1. Central Division OEC Instructor Continuing Education Clinic
Location: Chula Vista Resort

2. Instructor Re-Certification
Instructors: Sue Hayes Jeff Olsen Gary Clark Saturday, September 8, 2018

3. Objectives Review Website sign-in navigation and information tools.
Review components of Instructor Development and Adult Learning.
Continuing Ed and Spinal Motion Restriction (The Backboard Redefined)
Describe the layout of the current OEC curriculum and resources available for teaching Pearson My Lab & Mastering.
Identify the role expectations of OEC instructors.

4. Instructor as Administrator

5. Instructor online tools
Please see the NSP Course Tools documentation HERE

6. Instructor Logs
Be sure to turn yours in today!

7. Educating groups How Adults Learn (different learning styles)
Human Relations & Communication (Qualities of Effective Instructors)
Lesson Planning (6-Pack)
Lesson Content/Instructor Resources
Monitoring/Evaluation
Helping others become instructors
Mentoring Program

8. How Adults Learn (different learning styles)

9. Video

10. Human Relations & Communication
Three communication qualities of effective instructors…
They have excellent listening skills
They are good at interpreting and sending non-verbal communication
They provide constructive feedback to their students in a positive manner
How can we build our listening skills??
Eye contact when others are talking
Don’t interrupt
Put activities into learning…helps with participation
Clarify if information is not clear
Search for the whole meaning of the message…not the detail
Pay attention to the non-verbal, actions & expressions
Strategies for providing constructive feedback for poor/failed performance… (see book pg. 9)
Have the group brainstorm what to do prior to evaluation and what to do after evaluation…3 minutes per topic then SWITCH!

11. Lesson Planning / 6 Pack The Beginning The Heart The Ending The Set
The Concluding Objectives
The Content Delivery
The Learning Activities
The Student Summary
Monitoring and Evaluation
Pg 11

12. 6 Pack should be taught 1 Topic at a time
Topic Pack on a Splint
Topic Pack on CMS
Topic Pack Reposition
Show Immobilization
A ridged Splint
A traction Splint
A sling
Circulation
Motion
Sensation
Is the Pulse Present
Can it be moved
How many moves
What if it doesn’t work
When you teach a 6 Pack 1 topic at a time, and then combine them retention with the candidate is much higher.

13. Instructor as a Mentor Is a certified discipline-specific instructor.
Possesses exceptional abilities in needs assessment and communication
Establishes mentoring relationships with assigned instructor trainees.
Provides assessment and determines instructor trainee’s readiness to teach in a specific discipline.
Maintains records of meetings and observation assessments.
Recommends instructor trainee for Instructor Trainer observation and certification.

14. 2017 Division Spring Meeting Language Change Approved
“The expectation is that the final observation and sign off for a new OEC instructor be done by an OEC IT from an outside patrol”.
“Any exceptions to that must be approved by a candidates mentor in discussion with the ROA and the RD”.

17. 2017 Division Spring Meeting Language Change Approved
“The expectation is that the final observation and sign off for a new OEC instructor be done by an OEC IT from an outside patrol”.
“Any exceptions to that must be approved by a candidates mentor in discussion with the ROA and the RD”.
Well in advance. Mentoring a new instructor is a process. It is not an emergency. Planning is key.

19. National Ski Patrol Continuing Education
Welcome to the National Ski Patrol Spinal Motion Restriction training for Instructors.
This program can be modified for use at the 2018 OEC Cycle B refresher.
Spinal Motion Restriction
The Backboard Redefined

20. This is Ski Patrol, how can I help……
Radio Call:
“Ski Patrol, there has been a bad crash on the slope under the chair. The skier launched and landed really hard on his back and now is laying still in the middle of the slope. He had to have been 20 feet in the air.”
This is a typical call for someone that you might expect has a potential spinal injury. As you leave for the scene you should be thinking about what to look for
As the significant Mechanism of Injury, asking the questions to determine the reliability of assessment and how to complete a thorough and detailed physical exam
Which will help determine if a spinal protection device is required.

21. Recommendation of NSP Medical Committee
Spinal Motion Restriction, where backboards with straps are used to secure a conscious victim of trauma during extrication and transport for a possible spinal injury, may be overused or sometimes unnecessary.
National Medical Advisory Committee white paper presented to the NSP Board of Directors at Powderfall 2017.
Updated August 9, 2018 with the article written in the Prehospital Emergency Care journal.
It is the conclusion of the NSP Medical Advisory Committee that current medical evidence in 2017 demonstrates that the practice of “spinal immobilization”, where backboards with straps are used to secure a conscious victim of trauma during extrication and transport for a possible spinal injury, may be overused or unnecessary. In many cases typically encountered by ski patrollers, spinal immobilization may be causing harm to the patient while not providing any benefit.

22. NSP website-OEC Education Resources

23. Recommendation of NSP Medical Committee
Securing a conscious injured person to a backboard has potential consequences.
The patient is subject to pain, apprehension, potential injury to skin from pressure points and some limitations of airway protection when supine (especially if the person vomits)

24. UPDATE TO OEC 5
This information will be used as a clarification of the standard of training for the NSP Outdoor Emergency Care program (OEC 5th edition).
Patrols are required to follow local or state EMS guidelines, policies or law that would supersede this level of training
The information in this program and update can be found in the OEC Cycle B refresher workbook released in The student workbook needs to be maintained by
The OEC technician in order to have a copy of this information.
This information was compiled by the OEC Refresher Committee with the support of the National Medical Advisor Dr. David Johe and the White paper prepared by the NSP National Medical Advisory Committee which was
Presented and approved by the National OEC Committee and the National Board of Directors at the April 2017 Board Meeting.
This material is to be used in all Cycle B refreshers for and until OEC 5th edition is replaced . All OEC courses must use this assessment process going forward. Standard of Care requires that Patrols follow local or state EMS guidelines, policies or law that would supersede this level of training .

25. Spinal Update Assessment: Use of a Backboard
Backboard usage in pre-hospital setting has changed
Evidence based medicine has shown many patients may not need a hard board
May cause additional problems

26. Use of backboards inline with evidence based medicine
Physical application of a backboard is done the same way.
Assessment of who goes on the backboard has been clarified.
Patrollers using a complete and comprehensive assessment will be better in line with evidence based medicine.
If you think about it a backboard does not immobilize an injured persons spine. It only offers SPINAL MOTION RESTRICTION.
The application of the backboard has not changed, the assessment has been clarified to provide a more detailed and complete examination to determine if spinal protection is warranted.
When reviewing the Mechanism of Injury and reliability of assessment, with a complete and detailed physical examination indicates that spinal protection is required then the use of a backboard or other spinal protection device is warranted.

27. Considerations when Assessing for Spinal Protection
MECHANISM OF INJURY
RELIABILITY OF THE ASSESSMENT
RESULTS OF THE EXAM
The three main considerations when assessing someone for spinal protection include the significant mechanism of injury
The reliability of the Assessment
And the results of the physical examination

28. Concluding Objectives
Define what is a spinal protection device: i.e.. Backboard, gurney, vacuum mat, ambulance cot
Explain when it is appropriate to use a spinal motion restriction device
List and describe examples of some potential significant Mechanisms of Injury for a spinal injury
Describe the observations and questions that make up the Reliability of Assessment
List the specific items that make up the careful physical exam
Demonstrate how to perform a careful physical exam
After completion of the knowledge based portion of the training an exercise is available.

29. Concluding Objectives continued
Explain what to do when a complete and detailed exam is not possible on the hill
Explain the appropriate time and use of a standing backboard
List when spinal motion restriction is not needed

30. Spinal Motion Restriction and the use of a backboard
Background:
The factual material in OEC 5e is not wrong.
The assessment associated with spinal motion restriction for specific patients must be improved.
In particular:
The identification of mechanism of injury
The evaluation of reliability of assessment
Focus on a careful physical exam from the occiput to the coccyx in persons with potential spinal injury

31. What is a spinal motion restriction device
Spinal motion restriction: avoid further injury and to provide comfort.
Spinal motion restriction : transfers should be done with careful attention to limiting spinal motion
For persons with significant potential for spinal injury a Spinal motion restriction device in many cases is a backboard (and a collar )
However it could also be direct use of a gurney, toboggan or vacuum mat (with collar)
Each of these must also include padding and bracing to fill voids and limit movement both laterally and axially..
Spinal protection means that during the transfer of a suspected injured person steps are being taken to avoid further injury and to provide comfort. Spinal protection means that all transfers should be done with careful attention to limiting spinal motion and may include the use of multiple different devices.
Spinal protection devices are in many cases backboards but include other direct use devices.

32. Spinal Motion Restriction is required when there is:
Exam findings associated with a potential spinal injury.
MOI with significant potential for spinal injury WITH an alteration of the mental status such that a reliable physical exam cannot be done.
Multiple injuries in an unresponsive trauma patient.
A patient who has become unresponsive, without a witness present, so the mechanism of unresponsiveness is unknown.
Spinal protection is required when an MOI is identified with an alteration of mental status such that a reliable physical exam cannot be completed.

33. Determining the use of SMR
The process involves distinct steps to get to the completion of the thorough physical examination and best determine if spinal protection is warranted. First determine if the mechanism of injury is significant, second if any of the reliability of assessment questions are answered NO spinal protection is warranted, and third if the detailed and complete physical exam indicate any positive findings then particular spinal protection must be used. Spinal protection with the use of c-collar and backboard or other device are included and will be explained in detail .

34. Physical exam
The physical exam is not different from the current physical exam.
In this case we are focusing on what needs to be evaluated as it relates to Neurological, neck and/or Spine injury
A full exam is required as with every trauma assessment this is highly focused for the training.
The material covered is limited to the focus on the neck and spinal injuries. A full physical examination must be completed.

35. Assessment of a Patient with a Suspected Neurological, Neck, and/or Spine Injury:  Mechanism of Injury
When assessing for spinal protection, considerations include mechanism of injury, reliability of the assessment, and the results of the exam. Potential significant MOI are reviewed on the next two slides.

36. Potential Significant Mechanism of Injury
High speed collision of skier/rider with a fixed object (high impact trauma)
Falling from a ski lift
Avalanche burial
A fall greater than times a patient’s height
Was there a significant potential for spinal injury? If you have one of the following mechanisms of injury, the likelihood of the need for spinal protection is increased.
Your assessment is critical. This slide and the next list examples of common MOI’s for significant spinal injuries but this is not a comprehensive list.

37. Potential Significant Mechanism of Injury
A high-speed motor vehicle accident with a fatality, ejection from the vehicle, or an unrestrained passenger
A pedestrian or bicyclist struck by a motor vehicle
A major bicycle or motorcycle accident
High voltage electrical shock or lightning strike
Other serious mechanism of injury

38. Potential Significant Mechanism of Injury

39. Assessment of a Patient with a Suspected Neurological, Neck, and/or Spine Injury: Reliability of Assessment
Are they alert and oriented, responding normally to a verbal command?
Can they respond appropriately when asked about a sensory stimulus such as “can you feel me touching your toes?”
Can you rule out intoxication or altered mental status?
Can the patient respond to your questions and exam?
Can the patient focus on your questions rather than a distracting injury?
Can a younger pediatric patient answer your questions appropriately?
To determine if your assessment is reliable, you must evaluate the patient’s mental status. Keep the questions listed here in mind when you are going through your assessment. If the answer is no to any or all of the above questions, then you need to consider spinal protection and take this into consideration with your physical assessment.

40. Reliability of Assessment

41. Results of the Exam Perform a thorough physical exam looking for:
Deformity or step-off of the spinal alignment
Midline tenderness over the spine (not flank or rib tenderness)
Loss of sensation (numbness) or motor function distal to a possible spinal injury

42. Results of the Exam Flexor or extensor posturing to painful stimuli
Skull depression or fracture
Cerebral spinal fluid leak from the nose or ears
Sacral or posterior pelvic pain when side-to-side compression is performed

43. Detailed and complete physical exam
Needs SMR
Including c-collar and head blocks.
If the Exam reveals any of these

44. Thorough and complete Physical Exam
Review: Types of Spinal injuries
Review: Types of Skull fractures
Signs and Symptoms of Spinal Cord injuries
Assessing a Suspected Neurological Injury of the Neck and/or Spine
To aid in the thorough and completed physical exam we will review: types of spinal injuries, types of skull fractures, signs and symptoms of spinal cord injuries and the assessment of a suspected
Neurological injury of the neck and or spine.

45. Types of Spinal Injuries
Para spinal soft tissue injuries - muscles
Bony fractures
Spinal cord injuries
Spinal disc/nerve injuries
Any damage to the vertebrae or intervertebral discs may also damage the spinal nerves or other soft tissue associated with the spine. In addition swelling may occur as a result of trauma, and may also damage the spine and spinal nerves.

46. Types of Skull Fractures
Linear:
Single non-displaced fracture line.
Usually presents with significant soft-tissue swelling and tenderness of the scalp
Depressed:
Comminuted fracture with displacement resulting in a characteristic “soft spot”
Depending on force of injury, fracture fragments may or may not intrude on the underlying brain tissue
Basilar:
Occurs along the floor, or base, of the skull.
Fairly common in high-velocity blunt MOI such as when a skier strikes a tree.

47. Signs and Symptoms of Spinal Cord Injuries
Sensory impairment
Numbness, tingling
Motor impairment
Weakness, paralysis
Neurogenic Shock
Low blood pressure
Death
These are indicative of signs and symptoms of Spinal Cord Injuries.

48. Assessing a Suspected Neurological Injury of the Neck and Spine
Checking Level of responsiveness
Pupillary exam
Best motor response (GCS) which would include:
Patient follows commands
Localized pain
Withdraws from pain
Flexor posturing
Extensor posturing
The assessment of a patient with potential head and spine injury should include a thorough exam of the nervous system, which include the components listed here.

49. Assessment of the Potential Spinal Injury
Your assessment will begin like every other assessment:
Scene size up: Initiate BSI. Determine scene safety, and mechanism of injury. Ask yourself and the injured person questions to determine reliability of assessment and then begin your patient physical assessment. Remember an unresponsive trauma patient always receives spinal protection.
Palpate each vertebra as you walk your fingers down the spine. Pay particular attention for a step off deformity or any other abnormality.
Begin palpating along the spinal midline at the back of the skull; continue down the cervical, thoracic, and lumbar spine.

50. Assessment of the Potential Spinal Injury
Conclude the physical exam of the spinal column by palpating the sacrum and coccyx.
If during the pelvic examination you find sacral or posterior pelvic pain then spinal protection is appropriate.

51. Step Off Deformity
Step off deformity means the bones are not lined up properly, which can be seen and/or felt by the examiner. This is what a step off deformity looks like: notice the spinal column is no longer aligned normally.

52. CMS Check Check CMS on all four extremities.
check circulation, capillary refill, skin color
check motion and sensation
In a cold environment, exposing extremities to the skin may not be desirable; until the patient is in a warm setting.

53. CMS Check

54. Posturing, a response to painful stimuli indicates the need for spinal protection:
Decerebrate-extensor posturing
Decerebrate-extensor posturing is identified with abnormal extension of the arms and legs, downward pointing of toes, and arching of the head: due to an injury to the brain at the level of the brainstem

55. Posturing, a response to painful stimuli indicates the need for spinal protection:
Decorticate-flexor posturing
Decorticate-flexor posturing shows with the abnormal flexing of the arms and clenching fists and extending legs; due to an injury along the nerve pathway between the brain and the spinal cord.

56. Assessment of a Patient with a Suspected Neurological, Neck, and/or Spine Injury: Results of the Exam
Spinal protection is REQUIRED when there is:
Exam findings associated with a potential spinal injury. 
Mechanism of injury with significant potential for spinal injury WITH an alteration of the mental status such that a reliable physical exam cannot be done. 
Multiple injuries in an unresponsive trauma patient 
A patient who has become unresponsive, without a witness present, so the mechanism of unresponsiveness is unknown. 
Once you have completed your assessment, the listed situations are when you would use a spinal motion restriction device. Note that the questions from the earlier slide on reliability of your assessment apply to the second point on this slide.

57. In the rare instance when a complete and detailed exam is not possible on the hill
Use a backboard (with collar) with full immobilization as a transportation device
Take the patient to the first aid room for further evaluation
Complete a thorough and detailed evaluation
If no spinal protection is warranted the backboard can be removed according to state and local protocol, and regulations.
It should be a rare circumstance that a thorough, complete and detailed exam is not possible on the hill. If there is no indication of Mechanism of Injury, or the answers to the Reliability of Assessment are all YES and only the detailed exam is not possible then a backboard with c-collar and blocks is used as a transportation device until in the first aid room. Continued use of a backboard is not
necessary if spinal protection is not supported by a more complete examination in the first aid room and if allowed by local and state EMS guidelines, protocols and regulations. This
process is not “spinal clearance” because the backboard was used as a transportation device.

58. The use of Standing Backboard
Rarely used.
Only used when necessary and indications are appropriate.
Can be used as a transportation device when someone that has no physical findings but states “their back hurts” and needs to get off the hill.
Standing backboards are used rarely. They should only be used when necessary, and indications are appropriate. In instances where someone is standing or walking and displays physical findings that are indicative of needing spinal protection, they should be lowered on the spinal protection device.  Lowering a patient should be done with as little rotation of the spine as possible.  Cervical spine stabilization should be applied if exam findings indicate. Saying my “back hurts” without physical findings does not require spinal protection.   After evaluation, if the patient still refuses to move because their “back hurts”, use the standing backboard technique for transportation purposes only.  Once in the First aid room reevaluate the patient.

59. Spinal motion restriction is not needed
Low energy incidents even with minor physical findings (example: a contusion near the spine).
“Just in case” there is an injury or a low level of probability.
A headache, brief loss of consciousness or concussion in a patient who is now alert and oriented, and has no findings.
Patients who are up and walking at the scene with a mechanism of injury with the potential for spinal injury without documented physical findings or symptoms.
Penetrating injuries, unless near the midline spine area.
“My back hurts,” without any of the findings noted above.
This list of MOI’s and physical findings may not need spinal protection.

60. Student Summary and Resources
Review the concluding objectives
Use the OEC Cycle B refresher student workbook printed and distributed
Use of the Lesson plans for the Cycle B refresher
This is a highly focused spinal assessment review
Skills on backboards have not changed
Use of other spinal motion restriction equipment will take additional training at the local level
Review the objectives:
Define what is a spinal protection device: i.e.. Backboard, gurney, toboggan, vacuum mat
Explain when it is appropriate to use a spinal protection device
List and describe examples of some potential significant Mechanisms of Injury for a spinal injury
Describe the observations and questions that make up the Reliability of Assessment
List the specific items that make up the careful physical exam
Demonstrate how to perform a careful physical exam
Explain what to do when a complete and detailed exam is not possible on the hill
Explain when a cervical collar is required and what must always accompany the use of a cervical collar
Explain the appropriate time and use of a standing backboard
List when spinal protection is not needed
OEC instructors may find additional information at Under OEC Educational resources and OEC instructor resources

61. Exercise
Using the opening scenario complete a patient assessment and pay particular attention to:
Identifying MOI of concern
Asking questions of reliability of assessment
Complete a physical exam with focus and attention on palpation of the head, neck, and back along the midline of the spine trying to identify any pain or abnormalities.
Directions:
For instructor use:
Use opening scenario or other related scenario.
Identify all the MOI’s and list
Have individuals ask Reliability of assessment questions or make observations.
Each person completes a thorough and detailed physical exam from head to toe with emphasis on
Palpation from the occiput down the spine and to the pelvis. Further CSM checks.
Identify or list signs and symptoms of Decerebrate-extensor and decorticate-flexor posturing.

62. Questions

64. Instructor Re-Certification continued.
Teaching Tips
Resources
On & Off line
Mandatory skill guide
Instructor Roles
Pearson (Keys)
ADA (American Disabilities Act & NSP Training)
Chapter 36 – Not allowed to teach without local area management approval; minimum of ALS experience to teach. NOT part of the certification program.

65. OEC Teaching Tips
Teach only to the objectives that are outlined in the front of every chapter
The material that covers those objectives can be found in the margin of the text
OEC Skills in App. B must be signed
Teach smaller skill units to achieve better large skill success
Change delivery method to meet the needs of the students
Chapter 36 – Not allowed to teach without local area management approval; minimum of ALS experience to teach. NOT part of the certification program.

66. Offline Resources Appendix A – Survival: The Rule of Threes
Appendix B – Student OEC Skill Guide
Must successfully complete before evaluation
Appendix C – Emergency Care Equipment & Common Medications
Glossary
Answer Key*
Index

67. Online Resources NSP Website Central Division Region MEMBER RESOURCES
OEC Refresher Tools
OEC Exam Info
OEC Instructor Guides
BOOKSHELF
Current Event Release form
OEC-MSP Registration
OEC
FAQs
Online Course help
Pearson Instructions
Region Calendar
Contact info
Discussion of distance learning- web guided instruction.
Review Division/National Updates and information- going paperless, Refresher guide will be a word document/PDF.
Registering and Closing a course- where to find information on the various sites. (Web based)
Fifth Edition Updates; Refresher, Instructor Manual (Web based)

68. NSP 5th Edition Mandatory skill guide for certification

69. Two places you will find a list of the OEC Skills.
Online…
Instructor Resources on the NSP site
And
Central Division Site (OEC)
Two places you will find a list of the OEC Skills.

70. Roles of an OEC Instructor
Mentor
Administrator

71. Instructor Roles
Actively teaches a representation of the OEC course within the 3 year period.*
Attends Region recertification clinic at least once every three years.*
Is evaluated by an OEC IT at least once in 3 years*
Completes all OEC annual refresher requirements.

72. OEC Online Course Tools

74. IOR Instructor Pearson Code:
Pearson’s Access Code
HEAIRC-PUREE-AGENE-JAWAN-CRUSH-TAXES

75. hayes62119

76. Option 2
hayes16142

77. The ADA and NSP Training
ADA (Americans Disability Act) Sight, Limb, Paralysis, Hearing. ADA works along side the NSP Training in the aid and assistance of any person that may need assistance while at our locations

78. Conclusion…
Review components of Instructor Development and Adult Learning
Describe the layout of the current OEC curriculum and resources available for teaching
Review “The Backboard Redefined"
Identify the role expectations of OEC instructors