Development of new core competencies for Taiwanese Emergency Medical Technicians

Abstract

ObjectivesCore competencies are considered the foundation for establishing Emergency Medical Technician (EMT) and paramedic curricula, and for ensuring performance standards in the delivery of prehospital care. This study surveyed EMT instructors and medical directors to identify the most desirable core competencies for all levels of EMTs in Taiwan.MethodsA principal components analysis with Varimax rotation was conducted. An online questionnaire was distributed to obtain perspectives of EMT instructors and medical directors on the most desirable core competencies for EMTs. The target population was EMT training-course instructors and medical directors of fire departments in Taiwan. The questionnaire comprised 61 competency items, and multiple-choice and open-ended questions were used to obtain respondents’ perspectives of the Taiwanese EMT training and education system.ResultsThe results identified three factors at EMT-1 and EMT-2 levels and five factors at the EMT-Paramedic level. The factors for EMT-1 and EMT-2 were similar, and those for EMT-Paramedics identified further comprehensive competence perspectives. The key factors that appear to influence the development of the Taiwanese Emergency Medical Services (EMS) education system are the attitude of authorities, the licensure system, and legislation.ConclusionThe findings present new core competencies for the Taiwanese EMT system and provide capacity to redesign curricula and reconsider roles for EMT-1 and EMT-2 technicians. At the EMT-Paramedic level, the findings demonstrate the importance of incorporating competency standards in the current skills-based curriculum. Moreover, the core-competencies gap that exists between Taiwanese EMT-1s, EMT-2s, and EMT-Paramedics and internationally recognized core competencies needs to be addressed. By identifying the key factors that potentially impact the development of the EMS education system, such as the attitude of authorities, the licensure system, and legislation, these findings will inform future curricula design in Taiwan.

Cognitive skills of emergency medical services crew members: a literature review

“…The synthesis combines information from focused assessments that are here separated, yet in EMS professionals' minds, they tend to overlap. The main assessment is focused on child or adult patients [42], and their various medical conditions and problems [31,33,37 2), participant who did not state their profession (n = 4) The behavioral rating system includes one relevant categorygathering information. It is comprised of three elements and associated markers: conducting a risk assessment of the scene and ensuring it is safe to approach the patient before proceeding (e.g., noting any environmental hazards to self and the patient, stating the decision to approach the patient or not), reviewing decisions to ensure they are still appropriate requesting a second opinion from others (e.g., discussing alternative suggestions, stating the final decision), and trying alternative options when a certain approach is not working (e.g., stating alternative approach/intervention to be tried, beginning to use new approach/intervention).…”

“…They can be valuable sources of information to manage the emergency situation to a satisfying conclusion. It also emerged that it was crucial for those in a high-risk EMS profession to assess the environment and the safety of patients, bystanders, and personnel on scene and in the ambulance [31,33,34,38,40,41,47,48,55,57]. This means assessing clues and significant objects in the environment that can give a notion of what happens and to assess potential risks and threats.…”

“…Based on the collected information, EMS crew members made interpretations that are part of their mental model of the call. Although making good interpretations of patient's medical conditions is considered to be one of the required attributes [42,57], it is critical to evaluate findings while discriminating between relevant and irrelevant data, avoid premature closure [54], rely less on the initial diagnostic hypothesis [51], and verify it by generating and exploring a wider variety of hypothetical diagnosisdifferential diagnosis [33,36,51,54].…”

“…These decisions are primarily about medical treatment and management [40,41,44,47], using various medical equipment, devices, and drugs, and occurring mostly with high density during the on-scene treatment phase of an emergency call [41]. Moreover, there are decisions made about the management of labor and delivery [41], nursing care and support [39,40,48,53,57,58], deterioration prevention [48], extrication and transport [41,44,47], and safetyrelated decisions focused on preventing and mitigating risks of all persons involved [33,40,47,48,50,57].…”

“…Selecting and implementing an option can be found in several articles that discuss the importance of selecting a safe, effective, situation-specific, appropriately prioritized and timed management plan and/or decision strategy [33,34,47,54,56]. The research highlights that experts can decide and act at the right time and place [32] based on incomplete information as emergency situations often require [43,60].…”