Extended Abstract
Using Remote Instruction to Improve Knowledge and Skills
Jeri Pullum, MS
D. Breck Rushton, RN, MPH
This pilot test was designed to improve the pediatric airway management and positioning knowledge and
skills for emergency medical technicians working in a rural ambulance service. Problems with pediatric
airway management and positioning are well documented in the literature. Rural EMTs typically receive
some training in pediatric care, but low call volumes, especially in rural areas, provide few opportunities
to practice their skills or use their knowledge.1,2 Knowledge and skill deterioration is well documented in
EMS.3,4,5 Although training is often advocated to retain knowledge and skills,6,7,8, 9 high-quality local
training is not always available.
The Pediatric Emergency distance learning program included self-study materials contained on an
Internet World Wide Web site, in published textbooks, and on interactive CD-ROM programs. The
training was conducted by an instructor in Salt Lake City, UT, who communicated with 9 prehospital
providers, aged 20-59, in Fort Benton, MT, using E-mail and desktop video conferencing. The instructor
reviewed and critiqued videotapes
Performance Scores
of the ambulance crew members’
performance skills taped before
the training began. The
60
performance skill required
participants to assess and provide
care for a pediatric trauma patient
50
in a simulated emergency.
The providers took a written test,
filled out a questionnaire to
measure self-confidence, and
completed the performance test
before and after the training.
Quantitative data showed
statistically significant
improvement in performance but
no change in either written
knowledge or self-confidence.
40
30
20
10
0
Pretest
Posttest
During a focus group meeting and
personal interviews, the
ambulance crew members
Pretest performance scores range: 19.67 – 47 (median 38)
Posttest performance scores range: 33.7 – 50.67 (median 40.7)
identified the chance to review
their own performance on
Total scores significantly higher at posttest (M = 42.4)
videotape and to have access to
than pretest (M = 36.7), t (2.357), p = .025 (one-tailed)
an expert instructor as the most
valuable components of the
training program. The lack of improvement on the written test may have been because ambulance crew
members concentrated on the performance test, making little use of the self-study materials.
Extended Abstract
The pilot program shows promise for making high quality training, including performance skills training,
available to all prehospital providers, regardless of their location.
Major findings of program
Gave rural EMTs access to expert instructor in another state
Videotaped performance skill allowed EMTs to critique themselves
Remote instructor reviewed tapes and critiqued via E-mail
EMTs and instructor considered the videotaping the strongest
component of the program
Desktop video conference allowed remote instructor and EMTs to
discuss self-study materials and written performance critiques
Self-study didactic materials decreased required classroom time
Self-study was not well used
Students need good support system for self-study
1. Glaeser PW, Linzer J, Tunik MG, Henderson DP, Ball J. Survey of nationally registered emergency
medical services providers: Pediatric education. Annals of Emergency Medicine 2000;16:33-38.
2. Seidel JS, Henderson DP, Ward P, Wayland BW, Ness B. Pediatric prehospital care in urban and rural
areas. Pediatrics 1991;4:681-690.
3. Skelton MB, McSwain NE. A study of cognitive and technical skill deterioration among trained
paramedics. Journal of the American College of Emergency Physicians 1977;6:436-438.
4. Latman NS, Wooley K. Knowledge and skill retention of emergency care attendants, EMT-As, and
EMT-Ps. Annals of Emergency Medicine 1980;9:183-189.
5. Zautcke JL, Lee RW, Ethington NA. Paramedic skill decay. Journal of Emergency Medicine
1987;5:505-512.
6. Eichelberger MR, Stossel-Pratsch G, Mangubat EA. A pediatric emergencies training program for
emergency medical services. Pediatric Emergency Care 1985;1:177-179.
7. Hobbs GD, Moshinskie JF, Roden SK, Jarvis JL. A comparison of classroom and distance learning
techniques for rural EMT-I instruction. Prehospital Emergency Care 1998;2:189-191.
8. Larmon B, Schriger DL, Snelling R, Morgan MT. Results of a 4-hour endotracheal intubation class for
EMT-basics. Annals of Emergency Medicine 1998;31:224-7.
9. Stewart RD, Paris PM, Pelton GH, Garretson D. Effect of varied training techniques on field
endotracheal intubation success rates. Annals of Emergency Medicine 1984;13:1032-1036.
Contact: Jeri Pullum
Critical Illness and Trauma Foundation
2125 1st Ave. South, Great Falls MT 59401
406.761.2692
jpullum@citmt.org
Contact: D. Breck Rushton
Utah Bureau of EMS
P.O. Box 142004 Salt Lake City, UT 84116-2004
(801) 538-6719
brushton@doh.state.ut.us