Continuing Education for Prehospital Healthcare Providers in India – A Novel Course and Concept

Figures & data

Figure 1 Timeline of CEC development and delivery.

Figure 2 Three-staged process of CEC development.

Table 1 Demographics of Participants by CEC

		Medical/ Cardiovascular	Obstetrics	Trauma	Pediatrics	Leadership and Communication
		No (% or SD)	No (% or SD)	No (% or SD)	No (% or SD)	No (% or SD)
Sex	Male	48 (96)	124 (78)	106 (89.8)	99 (88.4)	63 (100)
	Female	2 (4)	35 (22)	12 (10)	13 (11.6)	0 (0)
Age (mean)	Years	30 (2.9)	28 (5.2)	32 (3.6)	32 (3.9)	32 (3.7)
Practice location	State
	Gujarat	0 (0)	23 (14)	61 (52)	44 (38.9)	0 (0)
	Telangana	50 (100)	30 (19)	57 (48)	69 (61.1)	63 (100)
	Karnataka	0 (0)	64 (40)	0 (0)	0 (0)	0 (0)
	Himachal Pradesh	0 (0)	43 (27)	0 (0)	0 (0)	0 (0)
Time worked as EMT	Years	5.8 (1.9)	10.9 (1.4)	6.4 (2.9)	6.5 (2.8)	8.2 (2.1)

Table 2 Core Didactics of Medical and Cardiovascular Emergencies CEC

Pre-arrival preparation Rapid medical/trauma exam Baseline vital signs History taking Patient reassessment Altered mental status* Behavioral emergencies* Hypoglycemia* Stroke* Envenomations* Submersions/Drownings* Hypothermia* Heat illness* Allergic reaction/anaphylaxis*

Poisoning* Intoxication* Smoke inhalation* Abdominal pain* Gastrointestinal bleeding* Respiratory distress* Syncope* Chest pain* Hypertensive emergencies* Tachycardia* Bradycardia* Non-traumatic shock Cardiac arrest* Return of spontaneous circulation*

Note: *Includes case-based discussion.

Table 3 Core Didactics of Obstetric CEC

Obstetric terminology Rapid obstetric history and exam Vaginal bleeding and abdominal pain Normal childbirth* Post delivery care* Neonatal resuscitation* Preterm labor Shoulder dystocia* Breech delivery* Limb presentation*

Prolapsed cord* Multiple births* Assessment of mother and neonate arriving after delivery** Postpartum hemorrhage** Non-Pneumatic Anti-Shock Garment Trauma in pregnancy* Hypertension, preeclampsia and eclampsia** Obstetric medications: mixing, dosing and administration*

Notes: *Included simulation scenario. **Included case-based discussion.

Table 4 Core Didactics of Trauma CEC

Video-Based Lectures	Simulation and Skills
Approach to the trauma patient-primary survey Approach to the trauma patient-secondary survey Airway and breathing* Circulation-hemorrhage control* Disability-approach to the head injured patient* Mass-casualty incident Approach to chest trauma* Approach to abdominal trauma* Extremity trauma* Burn injuries*	Trauma survey simulation Basic airway management Hemorrhage control Helmet removal Needle decompression Spinal immobilization Pelvic binder Splint placement + amputation station MCI practice session

Note: *All with accompanying case discussion.

Table 5 Core Didactics of Pediatric CEC

Video-Based Lectures*	Simulation and Skills
Introduction to pediatrics: vitals Pediatric resuscitation Neonatal resuscitation Altered mental status Pediatric trauma Shortness of breath: pneumonia and asthma Shortness of breath: anaphylaxis, croup, foreign body Pediatric fever Diarrhea and hypovolemic shock Drowning and hypothermia Pediatric IV tips video	Introduction to simulation: abdominal pain Airway, breathing and choking skill Spinal immobilization skill Neonatal resuscitation simulation Pediatric resuscitation simulation: overdose Trauma simulation: fall down stairs Seizure simulation: epilepsy Pediatric cardiopulmonary resuscitation skill station Nebulizer machine skill Anaphylaxis simulation Med dosing practice calculation skill

Note: *All with accompanying case discussion except Introduction and Pediatric IV.

Table 6 Core Didactics of Leadership and Communication CEC

Communication Track	Leadership Track
Setting the stage: communication videos Setting the stage: mass casualty incident simulation EMT – physician communication lecture * EMT – patient communication Introduction to public speaking * Conflict resolution * Charting * EMT teamwork *	Setting goals Professionalism Reflections – leadership Introduction to quality improvement * Tips for a long career: (stress management, burn out, bereavement and sleep hygiene) Becoming an expert Quality improvement presentations

Note: *Courses followed by small groups workshops or case studies.