Rural Metro WNY: Recertification Program

Session 1: Patient Assessment

4-Hour Session. Required for EMTs, EMTs, and EMT-Ps. Topics covered are: Therapeutic Communication, Life Span Development, Physical Exam Techniques, Patient Assessment in the Field, and Musculoskeletal System.

Section One - Therapeutic Communications¹
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511573-,00.html

Define "communication"
Identify factors that effect the interview
Define "open-ended" and "closed-ended questions"
Identify the role of body language in communicating with a patient
Address different styles of interviewing (hostile patients vs. child, for example)
Discuss how cultural backgrounds affect your ability to interview a patient
Discuss concerns and techniques for using an interpreter

Section Two - Life-Span Development
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511405-,00.html

Identify the average vital signs and physical differences between the following stages of development:
Infant, Toddler, Preschooler, School-aged, Adolescent, Early adult, Middle-aged adult, Late-aged adult
Also be able to identify the age ranges and psycho-social characteristics of each

Section Three - Physical Exam Techniques
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511601-.00.html

Describe the following terms:
Palpation, Auscultation, Inspection, Percussion
Describe the specific methods of examining each region of the body
Describe the evaluation of respiratory status
Distinguish between normal and abnormal breath sounds and heart sounds; and present and absent bowel sounds
Describe the methods used for evaluation of the cardiovascular system
Discuss the differences between adult and pediatric assessment
Describe the methods and guidelines for documenting your findings

Section Four - The Musculoskeletal System

Review the basic anatomy and physiology of the musculoskeletal system
Define the role of the musculoskeletal system
Understand the roles of ligaments, tendons, muscles, and bones
Define the sections of the skeleton
Discuss the pathophysiology fo the system

Section Five - Patient Assessment in the Field
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511663-,00.html

NYS DOH Evaluation forms for Stations 1 (medical assessment) and 2 (trauma assessment)
- Recognize hazards and hazardous scenes
- Discuss methods for making scenes safe
- Discuss mechanism of injury
- Discuss scene size-up and its elements
- Organize response on scene
- Discuss methods for managing injuries by system and severity
- Define life threatening emergencies
- Discuss the elements of patient assessment
- Differentiate between the Detailed Physical Exam and the Rapid Trauma Survey

Session 2: Medical Emergencies

4-Hour Session. Required for EMTs, EMTs, and EMT-Ps. Topics covered are: Behavioral Emergencies, Endocrinology, Allergies and Anaphylaxis, Environmental Emergencies, and Toxicology.

Section One - Endocrine Emergencies
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512049-,00.html

Describe the morbidity and mortality of endocrinologic emergencies
Identify the risk factors associated with such emergencies
Discuss the anatomy and physiology of the endocrine system
Define "ductless" and "ducted" glands
Discuss the assessment, transport and management of endocrinologic emergencies
Discuss the relationship between osmotic diuresis and diabetes mellitus
Distinguish between different types of diabetes mellitus
Discuss the management of diabetic emergencies (HHNK, hypoglycemia, etc.)
Discuss the difference between normal and diabetic glucose metabolism

Section Two - Allergies and Anaphylaxis
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512064-,00.html

Describe the pathophysiology of anaphylaxis
Describe the physiology of the immune system and its response to pathogens
Define "pathogen"
Discuss the common routes of substance entry into the body
Describe the signs and symptoms of allergic reactions

Section Three - Behavioral Emergencies
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512258-,00.html

Distinguish between normal and abnormal behavior
Discuss the pathophysiology of behavioral and psychiatric disorders
List the measures to take when faced with a dangerous situation
Discuss restraints and the restraining of patients
Discuss techniques for gathering information from the uncooperative patient
Differentiate between various types of behavioral and psychiatric disorders

Section Four - Environmental Emergencies
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512182-,00.html

Identify risk factors
Describe temperature monitoring
Differentiate between hypothermia, hyperthermia, and their varying degrees of severity
Discuss management of the hypo- or hyperthermic patient
Discuss dehydration
Differentiate between different types of drowning and their treatments
Discuss diving emergencies
Discuss the different considerations in implementing ACLS, BTLS, and PALS protocols when treating environmental emergencies

Section Five - Toxicological Emergencies and Substance Abuse<
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512132-,00.html

Discuss the physiology of organs related to toxicological emergencies
Discuss the pathophysiology, management, and treatment of different types of poisonous exposure
Discuss commonly abused drugs and treatments for overdose
Discuss routes of entry for poisons
Discuss alcohol and drug withdrawal (delirium tremens)

Session 3: Obstetrical Emergencies / Neonatal / Pediatric / Child

4-Hour Session. Required for EMTs, EMTs, and EMT-Ps. Topics covered are: Obstetrics,Gynecology, Pediatric Pre-Hospital Care, Neonatal Resuscitation, and Child Abuse.

Section One - Gynecology
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512283-,00.html

Describe how to assess a patient with a gynecological complaint
Describe the general care for any patient experiencing a gynecological emergency
Describe the pathophysiology, assessment, and management of gynecological emergencies
Describe the assessment, care and emotional support of the sexual assault patient

Section Two - Obstetrics
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512298-,00.html

Describe the female reproductive system
Describe the general assessment and management of the obstetrical patient
Identify and describe complications associated with pregnancy and delivery
State the steps in the delivery and care of a newborn
Describe the procedures for handling abnormal deliveries, complications of pregnancy, and maternal complications of labor
Discuss the steps in the delivery of the placenta
Describe the management of the mother post-delivery
Describe special considerations when meconium is present in amniotic fluid or during delivery
Describe special considerations of a premature baby

Section Three - Neonatal Resuscitation
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512323-,00.html

Define newborn and neonate
Identify important intrapartum factors that can determine high-risk newborn patients
Identify the factors that lead to premature birth and low birth-weight newborns
Identify the primary signs utilized for evaluating a newborn during resuscitation
Identify the appropriate use of the APGAR scale
Identify the signs and symptoms of distress in the newborn and describe the resuscitation pyramid

Section Four - Pediatrics
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512338-,00.html

The role of the EMS responder in pediatric care
Growth, development and assessment of the pediatric patient
Identification and treatment of medical and traumatic injuries to the pediatric patient
Determine appropriate airway adjuncts, ventilation devices, and endotracheal intubation equipment, their proper use, and complications of use for infants and children
Describe the general approach to the treatment of children and parental interaction
Describe the signs and symptoms of suspected child abuse and required reporting process

Session 4: Advanced Airway / Pulmonary / Fluid Resuscitation and Shock

4-Hour Session. Required for EMTs. Topics covered are: Advanced Airway Management, Pulmonology, and Shock Management/Fluid Resuscitation.

Section One - Pulmonology
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511975-,00.html

Idenfity and discuss the anatomy and physiology of the pulmonary system
Discuss the pathophysiology of common pulmonary disorders
Define and compare the various techniques used to manage pulmonary disorders
Identify common pathological events that effect the pulmonary system
Identify the signs, symptoms, and management of the following: ARDS, asthma, emphysema, chronic bronchitis, pulmonary embolism, neoplasms, upper and lower respiratory tract infections, spontaneous pneumothorax, hyperventilation syndrome

Section Two - Advanced Airway Management
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511546-,00.html

Describe the anatomy and physiology of the adult, infant, and child airways
Describe the proper use of BLS airway adjuncts
Review the use of oxygen therapy in patient management
Identify the indications and contraindications for NG tube use
Identify the indications and contraindications for endotracheal intubation
Describe the methods for selecting the correct size for an ET tube
Describe the technique for ET intubation (orotracheal) and for confirming ET tube placement
Explain the rationale for assessing lung sounds
Describe the different lung sounds (normal and pathological)
Demonstrate the use of the following: Pharyngotracheal Lumen airways and esophageal obturator devices

Section Three - Shock Management and Fluid Resuscitation
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511783-,00.html

Assessment of the shock patient
Identify the causes and types of shock and treatment modalities
Determine and calculate fluid infusion rates

Session 5: Roles and Responsibilities / Medical-Legal / EMS System and Communications

4-Hour Session. Required for EMTs and EMT-Ps. Topics covered are: EMS Provider Roles and Responsibilities, Ethics, Medical Legal, EMS System, Documentation, and Well Being of the Provider.

Section One - Roles and Responsibilities
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511177-,00.htm (Part 3)

Describe the EMT as a health-care professional
Describe the elements of professional conduct
Discuss the benefits of continuing education
Differentiate between certification and licensure
Discuss the primary role of the EMT as a patient advocate
Identify the benefits of becoming an educator
Discuss the benefits of actings as a primary-care provider in the field

Section Two - The Well-Being of the EMT
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511177-,00.htm (Part 4)

Discuss the concept of wellness
Describe the impact of circadian rhythms on shift work
Define the necessary elements of healthy living
Describe the impact of substance abuse on the EMT
Describe the impact of addictive behaviors
Differentiate between health and unhealthy methods of dealing with stress
Describe how an EMT's stress effects patient care
Discuss CISD
Discuss BSI

Section Three - Ethics
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511177-,00.htm (Part 6)

Define ethics and morals
Identify the premise that should underlie every action of the EMT
Analyze the relationship and differences between law and ethics
Describe the methods of honoring an advance directive
Identify ethical issues involving advance directives

Section Four - Medical/Legal Aspects of Care
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511254-,00.htm

Describe the basic structure of the legal system
Differentiate between tort, criminal, and civil law
Define and discuss the following: assault, battery, abandonment, advance directives, breach of duty, confidentiality, HIPAA, duty to act, emancipated minor, liability, libel, negligence, scope of practice, standard of care, and slander
Discuss the legal implications of medical direction
Discuss the four elements which must be present to prove negligence
Explain the importance of confidentiality
Describe the EMT's role in resuscitating potential organ donors
Explain liability
Describe the legal implications of refusals of care

Section Five - EMS Systems
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511177-,00.htm (Part 2)

Describe the different elements of EMS systems
Define the levels of EMS providers
Discuss the role of the EMS physician in providing medical direction
Describe the process of developing protocols
Describe the role of continuing education and quality assurance programs
Describe the difference between on-line and off-line medical direction

Section Six - Documentation
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511719-,00.htm

Describe the general importance of documentation and the ways in which EMS documents are used
Identify the properly used acronyms and terminology which should be used on a PCR
Define pertinent negatives and discuss their use
Describe the special documentation considerations concerning refusals of care
Define the differences in MCI documentation

Session 6: Neurology / Urology / Gastroenterology / Hematology

4-Hour Session. Required for EMT-Ps. Topics covered are: Neurology, Urology, Infectious Diseases, Gastroenterology, Hematology, and Medication Administration.

Section One - Hematology
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512167-,00.htm

Discuss the anatomy and physiology of the hematopoietic system
Define the following: plasma, hemoglobin, hematocrit, leukocytes, platelets, clotting, fibrinolysis, and hemostasis
Discuss cellular and humoral immunity
Identify blood grouping
List disorders of the: erythrocytes, leukocytes, and platelets

Section Two - Urology and Nephrology
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512114-,00.htm

Discuss the anatomy and physiology of structures relating to the urinary system
Define referred pain and visceral pain
Define chronic and acute renal failure
Discuss the management of renal failure by type
Define and discuss dialysis
Discuss the signs and symptoms of urinary tract infections and PID
Discuss the signs and symptoms of renal calculi (kidney stones)

Section Three - Infectious Disease
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512217-,00.htm

Discuss the anatomy and physiology of structures related to diseases and the pathophysiology of immune response
Discuss the role of public health in disease management
Discuss strategies for staying safe from infectious disease
Discuss commonly encountered diseases in the field
Define the following terms: seroconversion, virulence, viruses, bacteria, normal flora, and prion
Discuss the signs, symptoms, and management of specific diseases

Section Four - Gastroenterology
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,512084-,00.htm

Describe the anatomy and physiology of the gastrointestinal system
Describe the signs, symptoms, and pathophysiology of commonly found GI emergencies
Define "upper" and "lower" GI
Define somatic, visceral, and referred pain
Discuss the questioning and assessment techniques used to determine abdominal or GI distress
Define: upper GI bleed, lower GI bleed, hemoptemesis, varices, diverticulitis

Section Five - Medication Administration
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511497-,00.htm (Part 1)
http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511421-,00.htm

Medication calculations
Concentration, drip rates, metric conversions, volume
Routes of administration
Review the "Four Rights" of medication administration
Review the specific methods of administration for each route
Discuss the necessity of sterile technique and the methods for assuring a sterile site

Session 7: General Pharmacology / Respiratory / Cardiology

4-Hour Session. Required for EMTs and EMTs. Topics covered are: General Pharmacology/WREMS Epi and Albuterol in-service, Respiratory System, and Cardiology.

Section One - General Pharmacology / WREMS Epi & Albuterol In-Service
Resources: http://wps.prenhall.com/chet_limmer_emergencycare_10/0,9043,1282291-,00.html

Identify the indications and contraindications of Epinephrine administration
Identify the indications and contraindications of Albuterol administration
Review the WREMS protocol

Section Two - Airway/Pulmonology
Resources: http://wps.prenhall.com/chet_bledsoe_essentials_1/0,6522,511975-,00.htm

Identify the anatomical structures of the respiratory system
Differentiate between pediatric vs. adult airway
Describe the function of respiration and gas exchange
Identify pulmonary disease process

Section Three - Cardiology
Resources: http://www.americanheart.org/presenter.jhtml?identifier=2158
http://wps.prenhall.com/chet_limmer_emergencycare_10/0,9043,1282353-,00.html

Discuss the anatomy and physiology of the heart and major vessels
Discuss the pathophysiology of common cardiac etiologies
Discuss the signs and symptoms of the following: angina, acute myocardial infarction, unstable angina, cornonary artery disease, atherosclerosis, angiology, stent, CABG, and congestive heart failure
Identify the value of high-flow oxygen administration in the management of the acute cardiac emergency

International Trauma Life Support (ITLS)

International Trauma Life Support Courses give you the knowledge and hands-on skills to take better care of trauma patients. The ITLS framework is a global standard that enables you to master the latest techniques in rapid assessment, appropriate intervention and identification of immediate life-threatening injuries.

EMT-B

Attendance at a 2-day ITLS class will account for:

2 hours Airway
4 hours Trauma
2 hours Elective, and the following skills:
- Airway/Ventilation
- Hemorrhage Control & Splinting
- Spinal Immobilization
- Trauma Assessment
8 hours Other CME

Attendance at the 4-hour Core Session 1 (Patient Assessment) will account for:

1 hour Preparatory
3 hours Patient Assessment

Attendance at the 4-hour Core Session 2 (Medical Emergencies) will account for:

4 hours Medical/Behavioral

Attendance at the 4-hour Core Session 3 (OB/Neonate/Infants/Child) will account for:

4 hours OB/Infants/Children

Attendance at the 4-hour Core Session 7 (General Pharmacology/Respiratory/Cardiac) will account for:

4 hours General Pharmacology/Respiratory/Cardiac

Attendance at the above session will provide you with the Core training and 8-hours of Other CME. You will need to complete an additional 40 hours of documented CME, of which 3 hours must be dedicated to Geriatrics and 3 hours to WMD/Terrorism awareness. Other CME can come in the form of EMS-related drills, articles, seminars, etc. and are subject to the following limitations:

1) No more than 24-hours of self-study activity such as web-based courses, interactive CD’s, videos and magazine article summaries. If you wish to use self-study hours toward your Other CME then you must be able to substantiate the hour(s) claimed

2) No more than 12-hours in any one topic. NYS considers ALL non-patient care topics to be Operations i.e. auto extrication, WMD and Emergency Vehicle Operator courses are all considered “operations”.

EMT-I

Attendance at a 2-day ITLS class will account for:

2 hours Airway
4 hours Trauma
2 hours Elective
3 hours of CME
2 hours ILS Patient Assessment
3 hours ILS Trauma and the following skills:
- Airway/Ventilation (Basic and Advanced)
- Hemorrhage Control & Splinting
- Spinal Immobilization
- Trauma Assessment
- Suctioning

Attendance at the 4-hour Core Session 1 (Patient Assessment) will account for:

1 hour Preparatory
3 hours Patient Assessment

Attendance at the 4-hour Core Session 2 (Medical Emergencies) will account for:

4 hours Medical/Behavioral

Attendance at the 4-hour Core Session 3 (OB/Neonate/Infants/Child) will account for:

4 hours OB/Infants/Children

Attendance at the 4-hour Core Session 4 (Advanced Airway/Pulmonary Ventilation) will account for:

3 hours Advanced Airway
1 hour CME

Attendance at the 4-hour Core Session 5 (Roles/Responsibilities, Medical/Legal, EMS Systems, Communications) will account for:

2 hours Preparatory
2 hours CME

Attendance at the 4-hour Core Session 7 (General Pharmacology/Respiratory/Cardiac) will account for:

4 hours General Pharmacology/Respiratory/Cardiac

Attendance at the above sessions will provide you with the Core training and 6 hours of CME. You will need to complete an additional 32 hours of documented CME, of which 3 hours must be dedicated to Geriatrics and 3 hours to WMD/Terrorism awareness. Other CME can come in the form of EMS-related drills, articles, seminars, etc. and are subject to the following limitations:

1) No more than 24-hours of self-study activity such as web-based courses, interactive CD’s, videos and magazine article summaries. If you wish to use self-study hours toward your Other CME then you must be able to substantiate the hour(s) claimed

2) No more than 12-hours in any one topic. NYS considers ALL non-patient care topics to be Operations i.e. auto extrication, WMD and Emergency Vehicle Operator courses are all considered “operations”.

EMT-P

Attendance at a 2-day ITLS class will account for:

2 hours Airway
4 hours Trauma
2 hours Operations
2 hours of CME and the following skills:
- Airway/Ventilation (Basic and Advanced)
- Hemorrhage Control & Splinting
- Spinal Immobilization
- Trauma Assessment
- Suctioning

Attendance at a 2-day ACLS class will account for:

4 hours Airway Management
6 hours Medical
6 hours of CME and the following skills:
- IV Therapy / Medication Administration
- Cardiac Arrest Management

Attendance at a 2-day PALS class will account for:

1 hour Medical
4 hours Special Considerations
7 hours CME

Attendance at the 4-hour Core Session 1 (Patient Assessment) will account for:

3 hours Preparatory
1 hour CME

Attendance at the 4-hour Core Session 2 (Medical Emergencies) will account for:

4 hours Medical

Attendance at the 4-hour Core Session 3 (OB/Neonate/Infants/Child) will account for:

3 hours Medical
1 hour Special Considerations

Attendance at the 4-hour Core Session 5 (Roles/Responsibilities, Medical/Legal, EMS Systems, Communications) will account for:

3 hours Preparatory
1 hour CME

Attendance at the 4-hour Core Session 6 (Neurology/Urology/Gastro/Hematology) will account for:

4 hours Medical

Attendance at the above sessions will provide you with the Core training and 17 hours of CME. You will need to complete an additional 7 hours of documented CME, of which 3 hours must be dedicated to Geriatrics and 3 hours to WMD/Terrorism awareness. Other CME can come in the form of EMS-related drills, articles, seminars, etc. and are subject to the following limitations:

1) No more than 24-hours of self-study activity such as web-based courses, interactive CD’s, videos and magazine article summaries. If you wish to use self-study hours toward your Other CME then you must be able to substantiate the hour(s) claimed

2) No more than 12-hours in any one topic. NYS considers ALL non-patient care topics to be Operations i.e. auto extrication, WMD and Emergency Vehicle Operator courses are all considered “operations”.

EMT-CC

Attendance at a 2-day ITLS class will account for:

2 hours Airway
8 hours Trauma
1 hour Operations
5 hours of CME and the following skills:
- Airway/Ventilation (Basic and Advanced)
- Hemorrhage Control & Splinting
- Spinal Immobilization
- Trauma Assessment
- Suctioning

Attendance at a 2-day ACLS class will account for:

3 hours Airway Management
5 hours Medical
8 hours of CME and the following skills:
- IV Therapy / Medication Administration
- Cardiac Arrest Management

Attendance at a 2-day PALS class will account for:

1 hour Medical
2 hours Special Considerations
9 hours CME

Attendance at the 4-hour Core Session 1 (Patient Assessment) will account for:

1 hour Preparatory
3 hours CME

Attendance at the 4-hour Core Session 2 (Medical Emergencies) will account for:

4 hours Medical

Attendance at the 4-hour Core Session 3 (OB/Neonate/Infants/Child) will account for:

2 hours Medical
2 hours Obstetrics

Attendance at the 4-hour Core Session 5 (Roles/Responsibilities, Medical/Legal, EMS Systems, Communications) will account for:

4 hours Preparatory

Attendance at the 4-hour Core Session 6 (Neurology/Urology/Gastro/Hematology) will account for:

1 hour Medical
3 hours CME

Attendance at the above sessions will provide you with the Core training and 28 hours of CME. You will need to complete an additional 8 hours of documented CME, of which 3 hours must be dedicated to Geriatrics and 3 hours to WMD/Terrorism awareness. Other CME can come in the form of EMS-related drills, articles, seminars, etc. and are subject to the following limitations:

1) No more than 24-hours of self-study activity such as web-based courses, interactive CD’s, videos and magazine article summaries. If you wish to use self-study hours toward your Other CME then you must be able to substantiate the hour(s) claimed

2) No more than 12-hours in any one topic. NYS considers ALL non-patient care topics to be Operations i.e. auto extrication, WMD and Emergency Vehicle Operator courses are all considered “operations”.

Recertification Training Sessions Available from Rural/Metro for Buffalo and Western New York

NYS CME-Based Recertification Core Training Sessions from Rural/Metro WNY

CME-Based Requirements for EMTs EMTs and Paramedics