A new approach to teaching prehospital trauma care to paramedic students

Study objective: A modification of the standard Department of Transportatio n student paramedic curriculum encouraging individualized patient assessmen t decreases inappropriate on-scene procedures (OSPs) and scene time, measur ed on simulated patients. Methods: Scenario-based testing from 1991 through 1993 was videotaped for a ll students. A new trauma curriculum was introduced in 1992, individualizin g patient assessment and prioritization of OSPs. Recorded OSPs included spi nal immobilization, application of military antishock trousers, endotrachea l intubation, cricothyrotomy, intravenous catheter insertion, and needle th oracostomy. Twenty videotaped random student performances of the 1991 class was compared with a similar sample of 20 from the 1993 class; scene times and the OSP numbers were measured. Two board-certified independent emergenc y physicians unfamiliar with the students or the new curriculum reviewed al l 40 tests on a master videotape. Patient assessment appropriateness, scene time, OSPs, scenario difficulty and number of inappropriate OSPs were eval uated using a linear analog scale. Data are presented as means with confide nce intervals (CIs), analyzed by Student's t test and the Mann-Whitney 2-sa mple test. Results: Scene time from 1991 to 1993 decreased overall with a mean of 4.3 minutes (95% CI 2.8 to 5.8 minutes), as did the number of OSPs: 3.1 versus 1.7 (mean difference, 1.45 OSPs per scenario; 95% CI .91 to 1.99). Physicia n reviewers noted improvements in the appropriateness of patient assessment , scene time, and OSPs from 1991 to 1993. There was no significant differen ce in scenario difficulty for 1991 compared with 1993. Inappropriate OSPs d one on scene declined. Physician 1 indicated a mean of inappropriate proced ures of 1.6 in 1991 versus .5 in 1993. Physician 2 indicated a mean of 1.4 in 1991 versus .3 in 1993. Conclusion: This new paramedic curriculum decreased on-scene time and inapp ropriate use of procedures in stabilizing the condition of patients with si mulated critical trauma.