy that is assessment-based with management schemes driven by the clinical presentation of the patient. The advantages of the assessment-based approach are 1) it is a simple, easy-to-teach method that can be taught to basic and advanced levels of providers and 2) it allows for subsequent management strategies to be based on patient assessments and not a list of possible diagnoses. The disadvantage is that some educators believe it may be too simple and that by deemphasizing diagnoses, this educational method will decease the ability of the out-of-hospital and in-hospital-based providers to communicate information about the patient quickly.