Annual EMSC Grantee Meeting

T1 Grant and PECARN Reps

Using Technology Effectively for Data Collection, Training and More:

Web-Based Platforms for Information Gathering and Transfer Tools

June 20 – 22, 2006

ROBERT SAPIEN: So we’re going to look at two projects that we have in New Mexico that we’ve been working on that are web-based. One is our partnership grant, which because of the budget as we all know, is not tremendous for that grant. We’ve used a shorter version, PowerPoint mostly, to get EMT training out there to the state and then the more sophisticated one is the school nurse project that is a targeted issues grant so the budget was larger and we’ve been working on it a lot longer. So the first one is basically for the partnerships and for EMT education online. It’s all web-based. Slide show basically in PowerPoint. It’s simple but it’s really powerful and the content is written by our EMSC coordinator. We do a couple of assessments with it, we do a quiz because EMTs to get their continuing education, need to complete the test and you’ll see with the nurses, they actually do not need to complete the test and so because they need to complete a test, we actually do a pre-impose test and yes, they are the same questions, for those of you that were there earlier. And their answers are sent directly to a database.

So we know what they answer and we know whether their score improves or not but they do not know that because that would take an extra step in programming if we’re talking about the technology about it. We also are able to keep records for audits if the Department of Health decides to audit us since we have a license to give these CE’s then we have that readily available. As you’ll see, during the PowerPoint, it always gives you the correct answer so it appears as if it’s interactive but it actually is not interactive. In other words, some of the test or questions that I’m sure you’ve answered online will say, no, you’re wrong, here’s the correct answer. This one doesn’t do that. It just always goes to the correct answer and again, that saved us a step in programming but it also appears as if it’s interactive. Also to save some programming, we know who’s taking it but we can’t issue the CE from that. So the user has to mail our office and then we send them back our certificate. We’re afraid of them forging certificates, et cetera. And then we can also use the data for program evaluation.

These are the modules that we have currently available, we have one on the treatment of children in the EMSC that have been exposed to methamphetamine. We have two children with special healthcare needs modules. One on Down Syndrome, one on technology dependent kids, seizures and then blunt chest trauma as well. This is the basic outline of how we do it. So we come up with the idea and to get the idea, everybody starts with airwave reading circulation and figured there was a lot of information about that. So we actually went down the list of most common causes for EMS transports for kids and started to, I think, do some a little bit more interesting things. So we have the idea, then the coordinator researches it, writes it up, all along working with the web designer. The web designer then imports it and makes it pretty basically and sends it to the programmer. After we’ve proofed it, then it gets posted in the server. And we post it on our server at the University.

The EMS providers then access the server that then goes to into a database. We issue the CE’s and we also can do program evaluation and I’ll show you some of the preliminary data we have from that. So, so far, we have this to show in the different levels of training of medics that have logged on and received some training, EMDs or dispatchers and then the EMT paramedics. In New Mexico intermediate site. We realize not all states have an intermediates. These data are a little bit disconcerting. Yes?

UNKNOWN MALE: (Inaudible)

ROBERT SAPIEN: No.

UNKNOWN MALE: The providers or--

ROBERT SAPIEN: Those are total providers.

UNKNOWN MALE: Total providers.

ROBERT SAPIEN: Right, we have 6,000 EMTs in New Mexico and getting the word out there has been challenging. Yup, getting the word out there. So we’re going to say what we’re going to do about that in a minute. So this is a little disconcerting because most of our providers in New Mexico are not paramedical, those are the ones that are getting online to continue education. It’s about 50-50 rural versus urban access by the EMTs. And the small bar graph on your right shows the four largest counties in New Mexico, most populated counties in New Mexico and most of them are in Albuquerque area. So 50-50, which matches our population base, really. The state is divided up into three EMS districts or regions. EMS district one at the top and then the lower part of the state is two and three. Most of the people logging on are in EMS region one, which makes sense because that’s where most of the population is and because those were the larger cities and towns are. And when I say larger, by New Mexico standards that means 60,000, but that’s where they’re going to have Internet access. Speed is a little bit different in the different regions.

The pre-imposed test, this was an aggregate of all the modules of everybody that’s taken identity. They seem, at least through this type of evaluation, seemed to be getting some of the information. So let’s look and see what it looks like. It should be up already right now.

So this is the homepage for the Emergency Medicine Department. Refresh. There it goes. There you go.

So that’s our homepage for the division, and you see can this--across the top are the bars that have the different areas. We’ll go to School Nurse next but right now, we’ll go to EMSC. And it just talks about the EMSC programs like any other website, I’m sure these are very similar. We do have a tech requirement, viewing instruction, monitor resolution, browser size. And then these are the modules that are available. So this is the blunt chest trauma. It does have some motion to it, that’s only the Flash so it’s very easy to do and very inexpensive. And all of them have the same setups, so that once a person logs on and gets used to it, they can go to the modules fairly quickly. They have to take a pre-test and any number is fine. It answers the questions and, again, they don’t know the answers and then you have to type YES, and this was for I or B. So then that went right into the database.

UNKNOWN SPEAKER: If don’t say yes?

ROBERT SAPIEN: It doesn’t let them in. It doesn’t let them go to the next.

UNKNOWN SPEAKER: It doesn’t just not record their answer?

ROBERT SAPIEN: They are blocked at that point. And so again, they’re all basically the same set-up. And so there’s web designing and then there’s web designing. And we are fortunate to have a web designer who’s also a graphic artist and so she’s done I think a tremendous job with color selection, a layout, et cetera, et cetera. So there’s a technical part of web design but then there’s the artistic part of it also, and she’s done a tremendous job.

Basically, they are all pretty much the same. There’s a case study, you read through, review a conditions and then it’s mostly reviews. So this is a little static, honestly, but it’s the best we could do on the budget that we had, okay?

UNKNOWN SPEAKER: And there was no audio of it?

ROBERT SAPIEN: There’s no audio with this one, there’s no video at all, these was actually a Powerpoint that they got inserted into this format, so these are just slides and you just scroll into the slides.

UNKNOWN SPEAKER: Did you have to make it into sections that are (inaudible) 47 pages linear just--then we put that into the slide?

ROBERT SAPIEN: Yeah, I know. That’s excellent, yeah.

UNKNOWN SPEAKER: (Inaudible).

ROBERT SAPIEN: That would have been easier. Yeah. So that’s pretty much the basic view. And then this one’s a little bit more sophisticated. And this is the School Nurse and EMS, targeted issues EMSC-project. It’s more complex. It has training video in it. It is--how many hours, around 16? 14?

UNKNOWN SPEAKER: Fifteen.

ROBERT SAPIEN: Fifteen hours of continuing education for School Nurses online. It’s based on our two-day emergency training for school nurses that we had at targeted issues grant to do. That was a two-day, kind of like, panels with lectures and the scenarios, and so we’re trying to battle with how do we put scenarios on the internet, et cetera. So a lot of the work was--not a lot of the work but the content work was all done. So now we have 15 hours of continuing education but that translates into 60 or 70 hours of video, et cetera, et cetera. But a lot of the basic part of it was done -- the design, the curriculum, et cetera. And we had to then, basically, put it to make it web-friendly. We needed a lot of tech support, and we under-budgeted severely for that. And so we’ve had to scrape from other grants and other programs to really get more of the support that we need. And people are willing to give that to us. We’re now working with the bioterrorism people because some of it’s (inaudible) were there, projects et cetera. But that was one of the big things because we were really under-budgeted it.

It’s also on-going cause, which Mark mentioned, to support that updating, and adding, changing names, what’s coming next, and truly it coming next and what are you expecting in June and truly it being up in June, et cetera. So all of that is really, really important. This content for this is much more robust, you’ll see it’s all video -- not all of it but predominantly video-based. It’s interactive and that you’re listening to a person or watching the people speak or scenarios, et cetera on video. But again, it doesn’t actually interact with the person at the other side of the mouse. So it will give you the right answer but it doesn’t tell you if you are right or wrong, it just gives you the right answer. Okay?

Certificate is e-mailed, and each module is approved -- it’s being approved to stand-alone for a continuing education. Since the project is more complex, the slide is more complex as well. For the content, then we had to convert that content. If you don’t have the contents, you have to go start way back there and do that. But we already had much of the content done. So we had to convert that to video, it got edited by our programmer, who is also building the database, and the tests, and the web designer all work as a team with Rob Belchi, who’s our project manager. And then we sent it out for outside reviewers, and our expert reviewers are Honor House, and Gozar Sherry and a School Nurse, PHD educator down in New Mexico as well. Reviewed it for content and design, then it’s posted on the server.

The school nurses then will log on to the server, complete the continuing education -- now for school nurses, or for nurses in general, continuing education for they don’t have to pass the test. They just have to evaluate the program so it was much easier for that, except that doesn’t help us with program evaluation; that just helps us with them getting their continuing education. So we started to do that separately. So, there were a lot of people involved. You need a camera operator and that needs to be edited, both video and audio. A coordinator to watch contents and make sure everything gets done, kind of like a producer or director. The web designer, and a lot of AB support and then building the database for the programmers, et cetera, et cetera. Oh. Do you want to go back and talk about a little bit more about that?

MARK ADLER: Sure. I think the thing that get through here is there was a time in not the recent past where you could almost do this yourself because the technology was limited to things like, (inaudible) the active server pages, it was a Windows product. You could build a front page website. You could do this on your own, and it would look like pretty much like everyone else’s. Now, with the advent of better web technology, things like ASP.net, more other program options like Pearl, which is like a Linux-based thing, or just the -- I could go on for hours talking about different kinds of technology. The bottom line is, it’s now more than you and I can do. It’s a career. You need to know how the program is written out complex languages. I used to have a look at the web page and say, “I can sort of understand it.” Now, it’s complete Greek. But the good news is that it does more. And so now if you want more and you hire the right people, you can get a lot more out of what you do. All these people here, obviously we talked about costing money, but if you need it ahead of time

MARK ADLER: You need to have the time and you met with higher people to match those needs not the other way around, you don’t say, I want to use big thing I don’t have a lot of money. I can’t (inaudible) not going to do it. You have to do it right. What do you need basically? We started off talking about a server. Server is just a computer that host your website, a server can be a computer that you use to be using that sort of (inaudible). Because it require an enormous amount of thing for a very small website with a few – you’re serving a small (inaudible) really simple. Problem is that if you put it in your institution there’s going to be a firewall, they’ll never let you use it. So you want to host it at home? Great. But let’s not going—which people do but not really some of you’re going to do. So the question is where are you going to put this stuff? Or you can negotiate like he did with your IT department. Will they host for you. Who would they allow to get on it? What kind of things would they want content control?

So that’s the first thing you have to ask. Will they expect a huge banner across your site that says, you know, whatever. Or you can lease it, isn’t that expensive? I just picked up a site for something else for a $100 for a year. And that’s for basic sites probably about what you’re going to pay except for a couple of (inaudible). You have to ask yourself, once you have that server, “Who’s going to use it?” “What’s your need?” Back to your need again. “Who am I teaching and what am I trying to teach?” And then let’s say, “Where are my subjects?” If there’s a lot of rural people on dial-up access, streaming video isn’t going to make sense—Please get your (inaudible)

UNKNOWN SPEAKER: (inaudible)

MARK ADLER: Okay. If you’re streaming video can’t play it or its one (inaudible) then they’re going to be annoyed. So the first example he gave that’s great for dial-up but the other one is not. Pick things like Flash or pick things like everyone can get for free. Don’t pick up player that no one can find when it comes to a spyware or things like that. Pick web standards. So that your users aren’t going to be annoyed that you’re asking them to do things that they can’t do. And the last thing is the screen size. This seems kind of obsolete everyone has a 20-inch monitor, right? Everyone work – people build things that are this wide because they’re programmers and they got a big screen, right? And then it gets projected on the 15-inch screen at the medical center and it’s over here. So one of the nice things about joining usability assessment is send it to test people and then track it down and find out these basic things like, “Do you know how my computer look likes?” And so that way you know that your users are going to get the best out of it.

The software you need is not a big expense. You could budget it though, you need software to store your database, software for video streaming if you can do that, that isn’t necessary particular that can be expensive. And also web design software and then budget for bandwidth if you’re hosting video then that sucks up the amount of bandwidth you’re going to use and hosting services charge you for that. You might get one of those cell phone shock kind of bills, $20,000 for bandwidth use, you need to budget for that so that you don’t get over charges and things like that. And that’s something it’s going to be you want to guess, so you’re going to use your experts how much bandwidth am I going to use? And then we’re going to show off the video.

ROBERT SAPIEN: So just to go back to a couple of things for this one. So like Mark said, a lot of it depend on how they access and we did do about 15 sites around New Mexico, most of it is rural. To see how these school nurses were going to be able to do it. And of course dial-up wasn’t great, we are able to by compressing the video et cetera, we’re able to actually do somewhat with Adala, but most of it is much better if you have high speed of course and not all of the Mexico has high speed. And then the screen sizes are big thing, when we had started to plan the talk I had send Mark some links and he got back to me and he said, “ Why don’t you make this bigger?”

And then as we talk to it’s like well, because some of the monitors out there with the big tube and the whole bit and with a round screen, so it’s just wasn’t feasible for a lot of those screen to do it. So same page, this is a school nurse website and again just some flash at the top. Makes it nice without being too distracting I hope. There’s a couple of ways—there’s a technical system requirements and then just some other stuff that we built in. And then there’s the course directory right here, the other way to get to the course directory is up here which is nice because it kind of gives you an idea of what the modules are. So these are the modules that are done. And we should be completely online by September. So we have Emergency Preparedness Planning Program, School Nurse Continuum of Care, I’m going to show you that one.

ROBERT SAPIEN: Emergency, school emergency preparedness, assessment triars, special emergencies and gadgets, the airway, spying precautions, and see spying precautions. Module nine is all about splinting, and Module 10 is as well splinting and dressings, and then for the last four modules, we’re doing scenarios which was challenging to do them on the internet because it’s not as interactive as when you’re sitting across the table from somebody with a dummy in front, or some other way that you might run a scenario, and so those were a little bit challenging, and we have -- I’ll show you a couple of the ones that we did. We do some that are video-based but because we have so many scenarios, 10 scenarios, it would be cost prohibitive to do them all video-based, and so some of them are basically PowerPoint based, but they are a little bit more interactive, and I’ll show you those in a minute.

So, let’s go to “The Continuum of Care One,” as part of our stand-alone course, we used to, at the lunch hour, bring an ambulance to this course to have the school nurses got through it and actually interact with the EMTs, and see what’s available in the EMS setting because many of them didn’t know that and so we decided to try do that online as well, and so – sorry for the Pilates music. That wasn’t my choice.

UNKNOWN SPEAKER: Someone presses the button--

ROBERT SAPIEN: Oh, you can skip it.

UNKNOWN SPEAKER: Okay.

ROBERT SAPIEN: So, just in case somebody wanted to start getting up and start doing stretches, yeah. So again, and we think consistency is a good thing, and so all the modules and all the screens are pretty much designed the same, which made it easier from a programming standpoint. The web designer, basically, she had a template, that then she would just put into different windows. So this is Continuum of Care and it’s designed to – there’s 19 pages but some of those are video pages. It takes about an hour and a half to go through, so we’re not going to go through the whole thing, but they all basically have the same setup. A title page, and then a page with the objectives, and the different parts to it, the objectives again, and then the video.

ROB: Hi I’m Rob (inaudible) from the University of New Mexico. Today, we’re (inaudible) ambulance to meet a paramedic, who’s going to take us on a tour of an ambulance at an EMS Dispatch Center. Let’s meet Linda One. Hi, Linda.

LINDA: Hey, Rob. How’s it going?

ROB: Good.

Linda. We’re here to learn more about how school nurses can interact effectively with EMS, and I know that the different communities, I think – there’s different standards of EMTs out there, and I’m just wondering if you could help us understand this – like, how do the school nurses – how do they know who’s going to come when they call, I guess? What can I expect and what standards are they? Could you tell us (inaudible) some of that?

LINDA: I think it’ll be great if every school nurse knew what level of partition do they have in their local community in the EMS service.

ROB: Okay. The EMTs?

LINDA: Yes.

ROB: Okay.

LINDA: And I think the easiest way for them to find out is to contact their local EMS provider or fire department.

ROBERT SAPIEN: So you can see the video is five minutes down here, and they’re in clips. So then, it’s points to remember. They kind of summarizes what was discussed in that portion of the video. It’s test your knowledge, and again it doesn’t matter what you press on, it’s going to give you the correct answer, so it kind of appears interactive, and then it’s the next part in the next video.

UNKNOWN SPEAKER: That (inaudible) seeing us – the projector--

ROBERT SAPIEN: No.

UNKNOWN SPEAKER: (Inaudible)

ROBERT SAPIEN: Yeah.

LINDA: Okay Rob, this is my portable office. This is where I work everyday.

ROB: Your portable office, huh.

ROBERT SAPIEN: And so, it’s all basically the same, and then it goes to dispatch.

LINDA: So, this is the inside of the ambulance. This is our computer screen. It shows basically where we are. That’s our little triangle. This little house is our base station, and these are the streets surrounding us. When we get a call, they usually put the address in, and we’ll have an icon –

UNKNOWN SPEAKER: very interesting.

ROB: Okay, that’s me. That’s this screen (inaudible)

UNKNOWN SPEAKER: Yeah, that’s the screen I just hold up there--

ROBERT SAPIEN: So, this is a dispatch --

UNKNOWN SPEAKER: --where they’re sitting and how fast they’re driving at the left –

ROBERT SAPIEN: Because a lot of the school nurses we found in the course, didn’t know what was available or how the system actually worked. And then, we finished up with a scenario.

ROB: At this point, we see they’re here workings for the new EMS dispatch and Linda had gave us a tour of the ambulance. These are two very important (inaudible) in the EMS continuum of healthcare. Now, let’s watch and see how the school nurse interact with (inaudible)

UNKNOWN SPEAKER: Kimberly, what’s wrong? You’ve been acting strange all day. Are you okay? You want me to get the nurse?

UNKNOWN SPEAKER: Okay. (Inaudible) her hand.

UNKNOWN SPEAKER: (Inaudible)?

UNKNOWN SPEAKER: Yes.

UNKNOWN SPEAKER: Yes.

UNKNOWN SPEAKER: Everything’s okay?

UNKNOWN SPEAKER: Yeah.

UNKNOWN SPEAKER: (Inaudible) one of our diabetic patients.

UNKNOWN SPEAKER: Kimberly, can you hear me? It’s Miss (inaudible)

ROBERT SAPIEN: Now you can’t see it on here but on the screen, the actual module, it has the time at the bottom so, although it appears that everything’s moving really slowly, you can actually tell it is only a couple of seconds that have gone by.

UNKNOWN SPEAKER: There’s no injury as far as we know. Kimberly, can you hear me? Cathy, I want you to call 911. Take the kids to a safer place. I’m going back, the emergency transport form –

UNKNOWN SPEAKER: It is.

UNKNOWN SPEAKER: Okay.

UNKNOWN SPEAKER: The pulse is still thready.

UNKNOWN SPEAKER: Right.

UNKNOWN SPEAKER: Hey Bonnie, how’s she doing?

UNKNOWN SPEAKER: Stand by.

UNKNOWN SPEAKER: Yes.

UNKNOWN SPEAKER: Stand by, right over there.

UNKNOWN SPEAKER: All right.

UNKNOWN SPEAKER: Hi, I’m going to (inaudible) ambulance.

UNKNOWN SPEAKER: –Hi, I’m a school nurse here – she is --

ROBERT SAPIEN: Hence, we talk about how to give report and set of the EMS. And then, they fill out the module evaluation and they have to submit it. I’ll give us a nine. Can we give us a four. I got to do it all the way through it.

UNKNOWN SPEAKER: Now, pay attention. This is the curse and benefit of validation. Validation’s a great thing but then you get this.

UNKNOWN SPEAKER: (Inaudible) people who drop the session middle because they’re sick of filling boxes up?

UNKNOWN SPEAKER: I’m sure you do. You have to do specific things to track it.

ROBERT SAPIEN: Yeah. And we have talked about having a clock built in so we could see how long the person was actually online taking the class but that again it cost a fair amount of money.

UNKNOWN SPEAKER: (Inaudible) go to the dishes—

ROBERT SAPIEN: Right. So, then we were struggling with the scenarios. Sorry. We’ll get through that. All right, Mike. I think that we need to change the music, that’s pretty (inaudible). So, this module has two scenarios in it. One is video based and the other is not. And so the way we did it – I guess that’s four scenarios. So, you read through a lot of it. And there’s still photos for it. And it has a time in the top so, basically, lunch period many people playing, kids playing, et cetera. And again, it always gives you the correct answer. And at the very end, it goes through and puts all the stills together as a video so you see the whole mass (inaudible). And this is all going through assessment in (inaudible), mass casualty. And this is all of it put together. I’m going to play it through its completion because it’s only five minutes.

UNKNOWN SPEAKER: Oh my god. Guys, there’s a car.

UNKNOWN SPEAKER: Where’s Bonnie?

UNKNOWN SPEAKER: Hey.

UNKNOWN SPEAKER: There’s a maniac that starts running around the bunch of kids right over the playground

UNKNOWN SPEAKER: Oh, okay.

UNKNOWN SPEAKER: What am I going to do?

UNKNOWN SPEAKER: Is he gone?

UNKNOWN SPEAKER: He’s gone. The kids are hurt.

UNKNOWN SPEAKER: The scene is set (inaudible) so get over there --

UNKNOWN SPEAKER: Okay.

UNKNOWN SPEAKER: --and I want you to watch for the truck. If the same come back, don’t move fast, so we’ll know okay, Rob?

UNKNOWN SPEAKER: Okay, I got it. I’ll do it.

UNKNOWN SPEAKER: Cathy.

UNKNOWN SPEAKER: Yeah.

UNKNOWN SPEAKER: Code blue to the playground. Call 911 now.

UNKNOWN SPEAKER: Okay, got it. I’m on my way.

UNKNOWN SPEAKER: I need some help over here.

UNKNOWN SPEAKER: I need some help over here. Coach, coach, I need some help.

UNKNOWN SPEAKER: What happened?

UNKNOWN SPEAKER: This accident

ROBERT SAPIEN: You’ve no any idea how much--how far from being to close I am.

UNKNOWN SPEAKER: You need help, off this way. Off this way if you need help.

ROBERT SAPIEN: I used to do anything to get out of P.E.

UNKNOWN SPEAKER: Clark.

UNKNOWN SPEAKER: OK.

UNKNOWN SPEAKER: OK. OK. Get this off. Than you Kevin. That’s really sweet.

ROBERT SAPIEN: This is the only free blonde people in New Mexico. No, there fourth the other (inaudible).

UNKNOWN SPEAKER: Here’s a cup for you.

UNKNOWN SPEAKER: (Inaudible). Yeah. I’m good. Connor are you hurting? Where are you hurting? Tell me. OK. Anywhere else, Tammy? All right. I want you to be real still and take some slow breath. We’ll be washing this area. We’ll be right back. OK?

Connor: OK.

UNKNOWN SPEAKER: OK? You’ll be real still. Help is on the way. OK? Just breath slow. OK?

UNKNOWN SPEAKER: Yeah. Shannon, can you hear us? Can you hear us Shannon?

UNKNOWN SPEAKER: She’s not responding to pain. She’s breathing.

UNKNOWN SPEAKER: I bet really, really weak pulse, Tammy.

UNKNOWN SPEAKER: She’s breathing. She’s a live red tag on feeling.

UNKNOWN SPEAKER: OK. Let’s get out of here.

UNKNOWN SPEAKER: Does anyone--

UNKNOWN SPEAKER: Amy, Amy, can you hear me?

UNKNOWN SPEAKER: Oh God, her pulse is really, really weak.

UNKNOWN SPEAKER: I don’t get any breathing either. I’m going to reposition her head and try to open her airway.

UNKNOWN SPEAKER: I think--

UNKNOWN SPEAKER: Amy, can you hear me?

UNKNOWN SPEAKER: I don’t feel any chest right here.

UNKNOWN SPEAKER: She’s still not breathing in the chest. I’m going to start right here. I’ll just--the pulse is still weak. I’m just going to

UNKNOWN SPEAKER: Just hang with it. Hang with it. Amy, I’m just going to put this right over to your face. Is her chest rising?

UNKNOWN SPEAKER: Just barely.

UNKNOWN SPEAKER: OK.

UNKNOWN SPEAKER: I’m loosing it--the pulse.

UNKNOWN SPEAKER: Two, three, four, five. Two, three, four, five. Two, three, four, five.

UNKNOWN SPEAKER: I don’t feel anything. There’s nothing. Not even a degree.

UNKNOWN SPEAKER: Two, three, four, five. She’s a rep.

UNKNOWN SPEAKER: You got it. You got it (inaudible).

UNKNOWN SPEAKER: Hi Kelly.

UNKNOWN SPEAKER: Kelly, can you hear us?

UNKNOWN SPEAKER: She’s not breathing.

UNKNOWN SPEAKER: Funny, I better got a pulse scale and try Chest thrust. OK.

MARK ALDER: For every Halloween, we hit warmer.

UNKNOWN SPEAKER: Yeah. I don’t care--

UNKNOWN SPEAKER: Conni--

UNKNOWN SPEAKER: Yeah.

UNKNOWN SPEAKER: I see her chest rise is funny.

UNKNOWN SPEAKER: OK. She’s a rep.

ROBERT SAPIEN: She’s a little alive. They had little lives there.

UNKNOWN SPEAKER: Let’s get some help over here, please. OK. We’re good.

UNKNOWN SPEAKER: (Inaudible).

ROBERT SAPIEN: Yeah.

UNKNOWN SPEAKER: Kevin? Kevin?

UNKNOWN SPEAKER: Oh, Conni. This is stick.

UNKNOWN SPEAKER: Kevin right out of his chest?

UNKNOWN SPEAKER: Kevin?

UNKNOWN SPEAKER: I don’t hear any breathing? No air. No pulse.

UNKNOWN SPEAKER: I’ve got low pulse.

UNKNOWN SPEAKER: I’m going to turn this up here just to see the stairway obstructed. OK. Still no breathing.

UNKNOWN SPEAKER: No cup refill.

UNKNOWN SPEAKER: No breathing Cathy.

UNKNOWN SPEAKER: Still low pulse.

UNKNOWN SPEAKER: He’s a black.

ROBERT SAPIEN: So, I remember they’ve gone through the whole module as a scenario and now, this is just summarizing it for them.

UNKNOWN SPEAKER: (inaudible). OK. And then, we put the--

UNKNOWN SPEAKER: OK. Can I get some more?

UNKNOWN SPEAKER: Cranberry, Cranberry, can you hear us? Can you hear us Cranberry?

UNKNOWN SPEAKER: OK. She’s breathing. I hear a moaning.

UNKNOWN SPEAKER: I’ve got a good pulse.

UNKNOWN SPEAKER: Good.

UNKNOWN SPEAKER: OK. She’s a rep.

ROBERT SAPIEN: OK.

ROBERT SAPIEN: And that’s all in been five minutes so far. So, It seems like it’s Cranberry now. So, time.

UNKNOWN SPEAKER: Cranberry?

UNKNOWN SPEAKER: Still breathing. Must be luck.

UNKNOWN SPEAKER: Taylor, it’s Nurse Conni, can you hear me?

TAYLOR: Yeah.

UNKNOWN SPEAKER: Are you hurt anywhere?

ROBERT SAPIEN: That’s the fourth blonde person.

UNKNOWN SPEAKER: Where are you hurt?

TAYLOR: On the arm.

UNKNOWN SPEAKER: OK. We’re going to take care of your arm Taylor. You’ll be very, very still.

UNKNOWN SPEAKER: She’s a (inaudible).

UNKNOWN SPEAKER: Help is on the way Taylor. Be real still. We’re right here. OK?

TAYLOR: OK.

UNKNOWN SPEAKER: EMS is here. Over here guys. Over here.

UNKNOWN SPEAKER: (Inaudible).

MARK ADLER: No, that takes extra budgeting. So this one’s under construction and this is developed there. I’m going to be doing the depression and then there’s an abuse one with this also. So, this is, this ones are static. They’re going to have still pictures on the right, but they’re not going to have video to (inaudible) because we’re trying to do a 10 video scenarios was very expensive and very costly. Time wise.

Now we do the test. We’re going to be doing the test but it’s not -- the test in the module is not graded at all. As far as we don’t know, what they answer, ‘cause I always give the right answer. So we are giving them a pre-imposed test either by paper or online. Just one of our evaluation components, which I’ll talk about in a minute is actually on scene and of those ones who are getting it by paper. But then they evaluate the module at the end like we went through. The project evaluation is going to have, like I said a pre-imposed test. It also has pre-imposed confident surveys online and on paper. And then just like we, just how we evaluated the actual live course, we’re doing on-site mock scenarios. So a group of nurses, we’re going drops, we’re going to the school, bring in new large scenario for them, video-taping them as far as their performance on assessment scene safety, etcetera. Then we’re going to put a group through the course and then we’re going to go back then we’re going to do on-site with them do the same thing. And then those videos are graded by outside reviewers; they won’t they know if the nurse has taken the course or not.

ROBERT SAPIEN: All right. So now this is about information delivery. That was about information collection. One of the big things I think people have forgotten this; there was a time not that long ago when the web has completely static. Only HTML pages, all you got was text and pictures and without that, it was really cool. And then came along the Netscape browser and then the Explorer and then Dynamic Web. Everything that you do today, the Internet experience you now get today is completely different from the way the Internet started, in that, what you’re doing on the computer and in the web browser is able to, because of new technology, interact back and forth with the server your computer at the research center with the user. So there’s many things you can do. The most simple of that is, you are able to retrieve information. So the simplest thing is, do the web form, you saw one there, in which you have fields, those fields are kept in when you hit submit there it sends back, really as a web page back to your server as text. And then you can store that and do whatever you want. The nice thing about that this is sort of less miserable. Every time you collect information that way it’s a step of data entry where errors are reduced, that you’ll skip it.

So even if you’re thinking about doing a completely different project, you have five centers and you’re collecting simple data for a research study, and you want that all to come back, to the mother ship and be interrogated. We know that large places, have you heard about Pcoms this morning doing that. But, and yet, you don’t need to be P-cardio. Anyone can do that. That technology is very basic. The nice thing is it goes into access database that’s comes a hundred dollars. It’s big, as you know bigger; you have sequels or other ways of doing it. But you don’t, most of the time you need that kind of scale. The nice thing about that is that once it’s in that, it comes to Excel, it comes to SPSS, and you’re done. And you can start doing data analysis. We talked to a little about validation and that’s where the fields check things. Is it really a zip code? Is it really a phone number? Is it between, is the age not, you know, 172. Building invalidation like that means that there’s errors you’re not going to have to worry about. There’s a less data clean up to do. There’s a balance. You want the users to just try if the validation is over, as people will hate it. But if it’s well done, you will be much happier with the data that you get back. And it’s really simple.

And the most important thing for you to think about is it assisted you more with the research design that has to do with website ‘cause you want to know what am I collecting, how do I want to collect it, and more importantly, how am I going to analyze it. Because you start with the analysis plan you work back to your surveys either if they were paper or computer. And then you build it that way. Not that you really want it. You don’t find what cool technology, what goes in each slide or tool, or whatever. Then try to build your stuff around that. You go the other way.

As you know also, there’s no forms to lose, and you don’t, and you can make sure you don’t omit any entries. One of the things that makes me crazy is that I had a pen and a paper survey with 10 items and some people decide, “Um! I’m just going to leave that number nine” -- not for a reason. Or when you give them a lighted scale, everyone takes lighted scale and ask if, “why is it okay to circle three numbers?” You know, five to seven is not an answer. I don’t really understand that and one of the nice about it is that they don’t get to choose that. You can do this, this is technology that you can do. It’s probably easier than contact collection, whether you need a website to host it, a database to collect it and never tell us the limitations of people to break your system. That’s what I mean?

Secret bonuses, because you’re forced to do this, because there’s no choice when you’re talking to someone who’s putting a database, they’re going to ask you really annoying questions like was this a decimal field? Is it a digit field? Is it text? Nothing worst than finding that you had all your data in text and then you want to analyze it, it said PSP I can’t analyze because it’s text. These are things that really kind of nice to do out front and doing it on the web actually forces you to do it.

It also let’s you collect meta data. What is meta data? Well we brought it up already. How long are they on the website? Well if there’s a neat thing, because of the activity of the web, session variables and cookies, allow you to track how long someone’s there. You can even do things, depending on the technology, how much did they spend in a particular area. If you do a site with lots of logical contents that has link-outs, how often do they link-out? What links to the use? Did they do things like, skip all the way through to the end and take the quiz and not read anything? You can figure this out. It’s nice because then you can go back and say, when I do this next time I will. And that’s important because maybe you spend a lot of time doing something that doesn’t pan out. Well if users aren’t going to use it then don’t spend time on it. Meta data can be very, very helpful.

As far as prolonging life with content, I can only tell you what we’re thinking of doing since my project is about developing educational content and distributing it widely. We put in our grant, we’re going to buy a website, we’re going to buy a domain and we’re going to post all these stuff for free distribution. We’re going to up how we did it, how you use it, since it’s simulation-based, how you’re going to use the simulator with it and we promise you that we’ll keep it up for five years and we budgeted for that. It’s not a huge amount of money. But that’s a deliverable now; you can say I promised you I’m going to spread this around, here’s how I’m going to do to operation-wise that. And then further than that you can then actually report, well X number of people right to this website and download it and they use it. And therefore this hopefully is more successful than just the local intervention. There are of course stumbling blocks to everything.

He talked a little bit about continuing education units; we’ll get back to that. There’s IRB issues, oddly enough it varies enormously from place to place. Some IRBs are perfectly happy with you to do education wherever you want; others places expect you to get informed consent. You have to negotiate ahead of time. If you’re going to use it repeatedly, come to the IRB and say, this is something I’m going to do now and I’m going to be doing a lot in the future. Can we talk about this -- not sort of the low-level of the stamp of approval but what are you going to do overtime? I know my colleagues X, Y and Z get verbal consent. Here’s the logic behind that, maybe you can explain to them why it’s okay and if their peers are doing verbal consent maybe you can get around some of those stuff or just accept the consent.

Content ownership, once it’s on the web pretty much anyone’s. Copy and paste works really well so you have to ask what are the images that you’re just going to use have to be yours. Contents you’re going it has to be yours or you have the permission. It’s a little better if you use it internally, if you’re behind your firewall and your audience is only internal, you have a little more room. Once it’s on the web, there’s a different standard and then it just means -- it also means that you build your own stuff. You know you spent a 100 hours building content and someone else just appropriates it. You know the copyright thing, you can only use so far.

And then there’s the liability, if you’re hosting, if you’re going to risk hosting it they may say how do I know this is right? How do I know that you’re sending information that isn’t going to come back? That’s where the great disclaimer comes along. A little fine print in the bottom, this is how we’re going to represent X, Y and Z and it doesn’t necessarily represent the institution. And something as simple as this, I posted a website, I used a logo that I thought was fine apparently it can’t be blue so I got this very angry email, oh, this is a variation from -- every large institution now has a style standard, a web style standard in which you will find at northwestern is 18-pages on and they expect you to adhere to it. What web, where’s it going to go or what’s going to -- that’s the thing that’s better to find out ahead of time. Find out from your IT what you’re your web a standard is and then patent it. Did you have one?

UNKNOWN SPEAKER: Yeah.

MARK ADLER: Yeah. We’ll come back to that other idea in a second. But in summary the Internet provides an effective platform for immigration delivery and data collection and it’s something that as I said you can do. Consider the audience for planning. Rely on experts to help, and take care with the budgets so that not only you aren’t short upfront but you’re not short on the backend as well. And I want everyone to thank, and you should talk about CEU’s.

ROBERT SAPIEN: Oh, yeah. So one of the issues we had were, well, one is the limit of online CE’s. And so, the EMS here in New Mexico is limiting the number of CE’s that the EMTs can do online, and so we can put up 15, 20 CE’s for them, but they can’t access all of them in one year.

The other one is just going through rigor (inaudible) of doing this especially board of nursing and nursing continuing ed has been a quite difficult and taken a lot of time. In fact, we’ve had to purchase or partly purchase our own license in order to help with all of them. I wanted to specifically thank some people because they have done a tremendous job with the project actually. Rob Elgy is our project manager and he’s taken it from content all the way to completion. Linda Warren isn’t here now. She works with our partnership grant. She is the one that writes all the PowerPoint ones that you saw, and Jessica Peppers, our videographer, but he also edits and does database. Jean Caldwell is actually a PDR nurse, who has a web design business on the outside. She’s the one that’s responsible for all the, I think the wonderful colors and designs that she’s done.

Rhonda Spark, she’s up here. She’s Director of Clover School of Nurses and she’s been an instrument on this project. Vannie list away with the school nurse that you saw in the videos and she did quite a bit of work for us. And then Catherine Schafer appears have been helping with dissemination of the curriculum and coordination, etcetera. Somebody had asked about, “How come we don’t have so many people, so many EMTs logging on and off? And dissemination is a big part of it. So what we’re going to do this year, now that we have enough modules is we’re going to set-up a laptop lab at the State EMS conference, so that during break, etcetera. They can come in, hopefully log on, will be log on and they can just take some quick CE’s online and hopefully better help increase our numbers quite a bit.

MARK ADLER: I think if we can take some questions, but I want to point out two other globe tidbits. One is that, one old solution which is coming back in favor now that we realized that not everyone got high speed even though we all have high speed is that, if you want to do video to world audiences, you can build all the content on the web, except the video, and you can send the video out on the CD. And they put the CD on their drive, they run the website, and then, which rather than just putting everything on the CD, it automatically looks up the video. So that’s the way of sending out to rural areas, now its high definition video and still have everything web-based, in that way, you can change your dynamic--that means you’re not set with the content, it means your content can change a little bit as long as you stay with the videos. That’s one thing.

The other thing I want to plug in, and I have no affiliation with this website. Something this is called Survey Monkey, if anyone had used this. Say, a lot of member of it. This I would strongly encourage anyone who wants to click survey data. There are competitors, they are similar. This is example of one of their surveys. It’s free, for basic surveys, and literally, its $200 for thousands of entries at a time. I think if you’re doing something simple the reflection, everything that goes on it comes out to SPSX or Excel and you’re done. You don’t have to pay for hosting, you don’t have to do anything else. And there are similar things that’s online. Quiz posting if wanted to do just quiz. Another nice thing if your audience is, within your institution. Almost every university now has a black board or content management system, which is for undergrad that used tools are eligible to use. And that’s the nice things that ever content as well. The questions of which is for residents, they have to have a user name and IDs, but getting the user name and password isn’t that hard. So, your target is residents or other nurses within the institution. Consider using the built-in resources because there’s an expensive license, but if you so much paid for it, it’s crazy not to use it. Any questions?

UNKNOWN SPEAKER: One of the things that we didn’t do or stopping now is we used just the graph, what we found in this graph is that we use something nice, that we can get the data and graphic solution, well, you talk about this part.

UNKNOWN SPEAKER: They are a little more expensive than Survey Monkey, but not largely. Really under a dollar per user, and yes, you can say you can get graphics. There’s a variety of graphics you can get. They’ll automatically put up for you. Plus you can run customer report, it’s quite a nice--it’s test graphic.

MARK ADLER: Right. This is an enormous number of content management, educational quiz, stuff ranging from this little to very expensive that vary in what your output is, then we have an argument. It’s nice if you’re going to use it for feedback, if you’re providing graphic feedback to your user, on the fly, that’s great. If you’re collecting, you have to decide do you want to do it your own. If you’re telling it’s Excel you can put any graphic that you want. If you want it to be quick and dirty and you want your customers put your large number of users at the back end to see, then this thing make more sense.

UNKNOWN SPEAKER: You said something about anticipated costs and I think when you’re budgeting for any kind of grab it’s always good to know ahead of time what you’re cost are going to be like. And you said, that you have some cost that which was use, what do you think it was in terms of how a lot of information about the process on the exports that you might hit, so, was there something that cause the problem that other people might avoid that in terms of giving the same code of cost that you mentioned?

ROBERT SAPIEN: I think the thing is, like Mark said is to, hire the person for the job not a job that fits the person. We we’re fortunate, I mean, we have pretty good people, very good people, very talented people there but we didn’t put them on salary, we just pay them by the hour and then we had to pay them more by the hour because they were more hours and it was just getting very messy, so I would create an FTE for one just to make that part of the project.

So we have a project manager, whose fulltime, we have part of the staff assistant and myself and then we have a little bit of technical money that we put in that we split between the videographer/programmer and the web-based person, web designer, both of those should have been fulltime people. To do a project this size, with 15 hours of CE’s it really takes a staff of about four, fulltime to really get it done.

They worked extra on their own time to get it done because they believe in the project but, and we have to piece together other money to pay for as much of their time as we could but it’s really under budgeted.

UNKNOWN SPEAKER: Another solution that I have found in South Carolina were only 10 percent have high speed internet-access for those people under dial-up is what you called audio streaming. So, you’ll have still images with the audio through it. And they can come through phone lines and still give you that video type feel but it comes across, really.

ROBERT SAPIEN: That doesn’t buffer so you’re right that’s very smooth, it’s nice.

UNKNOWN SPEAKER: If this is you’ll be a here in number, you want to be in age to top, now we ask you to keep back who have taken the task and went to the module? And what about the full account, how did you manage to get closely protect their to keep your module closer to the firm and how’s that?

ROBERT SAPIEN: In order to get into the site they have to take the pre-test and type yes and submit including their license number. And in order to get their CE’s they have to complete the post-test so they know that they won’t get the CE unless they do it. And then we’ve added an extra step for them. They have to then log out of the site and email us that they just completed it because we don’t match the EMT number to the EMT name, so it’s an extra step for them but we were really worried about them downloading a certificate, xeroxing it with colored printers and colored copiers, etcetera, we were really very concerned about this, so in that way, in case we’re audited to be able to produce that list.

UNKNOWN SPEAKER: Do you manage to work with your ideals is that little box that basically saying, “Yes”, because their EMT number identifies them, we thought about of any way that you might be able to collect some data, where you have the potential for maintaining the data with the identifier but actually, you split it out so that you would have the identified data to work with or that you haven’t come up the point where you needed to do that?

ROBERT SAPIEN: I think most of the plans are to do accurate data, so, yeah. It would be nice to really hone down whether at logging on from (inaudible) dial-up or high speed or my suspicion is 50 percent of them are now, surprise that South Carolina doesn’t have more. Yes…

UNKNOWN SPEAKER: How long from start, very start, how long did it take you to inadequate framework go for serving the same direction? Do you spent two years on this?

ROBERT SAPIEN: We’re just started back in February, March we started at 30 and we still are not done with the actual content part of the course, but we’ve already done all the pre-onsite surveys, so that’s all done but it took…

MARK ADLER: It took a good 14 months for us to have the screen built with all the different components but then we could insert. Once we have that, it was a matter of video taping everything and then inserting them into these various boxes.

UNKNOWN SPEAKER: I raise a question because we often think that some software this commercial is expensive and yet 14 months to a couple and half of the years with way more software cost. So people are, they were thinking about doing this from scratch. And I would seriously consider the commercial things to cost 30 or 40, or $ 50,000, over $10,000 per year, they turn out to be far cheaper than self-development (inaudible). It’s just hard to keep and mind. Another question that where would you be because there are many people trying to even the lowest kind of denominator hardware and I always felt we have the highest common denominator part of (inaudible). It’s going to take two to three years to get where you’re landing in your curriculum to look. So help me clear these figures so that we’d know of how to use it. So how would you advise people about that?

MARK ADLER: Well, quite frankly, when we wrote the grant, we were aiming at the lowest common denominator so that people will dial-up and there’s a way to do that if you take each frame of the video and compress it down, you can actually and then take out every other frame, I think that’s how he does it. Our programmer can do it.

And we can get the video to actually stream on a dial-up. Fairly well, not quite as good as high speed, of course, but fairly well. But that takes a lot of time and that was more, more program time and we just decided, we’ll just go for broke and we’ll do this for the high speed if, and then we were kicking around other ideas, mailing out laptops with wireless for them to log on and do the course, putting it on a CD, of course. With the CD you can update the information or change the information. So those are other things. But yes, we switched now from when we wrote the grant that we’re going to try to do it to the very lowest denominator. Now we’re, we want just to get it done and get it online for as many people as can get it at a price pip.

ROBERT SAPIEN: The other, an additional answer to that is it depends on the audience. I’d move from one institution where computer replacement cycles were eight years and came out of the research budget to a place that replaces them whenever they feel like. I know that there is community centers in Chicago that residents go to are using.