Scenario-based education is a great learning tool for EMS people. I believe that scenarios are one of the best ways for EMTs and Paramedics to get their heads in the game and think deeply about potential problems they might face in the field before the tones go off and the pressure comes on. EMS scenarios allow the EMS person to look at potential problems, consider potential solutions, and test out the results of their actions in a safe environment.
I especially enjoy the recent collaborative scenarios that are put up in places like www. I think they give a good overview of the topics they cover and present the information in a way that makes you think about the topic in a more real-world setting. The problem with the scenarios I see on Facebook and elsewhere, however, is that they always seem to cover calls where the patient we are given is suffering from an awesomely severe medical or traumatic incident.
These scenarios are just as appropriate for the newest EMT as they are for the most seasoned leader of any EMS agency. Here we go:. Your ambulance is dispatched to a private residence in a quiet residential part of your coverage area. It is an area of town with smaller, yet well-kept homes where people tend to live in their houses for a long time. The house seems to be suffering from deferred maintenance all around and everything is showing its weather-worn age.
As you approach the house, you notice that the windows are all covered up with blankets on the inside which prevents your view from the outside area. It is practically barricaded from the inside and cannot be opened. The interior of the house is in bad shape. He appears emaciated, dirty, and scared of you as you approach.
You and your partner check him out. He complains of diarrhea, nausea, and general malaise. The patient says that he has no family in the area and that he has lived in the house alone since his wife passed away several years ago.
Paramedic Portfolio and Scenario Based Exam
You and your partner got into work early this morning and have come up with a great idea. As such, you do a quick check of your ambulance and run down to the local supermarket for supplies, sundry items, and breakfast foods you can use to whip up a scrumptious morning feast. You say that you do and continue to speak with her. He had taken too much heroin and ended up dying. I miss him so much and I just wanted to thank you for trying to help him. Lucky you. L-Roy is a good guy, a great medic, and a lot of fun to work with.XX is a regular patient of this clinic, and PMH and previous exams are all on record at this facility.
Chief Complaints: XX neither indicates nor verbalizes any chief complaints; all were noted and brought forward by the mother, XX XX states that XX began having a flattened affect and anorexia approximately three days prior.
Yesterday morning XX began exhibiting polydipsia and diarrhea. XX had no complications during birth, and records indicate no pre-natal, natal, or neonatal complications or distress. It was discovered that XX developed the Rickets due to his mother's social customs and XX seems to suffer no lasting effects from the Rickets. XX has never suffered accident or trauma, has had no surgery, and was only hospitalized for 2 days as part of the treatment for Rickets.
Skin is warm to hot, dry, and consistent in color with minor tenting noted on the forearms. Chest normal in appearance with no dyspnea noted. On auscultation lungs had CBBS, and equal chest rise with no retractions or accessory muscle usage noted.
Heart tones were unremarkable. Abdomen has hyperactive bowel sounds in the lower quadrants, and upon palpation is soft, but patient seems to indicate tenderness in all quadrants through withdraw.
No deformities, masses, swelling, or pulsating noted on palpation. Anus and surrounding tissues appear aggravated from recent and frequent cleaning following diarrhea, and some runny, brown stool was noted in the patient's training pants. Extremities and posterior thorax are normal and patient can ambulate without assistance.
Samples for both UA and stool cultures were obtained and sent to the lab. All UA findings were within normal limits, but stool culture showed Giardia lamblia trophozoites present in sufficient numbers to warrant a diagnosis of Giardiasis Giardia. Pathophysiology of Diagnosis Giardia lamblia is a species of the genus protozoa. This protozoan is bi-nucleated and possesses four sets of flagella. Protozoan form G. Therefore, the most common route of infection is through ingestion of food or water contaminated with fecal matter particles containing the Giardia cysts.
Once infested in the intestine, studies have shown that G. Infestation can present with signs and symptoms of diarrhea, fever, cramps, anorexia, nausea, weakness, weight loss, abdominal distention, flatulence, greasy stools, belching and vomiting. Symptom onset is usually around two weeks after exposure, and if untreated can last indefinitely, but usually only two to three months.
The perpetuation and epidemiology of G. Except for ensuring clean water quality, there is no known chemoprophylaxis for Giardiasis.
Treatment, though, is usually uncomplicated and involves a standard course of metronidazole, furazolidone, or quinacrine. Treatment Performed XX was given a prescription for metronidazole Flagyl. So, XX was given a prescription for 5 tablets divided into quarters 20 The treatment course then lasted almost one full week, and although it was a longer course with a greater total dose than recommended, it was felt this would be more effective given the questionable method of administration, which by its very nature, left ample room for error.
XX's mother was also given instructions as to the infectious state of XX's stool and was told to ensure it was not allowed to contaminate any surfaces and that no other children in the family were to come into contact with XX's stool.
A repeat lab analysis of XX's stool sample was negative for any G.It has been 5 years since the original EM Sim Cases simulation template was published on the blog. Over the last year or so, the Emergency Medicine Simulation Educators Research Consortium EM-SERC has been hard at work going through a rigorous process of standardizing our template through the use of multiple focus groups and rounds of feedback from interprofessional simulation educators and leaders across Canada.
The full methods will hopefully be published shortly in a journal format. At last, we are very excited to release the latest version of our template in free-open-access format for you to use! Send us your cases cases emsimcases. Always with due credit. This template is in Microsoft Word format.
More EMS Scenarios for the Real World
Pingback: Flowcharts, tickboxes and more — gpsimulation. You are commenting using your WordPress. You are commenting using your Google account. You are commenting using your Twitter account. You are commenting using your Facebook account. Notify me of new comments via email. Notify me of new posts via email. Search for:. Our new and improved template! Important notes: This is meant to be a dynamic template in that we will be collecting feedback over the next year in order to continue to improve the template.
This is meant to be used as you see fit. This is intentional so that you can delete sections, change sections, or add information. Make it your own so that it works best for your simulation purposes! All we ask is that you keep our footer at the bottom of the page. Share with us! Share this: Twitter Facebook. Like this: Like Loading Fill in your details below or click an icon to log in:. Email required Address never made public. Name required.Paramedic candidates are tested on 6 skills, including an integrated out-of-hospital IOOH scenario.
The scenario will reflect either a pediatric, geriatric or adult patient. This is a registration free workshop designed to provide you with hands-on experience developing formative and summative scenarios for use in your classroom. Workshops are limited to 50 participants who will be guided through the scenario development process by NREMT staff. Topics that will be covered are scenario writing, calibration, and evaluation in the workshop. Scenarios created in the workshop will be available for use following the event.
Find A Workshop. The first was a desire to ensure protection of the public by assessing psychomotor competency in a way that simulates actual practice in a simulated environment. The second factor is that EMS employers often find that while newly certified paramedics know how to perform individual skills, they cannot move to the next level and integrate those skills into scene and patient management.
Scenario examinations allow the NREMT to incorporate essential attributes of Team Leadership along with scene and patient management, thus better reflecting actual out-of-hospital care as opposed to continuing to test 12 isolated skills. The program tracks each student's portfolio throughout the formative and summative phases of education in the laboratory, clinical, and field internship settings. All students that begin their paramedic program on or after August 1, are required to complete a portfolio that becomes a part of their permanent educational file and is a prerequisite to seeking NRP Certification.
Starting on January 1,Paramedic candidates had three potential pathways to satisfy the psychomotor examination. In the new test model, Paramedic candidates will be tested on a total of six skills. Candidates are required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:.
The candidate is evaluated on their ability to manage cardiac arrhythmias and interpret ECGs. This will be verified in two portions:. You will be evaluated on your ability to manage a cardiac arrest situation, including actual delivery of electrical therapy and "voicing" all interpretations and treatments given a scenario.
The presentation of the portion will be similar to a "megacode. Given four 4 prepared ECG tracings with associated patient information, you must verbalize the interpretation of each rhythm and voice all associated treatments.
The candidate will be provided with a professional paramedic partner and evaluated on their ability to manage a call, lead a team, effectively communicate, and maintain professionalism throughout the simulated patient encounter. Download all the Paramedic Portfolio Forms in a single binder. Select a scenario type and a patient type to view a list of matching scenarios. What is the Integrated Out of Hospital Scenario? Phase 1 Paramedic Psychomotor Exam.
This will be verified in two portions: Dynamic Cardiology You will be evaluated on your ability to manage a cardiac arrest situation, including actual delivery of electrical therapy and "voicing" all interpretations and treatments given a scenario. Documents and Forms. Scenario Information. Scenario Type. Quick Links. EMS Certification.By signing up to the free HealthySimulation.
Saw on twitter yesterday that Dr. The website offers simulation scenario design guides, free cases, templates, and peer-review support!
Most EM residency programs are now using simulation in some capacity. Why should each program have to create new content? At EM Sim Cases, we want to showcase the fantastic cases that are already being used across the country. Starting a new simulation curriculum? Use the cases on this blog! Feel like your curriculum is getting tired?
Turn to the blog for ideas! Want a variation on a case you already use? Look here for suggestions. Have a great case? Your case could be featured on the EM Sim Cases blog. Relatively speaking, simulation is a labour-intensive method of teaching. It requires a high faculty to student ratio for a lengthy period of time. There are few ways to offset the number of instructors required for a given simulation session.
Using senior residents to teach junior residents is pretty much the only partial solution. Further, the development of curricular content can be tedious.
Writing high quality cases appropriate for learner level with clear objectives and a logical case progression is more challenging than it looks! While going through the process of creating a novel simulation component for the curriculum of my emergency medicine program, it occurred to me that one way educators across the country could save a fair amount of time would be to share cases.
This is where the idea for emsimcases.
More EMS Scenarios for the Real World
Collaborating with Martin Kuuskne of McGill University, who had just gone through the same process of creating a regular simulation curriculum for his program, we created a simulation case blog to address our mutual need. This blog will ultimately serve as a repository of simulation cases for emergency medicine educators to use. This is the void that emsimcases. Not only will we provide a repository of simulation cases, but we will also provide posts on key content related to running quality simulation.
Many educators are put into a position of running or teaching simulation before they understand or are familiar with the concepts involved.
We aim to have a repository of content on the basics, as well as the latest and greatest, in simulation education. Our blog is still in its infancy. But the response has already been fantastic. Either way, we have certainly enjoyed developing our own little EM simulation community of practice.
Collaborating with our colleagues has been the best reward. He lives with his wife Abigail in Las Vegas, Nevada. The Tech Sim Online program was designed to help those who are new to the clinical simulation industry or new to the role of simulation [ With over customizable patient cases, its cloud based learning environment supports multiple healthcare disciplines with both face to face and virtual online clinical training, maximizing IPE training opportunities while minimizing system [I just discovered your site thru LinkedIn.
Thank you for puttin so much effort into putting educational material out there. May I respectfully suggest putting the newest scenerio on the top of the list? A reverse chronological order, if you will. I think you will find it more helpful when referring back in discussions.
Done and done. I also reversed the order in the drop-down menu. Thanks for the kind words! Just found this site Decreally excellent, thank you. But why is there no new stuff in the scenarios? New content on the site has unfortunately taken a back burner after I went off to PA school. I love your website! I see you have taken a bit of a hiatus, but I would love to see you make some new scenarios. I love reading them! Thanks Lindsey. Notify me of new posts by email. Email Address.
Scenarios All prior scenarios will be listed here in running chronological order.
Comments Sheri says:. October 22, at pm. Sincerely, Sheri S. Brandon Oto says:. September 9, at pm. Antoinette says:. November 29, at pm.
December 8, at pm. Antoinette, New content on the site has unfortunately taken a back burner after I went off to PA school. Lindsey says:.You are just getting settled into bed at the station, after a long day of running calls. Suddenly, your pager advises you differently, you spring from your bunk and answer your call.
As you enter the room, you see an elderly female sitting on the edge of her bed, leaning slightly forward with her hands on her knees, while struggling to breathe. You can here audible rales as you approach. On initial contact with the patient you quickly introduce yourself and partner while obtaining her consent for treatment. You perform a quick assessment and find:. Your patient states the shortness of breath comes on at night but, is worse tonight. It wakes her from a sound sleep.
Further assessment reveals:. Increasing the O2 has offered little relief and the patient is counting on your expertise to help her breathe better. After evaluating the patient, taking vitals and conducting an interview; it is apparent that your patient will need a better respiratory status, in order to safely move her out of a tight residence to an awaiting unit outside minutes away if all goes well.
Knowing it would almost be impossible to bag her on the long stairway and hall, you make a decision. The patient advises she has had breathing treatments before and you proceed. You administer 1 nebulized Albuterol treatment and the patient reports worsening dyspnea. The albuterol treatment has had no effect, lungs sounds are actually worse, why?
Albuterol is a sympathomimetic bronchodilator that is effective for causes of bronchoconstriction i. The medic should place the patient in a sitting position with legs dependent to increase lung volume and capacity while decreasing the work of breathing and venous return to the heart. Continue to coach patient to keep mask in place and readjust as needed 13M. Contact medical control to advise them of CPAP initiation. Your patients color and respiratory effort is obviously improving within minutes and you continue treatment and assessment while transporting.