EMT-B to EMT-P Bridge EMT Allen Mobley enjoys working as a wheelchair van driver, but it's not his ultimate job goal. �In today's competitive work environment, I need to take advantage of every opportunity to grow professionally,� says Mobley. �My goal is to become a paramedic.� Although in other EMS programs his dream of working on the front lines of 9-1-1 might be on hold, 19-year-old Mobley is moving toward his dream with San Diego Medical Services Enterprise (SDMSE).
In 1997, SDMSE became the nation's first public-private EMS partnership. A limited-liability company formed by the City of San Diego (through the recently renamed San Diego Fire-Rescue Department [SDFD]) and Rural/Metro Corp., an international leader in the provision of emergency medical care, SDMSE provides ALS emergency care, critical care transport and BLS services, including wheelchair transportation. With nearly 1,000 EMTs (190 of whom work as BLS providers) and more than 400 paramedics, SDMSE brings efficient, cost-effective and quality care to the 1.3 million citizens of San Diego and its surrounding areas. SDMSE has a national reputation for breaking new ground. From its unique formation five years ago to its efforts in system status management, computer-aided dispatch and electronic documentation, SDMSE is firmly fixed on the forefront of EMS. A recent, groundbreaking effort is the BLS-ALS EMT Bridge Program, designed to assist EMTs in the transition from a BLS environment/organization (BLS: two EMTs) to an ALS EMT system (one paramedic + one EMT). The Bridge Program was developed in January 2001 to enhance the quality and delivery of ALS prehospital care to San Diego citizens and to ensure that the EMS system was optimally using its personnel. Course material emphasized in the Bridge Program reflects information gathered in a 1998 SDMSE clinical survey that demonstrated field employees' needs and preferences for continuing education. The Bridge Program consists of didactic presentations, skills labs and field experience. It's a dynamic program that consistently encourages and emphasizes interactive team building among students. �Optimal patient care can only be achieved when each member of the team understands the global goals of quality EMS care,� says Perry Peake, EMS battalion chief, SDFD. �The Bridge Program actually allows the EMT to walk in the medics' shoes while always remaining in their own EMT scope of practice. Thus, the EMT develops a much better understanding and a much clearer vision of comprehensive ALS prehospital care.� The purpose of the Bridge Program is to enhance the EMTs' knowledge and skills and make them better paramedic partners. The EMT receives training in the goals and details of ALS prehospital patient care, including medical management, treatment protocols and skills and ambulance operations. The program also reviews and reinforces legal issues, the EMT scope of practice and the roles and responsibilities of the EMT/paramedic team. �We wanted to take full advantage of our city's one-plus-one design [paramedic + EMT ambulance crews and ALS engines] and realized we needed highly effective EMT ambulance personnel,� says Jim Dunford, MD, City of San Diego EMS medical director. �The Bridge Program was designed to ensure that every EMT could anticipate their medic partner's needs. By providing a curriculum essentially on 'how to be a great paramedic partner,' we enabled our BLS personnel to be more successful in their current BLS and future ALS careers.� As part of the Bridge Program, EMTs spend 17.5 hours attending didactic classes, presented in six-hour increments, with multimedia and interactive presentations. Didactic topics include: patient assessment, EMT roles and responsibilities, paramedic roles and responsibilities, introduction to EMS pharmacology, introduction to ECGs, communications, mapping and focused team exercises. Bridge Program students also participate in 6.5 hours of labs, devoting time to EMS skills and mapping exercises. After they successfully complete the didactic portion of the program, students are scheduled for 60 hours of field ride-along time. During those hours, the EMT rides as the third member of an ALS crew, initially observing ALS care and, later, assisting with patient care as needed. Working within one's own scope of practice is emphasized at all times. �The Bridge Program has so many benefits,� says Matt Gilligan, EMT, SDMSE medical supervisor and Bridge Program coordinator. �The obvious [benefit] is that we are able to deliver higher quality patient care. � Additional benefits include significant staff development [of students and instructors] and an increase in staff cohesion and camaraderie.� Enhanced partnerships TOP Upon successful completion of the BLS-ALS EMT Bridge Program, an EMT can work alongside the paramedic as part of a one-paramedic/one-EMT team, with each person working within their particular scope of practice. The program clearly steps up the quality of medical care throughout the entire EMS system while increasing the opportunities for, and morale of, SDMSE employees. �From an operational standpoint, SDMSE has definitely and dramatically benefited from the Bridge Program,� says Wayne Johnson, EMT-P, SDMSE director of operations. �Unquestionably, we now have a far more effective, efficient and energetic field force�clear and direct results of the Bridge Program.� Because the Bridge Program offers the EMT such unique exposure to, understanding of and participation in the ALS EMS system, it provides an extraordinary and exciting opportunity for mobility and advancement. �The key to our Bridge Program is that it rapidly propels the EMT to become a significantly better and stronger partner,� says Phil Forgione, general manager of Rural/Metro of San Diego and vice president of SDMSE. �It also serves as a wonderful recruitment and promotional tool [because] it exposes the EMTs to close professional contact with the paramedics.� Field employees of SDMSE (both paramedics and EMTs) state they feel a heightened sense of professionalism, pride and energy after affiliation with the Bridge Program. Students consistently rate the Bridge classes as excellent, saying they feel challenged, supported and energized by the material presented during the class. They feel that completion of the Bridge Program class helps them to be clinically stronger EMTs and better prepares them to assist their paramedic partners. �The Bridge Program prepared me to anticipate the needs of my paramedic partner, and it took a lot of the anxiety out of my first ALS shift,� says Kathy Cleary, EMT. �I start paramedic school in a few months. The Bridge Program has given me a solid foundation of knowledge and expertise to build on.� SDMSE has surveyed paramedic partners of EMTs (both before and after the EMT completes the Bridge Program). Paramedics who responded to this survey agreed that the EMTs are uniquely qualified and much more effective in their jobs after completion of the Bridge Program. �I haven't heard a single complaint about EMTs since the Bridge Program began,� says Sal Ruiz EMT-P. �In a one-and-one ALS system, it's nice to have an EMT partner who is confident of his or her abilities and who you can really rely on to be a part of the patient care team.� Community impact TOP EMS patients and San Diego citizens are the true beneficiaries of the Bridge Program. Customer satisfaction survey returns demonstrate that more than 90% of patients are �very satisfied� with the care they've received from SDMSE personnel. As San Diego continues to grow and change, SDMSE also will continue to develop dynamically. Meeting the challenge of change in order to guarantee excellence in EMS care is but one benchmark of the SDMSE Bridge Program. �San Diego is exceptionally proud of its quality EMS system. The Bridge Program has quantitatively strengthened our EMT/medic teams &, thus, the entire EMS system.� �Augie Ghio, SDFD deputy fire chief & SDMSE president Publishing and Reprint Information TOP � Mary (Carey) Mottet, RN, who developed the SDMSE Bridge Program, has worked in EMS since 1978 as an ED nurse; MICN; and instructor of paramedics, EMTs and MICNs at the University of California San Diego Medical Center EMSTO/EMSTI and Palomar College, San Marcos, Calif. Currently, she's the clinical coordinator and QA nurse for San Diego Medical Services Enterprise and Rural/Metro of San Diego. Contact her at [EMAIL PROTECTED] . __________________________________ Do you Yahoo!? SBC Yahoo! DSL - Now only $29.95 per month! http://sbc.yahoo.com --- SMU-L Etes-vous inscrit a l'annuaire des professionnels de l'urgence ? Si non, inscrivez-vous a l'adresse : <http://www.urgence.qc.ca>
