IS THERE A DOCTOR IN THE HOUSE? Chris Miller, MICP Chris Miller, MICP Kendrick Davis, PhD Kendrick Davis, PhD Heidi Millard, MD Maegen Dupper, MD Tiffany Moxham, MLIS Tiffany Moxham, MLIS January 29, 2016 January 29, 2016

OUTLINE Problem – What? Problem – Why? What - Objectives How - Solution Results Conclusion – Future – Recommendations Questions

PROBLEM 5 th Leading Cause of Death - Accident, unintentional injuries. 1 1 passenger in 11,000 suffers an in-flight medical emergency. 2 3 rd Leading Cause of Death in Riverside County pedestrians a day are struck by an automobile, one every 7 minutes. 4 1 CDC National Vital Statistic Reports, Vol.64, No. 10, August 31, Is There a Doctor on the Aircraft: 3 Community Health Report, County of Riverside Department of Public Health, National Highway Traffic Safety Administration, Traffic Safety Facts, 2012

PROBLEM The lay-public expects physicians, no matter what their specialty or where they are in their education, to be life-savers. 1 Some international systems are requiring medical students to learn basic life support procedures. 2 Select U.S. medical schools are placing emergency medical technician certification at the front of first year of their curriculum. 3 There is a clear ethical obligation for the MS student to respond to the emergency. 4 1 Nelson M. A first aid and CPR course for first-year medical students. Medical Education 1982; 16: Perkins GD, Hulme J. Basic life support training for health care students. Resuscitation 1999; 41: Med Educ Online 2014, 19: Journal of Emergency Medicine, Vol. 50, No. 1, pp , 2016

OBJECTIVES Instruct medical students in basic life saving procedures beyond CPR. Improve and enhance inter-team communications. Reinforce critical thinking and clinical reasoning skills in an out-of-hospital environment.

OBJECTIVES Increase the students’ self-reported level of confidence in the performance of patient care skills. Reduce the students’ reported stress in an emergency situation. Introduce CERT (Civilian Emergency Response Team) and NIMS key points. Create better community healthcare partners.

SOLUTION Emergency Medical Technician certification course in California: 160 hours total – 136 hours didactic + 24 hours clinical Current SOM curriculum does not have 160 hours of time “cracks” to be leveraged. Though the current faculty are qualified to teach EMT skills, none have pre-hospital experience.

SOLUTION Reduce the EMT curriculum to bare essentials. Present in modules that have subject matter relationships to “Block” material. Reinforce EMT skills with simulation and standardized patient based scenarios. Form community partnerships with local public safety agencies for instructor support.

MODULAR TOPICS “He’s Been Cut Real Bad” “Help, I Think I’m Having My Baby NOW!” Splinting Suspected & Known Fractures “Is There a Doctor Onboard”, Inflight Medical Emergencies Patient Emergency Medications – EpiPens, Inhalers, NTG, Glucose Paste “Hurry, He’s Been Hit By a Car!” BLS Trauma Assessment and Transfer of Care

PARTNERSHIPS American Medical Response Cedars Sinai Medical Center Gaumard Scientific Moreno Valley College National College of Technical Instruction Riverside City Fire Department Riverside County Fire Department

MODULE PRESENTATION MEDIA ACTIVITY ACTIVITY REVIEW TABLE DISCUSSION/PRACTICE SCENARIO PRACTICE EVALUATION

Lesson Plan

An evaluative-assessment was generated and administered following each training workshop. Evaluative-assessment measurement components: 3 Self-report items – gauging student’s resulting confidence in their competence (or self-efficacy). 2 Assessment items - assessing student’s ability to demonstrate competence on newly acquired skills. RESULTS - Evaluative Measures

Sample Student Feedback: “This is great practical real world instruction. I hope I never need it.” “I was standing on a street corner and saw a woman in the crosswalk get struck by a car. I felt so helpless and useless. Now, I have the basic skills to handle the same event if it ever occurs to me again.” “I certainly feel better prepared for a medical emergency if it happens in front of me. It’s crazy that this instruction isn’t mandatory in every medical school.” “Since coming to California I’ve heard all this information about disasters and being prepared for them. Now, I know how the system works and how I would fit into it in the event of a real disaster.”

Participants

FUTURE PLANS Integrating the workshops into the curriculum. Staging a mock disaster every two years so students get the benefit of working inside the incident command system with actual fire responders. Placing more media online for viewing before the actual course. Offering the program to other UC Schools of Medicine.

References:  Is There a Doctor on the Aircraft:  CDC NCHS Data Brief No  National Highway Traffic Safety Administration, Traffic Safety Facts,  Perkins GD, Hulme J. Basic life support training for health care students. Resuscitation 1999; 41:  Tan I.S. First aid and basic life support of junior doctors: a prospective study in Nijmegen. Medical Teacher 2006; 28(2):  Nelson M. A first aid and CPR course for first-year medical students. Medical Education 1982; 16:7-11.  Das M, Elzubeir M. First aid and basic life support skills training early in the medical curriculum. Teaching and Learning in Medicine 2001; 13(4):

Questions?