Videos of EMS providers, working on real incidents, as well as dashcam or surveillance video of injury before EMS arrived can be valuable tools for education.
EMS educators can also purchase narrated videos from publishers, and other training videos are available for free on YouTube and Vimeo. Clips from EMS reality shows can also be used. Whether a class meets face-to-face or online, short videos of patient care engage students, stimulate discussion and bridge the gap between the classroom and the field.
A 10-minute clip from the 2011 Australian paramedic reality series Recruits, which follows rookie paramedics with the New South Wales Ambulance Service, is particularly useful for EMT students. The segment begins at 5:50 of episode six. On his first shift as an observer, 24-year-old recruit Reynir’s first call is for a hanging. The patient is reported to be unconscious and not breathing normally.
I initially showed the clip during the airway management module and returned to it for other lessons during the course. Here are a few ideas on how live patient care videos can be used to help make abstract concepts relevant:
1. Planning ahead
Based on the dispatch information — patient unconscious and not breathing normally — ask students what they anticipate will be needed when they arrive. Also ask about potential safety threats, such as upset bystanders or booby traps.
2. Walking versus running into a scene
Reynir and his mentors walked into the residence when they arrived on scene. Ask students what they think about this; some of mine thought that the paramedics should have run.
Discuss how the few seconds saved by running into a scene are unlikely to affect the outcomes of even critical patients, and may harm other areas of patient care. Walking allows for more time to observe for safety threats, communicates to family members and other responders that you are in control of the situation, and improves decision making. Follow the discussion by having one group run and another group walk into lab scenarios to illustrate this.
3. Primary assessment
The crew finds a male patient lying on the floor. He does not respond to pain and is breathing slowly. Ask students what they observe when they first see the patient. Does he notice when the paramedics walk in? How do you tell the difference between effective and ineffective breathing? What patient problems need to be addressed first?
4. Airway management
This patient has multiple insults to his airway and ventilation. Go around the room and ask students what some of them are.
We observed:
- Possible obstruction from his tongue
- Loss of gag reflex and risk of aspiration if he vomits
- Possible upper airway edema from trauma to the larynx
- Hypoxia caused by asphyxia
Discuss ways to manage these insults. Should a jaw thrust or head-tilt chin-lift be used to open his airway? Why does he need a ventilation with a bag-valve-mask instead of oxygen via nonrebreather mask? Which is better to insert; an NPA, an OPA, neither or both?
5. Reassessment
The paramedics apply manual C-spine stabilization, assist the patient’s ventilations with a bag-valve-mask, and monitor his heart rate and pulse-ox. The patient’s teeth then clench, he displays decerebrate posturing, and begins to kick his legs. Discuss the new threats to the patient’s airway now, and how to safely move a patient who is combative.
6. Glasgow Coma Scale
Ask students to write down the patient’s GCS on initial contact and after transport is initiated, then walk through how GCS is calculated. Is the patient’s brain injury getting better or worse? This video also shows the difference between decorticate and decerebrate posturing.
7. Bag-valve-mask technique
Reynir takes a turn ventilating and suctioning the patient’s airway while an experienced paramedic explains how to hold a mask seal. After viewing, have students practice this difficult technique on a mannequin or on each other.
8. Transport considerations
Given the status of the patient’s airway, poll students about what hospital would be best to take him to. Should it be the closest hospital or a regional trauma center? This could be used for discussion about levels of trauma centers, local resources, and the use of helicopters.
9. Communications
Have students record a radio report to the hospital. We had our students post their radio report recordings in a discussion board, limited to 30 seconds or less, and had them comment on classmates’ reports before reviewing in class. I discovered that asking students to list what they think is most important to lead off with in a report can also help guide clinical instruction.
10. Documentation
Have students write a PCR narrative of the incident. We assigned this in a discussion board and had students comment on what their classmates wrote. Small groups could also compose one together to present to the rest of the class. This activity led to discussion about objective findings (the patient was found lying supine on the ground and bystanders reported that they cut the rope and lowered him to the ground) versus conclusions that were drawn (the patient was lowered to the ground by family members after a suicide attempt).
11. Working under stress
Reynir fumbles while applying the straps to the scoop stretcher, which he describes as “one of the most basic things of ambulance practice, but putting it into an emergency situation you have all this happening around you else is going on around you, seeing it all for the first time, I found very difficult.”
Performance anxiety can affect different areas, and affects some people more than others. Kelly Grayson describes learning how to lead a call as learning how to eat an elephant one part at a time. I shared with students how my hands shook on calls as a new EMT and paramedic under stress, and that it can be overcome with experience and practice. This is also not limited to EMS. Ask students if they have had difficulty with a simple task under stress in other situations, such as an athletic event or musical performance, and how they handled it. This is also an opportunity to point out the importance of practicing in the lab the way they hope to perform in the field.
12. Health and wellness
Reynir shares that he is nervous about seeing critical trauma patients at the beginning of the segment, and his first call is for a patient that is a challenge for veteran paramedics to manage. After the call his mentor tells him that he did a very good job (which I completely agree with), and encourages him to get help if he needs it.
The clip closes with an interview with the service’s peer support team coordinator. She says, “The expectation that we can be immersed in suffering and loss daily and not be affected by that is as unrealistic as walking through water and expecting not to get wet.”
Share this segment along with posts from the Code Green Campaign or stories of EMS suicide, and ask students if they feel like it is acceptable to ask for help with a mental health issue. Emphasize early and often that asking for help is a sign of strength, not weakness, and discuss healthy ways to manage stress.
After watching this video, what other learning points can be taken from it? Do you recommend any other EMS action videos to use for education? Share your thoughts in the comments.
