June 23, 2011
News from the CoAEMSP

In This Issue
Quick Links
CoAEMSP Website

CAAHEP Website

NREMT Website

Institute of Medicine Report

National EMS Scope of Practice

EMS Agenda for the Future

Education Standards

National EMS Core Content 
American Academy of Pediatrics (AAP)

American Ambulance Association (AAA)

 American College of Cardiology (ACC)

American College of Emergency Physicians (ACEP)


 American College of Osteopathic Emergency Physicians (ACOEP)

 American College of Surgeons (ACS)

 American Society of Anesthesiologists (ASA)

 International Association of Fire Chiefs (IAFC)

 National Association of Emergency Medical Services Physicians (NAEMSP)

 National Association of Emergency Medical Technicians (NAEMT)

 National Association of EMS Educators (NAEMSE)

 National Association of State Emergency Medical Services Officials (NASEMSO)

 National Registry of Emergency Medical Technicians (NREMT) 
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Make the Most of Your Travels to Reno:

Accreditation Workshop at NAEMSE Symposium 


September 14-15

NAEMSE Symposium, Reno, NV

Accreditation Workshop: STEPS TO SUCCESS


This comprehensive two-day accreditation workshop will arm you with all you need for a successful accreditation experience. You will receive hands-on instructions and guidance. Plan to attend now. Get more information here




This workshop will cover the following:

  1. Concept and overview of accreditation 
  2. Process of accreditation 
  3. Steps to the self study report with examples 
  4. Site visit process--how to prepare for it and what happens during and after the visit 
  5. Common stumbling blocks to accreditation and how to overcome them



The registration fee of $215 includes the cost of the workshop plus refreshment breaks each day. Space is limited so register now! 





November 14-15, Atlanta

Registration will open at a later date.  

CoAEMSP Answers Your Questions:

Preceptor Training Webinar, Slides
& FAQ Now Available


Have you ever wondered how often and how one should deliver the preceptor training program? What documentation is CoAEMSP looking for to demonstrate that a program is conducting preceptor training? How should skills be counted when on duty or if they should even be counted? How should the evaluations be done for preceptors and students? These questions and many more are answered in the new Preceptor Training FAQ. The FAQ also includes resources provided by participants of the preceptor training webinar offered this past March.



View the preceptor training WEBINAR (scroll to bottom of page)  

View the preceptor training SLIDES

View the preceptor training FAQ


Meet CoAEMSP Vice Chair Deb Cason  

Debra Cason 


Deb Cason, MS, RN, EMT-P, is Program Director and Associate Professor of Emergency Medicine Education at the University of Texas Southwestern Medical Center in Dallas where she oversees initial EMT and paramedic educational programs and paramedic continuing education. Deb has been with the University of Texas Southwestern Medical Center for more than 33 years.  


Deb previously worked in the Emergency Department at Parkland Memorial Hospital as Head Nurse. She has worked closely with the EMS Education Agenda and its components. She is past president of the National Association of EMS Educators (NAEMSE), a member of the board of the National Registry of EMTs (NREMT), and a NREMT representative for CoAEMSP. Also past chair of CoAEMSP, Deb currently serves as CoAEMSP Vice Chair, and chair of the site visitor subcommittee.


Clinical and Field Internship Sites    

By Patricia Tritt, RN, MA; Director, EMS and Trauma

HealthONE, Englewood, CO  


High quality clinical and field internship sites are like rare minerals: sometimes hard to find, must be mined carefully, and should be guarded jealously. Obviously, all sites are not created equal. According to the CAAHEP Standards and Guidelines, through a combination of sites/experiences, the students shall "have access to adequate numbers of patients, proportionately distributed by illness, injury, gender, age, and common problems encountered in the delivery of emergency care..." One of the first things a new program must determine in a feasibility study is whether adequate clinical and field resources are available in the local area. For that matter, any program contemplating its continuing existence asks the same questions.


An emerging trend for some programs is to send students out of the region, or even out of state, to satisfy these experiential requirements. Whatever your approach, there are some questions to consider. How will your program orient key hospital and other clinical experience personnel to: the purposes of the student rotation; program evaluation tools; criteria for evaluating/grading; and contact information for the program? How will your faculty assess the quality of the clinical experience? How will your faculty determine if the student has developed the desired competencies? Are you only evaluating numbers or are you evaluating the quality of the student experience? Documentation that all students meet the required minimums set by the program for assessments of the various types of patient complaints and skill interventions is required. However, numbers alone do not determine competency. Also, if your students are traveling, is your student licensed or certified in the out-of-state rotation to perform the skills required in the program? And is there a medical director, with a license in that state, who is taking responsibility for this student? Does your program worker's compensation and liability insurance cover the student in this circumstance?


Additional challenges present when students complete a field internship in an out-of-state location. Additional training for preceptors is required by the Standards, beyond what is provided for hospital clinicals. What is your relationship with the agency? How does the program select an appropriate preceptor? How does the program determine competency? Have you abdicated all responsibility for assessing competency to a preceptor that you have never met?

The focus of the clinical experience is shifting
from a specific location to include locations that can meet the rotation goals and objectives. The Standards and Guidelines identify seven locations for hospital/clinical affiliations. Of course, the emergency department and labor and delivery will be standards. But, for example, pediatric patients may be encountered in an emergency department, a pediatric clinic, a pediatrician's office, or other venue and not necessarily a rotation on a pediatric unit. Programs may be creative about where students get the experience but the program must insure that it is a quality experience. The controlled clinical settings offer ideal opportunities to: perform patient assessments; develop patient interviewing and communication skills; and practice isolated skills such as medication administration, intravenous insertion, and airway management. Experience in the clinical setting usually provides 'pieces' while the field internship provides the 'whole'. 


The field internship is a capstone experience. A capstone course offers the student nearing graduation the opportunity to summarize, evaluate, and integrate their previous coursework. In addition, student work needs to be evaluated by faculty members responsible for the program, not just the preceptor. The purpose of the field internship in the paramedic program is to provide the opportunity to assess and manage all types of calls and develop experience team leading. In other words, to pull the knowledge obtained in the classroom, skills lab, and clinical areas together to assess, manage, and treat all types of patients in the prehospital setting. The obvious dilemma for a program, especially one with limited staffing/faculty, is how to effectively provide the supervision and sequencing that truly makes this a capstone experience. At a minimum the following is required:

  • Careful selection of field precepting agencies  
  • Careful matching of the preceptor and the student
  • Adequate preceptor training
  • Meaningful daily/shift evaluation by the preceptor with verbal and written feedback to the student
  • Review of patient care reports by a faculty member with feedback to the student
  • Milestone, summative evaluations by the preceptor: after a specified number of hours or shifts or patient encounters. This type of evaluation summarizes the student progress to date, based on where they are in the program, not just on a given shift
  • Final summative evaluation of the student by the preceptor
  • Periodic communication between a program faculty member and the preceptor
  • Periodic meeting and progress review with a faculty member and the student

Each of the four components of a paramedic program is vital to student success: the classroom or didactic portion, the skills laboratory, the clinical settings, and the field internship. And equal focus must be placed on content, delivery, and monitoring student progress in each of these areas.    

Curriculum: Does Sequencing Matter?   

By Patricia Tritt, RN, MA; Director, EMS and Trauma

HealthONE, Englewood, CO  


Paramedic education consists of a vast amount of medical and related content relevant to the assessment and management of patients in the prehospital setting. The best, or most appropriate, method to sequence that content is more complex than it might first appear. Many programs offer between 35-45 college credit hours for just this specific content: not including anatomy and physiology or other general education courses offered through the college. Contact hour numbers vary widely but commonly fall between 1100-1500 hours. In addition, paramedic programs include four primary components: classroom or didactic; skills laboratory; clinical setting; and field internship experience. The amount of time required for program completion can vary from an accelerated, full-time format of six months to 18-24 months. In addition, prerequisites vary from none (no experience as an EMT) to a minimum of one year experience as an EMT. Some programs have developed discrete content blocks into the traditional college two, three, or four hour credit hour courses. This approach has many advantages, including providing a mechanism for a student who has difficulties in one content area to be able to repeat just the necessary course (for example pharmacology). The traditional college credit course approach also provides easier access to articulation of credits as the individual moves through the higher education process. Whatever your format or prerequisites, programs must determine how to sequence that content to maximize the development of competent, entry-level graduates.

How do you analyze sequencing? The National Standard Curriculum provided a general road map for progression that many programs followed. The National EMS Education Standards open the opportunities for more creative sequencing. The challenge is what content is required before other topics? This subject alone can provide animated, heated discussion among educators. A common-sense approach is required to determine what works best for your institution and the schedule you follow: for example does the class meet for three or four hours per session or all-day eight-hour classes? And how often do classes meet each week?

But perhaps the larger question is how are the clinical (hospital, clinics, or other sources of 'clinical' experience) and the field internship integrated into the overall program? Unfortunately, some programs schedule clinical and field hours based on availability and convenience rather than how prepared the students are based on medical content already mastered in the classroom and skills labs. For example, how valuable is a hospital clinical in a pediatric setting if the student has not completed the pediatric course content? The clinical rotations should provide an opportunity to perform assessments on all types of patients and to practice skills after the student has satisfactorily completed the relevant course content.

In the field of medicine an internship follows completion of medical school. In other words, the individual has the core information necessary to apply the practical skills already gained, yet the individual is not ready for licensure. The intent of the field internship in the paramedic program is to provide the opportunity to assess and manage all types of calls and develop experience  team leading. In other words, to pull the experience learned in the classroom, skills lab, and clinical areas together to assess, manage, and treat all types of patients in the prehospital setting. Per the Guideline in the Standards and Guidelines, "Enough of the field internship should occur following the completion of the didactic and clinical phases of the program to assure that the student has achieved the desired competencies of the curriculum prior to commencement of the field internship. Some didactic material may be taught concurrent with the field internship." Content that is concurrent with the filed internship should not be core content but may be case reviews and case presentations, research presentations by students, completion of standardized courses (IE PHTLS or PALS), and other supportive content such as preparing resumes, interviewing for positions, etcetera.


A further challenge is how long should the field internship be? Internship is not only about hours, but must also consider the length of the shifts, the volume and types of patients encountered, and the opportunities for the student to meet all of the terminal competencies and objectives for graduate entry level competency. Another factor that significantly impacts the quality of the field internship is the structure of the preceptor-student experience. Ideally, the student should be assigned to a single preceptor for the duration of the field internship to provide optimal opportunity to develop a relationship of trust that promotes honest, objective assessment of the student and the maximum opportunity for the student to function as team lead. A second preceptor is also acceptable when scheduling issues provide challenges. In the preceptor de jour approach, this climate of familiarity and trust is typically lost and the rotations lose value.

Some programs choose to schedule field shifts throughout the program. Early on, these experiences are often observational only or with some assessment and skill opportunities. These rotations should be considered field experience and may not be included as field internship since it does not meet the definition/requirements of an internship. Carefully consider what part of your field hours actually meets the definitions/requirements of an internship.

Try taking your curriculum apart and putting it back together again. Assemble your faculty and medical director and: chunk objectives and course content into logical components; list specific clinical rotations; and identify types of field experiences. Write each one on a sticky note and arrange on a white board. Continue to move around until you have a logical progression. Or find another creative way to approach the process of assessing your curriculum. But always keep the goals and objectives of the four components of the program at the fore. Trial the revised format and evaluate and repeat the process until you are confident that your students are receiving the very best experience possible.

Meet Our Sponsors:

The American Academy of Pediatrics 






The American Academy of Pediatrics (AAP) representatives on the CoAEMSP are Thomas B. Brazelton III, MD, MPH, FAAP and Stephen Karl, MD, FACS, FAAP. Dr. Brazelton also serves on the CoAEMSP Executive Committee as the at-large member. 


The American Academy of Pediatrics (AAP) is an organization of 60,000 pediatricians committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. Founded in 1930, the AAP provides child health resources for health professionals and parents including programs, activities, publications and more from the nation's leading child health experts, with scientific research supporting its recommendations.


A major goal of the AAP is to further the professional education of its members. Continuing education courses, annual scientific meetings, seminars, publications and statements from committees, councils, and sections form the basis of a continuing postgraduate educational program.


Twenty-nine committee members develop many of the AAP's positions and programs, with varied focus including injury and poison prevention, disabled children, sports medicine, nutrition, and child health financing. There are also seven councils and 49 sections consisting of more than 41,500 members with interest in specialized areas of pediatrics. 

AAP publications include: Pediatrics, its monthly scientific journal; Pediatrics in Review, its continuing education journal; and its membership news magazine, AAP News. It also publishes manuals on such topics as infectious diseases and school health. The AAP also produces patient education brochures and a series of child care books written by AAP members.


The AAP conducts original research in social, economic and behavioral areas and promotes funding of research. It ensures that children's health needs are taken into consideration as legislation and public policy are developed, maintaining a Washington, DC office for this purpose. The AAP's state advocacy staff provides assistance to chapters, promoting issues such as child safety legislation and Medicaid policies that increase access to care for low-income children.


AAP is governed by a Board of Directors consisting of ten members elected by members in their regional districts, who also serve as district chairpersons. The Executive Committee conducts AAP business on a daily basis, and currently consists of President O. Marion Burton, MD, FAAP; President-Elect Robert Block, MD, FAAP; Immediate Past President Judith S. Palfrey, MD, FAAP; and Executive Director Errol Alden, MD, FAAP, Elk Grove Village, Illinois.


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Jennifer Anderson Warwick, MA