Reinventing and Redistributing EMS Education
Brewster Ambulance has always been at the forefront of improving EMS delivery. Over the family's century of business operation, they have had a noticeable impact on the caliber of service provided throughout eastern Massachusetts and the South Shore. When Brewster Ambulance Service returned to service in 2010, the practices and philosophy established by the family's founder also returned as well as a renewed desire to improve the quality of patient care and advanced clinical technology.
Part of the commitment to returning to service was to be a leader in education and training for EMS professionals, and to use the opportunities provided in the field to enhance, improve and drive innovation for all EMTs and paramedics. Coming up through the ranks of his family's ambulance business, Mark Brewster took his in-the-field EMT experience and used it as a platform to cultivate a robust EMS training approach that is leading the region today.
Education is not only in-classroom but in-the-field testing with in-service ambulances and working crews. New EMTs and paramedics are given appropriate mentorship so the Brewster approach and practices are consistent throughout the entire team. Partnerships with municipalities, regional hospitals, community senior centers, middle and high school students and local businesses allow EMS training to expand awareness and understanding of life-saving techniques such as proper portable AED use and compression-only CPR techniques.
Building the most Robust EMS training Platform
To further enhance the depth and quality of education provided to the team, Brewster Ambulance Service purchased CMTI, Inc. (Comprehensive Medical Teaching Institute, Inc.) in April, 2016. CMTI was founded in 2009 by Keith Wilson, who is now the Director of EMS Education at Brewster Ambulance. Keith is COO of CMTI. and oversees the operations of CMTI as well as Brewster Ambulance's training programs.
In 2016, Brewster Ambulance offered scholarships to a select group of applicants interested in attending classes through CMTI and advancing their careers. Other incentives created last year by Brewster Ambulance included guaranteed employment (with appropriate academic standings) with Brewster Ambulance to high school graduates interested in pursuing a career in EMS who attend CMTI training.
Incorporating all aspects of EMS delivery
Every aspect of emergency medicine and ambulance transportation is covered in the Brewster training programs. The goal is to have the student well-versed in the clinical aspects as well as the aspect of providing kindness and caring attention to patients. There is a philosophy of care for the patient to treat them as if it was your loved one. Often, a gentle gesture or active listening can improve the outcomes of patients because it soothes anxiety about their transport or condition as well as their family members who often accompany the patient.
All hands are involved when any new equipment, technology or clinical approach is implemented into service. There are thorough processes where clinical improvements are identified by Chris Dibona, Director of Clinical Quality at Brewster Ambulance, who then works with Keith Wilson to develop a training regimen and roll-out integration plan as any new procedure or equipment is placed into service.
There is also an online portal (MyBrewster.com) that houses updated training videos and presentations that the Brewster team and enrolled students can access. All new equipment use is trained live, with hands-on practice at Brewster locations with crews and also during refreshers.
Gaining Accreditation from State Regulators
As of 2017, CMTI has a letter of review with CoAEMSP (Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions) for CMTI/Tufts Medical Center Consortium for Paramedic Education in Hanover. This letter of review is for an Emergency Medical Services Paramedic Program, and will offer a paramedic certificate.
According to the Commission on Accreditation of Allied Health Education Programs (CAAHEP), a Letter of Review is NOT a CAAHEP accreditation status, it is a status granted by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) signifying that a program seeking initial accreditation has demonstrated sufficient compliance with the accreditation Standards through the Letter of Review Self Study Report (LSSR) and other documentation. Letter of Review is recognized by the National Registry of Emergency Medical Technicians (NREMT) for eligibility to take the NREMT's Paramedic credentialing examination(s). However, it is NOT a guarantee of eventual accreditation.
These and other efforts continue as Brewster Ambulance and CMTI expand on training and certification opportunities for EMS professionals.
Keith Wilson Weighs in on EMS Education and the future of CMTI
The following are excerpts from an interview with Keith Wilson, CMTI. COO and Director of Education at Brewster Ambulance Service.
Q: What are CMTI's current affiliations and partnerships that help extend CMTI'S EMS education reach?
KW: Right now we have an affiliation with Tufts Medical Center for the paramedic program, a consortium agreement where we work with TMC directly. We also have a relationship with Middlesex Community College which provides us with an articulation agreement that offers college credits to students who complete our paramedic program.
We are regulated on the paramedic side by the Commission on Accreditation for EMS programs (CoAEMSP). An example of what we have to go through to run a paramedic program is that we have a letter of review and wait for a site visit which should occur within the next 3-6 months.
Right now I have two great teams, Mark [Brewster] has a lot of faith in me and trusts that I'm going to build the CMTI side and he's also confident that the Brewster education is going in the right direction.
We have an approved EMT site at the West Chestnut Street location in Brockton that we run an EMT class out of there at night, and we run EMT and paramedic programs out of Witman-Hanson Regional High School. Once the new Brewster Ambulance headquarters opens in Weymouth, we'll have additional training space to expand into there.
Q: What do you see missing in EMS training among other ambulance companies or EMS schools?
KW: One thing that separates us that we've identified is our advanced inter-facility transfer pre-departure checklist, such as being able to properly care for and transfer sick patients intubated on pumps or ventilators. Most companies don't do that training. Chris Dibona and I have been working with crews to help facilitate muscle memory by setting up the mannequins and going over the pumps and the vents. We want our crews to have exposure to new equipment and procedures, and this is one area that we've seen lacking that we are now addressing in-house.
Q: What is a logical path for someone getting into EMS, whether they are just getting out of high school or choosing to expand their career as a professional?
KW: The path into the EMS industry is usually through the EMT program first, and they take it even if they are going to be in another health care field, such as a physician's assistant or going into nursing, etc. They enter the EMT program and then advance to paramedic training. There are four levels in the National Registry of Emergency Medical Technicians (NREMT) oversees the national EMS. The four levels are: 1. EMR Responder, 2. EMT Basic, 3. EMT Advanced and 4. Paramedic levels of certifications.
With Brewster Ambulance, when they get upgraded to being a paramedic, they have to attend hard equipment training during our orientation classes. Once they get that training they are assigned to a field training officer (FTO) for 2 to 3 shifts. Once the FTO feels they have been appropriately trained and readied, the field supervisors will place that paramedic into a shift.
Q: In keeping Brewster's and CMTI's educational curriculum teaching the latest EMS advances, how do you stay on top of EMS industry trends?
KW: I'm in touch with the changes due to the accreditation paperwork we have to do. Plus, I frequently attend conferences and read emergency medicine journals. I also attend EMS rounds which keeps me up to date on new procedures and equipment as well as the new trends coming on line in the EMS industry.
Q: How are you innovating CMTI's education programs?
KW: One area that we've changed direction in is to go totally electronic with an online system. Every student is assigned a Microsoft® Surface Pro tablet and all of the books are digital inside of the Surface Pro. We feel that having all of those resources available to the student is critical. The resources include study guides, virtual ride alongs, practice tests and other material. We are better equipping our students to stay on top of new technology and creating more efficient access to training material so they can study at their convenience in and out of the classroom.
Q: What are you looking to change or expand in CMTI education programs?
KW: We're looking to add into the paramedic program training and field work around inter-facility transfers. We will be building modules into our presentations and training material for ventilator support, respiratory pumps, which as I mentioned before, a lot of paramedic programs don't offer. Those who successfully complete our program can be up to speed on pumps and vents.
Q: How do you get the word out about your EMS training programs?
KW: The EMS world is a small world, and there's very few paramedic programs in Massachusetts, so the programs that are around now have been vetted and meet the high standards of Massachusetts and CoAEMSP's accreditation requirements. Plus, our website and word of mouth fill our programs.
Q: What is the most gratifying aspect about what you do?
KW: I've been teaching and conducting paramedic exams for the state for 15 years, and in that time I've had a lot of students go through my programs. I bump into them at hospitals or at restaurants and they come up to me and say, "Thank you for training me—you gave me a chance and you let me into your program," and they'll thank me for passing them if I was one of their examiners. They go on to say, "I wouldn't be where I am today if it weren't for you." It is so good to see my students excel and see them being successful, competent clinicians. I often come across a critical case and learn that the paramedic or EMT who ran the call was one of my students. It's rewarding and fulfilling to see them be so successful in this industry and to know that they are making a difference.
Q: How do you go about finding the right instructors or speakers for your classes?
KW: Again, EMS is a small world and a lot of my staff has a lot of clinical experience in the field. That's one quality that we like—we want instructors who've worked on the street and not only the proper credentials to teach, but the street experience to pass on to our students. That's another area that separates us. It's cardiology, pharmacology and our staff that separates our paramedic program from others.
CMTI courses are held at the Brewster Ambulance Brockton location on West Chestnut as well as at Whitman-Hanson High School. Learn more about CMTI, Inc. by visiting CMTIInc.com.