Mississippi Emergency Medical Services - Medical First Responder Training

Medical First Responder Training Authority and Program Approval

Training Authority Medical First Responder

The guidelines and minimum standards are set forth in order to establish a minimum level of training for the Medical First Responder in the State of Mississippi. These guidelines and minimum standards shall be met by all Medical First Responder courses in the state. BEMS may approve Medical First Responder programs if it is determined after review by the BEMS staff and the Medical Direction, Training and Quality Assurance Committee that the objectives of the training program equal or exceed those of the State of Mississippi. Additionally, organized EMS districts as recognized by BEMS, Mississippi State Department of Health, are authorized to provide this training. All Medical First Responder training programs must have BEMS approval prior to the start of class.

Request for approval of Medical First Responder training programs

A list of BEMS approved Medical First Responder training programs will be available at the BEMS office and on the BEMS website. Request for approval of Medical First Responder training programs not contained on the approved list shall be sent to BEMS with evidence and verification that:

(A) The Medical First Responder training program meets, at minimum, the requirements of the Medical First Responder curriculum as given in this Section.

(B) There are Medical First Responder instructor certification and re-certification requirements, including an evaluation of instructor terminal competencies, provided in the requested training program.

Note: Credentialed EMS instructors of BEMS as trained through the Mississippi EMS Instructor training program and in good standing, are considered as meeting the above requirement.

Approval must be given by the Medical Direction, Training and Quality Assurance Committee (MDTQA) and BEMS, prior to the start of any classes utilizing the proposed Medical First Responder training program.

Medical First Responder classes, class approval

The BEMS may approve Medical First Responder training classes if it is determined, after review of Medical First Responder class request forms, that the objectives of the class equal or exceed those of the State of Mississippi.

Medical First Responder class approval forms can be requested from BEMS or be completed on the BEMS website. Credentialed Medical First Responder instructors should complete the class approval form and submit to BEMS, at minimum, fourteen calendar days prior to the first day of class. BEMS will assign a class number to all approved requests and return to the credentialed Medical First Responder instructor. Incomplete paperwork will be returned without action.

Medical First Responder classes, initial roster

Initial rosters shall be completed by the credentialed Medical First Responder instructor immediately following the second meeting of the class. Initial roster forms can be obtained from BEMS or be completed on the BEMS website. A final roster for a full or refresher Medical First Responder class will not be accepted without an initial roster on file with BEMS.

Medical First Responder classes, final roster

Final rosters shall be completed by the credentialed Medical First Responder instructor immediately following the end of a full Medical First Responder or Medical First Responder refresher class. The final roster shall be inclusive of all students on the initial roster. The final roster will note students who withdrew, failed and completed the Medical First Responder class. The final roster form can be obtained from BEMS or be completed on the BEMS website. Students successfully completing the class will not be allowed to test National Registry until a final roster is on file with BEMS. Credentialed Medical First Responder instructors must complete the final roster affidavit regarding Medical First Responder DOT practical skills completion as well as automatic external defibrillator (AED) and oxygen therapy didactic and practicals.

Medical First Responder Training

"Medical first responder" means a person who uses a limited amount of equipment to perform the initial assessment of and intervention with sick, wounded or otherwise incapacitated persons who (i) is trained to assist other EMS personnel by successfully completing, and remaining current in refresher training in accordance with, an approved "First Responder: National Standard Curriculum" training program, as developed and promulgated by the United States Department of Transportation, (ii) is nationally registered as a first responder by the National Registry of Emergency Medical Technicians; and (iii) is certified as a medical first responder by the State Department of Health, Division of Emergency Medical Services;

Medical First Responder Curriculum

Medical First Responder training curriculums must conform, at minimum, to the National Standard Training Curriculum (NSTC) developed by the United States Department of Transportation and all current revisions as approved for use by BEMS. Minimum hours required for Medical First Responder are: 40 didactic/lab. In addition, the following modules will be taken from the EMT Basic National Standard Training Curriculum (NSTC) developed by the United States Department of Transportation and all current revisions: Automatic External Defibrillator (AED) and oxygen therapy. Written permission from BEMS must be obtained prior to the start of a Medical First Responder course.

Medical First Responder Training Programs

Mississippi Medical First Responder training shall also include the instructor lesson plan for Basic EMT National Standard Training Curriculum (NSTC), Automatic External Defibrillation (AED) and oxygen therapy sections. Additionally, it should be noted that current AHA Standards and Guidelines for CPR and AED will supersede the NSTC.

1.	The length of the Medical First Responder CPR and AED course shall not be less than 8 hours (didactic and practical).
2.	The complete Mississippi Medical First Responder educational program should be designed to provide the knowledge that will allow the student to arrive at decisions based on accepted medical knowledge and that will permit the professional growth of the Medical First Responder.
3.	The program should consist of at minimum two components: didactic instruction and clinical instruction, with optional supervised field experience in a system which functions under a medical command authority. The time required to complete each component may vary, in part being dependent upon the ability of students to demonstrate their mastery of the educational objectives by written, verbal, and practical examination.
4.	The program should maintain on file for each component of the curriculum a reasonable comprehensive list of the terminal performance objectives to be achieved by the student. These objectives should delineate mastery in all competencies identified, including curriculum documentation, measurement techniques used, and the records maintained on each student's work.
5.	The student should be informed about the methods and data used in determining grades and about the mechanism for appeal. Conditions governing dismissal from the program should be clearly defined in writing and distributed to the student at the beginning of the training program.
6.	Evidence of student competence in achieving the educational objectives of the program should be kept on file. Documentation should be in the form of both written and practical examinations.
7.	Classroom, clinical, and optional field faculty should also prepare written evaluations on each student. Documentation should be maintained identifying the counseling given to individual students regarding their performance and the recommendations made to correct inadequate performance. Documentation on whether or not the student followed through on faculty recommendations should also be maintained. Instruction should be supported by performance assessments.
8.	Faculty should be presented with the program's educational objectives for uses in preparation of lectures and clinical and field practice. The course coordinator should ensure that stated educational objectives are covered and should answer any questions from students or clarify information presented by a lecturer.

a.	Didactic instruction: Lectures, discussions, and demonstrations presented by physicians and others who are competent in the field.
b.	Clinical and other settings: Instruction and supervised practice of emergency medical skills. Practice should not be limited to the development of practical skills alone, but should include knowledge and techniques regarding patient evaluations, development of patient rapport, and care for and understanding of the patient's illness. Documentation should be maintained for each student's performance in all of the various areas. A frequent performance evaluation is recommended.
c.	Field Experience (optional): The field internship is a period of supervised experience in a structured overall EMS system. It provides the student with a progression of increasing patient care responsibilities which proceed from observation to working as a member of a team. There should be a provision for physician evaluation of student progress in acquiring the desired skills to be developed through this experience. The initial position of the student on the EMS care team should be that of observer and should progress to participation in actual patient care. The student should not be placed in the position of being a necessary part of the patient care team. The team should be able to function without the necessary use of a student who may be present.

9.	General courses and topics of study must be achievement oriented and shall provide students with:

The necessary knowledge, skills, and attitudes to perform accurately and reliably the functions and tasks stated and implied in the "Job Description” and “Functional Job Analysis” found in the DOT, NSTC Course Guide.

Comprehensive instruction which encompasses:

(i) Development of knowledge and clinical skills appropriate for this level of care

(a) Introduction to EMS Systems
(b) The well-being of the First Responder
(c) Legal and Ethical Issues
(d) The Human Body
(e) Lifting and Moving Patients
(f) Airway management procedures
(g) Patient assessment including both a primary and secondary survey
(h) Managing patient circulation
(i) Identify and manage illness and injury
(j) Childbirth
(k) Assessment and management of common medical and trauma situations of infants/children

NOTE: The following curriculum must be taught in addition to that listed above.

Medical First Responder –

EMT-Basic NSC Module 2-1 Airway (for oxygen therapy) and the associated lab and evaluation modules

EMT-Basic NSC Module 4-3 Cardiovascular Emergencies (for Automatic External
Defibrillation) and the associated lab and evaluation modules

Medical First Responder training must include the following objectives from the EMT-Basic National Standard Curriculum:

The following objectives should be added to the First Responder Module 2 on Airway from the EMT-Basic NSC Module 2 to provide oxygen therapy training to Medical First Responders.

Cognitive Objectives

2-1.2 List the signs or of adequate breathing

2-1.10 Describe the steps in performing the skill of artificially ventilating a patient with bag-valve-mask while using the jaw thrust

2-1.11 List the parts of a bag-valve-mask system

2-1.12 Describe the steps in performing the skill of artificially ventilating a patient with a bag-valve-mask for one and two rescuers

2-1.13 Describe the signs of adequate artificial ventilation using the bag-valve-mask

2-1.14 Describe the signs of inadequate artificial ventilation using the bag-valve-mask

2-1.15 Describe the steps in artificially ventilating a patient with a flow restricted, oxygen-powered ventilation device

2-1.16 List the steps in performing the actions taken when providing mouth-to-mouth and mouth-to-stoma artificial ventilation

2-1.19 Define the components of an oxygen delivery system

2-1.20 Identify a nonrebreather face mask and state the oxygen flow requirements needed for its use

2-1.21 Describe the indications for using a nasal cannula versus a nonrebreather face mask

2-1.22 Identify a nasal cannula and state the flow requirements needed for its use

Affective Objectives

2-1.24 Explain the rationale for providing adequate oxygenation through high inspired oxygen concentrations to patients who, in the past, may have received low concentrations.

Psychomotor Objectives

2-1.30 Demonstrate the assembly of a bag-valve-mask unit

2-1.31 Demonstrate the steps in performing the skill of artificially ventilating a patient with a bag-valve-mask for one and two rescuers

2-1.32 Demonstrate the steps in performing the skill of artificially ventilating a patient with a bag-valve-mask while using the jaw thrust

2-1.33 Demonstrate artificial ventilation of a patient with a flow restricted, oxygen-powered ventilation device

2-1.37 Demonstrate the correct operation of oxygen tanks and regulators

2-1.38 Demonstrate the use of a nonrebreather face mask and state the oxygen flow requirements needed for its use

2-1.39 Demonstrate the use of a nasal cannula and state the flow requirements needed for its use

2-1.40 Demonstrate how to artificially ventilate the infant and child patient

2-1.41 Demonstrate oxygen administration for the infant and child patient

The following objectives should be added to the First Responder Training Program from the EMT-Basic NSC Module 4 and/or nationally AHA guidelines to provide training for cardiovascular emergencies and the use of automated external defibrillators to Medical First Responders.

Cognitive Objectives

4-3.1 Describe the structure and function of the cardiovascular system

4-3.2 Describe the emergency medical care of the patient experiencing chest pain/discomfort

4-3.3 List the indications for automated external defibrillation

4-3.4 List the contraindications for automated external defibrillation

4-3.5 Define the role Medical First Responder in the emergency cardiac care system

4-3.6 Explain the impact of age and weight on defibrillation

4-3.7 Discuss the position of comfort for patients with various cardiac emergencies

4-3.8 Establish the relationship between airway management and the patient with cardiovascular compromise

4-3.9 Predict the relationship between the patient experiencing cardiovascular compromise and basic life support

4-3.10 Discuss the fundamentals of early defibrillation

4-3.11 Explain the rationale for early defibrillation

4-3.12 Explain that not all chest pain patients result in cardiac arrest and do not need to be attached to an automated external defibrillator

4-3.13 Explain the importance of pre-hospital ACLS intervention if it is available

4-3.14 Explain the importance of urgent transport to a facility with Advanced Cardiac Life Support if it is not available in the pre-hospital setting

4-3.15 Discuss the various types of automated external defibrillators

4-3.16 Differentiate between the fully automated and the semi-automated defibrillator

4-3.17 Discuss the procedures that must be taken into consideration for standard operations of the various types of automated external defibrillators

4-3.18 State the reasons for assuring that the patient is pulseless and apneic when using the automated external defibrillator

4-3.19 Discuss the circumstances which may result in inappropriate shocks

4-3.20 Explain the considerations for interruption of CPR, when using the automated external defibrillator

4-3.21 Discuss the advantages and disadvantages of automated external defibrillators

4-3.22 Summarize the speed of operation of automated external defibrillation

4-3.23 Discuss the use of remote defibrillation through adhesive pads

4-3.24 Discuss the special considerations for rhythm monitoring

4-3.25 List the steps in the operation of the automated external defibrillator

4-3.26 Discuss the standard of care that should be used to provide care to a patient with persistent ventricular fibrillation and no available ACLS

4-3.27 Discuss the standard of care that should be used to provide care to a patient with recurrent ventricular fibrillation and no available ACLS

4-3.28 Differentiate between the single rescuer and multi-rescuer care with an automated external defibrillator

4-3.29 Explain the reason for pulses not being checked between shocks with an automated external defibrillator

4-3.30 Discuss the importance of coordinating ACLS trained providers with personnel using automated external defibrillators

4-3.31 Discuss the importance of post-resuscitation care

4-3.32 List the components of post-resuscitation care

4-3.33 Explain the importance of frequent practice with the automated external defibrillator

4-3.34 Discuss the need to complete the Automated Defibrillator: Operator’s Shift Checklist

4-3.35 Discuss the role of the American Heart Association (AHA) in the use of automated external defibrillation

4-3.36 Explain the role medical direction plays in the use of automated external defibrillation

4-3.37 State the reasons why a case review should be completed following the use of the automated external defibrillator

4-3.38 Discuss the components that should be included in a case review

4-3.39 Discuss the goal of quality improvement in automated external defibrillation

4-3.40 Recognize the need for medical direction of protocols to assist in the emergency medical care of the patient with chest pain

4-3.43 Define the function of all controls on an automated external defibrillator, and describe event documentation and battery defibrillator maintenance

Affective Objectives

4-3.44 Defend the reasons for obtaining initial training in automated external defibrillation and the importance of continuing education

4-3.45 Defend the reason for maintenance of automated external defibrillators

Psychomotor Objectives

4-3.47 Demonstrate the assessment and emergency medical care of a patient experiencing chest pain/discomfort

4-3.48 Demonstrate the application and operation of the automated external defibrillator

4-3.49 Demonstrate the maintenance of an automated external defibrillator

4-3.50 Demonstrate the assessment and documentation of patient response to the automated external defibrillator

4-3.51 Demonstrate the skills necessary to complete the Automated Defibrillator: Operator’s Shift Checklist

4-3.54 Practice completing a pre-hospital care report for patients with cardiac emergencies

10. Operational Policies

(a)

Student matriculation practices and student and faculty recruitment should be non- discriminatory with respect to race, color, creed, sex, or national origin. Student matriculation and student and faculty recruitment practices are to be consistent with all laws regarding non-discrimination. It is recommended that records be kept for a reasonable period of time on the number of students who apply and the number accepted, as well as a placement history of those who complete the program.

Announcements and advertising about the program shall reflect accurately the training being offered.

The program shall be educational and students shall use their scheduled time for educational experiences.

Health and safety of students, faculty, and patients shall be adequately safeguarded.

Costs to the student shall be reasonable and accurately stated and published.

Policies and process for student withdrawal and refunds on tuition and fees shall be fair, and made known to all applicants.

(b)

Curriculum Description
Instructional content of the educational program should include the successful completion of stated educational objectives that fulfill local and regional needs and that satisfy the requirements of this curriculum section. The curriculum should be organized to provide the student with knowledge required to understand fully the skills that are taught in this program. It is important not to lose sight of the original purpose of the Medical First Responder level. The curriculum includes only the portions of the NSTC for the EMT-Basic which are relevant for this level of care. Students should have an opportunity to acquire clinical experience and practice skills related to the emergency medical care of these patients. Students should also understand the ethical and legal responsibilities they assume as students and are being prepared to assume as graduates.

Medical First Responder Training Program Minimum Admittance Criteria

1. Must be eighteen (18) years of age prior to class completion.