Guest guest Posted May 29, 2006 Report Share Posted May 29, 2006 Forget about test banks and written tests. The only way to determine competency to perform advanced sequences such as RSI is through scenario testing. Develop a realistic scenario and have the medics work through it as team leader. There should be no level 1s and 2s for RSI. Either you're competent to do it or you're not. Sit down and do a realistic task analysis showing exactly what items must be performed. That means writing down every single and separate move that must be done in performing the whole skill sequence. Then go through and put an asterisk next to " absolutes " that must be done or the person automatically fails. There can be some skipped items, but no items should be ranked less than Yes or NO. Did they do it or did they not. If they did all the items marked absolute, then they ought to be able to perform the skill sequence. If they did not do them all, then they need to practice and retest until they can do them all. This sort of testing is competency-based, and either you're competent or you're not. But there should be no set limit on how many times the candidate can test. When competency level is achieved, then it is achieved. Period. However, periodic competency retests should be done randomly, and often. Build your didactic knowledge competencies into the scenario. For example, it does no good for a medic to be able to figure out the number of gtts per minute for a dopamine drip on paper. All that matters is for that medic to be able to set up the dopamine drip and set the gtts or the pump correctly. So make the candidates do everything in real time, and don't allow any verbalization of anything. Require that all steps be done on the manikin and done in real time. Require that all drugs be drawn up, labeled, and arranged in sequence before the scenario starts. Same for equipment. Require that the bougie and Combitube/LMA/CobraPLA, et cetera be available at arms length. This is the only way to know whether or not a medic can perform the skill. Written tests tell you NOTHING other than that this person can guess the right answer. Use nothing less than a panel of three persons to evaluate these performances. One of the panel ought to be the medical director, another the EMS education director, and another the QI person or an experienced EMS instructor from outside the organization. NOBODY from administration or management should ever be allowed in the room. This sort of testing costs money. It takes time. Management hates it because they can't see it as making them a dime. But it might save them their company if a lawsuit were to arise. Few managers have the sense to understand that, but kudos to those who do. You know who you are, and the rest of you don't read this list anyway. Bottom line: Demand real-time performance and keep demanding it. Screw written tests. They are worthless in the context that you're talking about. Gene G. > Here is a question for those of you that require testing of personnel on > service protocols. My company wants to establish this type of testing, as they > want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would > be allowed to do more advanced procedures, such as RSI, while the level 1 > paramedics would not be able to do this unless tested and cleared by the MD. > > Where do most of you come up with your testing questions? Is there a good > test bank that can be bought, or does each service develop their own > questions and skills testing for protocols? > > Your input would be appreciated. > > Wayne > > > --------------------------------- > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! > Messenger with Voice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2006 Report Share Posted May 29, 2006 Here is a question for those of you that require testing of personnel on service protocols. My company wants to establish this type of testing, as they want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would be allowed to do more advanced procedures, such as RSI, while the level 1 paramedics would not be able to do this unless tested and cleared by the MD. Where do most of you come up with your testing questions? Is there a good test bank that can be bought, or does each service develop their own questions and skills testing for protocols? Your input would be appreciated. Wayne --------------------------------- Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! Messenger with Voice. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2006 Report Share Posted May 29, 2006 Dr Yamada makes his own tests. Very difficult...Not just based on the written protocols, which makes you think long and hard about each question. That is where he wants your critical thinking to kick in. D. Stone > > Here is a question for those of you that require testing of personnel on service protocols. My company wants to establish this type of testing, as they want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would be allowed to do more advanced procedures, such as RSI, while the level 1 paramedics would not be able to do this unless tested and cleared by the MD. > > Where do most of you come up with your testing questions? Is there a good test bank that can be bought, or does each service develop their own questions and skills testing for protocols? > > Your input would be appreciated. > > Wayne > > > --------------------------------- > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! Messenger with Voice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 Wayne, Contact Dr. Racht at Austin/ County EMS. We just went through a system wide retest for updated protocols. Barry Sharp -------------------------- Sent from my Wireless Handheld Protocol Testing Here is a question for those of you that require testing of personnel on service protocols. My company wants to establish this type of testing, as they want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would be allowed to do more advanced procedures, such as RSI, while the level 1 paramedics would not be able to do this unless tested and cleared by the MD. Where do most of you come up with your testing questions? Is there a good test bank that can be bought, or does each service develop their own questions and skills testing for protocols? Your input would be appreciated. Wayne --------------------------------- Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! Messenger with Voice. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 Just to play devil's advocate, what is the point of a provider's medical director to authorize all of these various skills and procedures? One of the biggest challenges I have seen in the past 15 years is ensuring that the medic or EMT in question has the ability to correctly assess a patient. One can have all of the skill knowledge in the world but it is useless (or dangerous) if one's assessment skills are insufficient or inaccurate. Thoughts?? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 Wayne, I agree with Gene, competency based evaluation is the only way to go. My question to your agency is why create 2 different leveles? Why not expect all your paramedics to be able to perform at an expected level? This sounds like you are moving back to the EMT/Paramedic team approach, which while it does have limited advantages, dual medics is much more desired. It seems like it would confuse staffing problems, with differenct levels of paramedics instead of just 1 standard. Protocol Testing Here is a question for those of you that require testing of personnel on service protocols. My company wants to establish this type of testing, as they want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would be allowed to do more advanced procedures, such as RSI, while the level 1 paramedics would not be able to do this unless tested and cleared by the MD. Where do most of you come up with your testing questions? Is there a good test bank that can be bought, or does each service develop their own questions and skills testing for protocols? Your input would be appreciated. Wayne --------------------------------- Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! Messenger with Voice. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 I agree, your either able to do the job or not. You don't need to have a set of paramedics who can do one thing, and those who can't because they weren't able to pass the test. What is the point of having them around at all if they can't do all of the tasks they are allowed or required to perform by their medical director. You can be the best paramedic in the world when it comes to knowing everything, but what good are you if you can't start an IV to give the medications that you need? The same can be said for the cook book medics who can do the skills but have no real clue as to when and why they are doing them. If we want to advance this profession, we need to stop making exceptions for those who can't. It is okay to tell someone they suck. We do it every year when people get fired, don't make a sports team, etc. Why should we be " nice " and make exceptions in EMS? > > Forget about test banks and written tests. The only way to determine > competency to perform advanced sequences such as RSI is through scenario testing. > > Develop a realistic scenario and have the medics work through it as team > leader. There should be no level 1s and 2s for RSI. Either you're competent to > do it or you're not. > > Sit down and do a realistic task analysis showing exactly what items must be > performed. That means writing down every single and separate move that must > be done in performing the whole skill sequence. > > Then go through and put an asterisk next to " absolutes " that must be done or > the person automatically fails. > > There can be some skipped items, but no items should be ranked less than Yes > or NO. Did they do it or did they not. > > If they did all the items marked absolute, then they ought to be able to > perform the skill sequence. If they did not do them all, then they need to > practice and retest until they can do them all. > > This sort of testing is competency-based, and either you're competent or > you're not. But there should be no set limit on how many times the candidate can > test. When competency level is achieved, then it is achieved. Period. > However, periodic competency retests should be done randomly, and often. > > Build your didactic knowledge competencies into the scenario. For example, > it does no good for a medic to be able to figure out the number of gtts per > minute for a dopamine drip on paper. All that matters is for that medic to be > able to set up the dopamine drip and set the gtts or the pump correctly. > > So make the candidates do everything in real time, and don't allow any > verbalization of anything. Require that all steps be done on the manikin and done > in real time. Require that all drugs be drawn up, labeled, and arranged in > sequence before the scenario starts. Same for equipment. Require that the > bougie and Combitube/LMA/CobraPLA, et cetera be available at arms length. > > This is the only way to know whether or not a medic can perform the skill. > Written tests tell you NOTHING other than that this person can guess the right > answer. > > Use nothing less than a panel of three persons to evaluate these > performances. One of the panel ought to be the medical director, another the EMS > education director, and another the QI person or an experienced EMS instructor from > outside the organization. NOBODY from administration or management should > ever be allowed in the room. > > This sort of testing costs money. It takes time. Management hates it > because they can't see it as making them a dime. But it might save them their > company if a lawsuit were to arise. Few managers have the sense to understand > that, but kudos to those who do. You know who you are, and the rest of you > don't read this list anyway. > > Bottom line: Demand real-time performance and keep demanding it. Screw > written tests. They are worthless in the context that you're talking about. > > Gene G. > > > > > > > Here is a question for those of you that require testing of personnel on > > service protocols. My company wants to establish this type of testing, as they > > want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would > > be allowed to do more advanced procedures, such as RSI, while the level 1 > > paramedics would not be able to do this unless tested and cleared by the MD. > > > > Where do most of you come up with your testing questions? Is there a good > > test bank that can be bought, or does each service develop their own > > questions and skills testing for protocols? > > > > Your input would be appreciated. > > > > Wayne > > > > > > --------------------------------- > > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! > > Messenger with Voice. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 Our dept. uses written & practical evaluations. We do this once a year. We also have someone from Medical Control (maybe nurse or Dr.) that will ride out periodically to evaluate us. I think a good bit of evaluation can be done by reviewing reports. As for having different levels of Medics, I don't think it is a bad idea. For example, I work for a fire dept. and we have approx. 80 paramedics. The drivers and officers are given the option of dropping their paramedic. They do not get rid of their cert through TDH, but they are EMTs under medical direction. For our Batallion Chiefs, it is mandatory. If a service uses RSI, I think it is reasonable to not make the drivers and officers responsible for that skill. One advantage that we have is that there are no EMTs except for a few (5 or so) that are drivers and officers. > > Wayne, > > I agree with Gene, competency based evaluation is the only way to go. > > My question to your agency is why create 2 different leveles? Why not expect > all your paramedics to be able to perform at an expected level? This sounds > like you are moving back to the EMT/Paramedic team approach, which while it > does have limited advantages, dual medics is much more desired. It seems > like it would confuse staffing problems, with differenct levels of > paramedics instead of just 1 standard. > > > Protocol Testing > > > Here is a question for those of you that require testing of personnel on > service protocols. My company wants to establish this type of testing, as > they want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics > would be allowed to do more advanced procedures, such as RSI, while the > level 1 paramedics would not be able to do this unless tested and cleared by > the MD. > > Where do most of you come up with your testing questions? Is there a good > test bank that can be bought, or does each service develop their own > questions and skills testing for protocols? > > Your input would be appreciated. > > Wayne > > > --------------------------------- > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! > Messenger with Voice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 , Firat, the levels of EMTs where in place before I started there, and it was actually put in there for the LP level, which is now what is going to be called the Level 2 Paramedic, or the more advanced paramedic (CCEMTP type thinking). As was stated, you either can or you can't, and there are some that are in the middle of the road, for lack of better terms. Most want to do all they can, while 1-2 just want to be able to do what they need to, this is where the testing comes into play. In the beginning, EMT's were working at the EMT-I level by starting IV's and giving D50, which was all approved by the MD. Now, all of this is going away, except for the EMT basic skills that are taught in school, nebs, epi pen, nitro, etc. Now, they can be tested on these within the service and be approved by the MD to give these. Most of these people are rural fire-based EMTs and Paramedics working part-time for this service, but have no additional training on more advanced paramedic procedures like RSI, advanced cardiac drips, etc., this is also part of the reason for level 1 & 2 in the paramedic setting. What Gene stated does sound like a good plan, and they are willing to do what is needed to test these people for evaluation of skills and knowledge. They want good quality people and not just warm bodies like many providers do. Anyone have more input, it would be appreciated. Wayne Wiseman wrote: Wayne, I agree with Gene, competency based evaluation is the only way to go. My question to your agency is why create 2 different leveles? Why not expect all your paramedics to be able to perform at an expected level? This sounds like you are moving back to the EMT/Paramedic team approach, which while it does have limited advantages, dual medics is much more desired. It seems like it would confuse staffing problems, with differenct levels of paramedics instead of just 1 standard. Protocol Testing Here is a question for those of you that require testing of personnel on service protocols. My company wants to establish this type of testing, as they want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would be allowed to do more advanced procedures, such as RSI, while the level 1 paramedics would not be able to do this unless tested and cleared by the MD. Where do most of you come up with your testing questions? Is there a good test bank that can be bought, or does each service develop their own questions and skills testing for protocols? Your input would be appreciated. Wayne --------------------------------- Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! Messenger with Voice. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 Gene, I do like what you say! I have no problem with protocol testing as long as it's not done by a " PARAGOD " , someone who belittles anyone, or someone who sits behind a desk who can't even perform out in the field, and scrutinizes every little thing as if he were a lawyer. In other words---------- Let a REAL to life individual who knows what it's like out in the field do the testing wegandy1938@... wrote: Forget about test banks and written tests. The only way to determine competency to perform advanced sequences such as RSI is through scenario testing. Develop a realistic scenario and have the medics work through it as team leader. There should be no level 1s and 2s for RSI. Either you're competent to do it or you're not. Sit down and do a realistic task analysis showing exactly what items must be performed. That means writing down every single and separate move that must be done in performing the whole skill sequence. Then go through and put an asterisk next to " absolutes " that must be done or the person automatically fails. There can be some skipped items, but no items should be ranked less than Yes or NO. Did they do it or did they not. If they did all the items marked absolute, then they ought to be able to perform the skill sequence. If they did not do them all, then they need to practice and retest until they can do them all. This sort of testing is competency-based, and either you're competent or you're not. But there should be no set limit on how many times the candidate can test. When competency level is achieved, then it is achieved. Period. However, periodic competency retests should be done randomly, and often. Build your didactic knowledge competencies into the scenario. For example, it does no good for a medic to be able to figure out the number of gtts per minute for a dopamine drip on paper. All that matters is for that medic to be able to set up the dopamine drip and set the gtts or the pump correctly. So make the candidates do everything in real time, and don't allow any verbalization of anything. Require that all steps be done on the manikin and done in real time. Require that all drugs be drawn up, labeled, and arranged in sequence before the scenario starts. Same for equipment. Require that the bougie and Combitube/LMA/CobraPLA, et cetera be available at arms length. This is the only way to know whether or not a medic can perform the skill. Written tests tell you NOTHING other than that this person can guess the right answer. Use nothing less than a panel of three persons to evaluate these performances. One of the panel ought to be the medical director, another the EMS education director, and another the QI person or an experienced EMS instructor from outside the organization. NOBODY from administration or management should ever be allowed in the room. This sort of testing costs money. It takes time. Management hates it because they can't see it as making them a dime. But it might save them their company if a lawsuit were to arise. Few managers have the sense to understand that, but kudos to those who do. You know who you are, and the rest of you don't read this list anyway. Bottom line: Demand real-time performance and keep demanding it. Screw written tests. They are worthless in the context that you're talking about. Gene G. > Here is a question for those of you that require testing of personnel on > service protocols. My company wants to establish this type of testing, as they > want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would > be allowed to do more advanced procedures, such as RSI, while the level 1 > paramedics would not be able to do this unless tested and cleared by the MD. > > Where do most of you come up with your testing questions? Is there a good > test bank that can be bought, or does each service develop their own > questions and skills testing for protocols? > > Your input would be appreciated. > > Wayne > > > --------------------------------- > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! > Messenger with Voice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 learningmedic wrote: Gene, I do like what you say! I have no problem with protocol testing as long as it's not done by a " PARAGOD " , someone who belittles anyone, or someone who sits behind a desk who can't even perform out in the field, and scrutinizes every little thing as if he were a lawyer. In other words---------- Let a REAL to life individual who knows what it's like out in the field do the testing wegandy1938@... wrote: Forget about test banks and written tests. The only way to determine competency to perform advanced sequences such as RSI is through scenario testing. Develop a realistic scenario and have the medics work through it as team leader. There should be no level 1s and 2s for RSI. Either you're competent to do it or you're not. Sit down and do a realistic task analysis showing exactly what items must be performed. That means writing down every single and separate move that must be done in performing the whole skill sequence. Then go through and put an asterisk next to " absolutes " that must be done or the person automatically fails. There can be some skipped items, but no items should be ranked less than Yes or NO. Did they do it or did they not. If they did all the items marked absolute, then they ought to be able to perform the skill sequence. If they did not do them all, then they need to practice and retest until they can do them all. This sort of testing is competency-based, and either you're competent or you're not. But there should be no set limit on how many times the candidate can test. When competency level is achieved, then it is achieved. Period. However, periodic competency retests should be done randomly, and often. Build your didactic knowledge competencies into the scenario. For example, it does no good for a medic to be able to figure out the number of gtts per minute for a dopamine drip on paper. All that matters is for that medic to be able to set up the dopamine drip and set the gtts or the pump correctly. So make the candidates do everything in real time, and don't allow any verbalization of anything. Require that all steps be done on the manikin and done in real time. Require that all drugs be drawn up, labeled, and arranged in sequence before the scenario starts. Same for equipment. Require that the bougie and Combitube/LMA/CobraPLA, et cetera be available at arms length. This is the only way to know whether or not a medic can perform the skill. Written tests tell you NOTHING other than that this person can guess the right answer. Use nothing less than a panel of three persons to evaluate these performances. One of the panel ought to be the medical director, another the EMS education director, and another the QI person or an experienced EMS instructor from outside the organization. NOBODY from administration or management should ever be allowed in the room. This sort of testing costs money. It takes time. Management hates it because they can't see it as making them a dime. But it might save them their company if a lawsuit were to arise. Few managers have the sense to understand that, but kudos to those who do. You know who you are, and the rest of you don't read this list anyway. Bottom line: Demand real-time performance and keep demanding it. Screw written tests. They are worthless in the context that you're talking about. Gene G. > Here is a question for those of you that require testing of personnel on > service protocols. My company wants to establish this type of testing, as they > want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would > be allowed to do more advanced procedures, such as RSI, while the level 1 > paramedics would not be able to do this unless tested and cleared by the MD. > > Where do most of you come up with your testing questions? Is there a good > test bank that can be bought, or does each service develop their own > questions and skills testing for protocols? > > Your input would be appreciated. > > Wayne > > > --------------------------------- > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! > Messenger with Voice. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 30, 2006 Report Share Posted May 30, 2006 Wayne, Thanks for the background, I can understand the issue when you have part-time employees. Hats off to your agency for ensuring quality personnel and not warm bodies. Real life scenarios that test the employees ability to practice the SOC's (not just spit them back out) will give you a wealth of information!! Good luck, Protocol Testing Here is a question for those of you that require testing of personnel on service protocols. My company wants to establish this type of testing, as they want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics would be allowed to do more advanced procedures, such as RSI, while the level 1 paramedics would not be able to do this unless tested and cleared by the MD. Where do most of you come up with your testing questions? Is there a good test bank that can be bought, or does each service develop their own questions and skills testing for protocols? Your input would be appreciated. Wayne --------------------------------- Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! Messenger with Voice. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 The author, respecting the tender sensibilities of many readers of this list, has generously deleted the expletives. Please feel free to add your own appropriately profane adjectives as needed to fit the meaning as you read. A nurse? A $@#^(^! NURSE? Give me a BREAK! What business does a nurse or a medical control doctor have coming onto an ambulance and evaluating anyone? And WHAT THE #@$% does anybody from medical control know about field work except how to read the protocol anyway? Sheesh. This makes me gag. I haven't given a bed bath in the truck in my whole career. So what's the nurse going to evaluate anyway. How about let's go into the hospital and evaluate the proficiency of the nurses and doctors there. Just how far do you think you'd get with that? But it makes as much sense (actually it makes more sense) to have us go into the hospital and evaluate the skills of those who practice there as it does for nurses and anybody other than a physician who spends lots of time in the field with medics (which narrows it down to approximately 5 in Texas) doing evaluations on paramedics. You have inadvertently identified what's wrong with EMS today. The wrong people control it. Senior, experienced PARAMEDICS are the ones that ought to be doing these evaluations and MAYBE your own medical director. The only nurses that should ever be involved are those who are also paramedics and who have extensive field experience AS A PARAMEDIC. The only docs who ought to have a word to say about how somebody performs in the field are those who have once been paramedics and YOUR medical control doc, and that's only for those whose docs are active in the field. Anybody got some phenergan? I'm nauseated. Nurse indeed~ Gene G. In a message dated 5/30/06 15:03:46 Central Daylight Time, jthornton@... writes: > Subj: Re: Protocol Testing > Date:5/30/06 15:03:46 Central Daylight Time > From:jthornton@... > Reply-to:texasems-l > To:texasems-l > Sent from the Internet > > > > Our dept. uses written & practical evaluations. We do this once a > year. We also have someone from Medical Control (maybe nurse or > Dr.) that will ride out periodically to evaluate us. I think a good > bit of evaluation can be done by reviewing reports. > > As for having different levels of Medics, I don't think it is a bad > idea. For example, I work for a fire dept. and we have approx. 80 > paramedics. The drivers and officers are given the option of > dropping their paramedic. They do not get rid of their cert through > TDH, but they are EMTs under medical direction. For our Batallion > Chiefs, it is mandatory. If a service uses RSI, I think it is > reasonable to not make the drivers and officers responsible for that > skill. One advantage that we have is that there are no EMTs except > for a few (5 or so) that are drivers and officers. > > > > > > > Wayne, > > > > I agree with Gene, competency based evaluation is the only way to > go. > > > > My question to your agency is why create 2 different leveles? Why > not expect > > all your paramedics to be able to perform at an expected level? > This sounds > > like you are moving back to the EMT/Paramedic team approach, which > while it > > does have limited advantages, dual medics is much more desired. It > seems > > like it would confuse staffing problems, with differenct levels of > > paramedics instead of just 1 standard. > > > > > > Protocol Testing > > > > > > Here is a question for those of you that require testing of > personnel on > > service protocols. My company wants to establish this type of > testing, as > > they want to develop a level 1 & 2 for each level. Ex: Level 2 > paramedics > > would be allowed to do more advanced procedures, such as RSI, > while the > > level 1 paramedics would not be able to do this unless tested and > cleared by > > the MD. > > > > Where do most of you come up with your testing questions? Is > there a good > > test bank that can be bought, or does each service develop their > own > > questions and skills testing for protocols? > > > > Your input would be appreciated. > > > > Wayne > > > > > > --------------------------------- > > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using > Yahoo! > > Messenger with Voice. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 See my comments regarding nurses doing the evaluations. GG In a message dated 5/30/06 20:00:03 Central Daylight Time, airmedic51@... writes: > Gene, I do like what you say! > > I have no problem with protocol testing as long as it's not done by a > " PARAGOD " , someone who belittles anyone, or someone who sits behind a desk who > can't even perform out in the field, and scrutinizes every little thing as if > he were a lawyer. > > In other words---------- Let a REAL to life individual who knows what it's > like out in the field do the testing > > > > wegandy1938@... wrote: > Forget about test banks and written tests. The only way to determine > competency to perform advanced sequences such as RSI is through scenario > testing. > > Develop a realistic scenario and have the medics work through it as team > leader. There should be no level 1s and 2s for RSI. Either you're > competent to > do it or you're not. > > Sit down and do a realistic task analysis showing exactly what items must be > > performed. That means writing down every single and separate move that > must > be done in performing the whole skill sequence. > > Then go through and put an asterisk next to " absolutes " that must be done or > > the person automatically fails. > > There can be some skipped items, but no items should be ranked less than Yes > > or NO. Did they do it or did they not. > > If they did all the items marked absolute, then they ought to be able to > perform the skill sequence. If they did not do them all, then they need to > > practice and retest until they can do them all. > > This sort of testing is competency-based, and either you're competent or > you're not. But there should be no set limit on how many times the > candidate can > test. When competency level is achieved, then it is achieved. Period. > However, periodic competency retests should be done randomly, and often. > > Build your didactic knowledge competencies into the scenario. For example, > > it does no good for a medic to be able to figure out the number of gtts per > minute for a dopamine drip on paper. All that matters is for that medic to > be > able to set up the dopamine drip and set the gtts or the pump correctly. > > So make the candidates do everything in real time, and don't allow any > verbalization of anything. Require that all steps be done on the manikin > and done > in real time. Require that all drugs be drawn up, labeled, and arranged in > > sequence before the scenario starts. Same for equipment. Require that > the > bougie and Combitube/LMA/CobraPLA, et cetera be available at arms length. > > This is the only way to know whether or not a medic can perform the skill. > > Written tests tell you NOTHING other than that this person can guess the > right > answer. > > Use nothing less than a panel of three persons to evaluate these > performances. One of the panel ought to be the medical director, another > the EMS > education director, and another the QI person or an experienced EMS > instructor from > outside the organization. NOBODY from administration or management should > > ever be allowed in the room. > > This sort of testing costs money. It takes time. Management hates it > because they can't see it as making them a dime. But it might save them > their > company if a lawsuit were to arise. Few managers have the sense to > understand > that, but kudos to those who do. You know who you are, and the rest of you > > don't read this list anyway. > > Bottom line: Demand real-time performance and keep demanding it. Screw > written tests. They are worthless in the context that you're talking > about. > > Gene G. > > > > > > > Here is a question for those of you that require testing of personnel on > > service protocols. My company wants to establish this type of testing, as > they > > want to develop a level 1 & 2 for each level. Ex: Level 2 paramedics > would > > be allowed to do more advanced procedures, such as RSI, while the level 1 > > paramedics would not be able to do this unless tested and cleared by the > MD. > > > > Where do most of you come up with your testing questions? Is there a > good > > test bank that can be bought, or does each service develop their own > > questions and skills testing for protocols? > > > > Your input would be appreciated. > > > > Wayne > > > > > > --------------------------------- > > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Yahoo! > > Messenger with Voice. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 In a message dated 5/31/2006 9:03:38 P.M. Central Daylight Time, sstephensmedic@... writes: stephen stephens Just a hick from the sticks with 2 first names no less! Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant LNMolino@... (Cell Phone) (Home Phone) (IFW/TFW/FSS Office) (IFW/TFW/FSS Fax) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) The comments contained in this E-mail are the opinions of the author and the author alone. I in no way ever intend to speak for any person or organization that I am in any way whatsoever involved or associated with unless I specifically state that I am doing so. Further this E-mail is intended only for its stated recipient and may contain private and or confidential materials retransmission is strictly prohibited unless placed in the public domain by the original author. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 In a message dated 5/31/2006 6:57:19 P.M. Central Daylight Time, wegandy1938@... writes: Senior, experienced PARAMEDICS are the ones that ought to be doing these evaluations and MAYBE your own medical director. The only nurses that should ever be involved are those who are also paramedics and who have extensive field experience AS A PARAMEDIC. The only docs who ought to have a word to say about how somebody performs in the field are those who have once been paramedics and YOUR medical control doc, and that's only for those whose docs are active in the field. Anybody got some phenergan? I'm nauseated. Nurse indeed~ how about some Thorazine instead? ck Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 In a message dated 5/31/2006 9:37:28 P.M. Central Standard Time, asearch4reason@... writes: we will see that there was a reason we all got into the medical profession ....Yeah. To drive a big truck full of drugs really fast and run red lights. (Grin..) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 Gene, Gene he's our man....................... wegandy1938@... wrote: The author, respecting the tender sensibilities of many readers of this list, has generously deleted the expletives. Please feel free to add your own appropriately profane adjectives as needed to fit the meaning as you read. A nurse? A $@#^(^! NURSE? Give me a BREAK! What business does a nurse or a medical control doctor have coming onto an ambulance and evaluating anyone? And WHAT THE #@$% does anybody from medical control know about field work except how to read the protocol anyway? Sheesh. This makes me gag. I haven't given a bed bath in the truck in my whole career. So what's the nurse going to evaluate anyway. How about let's go into the hospital and evaluate the proficiency of the nurses and doctors there. Just how far do you think you'd get with that? But it makes as much sense (actually it makes more sense) to have us go into the hospital and evaluate the skills of those who practice there as it does for nurses and anybody other than a physician who spends lots of time in the field with medics (which narrows it down to approximately 5 in Texas) doing evaluations on paramedics. You have inadvertently identified what's wrong with EMS today. The wrong people control it. Senior, experienced PARAMEDICS are the ones that ought to be doing these evaluations and MAYBE your own medical director. The only nurses that should ever be involved are those who are also paramedics and who have extensive field experience AS A PARAMEDIC. The only docs who ought to have a word to say about how somebody performs in the field are those who have once been paramedics and YOUR medical control doc, and that's only for those whose docs are active in the field. Anybody got some phenergan? I'm nauseated. Nurse indeed~ Gene G. In a message dated 5/30/06 15:03:46 Central Daylight Time, jthornton@... writes: > Subj: Re: Protocol Testing > Date:5/30/06 15:03:46 Central Daylight Time > From:jthornton@... > Reply-to:texasems-l > To:texasems-l > Sent from the Internet > > > > Our dept. uses written & practical evaluations. We do this once a > year. We also have someone from Medical Control (maybe nurse or > Dr.) that will ride out periodically to evaluate us. I think a good > bit of evaluation can be done by reviewing reports. > > As for having different levels of Medics, I don't think it is a bad > idea. For example, I work for a fire dept. and we have approx. 80 > paramedics. The drivers and officers are given the option of > dropping their paramedic. They do not get rid of their cert through > TDH, but they are EMTs under medical direction. For our Batallion > Chiefs, it is mandatory. If a service uses RSI, I think it is > reasonable to not make the drivers and officers responsible for that > skill. One advantage that we have is that there are no EMTs except > for a few (5 or so) that are drivers and officers. > > > > > > > Wayne, > > > > I agree with Gene, competency based evaluation is the only way to > go. > > > > My question to your agency is why create 2 different leveles? Why > not expect > > all your paramedics to be able to perform at an expected level? > This sounds > > like you are moving back to the EMT/Paramedic team approach, which > while it > > does have limited advantages, dual medics is much more desired. It > seems > > like it would confuse staffing problems, with differenct levels of > > paramedics instead of just 1 standard. > > > > > > Protocol Testing > > > > > > Here is a question for those of you that require testing of > personnel on > > service protocols. My company wants to establish this type of > testing, as > > they want to develop a level 1 & 2 for each level. Ex: Level 2 > paramedics > > would be allowed to do more advanced procedures, such as RSI, > while the > > level 1 paramedics would not be able to do this unless tested and > cleared by > > the MD. > > > > Where do most of you come up with your testing questions? Is > there a good > > test bank that can be bought, or does each service develop their > own > > questions and skills testing for protocols? > > > > Your input would be appreciated. > > > > Wayne > > Danny L. Owner/NREMT-P PETSAR INC. (Panhandle Emergency Training Services And Response Office Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 And Gene this is why I have only one Field Training Supervisor who evaluates my crews. The FTS has more experience then I care to list here. And guess what, he even evaluates me (the director) not that I screw up much anymore after 21 years of doing this. The FTS also helps do yearly evaluations of the employees. My medical director is proactive but the FTS and I are the ones who say yay or nay. Gene you are da man. About damn time we stand up for us, the EMS people, and not bow down to those who think they know best. stephen stephens Just a hick from the sticks > > > > > > Wayne, > > > > > > I agree with Gene, competency based evaluation is the only way to > > go. > > > > > > My question to your agency is why create 2 different leveles? Why > > not expect > > > all your paramedics to be able to perform at an expected level? > > This sounds > > > like you are moving back to the EMT/Paramedic team approach, which > > while it > > > does have limited advantages, dual medics is much more desired. It > > seems > > > like it would confuse staffing problems, with differenct levels of > > > paramedics instead of just 1 standard. > > > > > > > > > Protocol Testing > > > > > > > > > Here is a question for those of you that require testing of > > personnel on > > > service protocols. My company wants to establish this type of > > testing, as > > > they want to develop a level 1 & 2 for each level. Ex: Level 2 > > paramedics > > > would be allowed to do more advanced procedures, such as RSI, > > while the > > > level 1 paramedics would not be able to do this unless tested and > > cleared by > > > the MD. > > > > > > Where do most of you come up with your testing questions? Is > > there a good > > > test bank that can be bought, or does each service develop their > > own > > > questions and skills testing for protocols? > > > > > > Your input would be appreciated. > > > > > > Wayne > > > > > > > > > --------------------------------- > > > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using > > Yahoo! > > > Messenger with Voice. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 And Gene this is why I have only one Field Training Supervisor who evaluates my crews. The FTS has more experience then I care to list here. And guess what, he even evaluates me (the director) not that I screw up much anymore after 21 years of doing this. The FTS also helps do yearly evaluations of the employees. My medical director is proactive but the FTS and I are the ones who say yay or nay. Gene you are da man. About damn time we stand up for us, the EMS people, and not bow down to those who think they know best. stephen stephens Just a hick from the sticks > > > > > > Wayne, > > > > > > I agree with Gene, competency based evaluation is the only way to > > go. > > > > > > My question to your agency is why create 2 different leveles? Why > > not expect > > > all your paramedics to be able to perform at an expected level? > > This sounds > > > like you are moving back to the EMT/Paramedic team approach, which > > while it > > > does have limited advantages, dual medics is much more desired. It > > seems > > > like it would confuse staffing problems, with differenct levels of > > > paramedics instead of just 1 standard. > > > > > > > > > Protocol Testing > > > > > > > > > Here is a question for those of you that require testing of > > personnel on > > > service protocols. My company wants to establish this type of > > testing, as > > > they want to develop a level 1 & 2 for each level. Ex: Level 2 > > paramedics > > > would be allowed to do more advanced procedures, such as RSI, > > while the > > > level 1 paramedics would not be able to do this unless tested and > > cleared by > > > the MD. > > > > > > Where do most of you come up with your testing questions? Is > > there a good > > > test bank that can be bought, or does each service develop their > > own > > > questions and skills testing for protocols? > > > > > > Your input would be appreciated. > > > > > > Wayne > > > > > > > > > --------------------------------- > > > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using > > Yahoo! > > > Messenger with Voice. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 Oh, NOW I see the nurse reference. Totally agree, I think my comments reflected yours as far as criteria. Larry RN LP wegandy1938@... wrote: " ...What business does a nurse or a medical control doctor have coming onto an ambulance and evaluating anyone? ... (which narrows it down to approximately 5 in Texas) doing evaluations on paramedics. .... The only nurses that should ever be involved are those who are also paramedics and who have extensive field experience AS A PARAMEDIC. The only docs who ought to have a word to say about how somebody performs in the field are those who have once been paramedics and YOUR medical control doc, and that's only for those whose docs are active in the field.... " " A prudent man foresees the difficulties ahead and prepares for them; the simpleton goes blindly on and suffers the consequences. " Proverbs 22:3 --------------------------------- Yahoo! Messenger with Voice. PC-to-Phone calls for ridiculously low rates. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 Gene, You will need a prescription for Phenergan (yes, from a doctor.) It is no wonder why EMS has so much trouble going forward. Why don't you re-read your email and evaluate whether that is the message that you want to broadcast over the internet? To summarize, there are only 5 doctors in Texas who are qualified to evaluate a medic? And, in general, your medical director would not be qualified? It would be funny if it wasn't such a prevalent attitude.... Kirk D. Mahon, MD, ABEM 6106 Keller Springs Rd Dallas, TX 75248 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 And that is why noone ever forgets me..lol > > > > In a message dated 5/31/2006 9:03:38 P.M. Central Daylight Time, > sstephensmedic@... writes: > > > stephen stephens > Just a hick from the sticks > > > with 2 first names no less! > > Louis N. Molino, Sr., CET > FF/NREMT-B/FSI/EMSI > Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant > > LNMolino@... > > (Cell Phone) > (Home Phone) > (IFW/TFW/FSS Office) > (IFW/TFW/FSS Fax) > > " A Texan with a Jersey Attitude " > > " Great minds discuss ideas; Average minds discuss events; Small minds > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) > > The comments contained in this E-mail are the opinions of the author and the > author alone. I in no way ever intend to speak for any person or > organization that I am in any way whatsoever involved or associated with unless I > specifically state that I am doing so. Further this E-mail is intended only for its > stated recipient and may contain private and or confidential materials > retransmission is strictly prohibited unless placed in the public domain by the > original author. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 Please - These are just thoughts - and no more than that----- I do not believe in the Levels (Level 1 and Level 2), i agree that if the paramedic is competent to pass a protocol test then he should be allowed to follow ALL protocols. This takes away having to hold care just to wait for a level 1 or 2 which ever the case maybe to get there and actually treat the patient. Our protocols are given via scenarios that would require us to think and use our protocols. Our medical director, who is an ER physician also comes to our CE's and test us on our surgical airway and RSII protocols. I feel that a nurse, while good at what they do, do not need to be a part of the EMS testing as they do not know what privileges we have, unless they have been in our shoes. Nurses and Paramedics need to start getting along. they are no better than we are and visa versa, we are all in the same field trying to accomplish the same task. Helping others. AM i right, i hope so, this is why i got into this field. Not to say i am better than them or that they are better than me. I pity those that feel they are better than anyone, regardless of the years they have been on the streets or working in the hospital. These are the ones that will eventually kill someone, because they are all knowing. I have been doing this for a while, i know i haven't seen it all or done it all, and at the rate medicine is changing, i know I will NEVER know everything, but i am confident in the skills and knowledge that I do have. I work for a 911 service provider, i have volunteered and been paid. I have worked at a GTservice. I have been with those that " THINK " they know more than anyone because they have been in for YEARS, but in reality, when the S**T hit the fan, the old heads are just as lost as the rookies, and in some cases the rookies are telling the old heads what to do because they just learned it in school. I over heard someone the other day saying what does this paramedic know, he is just a " transfer medic " . WHAT DIFFERENCE does it make. Ok maybe some GT medics really shouldnt be on a truck, but I am sure we ALL know some 911 medics that really need to re-evaluate themselves as well. I know that I do. I even worked with some. Scary, to think... Regarding the medical directors or whatever evaluating the medics. Each MD has their weakness and strength. Just as each nurser and paramedic does. But if the MD is your medical director, he IS qualifies to evaluate you because he is the one that gave the OK to practice the medicine that we are practicing. Come on, we need to grow together as a profession and stop this backwards regression as to who's better nurses or paramedics. In my opinion, we are all the same, we both have those that think they are better than God, and we have those that were good in school but have NO clue what to do in the field, and we have those like myself, i would like to think, that know our limits and are not to scared to ask for assistance regardless of the call. If we all just really look at the BIG picture, we will see that there was a reason we all got into the medical profession and maybe, MAYBE we will all just melt together. just my thoughts... sorry for rambling.... NK EMT-P Kirk Mahon wrote: Gene, You will need a prescription for Phenergan (yes, from a doctor.) It is no wonder why EMS has so much trouble going forward. Why don't you re-read your email and evaluate whether that is the message that you want to broadcast over the internet? To summarize, there are only 5 doctors in Texas who are qualified to evaluate a medic? And, in general, your medical director would not be qualified? It would be funny if it wasn't such a prevalent attitude.... Kirk D. Mahon, MD, ABEM 6106 Keller Springs Rd Dallas, TX 75248 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 31, 2006 Report Share Posted May 31, 2006 Haven't we talked about your repressed feelings before??? C'mon Gene, let it out.... This reader truly appreciates you 'respecting my tender sensibilities' Mike Hatfield FF/EMT-P www.canyonlakefire-ems.org www.michaelhatfield.net Behalf Of wegandy1938@... The author, respecting the tender sensibilities of many readers of this list, has generously deleted the expletives. Please feel free to add your own appropriately profane adjectives as needed to fit the meaning as you read. A nurse? A $@#^(^! NURSE? Give me a BREAK! What business does a nurse or a medical control doctor have coming onto an ambulance and evaluating anyone? And WHAT THE #@$% does anybody from medical control know about field work except how to read the protocol anyway? Sheesh. This makes me gag. I haven't given a bed bath in the truck in my whole career. So what's the nurse going to evaluate anyway. How about let's go into the hospital and evaluate the proficiency of the nurses and doctors there. Just how far do you think you'd get with that? But it makes as much sense (actually it makes more sense) to have us go into the hospital and evaluate the skills of those who practice there as it does for nurses and anybody other than a physician who spends lots of time in the field with medics (which narrows it down to approximately 5 in Texas) doing evaluations on paramedics. You have inadvertently identified what's wrong with EMS today. The wrong people control it. Senior, experienced PARAMEDICS are the ones that ought to be doing these evaluations and MAYBE your own medical director. The only nurses that should ever be involved are those who are also paramedics and who have extensive field experience AS A PARAMEDIC. The only docs who ought to have a word to say about how somebody performs in the field are those who have once been paramedics and YOUR medical control doc, and that's only for those whose docs are active in the field. Anybody got some phenergan? I'm nauseated. Nurse indeed~ Gene G. In a message dated 5/30/06 15:03:46 Central Daylight Time, jthornton@... writes: > Subj: Re: Protocol Testing > Date:5/30/06 15:03:46 Central Daylight Time > From:jthornton@... > Reply-to:texasems-l > To:texasems-l > Sent from the Internet > > > > Our dept. uses written & practical evaluations. We do this once a > year. We also have someone from Medical Control (maybe nurse or > Dr.) that will ride out periodically to evaluate us. I think a good > bit of evaluation can be done by reviewing reports. > > As for having different levels of Medics, I don't think it is a bad > idea. For example, I work for a fire dept. and we have approx. 80 > paramedics. The drivers and officers are given the option of > dropping their paramedic. They do not get rid of their cert through > TDH, but they are EMTs under medical direction. For our Batallion > Chiefs, it is mandatory. If a service uses RSI, I think it is > reasonable to not make the drivers and officers responsible for that > skill. One advantage that we have is that there are no EMTs except > for a few (5 or so) that are drivers and officers. > > > > > > > Wayne, > > > > I agree with Gene, competency based evaluation is the only way to > go. > > > > My question to your agency is why create 2 different leveles? Why > not expect > > all your paramedics to be able to perform at an expected level? > This sounds > > like you are moving back to the EMT/Paramedic team approach, which > while it > > does have limited advantages, dual medics is much more desired. It > seems > > like it would confuse staffing problems, with differenct levels of > > paramedics instead of just 1 standard. > > > > > > Protocol Testing > > > > > > Here is a question for those of you that require testing of > personnel on > > service protocols. My company wants to establish this type of > testing, as > > they want to develop a level 1 & 2 for each level. Ex: Level 2 > paramedics > > would be allowed to do more advanced procedures, such as RSI, > while the > > level 1 paramedics would not be able to do this unless tested and > cleared by > > the MD. > > > > Where do most of you come up with your testing questions? Is > there a good > > test bank that can be bought, or does each service develop their > own > > questions and skills testing for protocols? > > > > Your input would be appreciated. > > > > Wayne > > > > > > --------------------------------- > > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using > Yahoo! > > Messenger with Voice. > > > > Quote Link to comment Share on other sites More sharing options...
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