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The Friesen Group contract for the Kansas EMS Transition will come to a close on December 31, 2013.

The web site with instructor and student documents will close on December 31, 2013. Course Coordinators are encouraged to download any needed materials as soon as possible. After that time, Course Coordinators will need to contact either the Board office or Friesen Group directly for any necessary files.

We have appreciated the opportunity to contract with the Board and support the transition process. Most of all, it has been a privilege to meet and learn to know many Kansas EMS professionals.

As someone who is not an EMS provider, my hope is that professional providers will continue to make decisions based on current best practices, the best research, hours and hours of practice, and what is best for this patient in this time and location.

With gratitude and best wishes,
Kathleen for Friesen Group

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:

MACC Lesson Plan
MACC User Manual
MACC Video – “No Error Found”
MACC Video – “With Error Found”

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.

Advanced EMT
Medication List

Kansas Board of EMS

May 1, 2012
Medication Method Application
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
18 Glucose Oral Acute hypoglycemia
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.

Cross post from Friesen Group

“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

Read Leading Volunteers originally published in the Kansas EMS Chronicle

The Road Ahead

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.

We spent Saturday in Overland Park at Johnson County Community College teaching day one of the train the trainer for Region V.  They stepped up to the plate to host one more session for those who missed out this fall.  A great group of people!

Just a quick note to update everyone regarding the final updates for the transition courses. Look for the EMR and EMT sometime next week. I know we said we’d have it done by the 24th; but we got side tracked by family, Christmas, school events and having the transition airplane in the shop for an overhaul. We are working on it.

Transition Airplane Overhaul

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.

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