The education of out-of-hospital emergency medical personnel in pediatrics: report of a national Task Force.
The education of out-of-hospital emergency medical personnel in pediatrics: report of a national Task Force.
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DOI：
10.1080/10903129808958841
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发表时间：
1998-01-01
期刊：
影响因子：
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通讯作者：
Foltin, G L
中科院分区：
文献类型：
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作者：
Gausche, M;Henderson, D P;Foltin, G L
在过去十年中，人们对为院外急救医务人员开发儿科急诊护理课程非常感兴趣。与此同时，在课程的设计和内容方面也存在着显著的争议。传统上，护理人员的指导是由诊断驱动的：紧急医疗服务（EMS）教育者通过修改“医学院”方法，并根据院外提供者的业务范围纳入信息，对院外提供者进行指导。尽管评估当前教育方法的数据很少，但许多教师和学生发现，当在现场实施时，基于诊断的方法对于医院外的提供者来说是不切实际的。造成这种情况的原因是多方面的，可能包括以下几点：1)在现场建立诊断是有问题的，因为物理评估可能受到不可预测的环境条件（光线不足、噪音增加和恶劣天气）和安全问题（枪击或犯罪活动）的阻碍；2)可供现场使用的具有成本效益的便携式诊断资源很少；3)医生与病人相处的时间有限。解决这一教育困境的方法是发展教育策略，即以评估为基础的管理方案，由患者的临床表现驱动。基于评估的方法的优点是：1)它是一种简单，易于教授的方法，可以教授给初级和高级水平的提供者；2)它允许后续的管理策略基于患者评估，而不是可能的诊断列表。缺点是，一些教育工作者认为这种教育方法可能过于简单，并且由于不强调诊断，这种教育方法将降低院外和院内提供者快速沟通患者信息的能力。
In the last ten years there has been considerable interest in the development of curricula in pediatric emergency care for out-of-hospital emergency medical personnel.1-4At the same time, there has been notable controversy in regard to the design and content of the curricula. Traditionally paramedic instruction has been diagnosis-driven: emergency medical services (EMS) educators had instructed out-of-hospital providers by modifying the “medical school” approach and incorporating information based on the scope of practice of the out-of-hospital provider. Although there are few data evaluating current educational methods, many instructors and students have found the diagnosis-based approach impractical for providers in the out-of-hospital setting when implemented in the field setting. The reasons for this are multifactorial and may include the following: 1) establishing a diagnosis in the field is problematic because physical assessment may be hampered by the unpredictable ambient conditions (poor lighting, increased noise, and inclement weather) and safety issues (gunfire or criminal activity); 2) few cost-effective, portable diagnostic resources are available for field use; and 3) the provider spends a limited time with the patient. The solution to this educational dilemma has been the development of the educational strategy that is assessment-based with management schemes driven by the clinical presentation of the patient. The advantages of the assessment-based approach are 1) it is a simple, easy-to-teach method that can be taught to basic and advanced levels of providers and 2) it allows for subsequent management strategies to be based on patient assessments and not a list of possible diagnoses. The disadvantage is that some educators believe it may be too simple and that by deemphasizing diagnoses, this educational method will decease the ability of the out-of-hospital and in-hospital-based providers to communicate information about the patient quickly.