The intention of the EMS provider is important, but it’s our impact that leaves a lasting mark on the lives of our patients. Our “intention in providing care” mixed with “how we deliver” make up the impact.
One of the most important tools we use is our touch. We touch our patients with quick hands and a confident and assured way. We also touch them through our communication and caring attitude, but it is our skills that make the real difference.
Ultimately, employees who have a will to succeed and a drive to do their best will follow through with skills excellence will fulfill on their good intentions. Unmotivated employees are less concerned about skills performance and willing to get by with minimum effort, leave their impact far apart from their intentions.
Encyclopedias have paragraph long descriptions and definitions for psychomotor skills also called sensori-motor and perceptualmotor skills. Basically, for EMS it’s the range of basic and complex skills necessary to deliver quality patient care. Delivery of these skills requires intention, thoughtfulness, preciseness and timing.
The problem with our skills is they are infrequently used on real patients. Sometimes the only practice method available is mannequins. When doing skills on the mannequin, we need to also practice communicating with our patients.
History of Keeping Skills Up
Keeping some skills up is easy, while some of the more advance skills can be challenging. EMS skills, especially those in industrial plants, can erode every second the clock ticks forward. Efforts have been made to identify infrequently used skills and put ongoing training in place to maintain competency.
Tracking training records, identifying infrequently used skills, maintaining sufficient simulation training equipment and medical control involvement are keys to quality assurance. However, the real responsibility lies with the EMT or Paramedic and his/her internal motivation.
Maintaining Basic Psychomotor Skills
Here is a list of basic skills that should be maintained through training and practice on a regular basis.
Patient Assessment and Management – Trauma or Medical
Performing hands-on, head-to-toe, physical assessment and voice treatment of a moulaged simulated patient or high fidelity simulation manikin for a given scenario requires many parts: scene size-up and safety, primary survey and/or immediate resuscitation, history taking and secondary assessment and reassessments as necessary when a patient’s condition changes both negatively and positively.
Practice providing ventilator assistance to an apneic patient who has a weak carotid pulse with no associated injuries. The skills include manually opening the airway, suctioning the mouth and oropharynx, inserting and oropharyngeal airway and ventilating a manikin with the bag-valve-mask.
Practice assembling a regulator to a portable oxygen tank and administer oxygen by nonrebreather mask to an adult patient who is short of breath.
Cardiac Arrest Management and AED Use
Integrating CPR skills while perform at least two minutes of 1-person adult CPR, attach and use the AED (including shock delivery) given a scenario of an adult patient found in cardiac arrest where no bystanders are present.
Immobilize an adult patient who is found supine with a suspected unstable spine using whatever medical director approved device is available.
Other EMT Skills
Spinal immobilization in a seated patient, bleeding control and chock management, long bone immobilization, joint immobilization.
Maintaining Advanced Skills
Advanced skills authorized by the medical director can include any of the following or more. The specifics of “how” shall be dictated by the medical director:
- Adult endotracheal intubation
- Pediatric endotrachael intubation
- Nasotracheal intubation
- Nasogastric suctioning
- King irway
- Trancutaneous cardiac pacing
- Intraossessous infusions
- Needle thoracostomy
- Needle circothyrotomy
When researching and monitoring several different EMS organizations on their skills practice schedule, I found that most practice skills monthly, quarterly and some annually. However, based on the judgement of the Medical Director, he/she may increase the frequency of the training intervals as necessary.
There are ways to help employees maintain their skills:
- Provide mannequins for practice
- Make practice game’s that allow others to compete in doing skills.
- Test skills regularly.
- Post pictures of skills steps and directions so that workers may see, read and reinforce.
- Talk about how to work through issues when doing skills.
- Practice doesn’t always make perfect, but perfect practice does.
- Use visualization techniques.
- Reward those who enthusiastically participate in the skills programs.
- Allow employees to attend conferences that provide practice of clinical skills.
Maintaining the skills of the EMS profession is necessary to maintain quality patient care and the professional image of emergency service workers. Employers must understand the nature of employee motivation and identify things found in the workplace that can affect it.