>> BY DAVID PAGE, MS, NREMT-P
WHAT CURRENT STUDIES MEAN TO EMS
Study rates global skill levels of students & medics
In the hierarchy of research, a case report often serves only as an FYI or a good war
story. In the case of the below study, we’re
lucky the authors had research on administration of intranasal (IN) glucose published for
the first time in a peer-review journal. I recommend you read it more for the review of the
literature on IN medication administration than for any earth-shattering news
I did find it interesting, however, that
2 mg of IN glucagon was just as speedy at
raising blood sugar as 1 mg of intramuscular (IM) glucagon, according to a 1992
study by Rosenfalck published in Diabetes
Research and Clinical Practice, and that
few studies have successfully compared IV
dextrose to IM glucagon. With a single dose
of IN glucagon being around $1.50 vs. $8
for dextrose, I doubt we’ll see IN glucagon
replace IV dextrose as a first-line drug. But
this write-up gives us some ammunition
for medical directors to approve the IN glucagon route as well as intramuscular. I’ve
already fired off the e-mail to my medical
directors. Will you?
PHOTO DAVID PAGE
Researchers measured intranasal glucagon for
the first time in a peer-reviewed journal.
I PARAMEDIC COMPETENCE I
Tavares W, Boet S, Theriault R, et al. Global rating scale for the assessment of paramedic clinical
competence. Prehosp Emerg Care. 2012; Jul 26 [Epub
ahead of print.]
We seldom see educational research in EMS, and even less frequently a
study dealing with clinical competency.
Kudos to this Canadian all-star group for
tackling such a difficult subject with such a
The group videotaped 81 performances
of 61 EMS students and 24 active para-
medics responding to a simulated scenario.
Two trained evaluators reviewed each video
using a prototype global rating scale (GRS).
The objective was to see if the GRS would
correctly identify a competent perfor-
mance. The candidates were lone para-
medics responding to a simulated unstable
cardiac patient in the back of a transfer
ambulance on the side of the road, which
deteriorates into cardiac arrest. The two
EMTs were allowed to assist the paramedic
being tested, and the scenario lasted nine
minutes. A high-fidelity manikin was used.
I GLOSSARY I
Adjectival rating scale refers to a numeric appraisal (similar to a pain scale rating) based on
descriptions (adjectives) that best fit their assessment.
Finally, an overall clinical performance
score was assigned.
It’s particularly encouraging that these
dimensions match the recently released
National Registry paramedic psychomotor competency package evaluations.
Although the NREMT followed a different
methodology, the categories are identical,
giving these rubrics more validity.
Interestingly, the individual categories
didn’t seem to be as reliable as the overall rating. The authors note that raters
had difficulty differentiating between the
dimensions, and suggest that a “Gestalt”
categorical judgment or “halo effect” may
be at work. Still, they noted, the GRS accurately identified who should pass and who
should fail. Without a doubt, every EMS
educator should read this study and start
using these rubrics.
An adjectival rating scale from 1–7 similar
to a Likert scale was used, with 1 being
unsafe, then unsatisfactory, poor/weak,
marginal, competent, highly competent
and 7 being exceptional. Although these
authors didn’t comment on their 1–7 scale,
previous studies have shown poor results
using similar rating scales.
From the descriptive statistics in this
study it would appear the scale could be
simplified without affecting the accuracy
of the pass/fail ratings, similar to those
recently proposed by the NREMT.
Although it appears we’re getting closer
to having defensible tools to measure
clinical competency, the reproducibility of
these methods would be challenging, such
as what would be required for large programs or even state and national exams.
Not everyone has access to high-fidelity manikins, quality video recording,
archiving and raters with 22 and 11 years
of experience. Both were trained over
a 60-minute period and viewed all the
videos, presumably gaining quite a bit of
experience along the way.