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We’ve placed several documents and links to video on this website that are accessible to anyone who wants to use them. The Medication Administration Cross Check (MACC) is a process designed in Sedgwick County, Kansas for use by Emergency Medical Service (EMS) providers when administering medications. The MACC process is designed to reduce errors in medication administration.
The copyrighted resources posted include an explanation, lesson plan, and links to the Sedgwick County, Kansas videos that show the MACC being used:
This copyrighted information is used with permission.
If you have questions about the MACC, please contact Jon Friesen at Sedgwick County Emergency Medical Services System.
Instructors: Please note that there are new requirements outlined below.
Several questions have been asked regarding the AEMT curriculum. Here’s a short explanation and process direction to use in working through these items.
Missing Check Sheets
Check sheets for Intraosseous (IO) and for Rectal Administration are not included in the curriculum. There are task sheets for these skills. In talking with the Kansas Board of EMS today (August 3, 2012), they stated that instructors must develop check sheets with which to assess these skills. Since the skills are referenced in the curriculum, they must be assessed and will be checked in the event of an audit. These check sheets must be included with the AEMT Student Lab Manual.
If anyone has already developed a check sheet for these skills and would like to share it, please email it to us, and we’d be happy to share this with the rest of the AEMT Transition community.
New Medications Added to Formulary
The Kansas Board of EMS, working with the medical advisory committee (MAC) has made additional recommendations in 2012 to the medications carried by AEMTs. These include the addition of Ondansetron and changes to the routes of administration for Lidocaine and Amiodarone. See the table below for a current PROPOSED formulary and use description for AEMTs. These changes are included in proposed regulation which is working through the approval process.
As with the above check sheets, in talking with the Kansas Board of EMS, in the case of added medications indications, and routes, (the addition of Ondansetron and changes to the routes of administration for Lidocaine and Amiodarone) they expect instructors to develop these course materials to be added to the AEMT course including: a lesson plan, media, formulary, task list, task analysis, and check sheet for the Student Lab Manual for each new medication. These check sheets must be included with the AEMT Student Lab Manual. They must be assessed and will be checked in the event of an audit.
If anyone has already developed the lesson plan, media, formulary, task list, task analysis, and check sheet for these skills, please email it to us, and we’d be happy to share this with the rest of the AEMT Transition community.
Kansas Board of EMS
May 1, 2012
|1||Activated charcoal||Oral||Non-caustic overdoses|
|2||Albuterol inhaler||Aerosolized, inhaled, nebulized||Acute asthmatic attacks, bronchospasm|
|3||Albuterol and Ipratropium - premix combined||Aerosolized, nebulized||Acute asthmatic attacks, bronchospasm|
|4||Amiodarone||IO bolus or IV bolus only; either bolus may be repeated. Continuous infusion not allowed.||Pulseless ventricular tachycardia; Refractory ventricular fibrillation; andinterfacility transfers only.|
|5||Antidote – Any||Auto injector||Self or peer care|
|6||Aspirin||Oral||Chest pain of suspected ischemic origin only|
|7||Atropine/Pralidoxime chloride||Auto injector||Cholinergic/nerve gas poisoning|
|8||Atrovent (Ipratropium) – Pt. assisted only||Nebulized, metered dose inhaler||Dyspnea and wheezing|
|9||Benzodiazepine||IM, IO, IV, intranasal, rectal||Status epilepticus only|
|10||Beta agonist||Determined by protocol or directcontact with a physician.||Dyspnea and wheezing|
|11||Dextrose Solutions – (D10, D25, D50)||IO, IV||Acute hypoglycemia|
|12||Diphenhydramine hydrochloride||IM, IV, oral||Acute allergic reactions|
|13||Dopamine hydrochloride||IV with pump only||Maintenance during interfacility transfer only|
|14||Epinephrine||Auto injector||Anaphylactic reactions|
|15||Epinephrine 1:10,000||IO, IV||Cardiac arrest only|
|16||Fentanyl||IO, IV, intranasal||Noncardiac pain relief only|
|17||Glucagon||IM||Acute hypoglycemia where oral glucose or IO/IV medications cannot be given|
|19||Ipratropium||Nebulized, inhalation||Acute asthmatic attacks, bronchospasm|
|20||IV electrolytes/antibiotic additives||IV with pump only||Maintenance during interfacility transfer only|
|21||IV fluids without medications or nutrients;monitor, maintain and shut off||IV gravity or pump||Established by medical protocols|
|22||IV solutions – Any combination of fluids||IO, IV||Medication administration, volume expansion|
|23||Lidocaine||IO bolus or IV bolus only; either bolus may be repeated. Continuous infusion not allowed.||Pulseless ventricular tachycardia; Refractory ventricular fibrillation; andinterfacility transfers only.|
|24||Medicated inhaler – Pt. assisted only||Nebulized or metered dose||Acute asthmatic attacks, bronchospasm|
|25||Morphine||IO, IV||Noncardiac pain relief only|
|26||Naloxone||IM, IO, IV, SQ, intranasal||Reversal of narcotic overdose|
|27||Nitroglycerine/nitro preparation||Dermal, oral, oral spray sublingual||Anginal pain relief|
|28||Nitrous oxide||Inhalation||Pain relief|
|29||Ondansetron||Oral, IV, IO, IM||Nausea/Vomiting|
|30||Over the counter oral medications||Oral||Not specified|
|Legend: IM = Intramuscular, IO = Intraossesous, IV = Intraveneous, Pt. = Patient, SQ = Subcutaneous|
This list was accessed on August 2, 2012 and is available from the Board web site.
Please direct questions regarding this information to the Board office. If you have questions about whether or not your check sheets will meet the requirements, please contact the Board office.
Here are some links that may prove useful for Course Coordinators:
The Board of EMS has issued a transition course checklist:
Scope of Practice Transition Course Guide
Here is a page summarizing the regulations, including links for downloading them or reading online:
February 2012 – Regulation Update
For Course Coordinators only, a link to the most current instructor and student manuals:
EMS Transition Curricula
The Board office issued two memos:
The transition requires all providers to pass written and skills tests
Changing Transition Course Dates and/or Times
Education standards for new, original courses of instruction for the new levels, EMR, EMT, and AEMT were created by Hutchinson Community College and posted by KSBEMS here.
Local services as well as many of the Kansas Community Colleges are offering transition courses.
“If we don’t find enough volunteers, we’re going to have to close. It will be a hardship for our community. I’m angry that we can’t find the resources we need.”
“It always feels like there’s a crunch to find volunteers, but they come through at the last-minute. I wish I didn’t have to worry about finding volunteers.”
Often non-profit organizations look to the corporate world for models of organization development and strategy. Yet non-profits are fundamentally different. While they have passion and vision, and deliver excellent service, the resources required differ from the business world. These resources may include charitable donations, grants, corporate sponsorships, and sometimes business revenues.
Non-profits rely on volunteers. Leading a team of volunteers is inherently different from leading paid employees. Volunteers commit their time, energy, money, and other resources because they want to make a difference, belong to a group with a common goal, and have pride in being a contributing member. Volunteers commit on their own terms. Leaders are the glue, attracting others to join and directing activities.
I have written a longer article about a 2-year study by Deloitte that looks at the characteristics of volunteers and suggests a list of questions that non-profit leaders can use to develop a strategy for leading and attracting volunteers. For more in-depth reading, I recommend Jim Collins’ monograph Good to Great for the Social Sectors and Baghai and Quigley’s As One: Individual Action and Collective Power.
There are encouraging statistics for those seeking to attract volunteers – from the overwhelming numbers of college students applying to Teach for America to the spontaneously organizing groups on the Internet such as the Linux users group, who jointly develop an operating system, and Wikipedia contributors. People envision helping their communities, learning new skills, and making a difference.
A community organizer is someone who uncovers [volunteers’] self-interest. They give [volunteers] an opportunity to work in their own self-interest and address problems in the community that they could not address by themselves.
– Jane Addams
We’ve been getting calls about the pre-tests and the post-tests in the last few weeks as transition classes have started across Kansas. The primary question is, “Where are the right answers?” The short answer is, “The answers are in the instructor manual.”
But, the right answers constantly change. When we developed the curriculum, the American Heart Association was recommending a 95% oxygen saturation. Now, with the 2010 guidelines, they are recommending 94% oxygen saturation.
As someone who is not an EMS provider, my hope is that the search for the right answer will not end with the transition. Perhaps the right answer isn’t an absolute, perfect answer. Perhaps the right answer is the one that comes when professional providers make decisions based on current best practices, based on the best research, based on hours and hours of practice, based on what is best for this patient in this time and location.
I hope that the stewardship of EMS continue beyond the next few years of transition. Stewardship will capture the power of being a steward, a guardian, a diligent caretaker, a person worthy of trust, a servant.
The AEMT update will likely be a ways out. We still have not contracted to do the rework and I suspect that Board Staff is working to figure out exactly what needs to be done. The AEMT is in a fluid state.
On a very different note, Merry Christmas and Happy New Year! We had the pleasure of being border to border this fall and got to see a lot of great people. From all of us to you, continue to carve out time for meaning and celebration during this holiday season. Stay safe!
Here are some of the opportunities presented by the Kansas EMS Transition. These were identified by persons in the coordinator training classes this fall. In random order:
- Update the skills of all Kansas EMS providers to a new, contemporary level.
- Throughout the transition timeframe, KBEMS is providing the continuing education curriculum package.
- Re-engage providers, including non-affiliated providers who will need to take the transition course.
- After the transition is complete, the Kansas provider will meet and exceed the National EMS Scope of Practice.
- All providers will deliver EMS care under medical director supervision and protocol.
- Review and update local protocols.
- Engage subject matter experts throughout the community including licensed physicians, physician assistants (PA’s), registered nurses (RN’s) and others in EMS training.
- Service Directors can lead by communicating and engaging with providers, medical directors, and others in communities.
If you’d like to add to the list, you’re invited to leave a comment on this post.
If you are a Service Director or transition coordinator, you need to be talking with your Medical Director about the Kansas EMS transition. For Medical Directors, Bill 262 states that all providers must deliver EMS care under medical director supervision and protocol. This includes not only EMS agencies, but all providers of EMS services in the community including first responders, fire-based responders, and private industry responders.
The transition should include a review of the local scope of practice and required skills. Updated local protocols for each level will need to be put into place before providers are certified to begin practicing at the new levels.
First some history. When the transition process began, it was the intention of the Kansas Board of EMS that providers would be able to transition downward in the levels. For example, by taking the EMT bridge transition, an EMT-I could become an EMT. This was put into a diagram in the 2008 FAQ document.
However, when 262 was passed and signed, the language required the following transition pattern for the levels:
|First Responder||→||Emergency Medical Responder (EMR)|
|EMT-B||→||Emergency Medical Technician (EMT)|
|EMT-D → EMT-I||→||Advanced Emergency Medical Technician (AEMT)|
|EMT-I or EMT-I/D||→||Advanced Emergency Medical Technician (AEMT)|
The “→” represents a required transition bridge course of instruction. The EMT-D must take an EMT-I initial course of instruction, followed by the AEMT transition course. MICT providers change their name only and will not take a transition course.
So the question is, “Can providers still transition to a lower level?”
Yes, at this writing (12/9/2010), providers can transition to a lower level by following the steps below:
At the individual’s renewal date:
- Submit a letter to the Board staff requesting to transition to a lower level.
- Submit the certificates indicating successful completion of the transition bridge courses for the requested level.
- Submit the required, standard number of recertification hours.