U.S.
Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
This document was prepared under HRSA contract
# 250-03-0022, U.S. Department of Health and Human Services, Health
Resources and Services Administration, Office of Rural Health Policy.
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Contents
Foreword
PART I: Literature Review
Literature Search and Selection
Results
Discussion
Distance education, distance
learning, distributed learning
Types of distance education
Continuing education
Trends in distance education
Use of distance education to fulfill continuing
education requirements
Medical physicians
Nurses
Emergency Medical Technicians and Paramedics
Summary Remarks
PART II: Rural/Urban Comparison
Methods
Data source and population
Dependant and independent variables
Analysis
Exclusions and missing data
Results
The 1999 EMT & Paramedic
Workforce
Methods of Receiving Continuing
Education
Likelihood of Receiving
Continuing Education via CD-ROMS, National Conferences, and Grand
Rounds
Discussion
Conclusions and Recommendations
References
APPENDIX A: Methods
Table A-1: Summary
of Search Strategy for Emergency Medical Services and Distance
Learning
Table A-2: Summary of Search Strategy for Nursing
and Distance Education
APPENDIX B: Acknowledgements
Contributors and Reviewers
APPENDIX C: REMSTTAC Stakeholders'
Group
Foreword
The initial training and continuing
education of Emergency Medical Services (EMS) personnel in rural
areas has been a persistent challenge. Academically based models
present challenges of access for what is often a voluntary workforce.
Conferences, workshops, and specialty trainings tend to happen in
urban centers, forcing rural personnel to take time away from their
primary jobs and family, not to mention leaving their home community
vulnerable in their absence.
Distance education or distributive learning has
been shown to be an effective means of delivering information and
skill sets to a variety of professions. Over the past 2 decades,
numerous distance learning products and delivery mechanisms have
been developed. These include interactive video discs, interactive
CD ROMs, televideo and Web-based applications, among others. Some
of these have been developed with the use of Federal funds, for
instance, through the Health Resources and Services Administration
(HRSA) EMS for Children program.
Therefore, many are available at little or no
cost. Utilization of these training programs in rural areas, however,
has not been widespread.
There are many theories about why such programs
have not enjoyed broader dissemination and use. These range from
a lack of awareness of their availability, to limited computer and
bandwidth access, or the lack of personal or social contact during
the asynchronous training event.
This document explores what is known about distance
learning in EMS and how it is currently used. It proposes recommendations
for future development and application. It is our sincerest hope
that it will help direct future program development to ensure that
training opportunities are more fully embraced and utilized by EMS
professional-- one of rural America's most vital health care resources.
Marcia K. Brand, Ph.D. |
Nels D. Sanddal, Director |
Associate Administrator
for Rural Health, HRSA |
Rural EMS and Trauma
Technical Assistance Center |
INTRODUCTION
Continuing professional education is valuable
and essential to ensuring high quality health care in the prehospital
arena.1 Access to, and availability of, institutional-based
Emergency Medical Services (EMS) education programs is limited in
rural communities.2,3 This places
the burden of travel, costs, and time away from family on EMS professionals
who have potentially limited resources. Education offered from a
distance is seen as one alternative to reducing the burdens and
challenges EMS professionals have with accessing initial and continuing
education. Unfortunately, very little is known about distance education
and continuing education in the EMS profession. We sought to investigate
and increase what is known about these issues by undertaking a scientific
review of the literature. The primary goal of this literature review
was to examine the utilization of different types of distance education
resources for fulfilling continuing education requirements in EMS.
LITERATURE SEARCH AND SELECTION
The review of literature was a multi-step process
performed sequentially. It was performed specifically to identify
published accounts of utilization of different types of distance
education resources. The effectiveness, advantage, disadvantage,
and ease of use of various resources were other issues of interest
to investigators, and as such, were abstracted from the literature
to enhance background knowledge.
The first step in the literature review process
involved identifying the primary source of literature. MEDLINE (1966-February
2006), was used as the primary database for the literature search.
Secondary searches were performed using email listserv announcements
of newly published journal articles and technical / academic or
government reports. Tertiary searches of the bibliographies of all
abstracted articles were undertaken, but were cut short due to the
study's timeline.
The search strategy was developed using the National
Library of Medicine Medical Subject Heading (MeSH) keyword categorization
developed specifically for MEDLINE. A medical research librarian
from the Cecil G Sheps Center for Health Services Research at the
University of North Carolina at Chapel Hill conducted the MeSH search
and assisted with the interpretation of results. The search strategy
used the following MeSH search terms: Emergency Medical Services,
Education-Distance, Education-Continuing, Inservice Training, and
Organization & Administration. Investigators performed a
second search of the literature using all of the same MeSH search
terms, except for Emergency Medical Services. This term was replaced
with Nursing. The nursing profession is a health profession
with a history and research base of greater depth than that of the
Emergency Medical Services literature. Investigators searched the
nursing literature to help fill in gaps in knowledge about the topic
under study in this investigation. This approach seemed logical
as issues and challenges experienced in the nursing profession are
regularly compared to those encountered by Emergency Medical Technicians.
For a detailed description of inclusion and exclusion criteria,
and outline of the search strategies; see Appendix A and Tables
A-1 and A-2.
RESULTS
The researchers reviewed 454 abstracts and 47
full-text articles. The mix of articles included random controlled
trials, editorials, commentaries, evaluation studies, and case studies.
Only one of the 47 full-text articles contained statistical data
on the utilization of various EMS education methods. Dawson and
associates'4 study of nationally registered EMTs
and Paramedics discovered that EMTs and Paramedics primarily use
classroom instruction to fulfill continuing education requirements.
Telemedicine, grand rounds, or national conferences were used less
frequently (Figure 1.1).
One study, limited to urban environments and containing
no information about differences in the methods used for fulfillment
of continuing education, had identified that paramedic continuing
education programs in most EMS systems mandate both didactic and
clinical continuing education.5 This particular
study is informative, shedding light on continuing education course
structure nationally, and is worth highlighting in this review.
The study does not, however, improve what is known about use of
distance education in EMS.
Publications evaluating the effectiveness or preferences
of EMS professionals include research by Sanddal et al, Herman and
associates, and Porter.5-7 These
studies closely examined the effectiveness of different methods
for delivering continuing or initial EMS education, and identified
EMS professionals' preferences for receiving continuing education
-- all issues important to focused discussion in this report.
Editorials, commentaries, and other articles identified
in the literature search discussed various aspects of initial, continuing,
or distance education. Williams,8 for example,
addressed online EMS degree programs, commenting on program prevalence
and trends over time. According to the author, many universities
have begun offering portions of entire degree programs via distance
learning. Drexel University, Western Carolina University, and George
Washington University were specifically mentioned.
The remainder of the literature assessed in this
review contained no national or State utilization estimates for
any particular method of fulfilling continuing education requirements.
DISCUSSION
There are many methods available for fulfilling
continuing education requirements in EMS. This review of the literature
reveals that very little research has been done examining use of
distance education for fulfillment of continuing education requirements.
Only one study was identified containing information on the use
of various distance education resources that can be extrapolated
nationally. The bulk of information reviewed discusses distance
education or continuing education in a general sense, or compares
one method of education to another.
Below is a discussion of continuing education,
distance education, and a review of terminology, requirements, and
trends. These discussions are intended to expand upon the review
of literature and contribute to guiding the future directions rural
EMS professionals, policy makers, and advocates may pursue with
respect to distance education in EMS.
Distance education, distance learning, distributed
learning
Used interchangeably, distance education, distance
learning, and distributed learning are terms used to describe a
type of educational delivery. There is no single definition or uniformly
accepted description of distance education. Many organizations like
the United States Distance Learning Association (USDLA) describe
distance learning as "The acquisition of knowledge and skills
through mediated information and instruction, encompassing all technologies
and other forms of learning at a distance."9
The California Distance Learning Project (CDLP)
defines distance learning as: "an instructional delivery
system that connects learners with educational resources. Distance
learning provides educational access to learners not enrolled in
educational institutions and can augment the learning opportunities
of current students. The implementation of distance learning is
a process that uses available resources and will evolve to incorporate
emerging technologies."10
The Continuing Education Coordinating Board for
Emergency Medical Services (CECBEMS) defines distributed learning
as: an educational activity in which the learner, the instructor,
and the educational materials are not all present in the same place
at the same time. Therefore, continuing education activities that
are offered on the Internet, via CD ROM or video, or through reading
journal articles or listening to audio tapes are considered distributed
learning.11
Types of distance education
Instructors, educational institutions, and private
industry use journals, CD-ROMS, teleconferencing, satellite broadcasting,
the Internet, and mailing of materials to facilitate education of
students from a distance. Effective use of these often requires
that the learner possess a variety of resources, including computers
and other electronics. For educators and institutions providing
Internet based learning, the learner must possess a computer, Internet
provider, and high-speed or telephone dial-up Internet connectivity.
Depending on the course, the learner may be required to purchase
one or more software applications or hardware to facilitate distance
education/learning.
For courses offered via audio/video-cassette or
via CD-ROMS, the learner should have in his or her possession a
stereo-cassette system, television, VCR, DVD player, or computer
with a CD drive. Additional requirements may include software to
read CD-ROM materials and subscription fees. A valid mailing address
is a requirement for receiving distance education via professional
or trade industry journals. Students signed up to receive education
via satellite or teleconferencing may be required to travel to a
local institution or facility receiving broadcasts from the designated
home institution.
Continuing education
Most medical professionals are required to continually
educate themselves. Continuing education is used to keep health
care providers competent and familiar with the latest trends in
their discipline and delivery of care. Continuing education can
be described as organized learning experiences that are typically
offered to those professions that have previously received a degree
or certification/licensure. Colleges, universities, community and
technical colleges, private organizations, government regulatory
agencies, and businesses offer or fund the provision of continuing
education. While not the norm, some may offer college-level credit
to be applied towards completion of a degree or certificate program.
Some form of educational credit may also be awarded by professional
societies as a mark of professional distinction and further education.
In terms of demographics, recipients of continuing education are
typically adults, which is why the phrase "adult learner"
is commonly seen in descriptions of continuing education courses.
Trends in distance education
Continuing education has advanced significantly
since the mid-19th century when students and instructors used the
postal service to mail assignments and exams. Mailing materials
and other educational correspondence represented the beginning of
distance education. As technology evolved, television and audio
media replaced or augmented this process. Today, the Internet plays
a key role in providing opportunities for distance education and
learning.
Total distance education program enrollment data
are not readily available. Numerous Internet Web sites, journals,
magazines, and other sources provide a wide assortment of data and
information, much of which is difficult to validate. Data and information
available from the National Center for Educational Statistics show
that over 3 million students in the U.S. enrolled in 127,400 different
distance education courses between 2000 and 2001.12
Fifty-six percent of all Title IV eligible, 2-year and 4-year degree
institutions offered distance education courses for any level and
any audience between 2000 and 2001.12 Most students
used Internet and video technologies. Based on a survey by the Sloan
Consortium, over 1.6 million students were enrolled in some form
of on-line education program in the fall months of 2002.13
Other data from the Sloan Consortium shows that over one-third of
the 1.6 million students completed all courses online.
In 1994, 35 percent of public elementary and secondary
schools in the United States had access to the Internet. In 2003,
100 percent of these public schools had Internet access. Public
schools have made steady progress towards increasing the availability
of Internet access to students and facilitating learning through
use of computers, closed circuit television, and other educational
media. Institutions of higher learning have also expanded distance
education opportunities for completion of baccalaureate, master's,
and doctoral degree programs. Continuing education programs have
expanded significantly in concert with other advancements, offering
adult learners flexibility to meet their respective occupational
continuing education requirements. The observed trend in education
at present is to support distance learning using computers and other
strategies to facilitate independent education. The familiarity
younger students have with computers and Internet technologies will
require institutions of higher learning, as well as other providers
of education, to adapt to the needs and wants of a more independent
and technologically sophisticated learner/student. Perhaps, not
surprisingly, the resounding growth in distance education has called
into question the future of institution-based learning environments.
Use of distance education to fulfill continuing education requirements
Rules and regulations adopted by State medical
licensing boards, national societies, and educational governing
bodies play a key role in decisions involving use of distance education.
Using the State of North Carolina as an example, below is a discussion
of the rules and regulations guiding physician and nurse use of
distance education resources for fulfillment of continuing education
requirements. Restrictions imposed on EMTs and Paramedics by the
National Registry of EMTs is also presented.
Medical physicians
A States' general assembly delegates the authority
to regulate the practice of medicine by medical doctors and physician
extenders to State medical boards. This authority varies across
States and so do the continuing education requirements for renewing
licensure. According to the most recent (2006) State medical licensure
requirements gathered by the American Medical Association (AMA);
58 boards require anywhere from 12 hours (Alabama) to 50 hours (several
States) of continuing medical education (CME) per year for license
re-registration.14
Under Title 21, Chapter 32 (.0101-.0102) of the
North Carolina Medical Board medical education regulations, the
board requires that each person licensed to practice medicine in
the State shall complete 150 hours of relevant CME every three years.15
The rule further States that at least 60 hours involve one of the
following four options: formal courses, scientific/clinical presentations
or publications, enduring material (printed or electronic), or skill
development.15 The remaining hours can be fulfilled
through physician-initiated CME (e.g., self study, mentoring, journal
clubs, or teaching).15
Other restrictions on physician use may be imposed
by specialty boards. For example, the American Board of Emergency
Medicine (ABEM) may require a physician or extender accumulate CME
credits that focus on a specific medical specialty. The ABEM specifically
requires that physicians applying for Emergency Medicine recertification
complete and submit for review an average of 50 hours of CME per
year in Emergency Medicine.16 It is possible that
additional hours of CME be completed if the physician does not apply
within a certain time period after graduation from a residency program.
In addition to the required CME credits per year, board certified
emergency physicians must also have completed eight Lifelong Learning
and Self Assessment (LLSA) tests equivalents every 10 years.17
Restrictions on the type of resources used to
fulfill continuing education requirements are uncommon. Although
dependent on specialty board and State medical regulatory board
requirements, physicians have substantial flexibility in choosing
the method in which they receive continuing education.
Nurses
Similar to the variability in regulations guiding
the continuing education and licensure of physicians, the licensing
authorities regulating the practice of nursing vary considerably
from State to State. Nurse practitioners and mid-wives, as well
as physician assistants, are often considered physician extenders
and must adhere to a different set of CME requirements.
North Carolina, a State that has recently changed
its requirements, offers a good example of CME requirements for
nurses. As of July 2006, all nurses licensed by the North Carolina
Board of Nursing must do the following every 2 years prior to receiving
a renewed license. 1) Perform a self-assessment of practice. 2)
Develop a plan for continued learning. 3) Identify one or more objectives
consistent with dimensions of practice. 4) Select one activity from
a list of eight learning activity options. Available options are
included in the table below.
Available / approved learning activity
options for NC licensed nurses fulfilling continuing education
requirements |
Obtain national certification |
Complete 30 contact hours of continuing education
activities related to nurse's practice |
Complete of a board approved refresher course |
Complete 15 contact hours of a continuing
education activity related to nurse's practice and complete
a formal nursing project or research study as principal or co-investigator
which includes a statement of the problem, project objectives,
methods, and summary of findings |
Complete 15 contact hours of a continuing
education activity related to nurse's practice and author or
co-author a published nursing related article, paper, book or
book chapter |
Complete 15 contact hours of a continuing
education activity related to nurse's practice and conduct an
educational presentation or presentations totaling a minimum
of 5 contact hours for nurses or other health professionals;
or |
Complete 15 contact hours of a continuing
education activity related to the nurse's practice and 640 hours
of active practice within the previous 2 years |
Nurses with certain specialties may also be required
or encouraged to become nationally certified. The American Nurses
Association (ANA) is one of the largest nursing certification organizations
in the U.S. The ANA and American Nurses Credentialing Center (ANCC)
have partnered to provide material recognition of professional achievement
in nursing. Certifying more than 150,000 nurses, the ANA and ANCC's
basic re-certification requirements call for applicants to complete
two of the five activities every 5 years:
- Complete 75 contact hours, of which half must
come from an ANCC approved course.
- Complete five academic semester hour credits
towards higher education in nursing (no core course allowed).
- Present or lecture a total of five times to
other allied health professionals on topics related to area of
certification.
- Publish one article or book chapter or one
research project or one "other educational media" project or complete
a doctoral dissertation or master's thesis in the specialty area.
- Complete 120 hours of a preceptorship. Each
individual requirement has restrictions and each medical specialty
has its own requirements in addition to these core requirements.
Emergency Medical Technicians and Paramedics
The amount of hours and ways in which continuing
education can be obtained by an EMT or Paramedic varies from State
to State. Those that are nationally registered EMT-Basics and Paramedics,
however, must fulfill a uniform set of continuing education requirements
for re-certification by the National Registry of EMTs (NREMT).
Every two years, nationally registered EMT-Basics
must complete a 24-hour refresher course, have evidence of current
Cardio-Pulmonary Resuscitation (CPR) training, and complete 48 hours
of additional continuing education. The source of the continuing
education must be approved by the Continuing Education Coordinating
Board for Emergency Medical Services (CECBEMS). The NREMT policy
allows EMTs and Paramedics to use distributed learning resources
to fulfill a portion of their total continuing education requirements.
Ten hours of the 24-hour refresher course can be taken via distributed
learning. Of the additional 48 hours of continuing education, 24
hours can be taken via a distance education resource.
Nationally registered Paramedics' continuing education
requirements differ from those required of EMT-Basics. Paramedics
must complete a 48-hour refresher course, have current CPR and Advanced
Cardiac Life Support (ACLS) certifications, and fulfill 24 hours
of additional continuing education. All courses must be approved
by the Continuing Education Coordinating Board for Emergency Medical
Services (CECBEMS) and Paramedics cannot use distributed learning
resources to fulfill more than 10 hours of the 48-hour refresher
course or 12 of the additional 24 hours of additional continuing
education. Notably, use of distance learning by EMTs or Paramedics
may be less in some States than in others. For example, State offices
of EMS can require that all refresher course hours be taken in a
classroom setting, limiting the opportunities EMTs and Paramedics
may have to use distance education resources.
SUMMARY REMARKS
This study used MEDLINE, a popular medical search
engine, to identify research focused on distance education, continuing
education, and EMS professionals. Other databases were not explored
using the systematic approach involving PUBMED's MEDLINE, Old MEDLINE,
and in-process citations, and the collection of references contained
within primary article bibliographies was limited. The results of
this study, therefore, are subject to some criticism based on these
methodological limitations. Additional research addressing the issues
under study, accordingly, may be indicated.
In light of the study's limitations, several conclusions
are clear.
1. Very little is known about use of distance
education to fulfill continuing education requirements within the
EMS profession.
Data from the study by Dawson and associates4
is the only study referenced containing national utilization estimates
for various methods of continuing education delivery, including
methods common to distance education.
Figure 1.1: Resources - methods - used previously
to fulfill continuing education requirements among Nationally Registered
EMT-Basics and Paramedics (1999) [source: Dawson et al, 2003].
2. Additional research exploring utilization
and preference of different methods of receiving and delivering
continuing education is needed.
Data from the National Center for Educational
Statistics show that technologies used to deliver distance education
are abundant in our elementary, secondary, and educational institutions
of higher learning. The younger cohort of EMS professionals, therefore,
is not only familiar with the Internet, computers, and computer
technologies; but may actually prefer to receive continuing education
through one or more of these media over education delivered in a
classroom setting.
Research identifying the supply and availability
of continuing education programs for initial and continuing EMS
education is needed. Studies of educational delivery in other health
care disciplines are also basic and few in number.18
At least one researcher has failed to identify use of any valid
theoretical framework for delivering and evaluating continuing education.18
Approaches and programs delivering continuing education are unfocused,
using no real outcomes for evaluation and quality assessment.
Although limited, research in other disciplines
offer some insights and direction for formulating research questions
and hypotheses. The Internet, according to one study, is an effective
tool for delivering continuing education.18 Computer
competency and technological difficulties are issues of importance,
however.18 Gender,19-21
literacy,22 organizational infrastructure and
support,23 and costs24 are also
important, and actually may play a role in facilitating or limiting
use of distance education resources focused on the delivery of continuing
education. Research should also address preference, identifying
which among the many distance education technologies is most sought
after by EMS professionals.
3. Distance education as the rule instead of
the exception.
Leaders in medical education have a new, global
vision for the delivery of continuing medical education.25
There are old and new demands that health care professionals must
meet in an environment which is growing more complex daily. It may
no longer be convenient or cost-effective to deliver or receive
education in a fixed location26 particularly in
rural environments. Use of electronic tools for fulfilling continuing
education requirements has grown considerably in recent history;
18, 20 and significant differences
in achievement of learning objectives are thought to exist. Distance-based
learning programs may be superior to traditional classroom-based
programs.26 Experts are focused on differences
in learning styles and student needs, individualized study plans,
appropriate human interaction, material and activity variety, and
continuous quality assessment.26 As noted, considerable
advances have been made, and many in EMS are attempting to use these
advancements to improve the EMS education experience.27
There are important implications accompanying
the growth and utilization of new and various methods of delivering
EMS education via distance. It is safe to say that acceptance of,
and comfort with, these newer techniques in education will continue
to increase. It is important that those concerned with EMS continuing
education expand the knowledge base on utilization, preference,
and challenges to using distance education.
Distance
Education in EMS:
Rural/Urban Comparison
PART II
INTRODUCTION
Like many health professionals, Emergency Medical
Technicians (EMTs) and Paramedics are required to have continuing
education to maintain licensure or certification. Every 2 years,
nationally registered EMTs and Paramedics must complete a total
of 72 hours of continuing education and refresher training. Individual
State requirements vary, but are often similar to these national
guidelines. Some systems require as much as 200 hours of didactic
and 120 hours of clinical continuing education every year.5
For professionals practicing or residing in rural and frontier areas,
meeting these requirements is difficult. There is limited availability
of institution-based EMS education programs in the sparsely populated
areas that are prevalent in rural and frontier America. Accessing
existing programs can be a challenge when in-service training and
education is limited.2
As the number of volunteer and paid EMS personnel
decreases nationwide,28-33 reducing
or eliminating challenges and burdens associated with fulfilling
EMS continuing education requirements should be a high priority
for parties concerned with the well-being of our nation's EMS systems.
Recent advances in educational technologies have increased, such
as those offered through the Internet. This may help reduce challenges
and burdens of educating and retaining EMS professionals.
While distance education holds much promise, and
appears to be gaining more acceptance in EMS circles,34,
35 overall, very little is known about its availability
and use in EMS on a national level. What is known is that EMTs and
Paramedics have received continuing education using a wide variety
of mechanisms.4 Most urban-based EMS systems mandate
Paramedics receive continuing education through didactic instruction.5
Geographic variation in EMT and Paramedic acquisition of continuing
education has not been investigated in detail. Identification of
any rural-urban variations in the use of commonly used methods may
be very informative for EMS education professionals and should help
improve the availability of continuing education resources where
needed, via changes in education policy and resource allocation.
The purpose of this study is to examine rural/urban
or other differences in the mechanisms commonly used to fulfill
continuing education requirements in EMS. It explores the nature
of geographic differences using a nationally representative sample
of EMTs and Paramedics. Careful attention will be given to EMT demographic
and professional practice factors. Any of these factors may explain
variations in use of certain mechanisms when differences between
rural and urban groups are identified.
METHODS
Data Source and Population
Data used for this study come from the 1999 core
and educational supplement of the Longitudinal Emergency Medical
Technician Attributes and Demographics Study (LEADS) survey. The
LEADS Project is a 10-year longitudinal study of the EMT workforce
supported by the U.S. Department of Transportation, National Highway
Traffic and Safety Administration (NHTSA) Office of EMS, and administered
by the National Registry of EMTs (NREMT). The NREMT LEADS committee
manages and coordinates the LEADS project, as well as, approves
all proposals involving analysis of LEADS data.
The core survey contains 47 questions divided
into 6 different categories (i.e. general, professional, education
related, personal, finance related, demographic and background).
The 1999 educational supplement contained 16 questions related to
the use, type, and expenses of EMS education.
Each year, approximately 5,700 nationally registered
EMT-Basics and Paramedics are randomly selected from the population
of Nationally Registered EMTs and Paramedics; near 185,000 in 1999.36
Those randomly selected receive the core and a supplemental survey
on a topic of interest. The national registry organization samples
EMT-Basics and Paramedics across three categories and six strata:
certification, race, and experience. Weights are applied to each
respondent to allow for national extrapolation. A detailed description
of the survey methodology and sampling is presented elsewhere.36
Study investigators received approval to undertake
the study described here by the Institutional Review Board (IRB)
of the University of North Carolina, School of Medicine and research
review committee of the National Registry of Emergency Medical Technicians
(NREMT).
Dependent and Independent Variables
The primary dependent variables of interest were
drawn from question #16 in the 1999 EMS education supplement survey.
The question and its responses are noted in Table 2.1:
Table 2.1 In which of the following ways have
you received continuing EMS education?
Classroom instruction |
Yes |
No |
State conferences |
Yes |
No |
National conferences |
Yes |
No |
Run reviews or case reviews |
Yes |
No |
Internet |
Yes |
No |
CD-ROM and interactive computer programs |
Yes |
No |
Telemedicine |
Yes |
No |
Journal articles |
Yes |
No |
Grand rounds |
Yes |
No |
Video cassette |
Yes |
No |
Satellite TV |
Yes |
No |
The primary independent variable of interest was
practice location, which we refer to as rural status of the EMT.
Rural status was defined using responses to question #4 of the core
survey. This question requested respondents select one of eight
possible responses that best describe the community in which the
EMT does most of his/her work. Responses were collapsed into the
following 4 categories: Rural area (less than 2,500 people), Small
town (2,500 - 24,999 people), Medium-sized town (25,000 - 74,999
people), and All others (75,000 + people).
Other independent variables of interest included
certification level, volunteer status, age, EMT tenure status, and
type of EMS service in which the EMT was employed.
Analysis
Frequencies and percentages were used to describe
the sample across the four categories of community size. Chi-square
tests were used to identify significant differences based on community
size for all dependent and independent variables. Significant variations
in the dependent variables were explored further using multivariable
logistic regression models controlling for all independent variables
of interest. Significance for chi-square and multivariable tests
was determined using a p-value of 0.05. All analyses were performed
in SAS Callable SUDAAN Version 9.1 (Cary, North Carolina).
Exclusions and missing data
The 1999 supplement contained responses from 1,743
EMT-Basics and Paramedics (~28% overall response rate4).
For the purposes of this study, all EMTs indicating that they were
temporarily or permanently not practicing or have already left the
profession were excluded from the analysis (n=212). An additional
37 EMTs and Paramedics were missing information about the size of
the community in which they did most of their work.
The proportion of EMTs and Paramedics missing
gender was excessive, and therefore prevented its inclusion in all
analyses. For the dependent variables of interest, missing responses
were relatively minimal (< 7 percent).
Variable |
Frequency Missing |
Percent Missing |
Classroom instruction |
54 |
3.6% |
Run/Case reviews |
77 |
5.2% |
Video-cassette |
80 |
5.4% |
State Conferences |
85 |
5.7% |
Journal Articles |
84 |
5.6% |
Satellite TV |
94 |
6.3% |
Internet |
90 |
6.0% |
Grand Rounds |
105 |
7.0% |
Telemedicine |
93 |
6.2% |
Calculation denominator
= 1,494
All analyses were performed on 1,494 or 85.7% of the original
sample 1,743. |
RESULTS
The 1999 EMT & Paramedic Workforce
While data show that one-third of all nationally
registered EMTs and Paramedics are volunteers (Table 1), our analyses
also find that there is substantial variation in the proportion
of volunteers to paid professionals when examined in relation to
community size (Figure 1). Three quarters (74 percent) of all EMTs
and Paramedics in rural areas with less than 2,500 residents are
volunteers. The number of volunteers practicing in a community is
inversely proportional to the size of the community.
Two-thirds of all NREMT member EMS professionals
are certified at the EMT-Basic level (Table 2.2). Ninety percent
of Emergency Medical Technicians working in communities with less
than 2,500 residents are certified at the EMT-Basic level. The proportion
of EMT-Basics decreases as the size of the community increases.
One in every three (33 percent) EMT and Paramedic
works at a Fire-based EMS agency (Table 2.2). Employment at a Fire-based
EMS agency is significantly less in communities with fewer than
25,000 residents as compared to communities with 25,000 residents
or more. One in five professionals works at a county / municipal
or volunteer rescue squad. Most EMTs and Paramedics working in sparsely
populated communities work at volunteer rescue squads or in EMS
agencies operated by the county or other municipal government.
Half of all Emergency Medical Technicians are
between the ages of 18 and 34 (Table 1). While overall less than
10 percent of EMS professionals are 50 or older; more older respondents
appear to be practicing in smaller communities (Figure 2.2). Nearly
one-third (31.5 percent) of all EMTs and Paramedics working in a
rural area had been certified for less than 1 year when they completed
the LEADS survey. Comparatively, one-quarter of professionals working
in densely populated communities were certified for 1 year or less.
Methods of Receiving
Continuing Education
For many of the methods by which an EMS professional
receives continuing education, there is no difference in prior use
between providers working in sparsely populated communities and
those working in more densely populated communities (Table 2.3).
The most common methods used to meet continuing education requirements
in all locations include classroom instruction, run reviews, and
video cassettes. The least common methods include telemedicine,
grand rounds, and national conferences.
In examining the individual methods utilized by
the entire study group, variations in experience or practices using
CD-ROMS (p=0.0001), national conferences (p=0.0226), and grand rounds
(p=0.0173) were identified (Table 2.3). The proportion of EMTs and
Paramedics having received continuing education using CD-ROMS, attending
national conferences, and via grand rounds is significantly greater
among those working in communities with 75,000 residents or more
than among those working in communities with less than 25,000 residents
(Figure 2.3 & Table 2.3).
Click on image for larger version.
Likelihood
of Receiving Continuing Education via CD-ROMS, National Conferences,
and Grand Rounds
Bivariate analysis presented in Table 2.3 show
significant geographic differences in use of CD ROM, National Conferences,
and Grand Rounds. After controlling for multiple EMT demographic,
professional, and systems characteristics, geographic differences
are not demonstrated (Tables 2.4, 2.5, 2.6). Factors such as the
level of certification are more predictive of an EMT's experience
with using CD ROMs, National Conferences, and Grand Rounds. Paramedics
were more likely than were EMT-Basics to have received continuing
education using CD-ROMS or other interactive computer programs (Table
2.4). Receiving continuing education via National Conferences was
also much lower among EMT Basics than among Paramedics, and was
significantly lower among younger aged EMTs and Paramedics than
among those 50 years and older (Table 2.5). Newly certified EMTs
and Paramedics were also less likely to have received continuing
education via National Conferences than were professionals certified
longer than one year. EMT-Basics and professionals with less than
1 year tenure were much less likely to have received continuing
education via Grand Rounds than their respective referent groups
(Table 2.6).
DISCUSSION
This study utilized the 1999 core and educational
supplement Longitudinal EMT Attributes and Demographics Study (LEADS)
surveys to explore existence of rural-urban differences in commonly
used mediums for fulfilling continuing education requirements in
EMS. Among all EMTs and Paramedics, the two most commonly used methods
for fulfilling continuing education requirements were classroom
instruction and run reviews or case reviews. Eight of the eleven
continuing education media were utilized equally across EMTs and
Paramedics working in communities of various population sizes.
Likelihood of acquiring CME by any medium is greater
in larger communities than in less densely populated ones. The medium
utilized appears to be dependent on social and professional factors,
such as certification level, age, and job tenure. Utilization of
various media does not appear to be dependent on the size of the
community where the EMT is practicing.
The lack of prior research in this area prevents
testing of prior hypotheses or comparisons across different populations
or over different time periods. The current study was an exploratory
investigation of general educational medium utilization, and sought
to identify possible geographic variations in reported use. These
preliminary findings may have several potential explanations.
First, vendors preferentially produce EMS education
materials and may market computer-based education programs more
aggressively to Paramedics. Paramedic-level trained EMS professionals
are in high demand.33 Rural EMS experts suggest
that communities have come to expect Paramedic level care when accessing
the EMS system.2 This expectation of advanced EMS
care, quite possibly, has influenced the development of EMS education
curriculums and programs, resulting in a decrease in the variety
and availability of EMT-Basic level certification programs nationally.
Vendors may be producing more educational materials and developing
innovative CD-ROM software programs targeting Paramedic and other
advanced level providers rather than Basic-level providers. Additional
research is needed to confirm such a theory.
With regard to the demonstrated variation in use
of national conferences between EMT-Basics and Paramedics, this
may be related to the EMT's experience. In general, EMT-Basics are
less experienced than Paramedics and quite possibly less concerned
with industry developments. National conferences are venues for
debate and discussion of old and new techniques and technologies
for delivering patient care. Paramedics are certified to provide
advanced levels of patient care and are thus more likely concerned
with care quality improving the way in which care is provided. Alternatively,
EMS administrators may reward experience by offering scholarships
or other funding to attend national conferences. The less experienced
EMT-Basic, therefore, may lack the resources of Paramedic colleagues.
Additionally, given that many members of the EMT-Basic strata are
volunteers, time away from work to attend national conferences may
create a financial disincentive for participants. Lastly, while
geography does not seem to be a significant factor in the choice
of media for CME, attendance of conferences for CME purposes seem
to be more prevalent among professionals working in larger communities;
where such conferences are typically held.
Another issue is that "grand rounds"
are a CME activity used by academic medical institutions to keep
staff current and expose medical students, nursing students, and
other allied health professionals to patient care. An EMT-Basic's
scope of practice is limited with respect to patient assessment
and administration of medications and procedures. A Paramedic, on
the other hand, is instructed in medication administration, inserting
intravenous catheters, and in performing detailed patient assessments
and medical procedures. Grand rounds, therefore, are intuitively
more relevant to the daily duties and responsibilities of a Paramedic
than of an EMT-Basic. The findings show that EMT-Basics and EMTs
with less tenure report using grand rounds less than Paramedics
and more experienced professionals should not be interpreted as
surprising. Local availability and relevance to the practice of
both EMT-Basics and Paramedics remain problematic, in that grand
rounds are usually oriented toward the patient rather than around
pre-hospital issues.
Finally, continuing education policies adopted
by EMS education, certification and licensing agencies or organizations
limit the use of distance learning for fulfillment of continuing
education requirements. Undeniably, National Registry policies permitting
(or restricting) use of distance education resources influence an
EMS professional's decision to use such resources. To the best of
our knowledge, the amount of influence these policies have on a
professional's educational resource decisions has not been explored.
CONCLUSIONS AND RECOMMENDATIONS
Many EMTs and Paramedics possess a less than favorable view of the
continuing education process.37, 38
Travel associated with continuing education has been identified
as burdensome by some, the process too repetitive and costly,38
and too time consuming, taking up limited time EMS professionals
have with family members.37 Further study of distance
education in EMS may lead to a better understanding of its use,
professional preference, and policies.
Consideration should be given to the following
conclusions and final thoughts:
- There is little information available regarding
methods used to acquire EMS CME or the use of distance learning
strategies to deliver it.
- Time and effort should be devoted to further
identifying and addressing incentives and disincentives to obtaining
EMS CME stratified by social, professional, and population density
factors shown to be influential in this study.
- There are challenges in delivering EMS CME
related to provider attitudes towards CME, cost, inconvenience
and evidence of positive impact on practice or patient outcomes.
- Preliminary findings of this study would suggest
a role and need for distance learning, particularly for those
EMS providers practicing in smaller communities. It also suggests
that the use of certain delivery media may be influenced more
so by social and professional factors, such as length of time
in practice and certification level, rather than size of the community
in which providers practice.
- More research into distance learning targeted
at EMS should be undertaken, concentrated on Web-based, interactive
modalities, and on the development of media that offer choices
to the learner.
Table 2.2: Characteristics of nationally registered
Emergency Medical Technician (EMT) Basics and Paramedics reported
across size of community in which they work
|
TOTAL
(n=1,494)
|
Rural Area
(<2,500)
(n=235)
|
Small town
(2,500-24,999)
(n=372)
|
Medium sized town
(25,000-74,999)
(n=306)
|
All others
(75,000 +)
(n=581)
|
Chi-square
p-value
|
Volunteers |
34.1% |
74.1% |
43.1% |
14.9% |
10% |
<0.0001 |
EMT-Basics |
64.3% |
91.4% |
70.8% |
53.5% |
46.2% |
<0.0001 |
Type of EMS
service working at:
Hospital-based
Fire-based
County / Municipal
Volunteer rescue squad
Other
Unaffiliated |
13.6%
32.7%
19.7%
18.8%
14.2%
1.1%
|
10%
9.2%
20.9%
42.9%
15.7%
1.3%
|
15.3%
28.8%
19.4%
23.8%
11.3%
1.3%
|
13.4%
43.5%
16.2%
8.6%
17.3%
0.9%
|
14.6%
46%
21.2%
3.7%
13.7%
0.5%
|
<0.0001 |
Age category
18-34
35-49
50+
|
50.7%
40.6%
8.7%
|
38.5%
48.4%
13.1%
|
47.4%
40.4%
12.2%
|
55.8%
39.4%
4.9%
|
59.2%
36.1%
4.8%
|
0.0001 |
New EMT or Paramedic
(< 1 year as an EMT or as a new Paramedic)
|
28.2% |
31.5% |
30.1% |
27.4% |
24.9% |
0.1777 |
n=1,494
Table 2.3: Geographic differences in use of
various types of resources for fulfillment of continuing education
requirements
Have previously received
or used the following for fulfillment of continuing education
requirements |
TOTAL (n=1,494) |
Rural Area (<2,500)
(n=235) |
Small town (2,500-24,999)
(n=372) |
Medium sized town (25,000-74,999)
(n=306) |
All others (75,000 +)
(n=581) |
Chi-square p-value |
Classroom instruction |
93.8% |
95.3% |
91% |
95.4% |
94.1% |
0.2184 |
Run reviews or case reviews |
65.2% |
65.6% |
62.4% |
65.6% |
67.2% |
0.7162 |
Video cassette |
57.9% |
56.4% |
59.5% |
53.7% |
60% |
0.5373 |
State conferences |
39.6% |
45.2% |
41.5% |
38.1% |
35% |
0.1447 |
Journal articles |
50.6% |
44.4% |
51.8% |
52.5% |
52.9% |
0.3232 |
Satellite TV |
10.9% |
14.4% |
12.3% |
10% |
7.7% |
0.1191 |
Internet |
14.5% |
13.7% |
13.7% |
15.7% |
15.1% |
0.9117 |
CD ROM and interactive computer
programs |
18.3% |
10% |
15.3% |
20.6% |
25.2% |
0.0001 |
National conferences |
10.5% |
6% |
8.8% |
13.4% |
13.2% |
0.0226 |
Grand rounds |
10.1% |
5.3% |
9.3% |
14.2% |
11.7% |
0.0173 |
Telemedicine |
5.3% |
5.2% |
7.8% |
3.8% |
4.1% |
0.2996 |
n=1,494
Table 2.4: Likelihood of having received continuing
education from CD-ROM or other interactive computer programs
PARAMETER |
Beta |
SE |
ODDS RATIO |
95% CI |
P-VALUE |
|
|
|
|
|
|
Intercept |
-0.4662 |
0.4332 |
0.6274 |
0.2683, 1.4674 |
|
Rurality
Rural (<2,500)
Small town (2,500-24,999)
Medium town (25,000-74,999)
All others (75,000+)
|
-0.5650
-0.3661
-0.1791
---- |
0.3443
0.2371
0.2311
---- |
0.5683
0.6935
0.8361
----
|
0.2893, 1.1165
0.4355, 1.1041
0.5313, 1.3155
---- |
0.2997
|
Volunteer Status
Volunteer
Non-Volunteer
|
-0.3178
---- |
0.3149
----
|
0.7277
---- |
0.3924, 1.3495
---- |
0.3129 |
EMT Certification
Basic
Paramedic |
-0.8919
---- |
0.2080
---- |
0.4099
---- |
0.2726, 0.6164
---- |
0.0000 |
Type of EMS service
working at:
Hospital-based
County / Municipal
Volunteer rescue squad
Unaffiliated
Other
Fire-based
|
-0.2443
-0.0584
0.1313
1.2718
-0.3000
---- |
0.2686
0.2294
0.3492
0.7471
0.3007
---- |
0.7833
0.9433
1.1403
3.5671
0.7408
---- |
0.4626, 1.3264
0.6015, 1.4794
0.5749, 2.2617
0.8241, 15.4407
0.4107, 1.3362
---- |
0.4088
|
Age category
18-34
35-49
50+ |
-0.2940
-0.1450
---- |
0.4171
0.4176
---- |
0.7453
0.8650
---- |
0.3289, 1.6888
0.3814, 1.9622
---- |
0.6263
|
EMT tenure status
New EMT/Paramedic (< 1 year as EMT)
Old EMT/Paramedic (> 1 year as EMT) |
0.1157
---- |
0.1723
---- |
1.1226
---- |
0.8007, 1.5739
---- |
0.5021 |
n=1,494
Table 2.5: Likelihood of having received continuing
education at national conferences
PARAMETER |
Beta |
SE |
ODDS RATIO |
95% CI |
P-VALUE |
|
|
|
|
|
|
Intercept |
-0.6253 |
0.4566 |
0.5351 |
0.2185, 1.3103 |
|
Rurality
Rural (<2,500)
Small town (2,500-24,999)
Medium town (25,000-74,999)
All others (75,000+)
|
-0.1444
-0.3044
0.0816
---- |
0.4806
0.3152
0.2917
---- |
0.8655
0.7376
1.0850
---- |
0.3372, 2.2214
0.3975, 1.3687
0.6123, 1.9227
---- |
0.7282
|
Volunteer Status
Volunteer
Non-Volunteer |
-0.2189
---- |
0.4883
---- |
0.8034
---- |
0.3083, 2.0934
---- |
0.6540 |
EMT Certification
Basic
Paramedic |
-1.4124
---- |
0.3218
---- |
0.2436
---- |
0.1296, 0.4579
---- |
0.0000 |
Type of EMS service
working at:
Hospital-based
County / Municipal
Volunteer rescue squad
Unaffiliated
Other
Fire-based |
0.3367
0.3397
0.1202
*
-0.0797
----
|
0.3099
0.3173
0.5860
.
0.3865
---- |
1.4003
1.4045
1.1278
.
0.9234
---- |
0.7625, 2.5717
0.7537, 2.6172
0.3573, 3.5594
.
0.4327, 1.9706
---- |
0.6857
|
Age category
18-34
35-49
50+ |
-1.0654
-0.4072
---- |
0.4179
0.4065
---- |
0.3446
0.6655
---- |
0.1518, 0.7820
0.2998, 1.4771
---- |
0.0072
|
EMT tenure status
New EMT/Paramedic (< 1 year as EMT)
Old EMT/Paramedic (> 1 year as EMT) |
-1.1699
---- |
0.2481
---- |
0.3104
---- |
0.1908, 0.5049
---- |
0.0000 |
n=1,494
* Statistics could not be produced for this category
because all responding EMTs falling within this particular category
selected yes or no. There was no variation in responses.
Table 2.6: Likelihood of having received continuing
education via Grand Rounds
PARAMETER |
Beta |
SE |
ODDS RATIO |
95% CI |
P-VALUE |
|
|
|
|
|
|
Intercept |
-2.0081 |
0.5747 |
0.1342 |
0.0435, 0.4144 |
|
Rurality
Rural (<2,500)
Small town (2,500-24,999)
Medium town (25,000-74,999)
All others (75,000+)
|
-0.5037
-0.0374
0.2787
---- |
0.4603
0.3308
0.2880
---- |
0.6043
0.9633
1.3215
---- |
0.2450, 1.4906
0.5035, 1.8432
0.7512, 2.3245
---- |
0.3730
|
Volunteer Status
Volunteer
Non-Volunteer |
-0.0629
---- |
0.3462
---- |
0.9391
---- |
0.4763, 1.8517
---- |
0.8559 |
EMT Certification
Basic
Paramedic |
-1.1613
---- |
0.3062
---- |
0.3131
---- |
0.1717, 0.5708
---- |
0.0002 |
Type of EMS service
working at:
Hospital-based
County / Municipal
Volunteer rescue squad
Unaffiliated
Other
Fire-based |
0.4470
0.2933
0.8538
1.1911
0.7001
---- |
0.3481
0.3343
0.4153
0.7893
0.3554
---- |
1.5637
1.3409
2.3484
3.2906
2.0139
---- |
0.7901, 3.0947
0.6961, 2.5831
1.0399, 5.3036
0.6998, 15.4727
1.0031, 4.0434
---- |
0.2300
|
Age category
18-34
35-49
50+ |
0.2510
0.3470
---- |
0.5282
0.5287
---- |
1.2853
1.4149
---- |
0.4561, 3.6215
0.5016, 3.9906
---- |
0.7817
|
EMT tenure status
New EMT/Paramedic (< 1 year as EMT)
Old EMT/Paramedic (> 1 year as EMT) |
-1.0040
---- |
0.2528
---- |
0.3664
---- |
0.2232, 0.6016
---- |
0.0001 |
n=1,494
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Leith, K.H., Corwin. S.J. & Powell, M.P. (2005). Recruitment
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Action Leadership, 18-20.
APPENDIX
A: Methods
Inclusion and exclusion criteria were developed
for literature searches to help focus the literature review and
help reduce the total number of articles included in the study to
an appropriate and searchable quantity.
Inclusion criteria include the following:
- The article was an empirical investigation,
review article, evaluation study, or editorial.
- The study population must include Emergency
Medical Technicians or other Emergency Medical Services personnel.
- All studies related to the research questions
(both broad and focused) were included.
- The study design included controlled trials,
cohort studies, case studies, or cross-sectional studies.
Exclusion criteria include the following:
- The article did not address distance education
or any of the other terms falling under the broader term of distance
education (e.g. distributed learning and continuing education).
- The study population was not Emergency Medical
Technicians or other Emergency Medical Services personnel.
- Articles did not meet inclusion criteria.
Except for the Emergency Medical Technicians or
other Emergency Medical Services personnel criteria, all articles
meeting inclusion and exclusion criteria but focused on the nursing
profession were included. The search of the nursing literature was
performed separately from the initial search of Emergency Medical
Services literature. Results from these separate searches are presented
in tables A-1 and A-2.
Our MeSH keyword literature search of both the
Emergency Medical Services and Nursing disciplines yielded 861 English
language articles, of which 454 had abstracts available. The abstract
of each article was reviewed against study inclusion and exclusion
criteria by the principal investigator. No additional review of
articles without abstracts was undertaken.
MEDLINE Search #1 and Search #2 produced 300 and
154 English language abstracts, respectively. All were reviewed
by the principal investigator across inclusion and exclusion criteria.
At the full-text screening stage, 47 articles were reviewed independently
by the principal investigator. Seventeen additional articles could
not be accessed through university (free, full-text) agreements
with publishers or journals. Based on review of article title, journal
in which it was published, and MeSH keywords outlined in the MEDLINE
display; these 17 were determined to not offer any additional information.
The full-text review involved a search for actual utilization figures
or estimates of use of distance education resources. Findings are
presented in the results section.
Table A-1: Summary of search strategy for Emergency
Medical Services and Distance Education
MEDLINE MeSH Search #1
|
Search # |
Search Description |
Results |
#6 |
Search “Education, Distance”
[MeSH] or “Education, Continuing” [MeSH] |
39731 |
#10 |
Search “Emergency Medical Services”
[MeSH] |
53813 |
#11 |
Search #6 AND #10 |
633 |
#12 |
Search #6 AND #10 Field: All
Fields, Limits: English |
557 |
#13 |
Search #6 AND #10 Field: All
Fields, Limits: English, Review |
38 |
#15 |
Select 38 document(s) |
38 |
#16 |
Search #6 AND #10 Field: All
Fields, Limits: English, Randomized Controlled Trial |
4 |
#18 |
Search #6 AND #10 Field: All
Fields, Limits: English, Editorial |
7 |
#20 |
Search #6 AND #10 Field: All
Fields, Limits: English, Practice Guideline |
2 |
#21 |
Search #19 OR #16 OR #13 |
49 |
#22 |
Search #12 NOT #21 |
508 |
#24 |
earch "Emergency Medical Services[MAJR] |
36254 |
#25 |
Search #22 AND #24 |
351 |
#27 |
Search #22 NOT #26 |
157 |
#40 |
Search In-service Training/*organization
& administration |
3726 |
#41 |
Search #10 AND #40 |
155 |
#42 |
Search #41 NOT #12 |
120 |
#43 |
Search #41 NOT #12 Field: All
Fields, Limits: English |
117 |
Table A-2: Summary of search strategy for Nursing
and Distance Education
MEDLINE MeSH Search #1
|
#29 |
Search nursing |
394025 |
#30 |
Search #6 AND #29 |
17597 |
#32 |
Search #30 NOT #10 |
17377 |
#40 |
Search Inservice Training/*organization &
administration |
3726 |
#45 |
Search #29 AND #40 Limits: English |
1703 |
#46 |
Search #29 AND #40 Field: All Fields, Limits:
English, Randomized Controlled Trial |
20 |
#48 |
Search evaluation studies [pt] Field: All
Fields, Limits: English |
61961 |
#49 |
Search #45 AND #48 Limits: English |
162 |
#51 |
Search #45 AND #48 All Fields, Limits: English,
Review |
131 |
APPENDIX
B: ACKNOWLEDGEMENTS
Data for the statistical
analysis component of this study was made available by the National
Registry of EMTs (NREMT), whom approved the plan of analysis December
13, 2005. We would like to extend a special thanks to the Longitudinal
EMT Attributes and Demographics Study (LEADS) committee. Without
access to the LEADS survey data, this study would not have been
possible.
This compendium was made
possible by funds provided by ORHP and the Rural Emergency Medical
Services and Trauma Technical Assistance Center (REMSTTAC), University
of North Carolina at Chapel Hill - Cecil G. Sheps Center for Health
Services Research (UNC). Special thanks for producing this compendium
go to UNC staff P. Daniel Patterson, AHRQ-NRSA Post-Doctoral Research
Fellow and Charity Moore, Research Assistant Professor and to REMSTTAC
staff Nels Sanddal, Director; Heather Soucy, Program Support Specialist;
Teri Sanddal, Associate Director; and Joe Hansen, Assistant Director
and members of the Distance Education Workgroup at REMSTTAC.
Nels D. Sanddal, MS, REMT-B,
Co-chair
Director
Rural Emergency Medical Services and Trauma Technical Assistance
Center
P. Daniel Patterson, PhD, MPH, EMT-B, Co-chair
AHRQ-NRSA Post-Doctoral Research Fellow
Cecil G. Sheps Center for Health Services Research
University of North Carolina at Chapel Hill
Contributors and Reviewers:
Thomas J. Esposito, MD, MPH, FACS
Medical Director, REMSTTAC
Professor & Chief Section of Trauma Surgery
Department of Surgery
Loyola University Medical Center
N. Clay Mann, PhD, MS, Professor
Associate Director of Research
Intermountain Injury Control Research Center
University of Utah
Charity G. Moore, PhD, MSPH
Research Assistant Professor
Cecil G. Sheps Center for Health Services Research
University of North Carolina at Chapel Hill
Kimberly K. Obbink, M.Ed., Director
Extended University
Montana State University
Jacob L. Rueda III, PhD, MPH
Project Officer
U.S. Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
APPENDIX
C: REMSTTAC STAKEHOLDERS GROUP
Katrina Altenhofen, MPH,
REMT-B
State Coordinator
Emergency Medical Services of for Children
Iowa Department of Public Health
Jane W. Ball, RN, DrPH
Executive Director (Retired)
EMSC National Resource Center
Trauma-EMS Technical Assistance Center
Bethany Cummings, DO
Rural Affairs Ad Hoc Committee
National Association of EMS Physicians
Drew Dawson, Chief, EMS Division
National Highway Traffic Safety Administration
Tom Esposito, MD
Medical Director
Rural EMS and Trauma Technical Assistance Center
Blanca Fuertes, Past Project Officer
U.S. Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
Christian L. Hanna, MPH
Michigan Public Health Institute
Child and Adolescent Health
Bob Heath, EMS Education Coordinator
Nevada State Health Division
Intermountain Regional EMS for Children Coordinating Council
Marilyn Jarvis
Assistant Director for Continuing Education
Extended University
Montana State University
Douglas F. Kupas, MD
Rural Affairs Ad Hoc Committee
National Association of EMS Physicians
Fergus Laughridge, Program Manager
Nevada State Health Division
EMS Bureau of Licensure & Certification
Tami Lichtenberg, Program Manager
Technical Assistance and Services Center
Rural Health Resource Center
Tommy Loyacono, MPA
National Association of Emergency Medical Technicians
Patrick Malone, Director
Initiative for Rural Emergency Medical Services
University of Vermont
N. Clay Mann, PhD, MS
Center Director of Research
Professor of Pediatrics
Intermountain Injury Control Research Center
University of Utah
Evan Mayfield, MS
U.S. Department of Health and Human Services
Center for Disease Control
Office of the Commissioner
Charity G. Moore, PhD
Research Assistant Professor
Cecil G. Sheps Center for Health Services Research
Univ. of North Carolina at Chapel Hill
Carol Miller, Executive Director
National Center for Frontier Communities
Kimberly K. Obbink, M.Ed, Director
Extended University
Montana State University
Jerry Overton, Executive Director
Richmond Amublance Authority
Daniel Patterson, PhD
AHRQ-NRSA Post-Doctoral Research Fellow
Cecil G. Sheps Center for Health Services Research
Univ. of North Carolina at Chapel Hill
Davis Patterson, PhD, Research Scientist
Battelle Centers for Public Health Research and Evaluation
Ana Maria Puente, Past Project Officer
U.S. Department of Health and Human Services
Health Resources and Services Administration
International Health / Office of Rural Health Policy
Jacob L. Rueda III, PhD, Project Officer
U.S. Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
Kristine Sande, Project Director
Rural Assistance Center
University of North Dakota Center for Rural Health
Mary Sheridan, Director
State Offices of Rural Health
Idaho Department of Health and Welfare
Dan Summers, RN, BSN, CEN, EMT-P
Director of Education
Center for Rural Emergency Medicine
West Virginia University
Chris Tilden, PhD, Director
Kansas Department of Health & Environment
Office of Local & Rural Health
Robert K. Waddell II
Secretary /Treasurer
National Association of EMS Educators
Bill White, President
National Native American EMS Association
Gary Wingrove, Technical Consultant
Technical Assistance and Services Center
Rural Health Resource Center
Jill Zabel Myers, Healthcare Consulting
Wipfli LLP
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