This section provides recommendations regarding paramedic education curriculum and training by medical directors or their designees.
C.1 Panel Recommendation: Changes to Paramedic Education
The panel recommends changes to the curriculum used for paramedic education, specifically, that CDPHE encourage EMS educators to augment paramedic educational curriculum to incorporate the following subjects or modalities:
- Pharmacology: Increased emphasis on anticipation and mitigation of complications for selected medications (e.g., sedatives, anti-psychotics, opiates, dissociatives). Emphasis should be placed on structured physiological monitoring immediately following administration.
- Clinicals: Expanded objectives and expectations during operating room rotations beyond airway management (which is current focus) to administration and monitoring of sedatives.
- Behavioral: Add or create content on patient assessment, including how to identify imminent harm to self or others in ways that protect patient and provider safety, de-escalation, and safe restraint (physical and chemical).
- Bias: Add or create recommended content for addition to Colorado EMS education standards on bias.
C.2 Panel Recommendation: Paramedic Training on Verbal De-Escalation
The panel recommends, and the chemical restraint law requires, that paramedics must make (or, at least, attempt) verbal de-escalation efforts before deciding to administer ketamine for chemical restraint. (See Recommendation B.1) Consequently, paramedics who administer ketamine for chemical restraint should be trained in de-escalation tactics. The panel is aware that these types of training programs exist, such as the Verbal Judo training program and training offered by the Crisis Prevention Institute. The panel stresses that EMS medical directors should not assume this training will occur during paramedic training or during hospital or EMS clinicals/internships.
C.3 Panel Recommendation: Paramedic Training on Law Enforcement Interaction, Transfer of Care (Hand-off), and Medical Decisions on Scene
Law enforcement’s role in the field is to protect the public, while EMS’s role is to provide care for the patient. While the conditions at the scene sometimes make it difficult for these professions to conduct their respective responsibilities independently, police are not authorized to dictate medical treatment. Therefore, the panel recommends that paramedics receive mandatory training in the following areas:
- Distinctions between the roles of EMS and law enforcement in the prehospital setting: Law enforcement must give EMS providers access to the patient for assessment and treatment, which may include assessment for chemical restraint, as soon as possible. The hand-off process from law enforcement to the paramedic should be made clear during training. A power differential between law enforcement and paramedics can exist; therefore, both entities should be trained to understand and adhere to the parameters of their respective responsibilities. At minimum, paramedic training should give paramedics the tools to fully perform their role in the prehospital setting.
- Paramedic authority to make medical decisions: Clear authority to make all medical/treatment decisions at the scene lies with paramedics and not law enforcement. The authority of paramedics to refuse requests or dictates from law enforcement concerning patient and transition of care issues, and ways in which this can be done, should be incorporated into training requirements.
C.4 Panel Recommendation: Paramedic Training on Ketamine - Chemical Restraint
The panel recommends that with each chemically restrained patient, paramedics should be trained to:
- engage in verbal de-escalation and/or physical restraint first;
- have all necessary resuscitative equipment present at the patient-side;
- gather available factual information from police and bystanders while receiving the hand-off from law enforcement; and
- prior to administering chemical restraint, complete a gross neurological assessment, as is practicable.
The panel recommends that a checklist concerning appropriate dosing, monitoring and resuscitation (see Recommendations B.3 and B.4) be available in each ambulance and that paramedics be trained to follow the checklist when ketamine is used for chemical restraint.