Louis Gonzales: Welcome to the pre hospital breakout group we're going to let more join before we get started keto welcome I see up there.
Keito Ortiz Training Coordinator PHC: Hello Hello hi good afternoon everyone.
Thank you.
Keito Ortiz Training Coordinator PHC: i'm gonna lie, I can share my screen correct.
Louis Gonzales: Yes, i'll do a little intro of what we're going to be doing and and then we'll turn it over to you, but you're welcome to share your screen whenever you'd like perfect.
Keito Ortiz Training Coordinator PHC: i'm not good with checkbooks, by the way, I kind of like I kind of put them off to the side because I.
distracts me a little bit.
Louis Gonzales: that's that's fine he will kind of be watching that and then, when we're done when you're done then we'll kind of regroup on anything we missed from the chat box so.
Louis Gonzales: Perfect for you.
Keito Ortiz Training Coordinator PHC: Perfect little quick.
Keito Ortiz Training Coordinator PHC: share my screen.
Louis Gonzales: Michelle is that you recording.
Michelle Murphy: I think it'll automatically report.
Okay.
Keito Ortiz Training Coordinator PHC: just give me one second to this thing squared away all of a sudden, the computer wants to have like a rabies or something.
Louis Gonzales: Okay.
Keito Ortiz Training Coordinator PHC: I guess.
Louis Gonzales: So if you just joined we're going to give it a couple more minutes for others to join.
Louis Gonzales: And then.
Louis Gonzales: we'll go over the plan and then introduced for the first part of the next sessions.
Louis Gonzales: numbers are pretty leveled off here so.
Louis Gonzales: My name is when this console is.
Louis Gonzales: i'll be facilitating along with Michelle Murphy this particular breakout room so welcome everyone to the pre hospital practitioner breakout room.
Louis Gonzales: A couple things we want to try to do.
Louis Gonzales: first thing they will do i'll introduce in a second are our guest speaker.
Louis Gonzales: And then.
Louis Gonzales: When he's finished we'll have some time for questions and answers with with our speaker Tito.
Louis Gonzales: And then, after that someone I will kind of lead some discussions, and we certainly want you to to chime in, and we want to have some discussions about.
Louis Gonzales: aim statements and measurement surrounding this topic we can about training and competency verification so that's kind of what we'll do in the next.
Louis Gonzales: Five minutes or so so we'll get started, if you have questions, please put them in the chat box and if the logistical questions Michelle I will try to answer them is generally then feel free to chime in see so per speaker for this afternoon is Tito ortiz who's a paramedic.
Louis Gonzales: With more than 25 years experience with cms he is also a New York state certified instructor he has been for a dozen years he's a very experienced paramedic educator.
Louis Gonzales: and has done a lot if you Google him you'll see a few things that he's done.
Louis Gonzales: And he is currently the permit training coordinator for Jamaica hospital medical Center in New York City, which has to be a level one promise Center so with that i'll turn it over to you Quito.
Keito Ortiz Training Coordinator PHC: Well Thank you everyone for joining me, I appreciate it thanks for the awesome intro so.
Keito Ortiz Training Coordinator PHC: As he said, this is me i'ma let you see my there it is if this thing work percent.
Keito Ortiz Training Coordinator PHC: it's acting silly again let's see if it'll go okay so that's me, I have a very large resume and that's not really why i'm here to talk about today, but I wanted you guys understand.
Keito Ortiz Training Coordinator PHC: For some of the educational stuff came from and how I developed it over time and and how and why things exist, so I am.
Keito Ortiz Training Coordinator PHC: A couple of things I want to point out, I am the membership committee Member, one of the membership guys on an emt.
Keito Ortiz Training Coordinator PHC: I also do a lot of textbook reviews on my personal time it's actually something enjoy to do so i'm really active as far as education nationally internationally, I feel it's important for us to further profession.
Keito Ortiz Training Coordinator PHC: let's talk about little people because that's what most professors will call them right we'll call it a little people but they're not.
Keito Ortiz Training Coordinator PHC: So when the pet program first started came starting came to New York state specifically who came out MC msc specifically came out very, very I guess muted, so to speak, a lot of the.
Keito Ortiz Training Coordinator PHC: People in the Ms didn't really appreciate it me being one of them.
Keito Ortiz Training Coordinator PHC: Being in a road for gosh how many years working in bronx South bronx for many, many years, I still was not fun handling pediatrics care for them, so my knowledge was more like hey let's scrap and then go and that's clearly not where we need to be in this healthcare profession so.
Keito Ortiz Training Coordinator PHC: When the when the PCC program came to New York initially was like a small group of people were like putting it together and I gladly put my hat in the ring to help getting started.
Keito Ortiz Training Coordinator PHC: My problem was I work for a very large organization.
Keito Ortiz Training Coordinator PHC: It is many says health network but it's actually Jamaica hospital medical Center flushing hospital medical Center and our private transport service cold medicine standalone service so it's.
Keito Ortiz Training Coordinator PHC: i'm responsible for about 350 employees and paramedics system, why not including dispatchers your message vacation so.
Keito Ortiz Training Coordinator PHC: When you look at it it's going to cost a ton of cash to educate all these people and we're Union employees, so it's going to cost a ton of cash and I now have to pitch it to management So how do I pitch this top management saying hey listen, we really need to make a change.
Keito Ortiz Training Coordinator PHC: We need to do better, so I really looked hard at the data out there, I really looked hard, the last, the cost of last costs of life.
Keito Ortiz Training Coordinator PHC: Cost of equipment and I kind of pitched it to the management to that in that perspective, and they were all for it.
Keito Ortiz Training Coordinator PHC: I sat down I explained to the director department and several other management upper management explaining them that there's gonna be some costs up front, but the returns on it are measurable from either from a life or from.
Keito Ortiz Training Coordinator PHC: A lawsuit that could be in pending from poor education of portray so it took me about a good six months of going back and forth with management and they decided to say okay.
Keito Ortiz Training Coordinator PHC: And, of course, when I was doing this management message, but you got to keep costs that minimum, you have to figure out how to make it work without costing more money.
Keito Ortiz Training Coordinator PHC: And that's where the trouble is it's all about money, unfortunately, because that's life, then I started looking around as well Okay, well before I start going into the empties and paramedics around in my work with.
Keito Ortiz Training Coordinator PHC: I said to myself well how do I get these salty paramedics.
Keito Ortiz Training Coordinator PHC: who've been working on a 30 years working.
Keito Ortiz Training Coordinator PHC: paramedics 35 years 40 years how do I get them to change that paradigm change that thought process.
Keito Ortiz Training Coordinator PHC: And I said to myself, let me put out a query let me ask them what they think, let me ask them how they feel.
Keito Ortiz Training Coordinator PHC: Let me ask them what they know and that's what I did, and it took me another few months.
Keito Ortiz Training Coordinator PHC: To get some information and poking and prodding and meeting with crews and talking with them individually and trying to understand where they're what what they know what they don't know.
Keito Ortiz Training Coordinator PHC: And how to drill down things that I can make work within our budget and still be an effective learning tool.
Keito Ortiz Training Coordinator PHC: There are something I did learn is to her lot of salt, the SMS providers in extreme my Community a lot and they know they're all quality people there are great emt paramedics but they're very, very salty.
Keito Ortiz Training Coordinator PHC: How does that happen that happened because of education they when they went to paramedic school emt school there was not a lot of information pushed out for pediatrics I remember when I was a little audience permanent Program.
Keito Ortiz Training Coordinator PHC: They there was not a lot of push to for pediatric education was more focused on adult education and I realized that I have an uphill battle here.
Keito Ortiz Training Coordinator PHC: So I said to myself well how, how can I make this happen.
Keito Ortiz Training Coordinator PHC: It was a big uphill battle, I said to myself.
Keito Ortiz Training Coordinator PHC: i've got to pitch this to management i've got to pitch this to these crews out here, where it's going to be something that's going to be.
Keito Ortiz Training Coordinator PHC: everybody's going to get something that they want, and I really thought hard it took me another few months to figure out where I wanted to be.
Keito Ortiz Training Coordinator PHC: And then I had this massive Aha moment.
Keito Ortiz Training Coordinator PHC: So this annual a hot this annual credentialing program was created and actually we call it skills, update and that was created a few years back, and I said to myself well how do I get people to want to do skills update.
Keito Ortiz Training Coordinator PHC: what's in it for them, Ms providers want to know what's in it for them, what do they get out of the deal.
Keito Ortiz Training Coordinator PHC: And that was a big trouble together so skills update initially started out with the focus on the adult education.
Keito Ortiz Training Coordinator PHC: was focused on adult skills adult adult adult and it was hard to get people to shift over to listening to pediatric education.
Keito Ortiz Training Coordinator PHC: And again portion of this was because a lot of the material that was out there when I started doing pediatric education about eight years eight or nine years ago wasn't really readily available as it is today the equipment was there, but it's almost laughed upon when you utilized it.
Keito Ortiz Training Coordinator PHC: From airway management from transportation devices to to just general ideas from even.
Keito Ortiz Training Coordinator PHC: Some of the emergency pediatric care programs, and so on and so forth, so I had to really pitch hard to get everybody on board and took me a long time, so I said to myself well how do I get these guys on board.
Keito Ortiz Training Coordinator PHC: I really thought hard again.
Keito Ortiz Training Coordinator PHC: I needed to change the culture of how people thought.
Keito Ortiz Training Coordinator PHC: And so what I did was.
Keito Ortiz Training Coordinator PHC: I worked really, really hard with management and we got the New York state, specifically the need the CME based rooms fresher program was really not developed as it is now, it is extremely develop New York state.
Keito Ortiz Training Coordinator PHC: Most states US National registry your state does not, and so we had to I had to come up with a plan to figure out how to get people on board with what I needed some time.
Keito Ortiz Training Coordinator PHC: So, like what skills update I pitched it to them like this hey we're going to get them some pediatric see me hours.
Keito Ortiz Training Coordinator PHC: we're going to get you some pediatric skill assessments done we're going to get you guys not having to take the New York state exam every three years.
Keito Ortiz Training Coordinator PHC: So this is a win, win for everybody involved I then said, my pitch it to the paramedics who are out there, I said hey, how can we get you guys to come inside and do some more education, I said well how about we do some empty classes.
Keito Ortiz Training Coordinator PHC: Maybe emergency pediatric care classes and pH DS.
Keito Ortiz Training Coordinator PHC: And it will they are all going home for it, so I use a lot of the MC classes, specifically the PC classes to really drill in pediatric education, I then said to myself well how do I get more paramedics involved with.
Keito Ortiz Training Coordinator PHC: Changing that culture of from loading loading and going to I don't want to know about pediatrics to get in just getting them on board.
Keito Ortiz Training Coordinator PHC: So then ramped it up a little bit higher I said okay hey listen, you want to do senior research with the hospital, because nobody wants to take the exam anymore, I said well you're now going to have to do a CLS vcs and pals.
Keito Ortiz Training Coordinator PHC: At the time, it was not a requirement now it is a requirement, but when I started pals was not a requirement, so now forced every paramedic who wanted to certify to get their pals card.
Keito Ortiz Training Coordinator PHC: This was beneficial to the network, because the network didn't have to pay it be beneficial to the individuals, because the individuals to now go ahead and.
Keito Ortiz Training Coordinator PHC: recertified utilizing a seeming risk for certification program versus having to take an exam I was extremely happy everybody was happy.
Keito Ortiz Training Coordinator PHC: So then i'm looking at my mercy pediatric care and I, my background really isn't Ms education, but it really focuses on high fidelity simulations I love simulations.
Keito Ortiz Training Coordinator PHC: I love in situ simulations or in situation I love taking the equipment outside in a structured learning program with true simulations with truth things that people see every day.
Keito Ortiz Training Coordinator PHC: and putting them to work.
Keito Ortiz Training Coordinator PHC: So.
Keito Ortiz Training Coordinator PHC: PPC or the mercy pediatric care program I took them I am everything up, we went inside the classroom we did all of our didactic material in the classroom.
Keito Ortiz Training Coordinator PHC: And we drilled it down outside with skills so everybody had almost I would say six hours of skills skill of the skill after school after school after school.
Keito Ortiz Training Coordinator PHC: drill after drill I would take the mannequins I would put them we would use to pleased we still use today we use the parking lot.
Keito Ortiz Training Coordinator PHC: We use cars in in our private parking lot we use cars and are in different positions I have.
Keito Ortiz Training Coordinator PHC: Multiple different types of vans from van to a cargo van to a regular car utilize those for these drills I take the mannequins i'll put them underneath the car which.
Keito Ortiz Training Coordinator PHC: Is a little dirty but everybody's used to it, have to put signs up because we have a lot of people walking by saying oh my God.
Keito Ortiz Training Coordinator PHC: there's a bunch of US providers that was a lesson learned, by the way, 911 was called on us because.
Keito Ortiz Training Coordinator PHC: people thought there was an actual event occurring not realizing that this was a drill so I had now go back and put signs up it cause a bit of a fiasco that I had to answer to, but it was just a learning lesson for me and for everybody involved to to make things better.
Keito Ortiz Training Coordinator PHC: So currently when we do run our our mercy pediatric care program courses, we do with them outside rain or shine so everybody's instructed to come with their equipment to be prepared to be outside rain or shine.
Keito Ortiz Training Coordinator PHC: Yes, I do try to plan it on days when the weather is not bad, so people are not to cranky but the overall people are extremely enjoyable of the class and they love it.
Keito Ortiz Training Coordinator PHC: We do a lot of airway management processes, we have the mannequin what i'll do is i'll take the mannequin head mannequin body.
Keito Ortiz Training Coordinator PHC: And i'll flip it upside down so now they they're integrating a pediatric and inverted position or or instead of Chelsea.
Keito Ortiz Training Coordinator PHC: I take the QC PR mannequins outside and we go outside we do that, outside as well, so.
Keito Ortiz Training Coordinator PHC: it's a lot of prep on my end, but I think at the end of the day, I think it's extremely worth it, and and and for anybody who wants to do stuff like this it does require a little bit of work but it's definitely worth doing it.
Keito Ortiz Training Coordinator PHC: So.
Keito Ortiz Training Coordinator PHC: This is the biggest on how do I know it even works, what do I know i'm a trainer i'm an educator how do I get how do I know if people are actually understanding what's being asked of them, how do I know if they're actually applying the information given to them.
Keito Ortiz Training Coordinator PHC: wow that's The big question So how do you know what you're doing.
Keito Ortiz Training Coordinator PHC: What I did was I went outside and I talked to the cross.
Keito Ortiz Training Coordinator PHC: I actually.
Keito Ortiz Training Coordinator PHC: interviewed crews after call I spoke to them.
Keito Ortiz Training Coordinator PHC: It gives you all they parked.
Keito Ortiz Training Coordinator PHC: At our at night or crusty locations, because we sit on a street corner dental Center firehouse in New York City actually physically on the street.
Keito Ortiz Training Coordinator PHC: I would send out surveys, a lot of surveys and I would physically just talk to people talk to people and say hey do you think it's working for you, how does it feel for you do, you get it, you get it, you get it, what can I do to make it better for you.
Keito Ortiz Training Coordinator PHC: On top of that what we do in the back end is we have.
Keito Ortiz Training Coordinator PHC: Quality Assurance water watching the ACR as well as.
Keito Ortiz Training Coordinator PHC: Identifying calls that need to be looked at, specifically from individuals, so I do look at when I call is captured for that specifically i'll say this i'll look at the ACR.
Keito Ortiz Training Coordinator PHC: And I have to try to dissect it because I don't want the crews to feel like i'm picking on them or or that they can't come to me I want them to understand hey listen.
Keito Ortiz Training Coordinator PHC: i'm coming to you and I look at your ACR and I can see you having a stressful call.
Keito Ortiz Training Coordinator PHC: And I see that you wrote this can you explain to me why you wrote that and can you explain to him what he did first is what you wrote, because sometimes what I find was there was this massive disconnect and and I gotta tell you it.
Keito Ortiz Training Coordinator PHC: Crews now can run cardiac arrest ACS be see less and less they run the medics name teas are running cardiac arrest on a very comfortable level, personally, I can run a pediatric cardiac arrest on no more comfortable level.
Keito Ortiz Training Coordinator PHC: The empties here are so much more comfortable teach treating treating as maddox treating epic as managed epinephrine and nebulisers the medics oh it's a it's a complete flip from where we started to now it's a complete flip and i'm very happy that I was able to make that change.
Keito Ortiz Training Coordinator PHC: So that's pretty much the end of my Program.
Keito Ortiz Training Coordinator PHC: I invite everybody asked questions.
Keito Ortiz Training Coordinator PHC: And please do.
Louis Gonzales: Thank you keto very good presentation.
Louis Gonzales: I know i've got a list of questions, but I want to see does anyone else have any questions you're welcome to unmute and ask your question directly to Quito.
Louis Gonzales: Or you can put it in the chat box either way.
Juliana Soriano: How you doing this is Brian brown or from my chest, the fire department's.
Keito Ortiz Training Coordinator PHC: yesterday.
Juliana Soriano: afternoon i'm just curious um so I have just been.
Juliana Soriano: given up to become a peck at just the fire department and i'm completely clueless on it, and my question is where you assigned that job or was there, like a.
Juliana Soriano: Like a running for everybody to actually do that position if there's something that you just inspired to do.
Keito Ortiz Training Coordinator PHC: So yeah i'm welcome aboard first of all congratulations and taking a big step is your organization of volunteer or paid service.
Juliana Soriano: it's a paid service.
Keito Ortiz Training Coordinator PHC: Okay there's that and that's interesting Virginia right.
Juliana Soriano: Yes, it is.
Keito Ortiz Training Coordinator PHC: I love Virginia beach i'm there every year.
Juliana Soriano: yeah.
Keito Ortiz Training Coordinator PHC: Well, so beautiful place.
Keito Ortiz Training Coordinator PHC: So I love that place I love Chesapeake Bay I love it, I actually found out fairly recently that people pay other people to drive across the Chesapeake Bay bridge which I had no idea.
that's sure.
Keito Ortiz Training Coordinator PHC: So I was very shocked by that I was like really okay so i'm going to give you my email my personal email address if if anybody has any questions I will give you a sexually first name and last name at gmail COM, which is K Ai to or tea ice it gmail.com K to or to z@gmail.com.
Keito Ortiz Training Coordinator PHC: So, to answer your question um I was initially part of the like the setup group, where the month and I guess you'd call a discovery group in New York state, and I was called to it personally as a parent.
Keito Ortiz Training Coordinator PHC: of two or three young very young girls my kids are out of their minds, they do crazy things and I felt like you know I look I said well.
Keito Ortiz Training Coordinator PHC: What what kind of education out, then I realized, it really is none, and I felt called to just do it and initially.
Keito Ortiz Training Coordinator PHC: My director wanted somebody else to do it.
Keito Ortiz Training Coordinator PHC: I had to sit and have a chat with them and say hey listen, you know, this is my passion, this is where I want this, what I feel that we have to do i've got ideas and and I can make it happen, and he said okay and that's how I ended up being 43 agencies.
Wonderful good.
Juliana Soriano: Though i'm still in the midst of maybe 10% of where you are right now.
So.
Juliana Soriano: i'm seeking out other PICs in the area, I noticed there's a lot of efficiencies.
Juliana Soriano: This this This collaboration is actually helping you I quite a bit I kind of see pre hospital care more than i've been in hospital and I find that the, it is definitely making an effect and one of the things I liked about your slide is the culture.
Juliana Soriano: yeah It is absolutely the biggest thing I have a hard time right now is the culture of the salty senior medics to do not want to do pediatrics because I think they're afraid.
Keito Ortiz Training Coordinator PHC: That if you're 100% correct hundred percent yeah hundred percent sorry to cut you off, but.
Juliana Soriano: yeah well, I appreciate you presenting and I think you're you got some good stuff and I hope to connect with you via email, and maybe pick your brains, a little more.
Keito Ortiz Training Coordinator PHC: Absolutely listen just don't worry about it, I have don't if you feel you need to create content asked me first probably I more than likely already created the content and i'll gladly share it with you.
Keito Ortiz Training Coordinator PHC: I have no issue sharing content.
Juliana Soriano: Thank you so much, I appreciate it.
Keito Ortiz Training Coordinator PHC: Welcome aboard.
Louis Gonzales: keto one of the questions that's in the chat box now and you don't do this right this incident, but there's a request, if you could share your contact information in the chat box for others as well, some are here, that would be great.
Actually.
Keito Ortiz Training Coordinator PHC: Oh hi Donna.
Keito Ortiz Training Coordinator PHC: I know Donna going on, I know that name.
Keito Ortiz Training Coordinator PHC: Right now yeah email me please.
Louis Gonzales: just another question for you know kind of related to the last question early on in your presentation, you talked about having to get buy in first, which certainly is always.
Louis Gonzales: An important first step and it's sounds like that was largely with your.
Louis Gonzales: Your actual practitioners, did you did you have any challenges with buying from your leadership or administration to do what you love to do.
Keito Ortiz Training Coordinator PHC: You know Lewis that's a great question yeah it took me a long time to get management to buy into it.
Keito Ortiz Training Coordinator PHC: Where we are an underserved facility so.
Keito Ortiz Training Coordinator PHC: Money for us is extremely tight, so I had to be extremely creative about how I do my my my education for pediatrics.
Keito Ortiz Training Coordinator PHC: Part of that what I did was I sold it on hey listen boss, I can switch some of that time from adults, when we do our annual competencies.
Keito Ortiz Training Coordinator PHC: switch some of that time to pediatric trauma education, specifically, and he said Okay, and as and as long as it did not cost more time.
Keito Ortiz Training Coordinator PHC: And I was able to accomplish all the goals that I really needed to accomplish us fine fine with it, but it took a long time to get them to buy in I just kept going and going and going and showing them data and showing him installation and, finally, he bought into it.
Louis Gonzales: Great Thank you very much, any additional questions i've got a couple more, but I don't want to monopolize things so any additional questions.
Louis Gonzales: All right, let me ask you something keto I really liked that one of the things you talked about is what i'm a show on K talks about as well.
Louis Gonzales: And that's about you know getting feedback and it sounds like one of the things you did was he went right out to the cruise and.
Louis Gonzales: And spoke with them to get their feedback and do do you have you know any any tips for others about you know, the best way to set that up, and of course I realize it varies depending on the.
Louis Gonzales: The construct of your Ms organization and whether it's you know, in a large city very rural area very remote area all those things that but any specific tips that you want to offer in terms of how to do that seeking feedback from your crews about the training and competencies.
Keito Ortiz Training Coordinator PHC: Oh yeah there's a lot, so a couple of things that I encountered actually i'll be frank with everybody on here it It ranges from everything from personality to I don't like you to I want to be, I want to help you to.
Keito Ortiz Training Coordinator PHC: To I want to know, but I don't want to know to hey man whatever you want me to do I don't really care i'm here on the clock.
Keito Ortiz Training Coordinator PHC: And because we are a union organization and to find that balance so I like I said by sending out the surveys and I made it I put it out on our Ascension Program.
Keito Ortiz Training Coordinator PHC: I said hey if you want to let me know, let me know and and I put it out on my personal Google survey, I put that out as well, I gotta tell you.
Keito Ortiz Training Coordinator PHC: Out of 325 people I had over I would say 4050 replies which is not bad, in general, and then I went around physically talk to people and I went you know.
Keito Ortiz Training Coordinator PHC: Thank Louis even one further I wanted to the emergency rooms and I spoke to the er nurses and I asked them how is the handoff between Ms.
Keito Ortiz Training Coordinator PHC: And pediatrics with you how is the handle with your traumas with us what education, do you think we need and what education, would you like from us because again nurses don't really know what we do your nurses don't know or half of our equipment.
Keito Ortiz Training Coordinator PHC: So I physically it took me a long time again, some of the salty or nurses were like get the hell out of here I don't need you, and some of the other nurses were like sure show me.
Keito Ortiz Training Coordinator PHC: and tell me, and then they kind of hold them the Ms crews accountable for what they learned, it took a little bit of time and it's an ongoing process because right now, healthcare, clearly, is a high turnover.
Keito Ortiz Training Coordinator PHC: So it's a very ongoing process, specifically, now that we're having I find this issue less with the newer people who are a little bit more receptive than the people who have been here for a long time, who are very salty.
Louis Gonzales: Very good, thank you very much Kato.
Louis Gonzales: I I certainly understand what you're talking about there is especially in terms of the.
Louis Gonzales: Those with a few more years and doing this.
Louis Gonzales: Sometimes there's a tendency to resist some teams, such as in that.
Louis Gonzales: And those are really good good tips of of looking at the specific personality of the individuals and certainly knowing them and developing those relationships certainly helps and that's where i've packed certainly has a critical role is knowing those a little bit better.
Louis Gonzales: understanding what you just how to speak with them, depending on who they are.
Keito Ortiz Training Coordinator PHC: Yes, it took a long time for me to figure it out, because there are some people who are cut and dry and there's others who want to have this long dialogue over coffee, so I had to kind of mix and match it to make it work.
Louis Gonzales: And one last question unless someone else has one before we jump to the next thing any other questions for Quito there's a question actually there's a discussion or just started on the chat about specific pediatric mannequin and.
Louis Gonzales: I don't know if that's for a specific purpose.
Louis Gonzales: or for any specific type of mannequin.
Keito Ortiz Training Coordinator PHC: Okay i'm looking at the shutdown boots just pulled up so so yeah, thank you for putting on I told you about chat groups to kind of distract.
Keito Ortiz Training Coordinator PHC: I have learning disabilities, so I have to stay focused.
Keito Ortiz Training Coordinator PHC: So i'm high fidelity mannequins I used a little mannequins for those I have some why we're doing really down and dirty work I have some really beat up older mannequins and waited and waited and malleable I tend to use those to.
Keito Ortiz Training Coordinator PHC: To go outside in the dirt I want to have to take the high fidelity mannequins outside of cringe a little bit because they're expensive and their hardest to clean.
Louis Gonzales: very true, especially the expensive part.
Michelle Murphy: I just have a quick question with regards to how frequently we do these different training sessions are, how do you track or the quarterly.
Michelle Murphy: monthly yearly and then, how do you track.
Keito Ortiz Training Coordinator PHC: who's participated in.
Michelle Murphy: A large staff.
Keito Ortiz Training Coordinator PHC: sure you know what let me.
Keito Ortiz Training Coordinator PHC: i'm going to show you my master spreadsheet here.
Keito Ortiz Training Coordinator PHC: For a second, so what I do okay so everything right now is way off because of covered so i'm going to pull it up and show you and then i'll hide.
Keito Ortiz Training Coordinator PHC: This name so nobody knows she's the names.
Keito Ortiz Training Coordinator PHC: Okay, so um.
Keito Ortiz Training Coordinator PHC: let's see here.
Keito Ortiz Training Coordinator PHC: Okay, you should be able to see the my spreadsheet so I have this massive spreadsheet it's it's literally about 15 meg's for a spreadsheet is pretty large and I track everything.
Keito Ortiz Training Coordinator PHC: Every individual gets tracked every class they attend gets tracked, and this is something I do to constant rolling thing.
Keito Ortiz Training Coordinator PHC: We do have a learning management system and I try to push everything I can on to the learning management system.
Keito Ortiz Training Coordinator PHC: I try to shift right now, especially with cousin I try to push all the didactic on tune the learning management system.
Keito Ortiz Training Coordinator PHC: and try to do skills focus on skills in person, as they should be, and and shift that didactic on to learning management platform.
Keito Ortiz Training Coordinator PHC: When it comes to annual skills again it's an annual thing that's costly going right now we're on pause because New York is really having a hard time dealing with the coven recurrence but i've got my fingers crossed I will have a start up in the second quarter of this year.
Keito Ortiz Training Coordinator PHC: I think everything in quarters and I store like I said I store all the data all the classes, that people attend my spreadsheet is actually i'm prepping it for 2022 So you see a lot of blanks, but when I go through, as I go through the year it gets filled in sequentially.
Thank you sure.
Keito Ortiz Training Coordinator PHC: Is that.
Louis Gonzales: vm additional questions for Quito before we shift gears and and talk more broadly.
Louis Gonzales: Alright, well, I think all of you, hopefully, you saw kido'z contact information in the chat box.
Louis Gonzales: And it sounds like he's pretty open to hearing from you, so we appreciate that you know we appreciate your presentation.
Louis Gonzales: So just kind of shifting and actually building upon what what ketones already talked about.
Louis Gonzales: we've talked about over the last few weeks, you know different kinds of approaches different kinds of key drivers towards improving pediatric emergency care.
Louis Gonzales: And the idea of this particular session right now but we're doing now and which.
Louis Gonzales: is to.
Louis Gonzales: share some specific examples or experiences of how others use the process of improving what tools they use what they learned what didn't work well you know what worked well.
Louis Gonzales: And this is also the time for you guys to share your experiences so in terms of.
Louis Gonzales: aim statements or fiduciary especially you think about face to or measurements that by either one that you guys would like to what are your thoughts on some specific needs some specific measurements for.
Louis Gonzales: Training, and more specifically competencies and competency verification anyone have any experience or share your your ideas of what you do currently that's worked well, or maybe didn't work well.
Louis Gonzales: competency verification measurement, how do you measure it.
Louis Gonzales: Are you guys ready to mess guys, I know that you're not shy, it will be less people so.
Louis Gonzales: If you recall what what.
Louis Gonzales: Kate and.
Juliana Soriano: Michelle.
Louis Gonzales: talked about in terms.
Of.
Louis Gonzales: measurement that could be you know measurement of just cognitive kind of measurement so that's just maybe maybe testing of knowledge.
Louis Gonzales: Self assessment and talked about feedback, like the keto talked about simulation like you talked about maybe chart audits.
Louis Gonzales: Maybe it's it's skill verification on on hands on equipment utilization.
Louis Gonzales: So if you have any anything that have worked well for you there or didn't work well lessons you learn we share those let's see what we see here Lisa.
Juliana Soriano: i'd like to share something with that.
Louis Gonzales: Yes, please do.
Juliana Soriano: So it's a bra strap I got from Chesapeake, so we are we we use industry which is electronic PCR.
Juliana Soriano: i'm i'm going to share more difficulties about it more than the success of it so every month every Monday I get a pediatric list of all the calls that we've had for for for that for that week and.
Juliana Soriano: When normally do is I I open up all those PPC ours that are kind of interesting that I think that are kind of need to be focused especially the unusual ones and.
Juliana Soriano: documentation is probably I mean like I said it's just it's just my tech program is just in its infancy so i'm still going to sort out but with accessibility, the PPC ours.
Juliana Soriano: I think sometimes documentation is the issue is like when they do like integration of pediatric you know, some people might not say that.
Juliana Soriano: You know the first attempt was actually a first attempt know so your data is kind of toward so we do have a QA program and he's the one that sends it to me every week, so I kind of.
Juliana Soriano: You know, we do have audio recording on the light pack 15 that we use, we still have not been videos I don't know what the you know that's that's cares a lot of providers, when you start doing that.
Juliana Soriano: When you start showing where we're we're deficient they start getting kind of hesitant on being open minded to you.
Juliana Soriano: And, even with the PCR it's only as truthful as the author itself so, and if you've ran 10 or 15 calls sometimes you know it's not very accurate.
Juliana Soriano: So follow up on all the calls is actually really important I know keto was saying that he actually did physically follow up on a lot of these calls, and I think it's a tremendous.
Juliana Soriano: You know effort on his end I actually do that I find that.
Juliana Soriano: That might be one of the first thing that I do as a pack is actually physically go up there i've only done it occasionally because we're such busy agency probably not as busy New York, but.
Juliana Soriano: Being a single person it's still very difficult, so I was kind of reaching out to you know how else do you guys find you know where are you where are we lacking, you know where where do we need to focus, you know, based on you know.
Juliana Soriano: The the data that we see.
Louis Gonzales: So excellent points anyone else, let me ask the question here, and you just made a really good point and one that i've experienced as well as.
Louis Gonzales: How many of you have had that happen, where you reviewed a chart or someone you work with reviewed a chart, then you go talk to the crew and you find.
Louis Gonzales: That didn't happen exactly the way it was in the in the chart.
Louis Gonzales: Is is that a common thing.
Jason Mahoney CCPH: Now this is Jason mahoney up in Montana, I do a QA QA for rural Ms agency and I get the feeling that that happens all the time i've seen it in my own practice when I worked at a Mr in a larger operation.
Jason Mahoney CCPH: I think a lot of folks tend to kind of clean up the the progress and the things that happened on it all in the document it.
Jason Mahoney CCPH: Because they're worried about getting being to the QA July process or looking.
Jason Mahoney CCPH: Not as.
Jason Mahoney CCPH: appearing as not as competent as they think they are those sorts of things.
Jason Mahoney CCPH: yeah i'm not sure how to get around that you don't want to create an atmosphere where people are telling on their partners or things like that I grew a lot of morality things, but I think it can be a problem, sometimes.
Stephanie Ashford: This is stephanie from St Charles county I want to.
Stephanie Ashford: Address something Jason just said and it's about the, how do you get around that.
Stephanie Ashford: One of the things we did a few years was probably five or six years ago, as we and implemented just culture in our system for non punitive error reporting and so telling on your partner becomes you know non punitive if it was human error or even.
Stephanie Ashford: The second level there's like three levels within the just culture algorithm.
Stephanie Ashford: You know, and then it gives the leadership a chance to address the root cause analysis, we had a literally, we had a pediatric one of those a few weeks ago.
Stephanie Ashford: Where a crew was having an issue with the vials of first said the vials were broken, or they weren't working right.
Stephanie Ashford: And so they went their their entire narc box, full of verse at and use like five of them on a call they didn't give five to the patient.
Stephanie Ashford: But they were worried that we're going to get in trouble, because they messed up the narc because you know you can mess up someone's life but don't mess up in our blog right.
Stephanie Ashford: But because of the just culture algorithm being in place, there was no punishment, because ultimately the crew did what was best for the patient, which was stopped the seizure.
Stephanie Ashford: It was really just a problem with the needles and we were able to come up to a system issue where the needles were too large for the vials that they were trying to access.
Stephanie Ashford: And we were able to actually improve the system based on this problem call that you know ahead, they work somewhere that didn't have just culture, the person probably would have been disciplined and or fired.
Louis Gonzales: very good point stephanie and I appreciate you bringing up just culture it's very important especially We certainly see it in the in the Ms world so appreciate you bringing that up and the example.
Louis Gonzales: So both of you Jason and stephanie actually bring up to potential improvement opportunities, maybe not in your organization, but in someone's organization stephanie you bring up an excellent one, which is improvement on the on the level of.
Louis Gonzales: striving towards just culture and making things non punitive because that's how we learn.
Louis Gonzales: And Jason brings up another really good point which is about chart review and I think Jason asked the question.
Louis Gonzales: Of what, how do you kind of get around this idea of is kind of cleaning up the chart to make it to where I don't you know get in trouble, and that type of thing which really is an improvement opportunity to find ways to.
Louis Gonzales: chart what really occurred as best we can, so that we can learn from that and and that fits handed him what's definitely talked about it, which is the just culture part but it's really an improvement opportunity to to.
Louis Gonzales: To help us to understand how we can improve things, but if the chart doesn't represent what really happened it's hard to improve very good points, thank you both anyone else.
Louis Gonzales: have anything on that topic as well.
Stephanie Ashford: I did want to make another comment about measurements and training, because.
Stephanie Ashford: i'm an educator in my soul, but my job is actually quality and safety that our organization, and so I have sort of a foot in both worlds.
Stephanie Ashford: And one of the measurement strategies we use with training, as we follow the kirkpatrick model for training evaluation I don't know if anyone is familiar with it on the call, but it has.
Stephanie Ashford: four levels of measurements for education right everybody captures probably the first two levels, which is reaction.
Stephanie Ashford: So, like did they like it, you know they were they rate you on a scale of one to five, and they give you, you know five stars highly recommend or not.
Stephanie Ashford: next level is knowledge, which is the you know, cognitive assessments, the checklists the even observations can be considered knowledge, you know you can measure knowledge with that.
Stephanie Ashford: The other two are things where I get to partner up with training and that's for to measure behavior change you really have to go into.
Stephanie Ashford: The chart review and find did they perform the thing in real life that we taught them in training.
Stephanie Ashford: And then the other one is outcome or results level evaluation and that one takes a lot longer to get Ahold of but we've.
Stephanie Ashford: Developed some pretty solid relationships with our hospital partners so that if it's a really important training rollout we do follow patient outcomes and link it back to the training so that we can deliver that sort of executive summary of those four levels to say.
Stephanie Ashford: You know they liked it they learned it.
Stephanie Ashford: They did it and here's what happened.
Louis Gonzales: And it's very interesting stephanie I have a question for you.
Louis Gonzales: i'm gonna have to go look up the kirkpatrick model, I certainly have a background in education as well, but don't i'm not familiar with that so you're you're suggesting it's very, very helpful.
Louis Gonzales: I do have a question of the last level, you talked about which really kind of the more the outcome types of measures.
Louis Gonzales: There are a couple ways of looking at outcome, one is to to get the outcome, meaning the performance that you expected or desired.
Louis Gonzales: Of the person meaning me as the paramedic performed, as I was expected to which is a little different than the outcome for the patient, of what we'd like to have happen for the patient.
Louis Gonzales: So, so do you guys measure both or does it depend on the situation.
Stephanie Ashford: So in the four levels, the second level is knowledge and so learning outcomes, we would we in our system we pair that learning outcomes within the knowledge level.
Stephanie Ashford: It now you could interpret it a little bit different if you, especially if you were doing like an entry level student.
Stephanie Ashford: kirkpatrick package you would probably format different, but when i'm talking about you know professional education for practitioners.
Stephanie Ashford: I linked the behavior level and the knowledge level to actual patient.
Stephanie Ashford: You know, did they perform it on the patients and results did the patient receive the you know, for example, we have a peach pit crew program and so you know, did the pediatric survive to discharge, you know it takes us a little while to find those results, but ultimately we like to.
Stephanie Ashford: link those up at the end.
Louis Gonzales: and hopefully on this topic, this measurement topic we've been discussing it internally here among that the the collaborative team here about when or how to touch on the measurement part because that by itself, we could spend days talking about it's a very complex issue.
Louis Gonzales: But it is important and stephanie raises some really good points, and we can maybe talk about it in the q&a portion, which is in March, at least touch on it, some, but it is important that, when we look at measurement that we we look at the potential for unintended consequences.
Louis Gonzales: I, like you, stephanie spent the last 13 years in quality and peace and safety for tms system, and one of the things I learned the hard way was.
Louis Gonzales: To.
Louis Gonzales: to separate, or at least recognize the disadvantage of patient outcomes and because we know outcomes patients may have poor outcomes, regardless of.
Louis Gonzales: performance, so I really focus more on on performance that's why I asked you the question but patient outcomes are important because that's what the patient cares about the most severe the patient, you want a good outcome that's certainly what I want so.
Stephanie Ashford: So sometimes sometimes like for P pit crew is a perfect one, because almost never do we have a great outcome we've had a couple but.
Stephanie Ashford: When kids die in the field, they don't very often come back.
Stephanie Ashford: But some of the other outcomes, we look at our.
Stephanie Ashford: Less binaries like did the crew come back to work, you know, because sometimes that kind of call will wreck your career and you'll quit you know, did they show back up to work, did they you know.
Stephanie Ashford: seek counseling you know, like sometimes they'll text me and they'll say I could hear your voice in my head talking me through this scenario, and so we'll track that as a wind, you know.
Stephanie Ashford: it's it's not as binary and discreet, as you would have for those other measures, but we still consider it as a results level, you know they.
Stephanie Ashford: They saw they found closure after the call, and you know they showed back up to work and so again the results level is not something you get on every type of training, you do.
Stephanie Ashford: But on the big important ones you, you want to think about what kind of results, will you consider a success and plan your training accordingly.
Stephanie Ashford: Like if I know that i'm never going to you know we run six peed codes a year so it's like you know you can't capture a ton of data on that, but if I know that i'm going to have these really nebulous outcomes I plan on it, I plan on what can what am I gonna look for as a success.
Louis Gonzales: That it's good that you're looking at a broader perspective on outcomes, I, like the one about looking at the impact on providers afterwards so that's that's a really good.
Louis Gonzales: example of of where we don't look and you put it very well stephanie i'm not looking at just one.
Louis Gonzales: measure which is also why sometimes when you create an aim statement if you're looking at quality improvement kind of project to keep it very specific and very tight.
Louis Gonzales: So the term measures are more more focused on very good and you wouldn't have anything else any other good experiences on on work board lessons learned on training, your competency verification measurement or.
Louis Gonzales: are just because i'm curious and you don't have to commit anything because meredith will send you a survey here later is Is anyone.
Louis Gonzales: In this group planning first wedding to continue on to phase two and, if so, is training or competency verification something you're thinking about in terms of your quality improvement project.
Louis Gonzales: Yes, right here, yes, see yes from Giuliana great.
Louis Gonzales: But something to think about, because it is a challenging one, though in Quito certainly demonstrated that it's it's complex at times and takes a lot of work.
Louis Gonzales: And it can be costly so it's a tough one um but sometimes you can just take small little chunks and you can maybe get get some improvement.
Louis Gonzales: And quarterly competencies I like that that's brad.
Louis Gonzales: So Lisa so it sounds like you guys are doing an annual competency verification as well for pediatric skills Is that correct.
Louis Gonzales: I think that's that's your answer to that so that's good, so I see some of you are doing that I guess airway I O and some type of scenario okay.
Louis Gonzales: anyone else, want to share we've got about five minutes.
Keito Ortiz Training Coordinator PHC: it's kiddo just going to jump in i'm looking at the comments i'm actually reading this now and we're playing some of the people.
and
Keito Ortiz Training Coordinator PHC: I gotta tell you, so I just want to put it into your heads.
Keito Ortiz Training Coordinator PHC: Up everybody's listening listen i've been a day don't kill yourself start slow and work your way up.
Keito Ortiz Training Coordinator PHC: I think that sometimes people are excited about something and I learned this the hard way.
Keito Ortiz Training Coordinator PHC: Go slow you work your way you say okay hey listen, I want to do, skills, well, should I use a national register sheets fine, you should national school suits.
Keito Ortiz Training Coordinator PHC: If that works for you, if it doesn't work for you then take them and skim them around and make them work for you.
Keito Ortiz Training Coordinator PHC: And then, like what I do personally is I use a national registry simply for New York state is not caught up to the level of education, I want to be at so I actually teach to the national registry curriculum, so I use a national registry here.
Keito Ortiz Training Coordinator PHC: Again, you don't have to go crazy I always great for your pediatrics we practice this in our skills competency we pre practice pediatric bolus removal.
Keito Ortiz Training Coordinator PHC: which a lot of medics don't get to do until they have to do it, and then we suck at it, because we have never done it before accepting school.
Keito Ortiz Training Coordinator PHC: Under under light and low stress environment so one of the simulations that I have in the mock.
Keito Ortiz Training Coordinator PHC: APC class that we do is there's a bolus and the kids in a chair in the chair now you have to go to work.
Keito Ortiz Training Coordinator PHC: Now, your stress because i'm staying on olivia and I probably have a megaphone and i'm telling you let's go, so now I try to amp up.
Keito Ortiz Training Coordinator PHC: The feeling I try to make you feel anxious, so that you feel what it really feels like to do your job and it's kind of tough.
Keito Ortiz Training Coordinator PHC: And some of the medics love me for it and other say I don't like it, but I understand what you're getting at and a lot of people and, in general, people, just like they appreciate.
Keito Ortiz Training Coordinator PHC: That i'm trying to amp up the stress level by taking that airway manic and and doing those ios out and in the situation that they're physically in under high stress situations.
Keito Ortiz Training Coordinator PHC: When they actually go to do the skill, there will tell you that it felt like they were in class.
Keito Ortiz Training Coordinator PHC: Which is where you want them to be you want them to feel comfortable if they do the school over and over again in a high stress situation when they do it in an actual true social religion or they're stressed out to them it's nothing.
Keito Ortiz Training Coordinator PHC: I don't okay so i've read i've read so i'm at my hospital we can't really we can't really do that um.
Keito Ortiz Training Coordinator PHC: So, and I don't really yell at them i'm just kind of like hey come on Come on, I kind of encourage them it's more of like a loud.
Keito Ortiz Training Coordinator PHC: sounds but i'm not allowed to do that, but you can do that again everybody has their own I find that recording people I having them watch their actions is an effective tool for certain groups.
Keito Ortiz Training Coordinator PHC: If you can't just take one one stop shopping for everybody, so in my sin classroom I do record the simulations and I show them to people who question what's being said to them.
Keito Ortiz Training Coordinator PHC: But as a whole, usually people do not question what said to them, because you know they're being recorded just accept it for what it is.
Louis Gonzales: Right, thank you, you know there.
Louis Gonzales: that's a whole other topic of recording that has some other implications on the inside, depending on your state.
Louis Gonzales: Regulation, whether you're with a PA so that type of thing, but certainly very helpful to see video and audio recordings when when possible.
Louis Gonzales: In a in a good setting I unfortunately we've had a couple situations where the video came from.
Louis Gonzales: Someone who happened to be at the scene, and it was not complimentary video of performance on a patient, so I think, seeing it in an educational setting with you guys you're talking about would be ideal um any other.
Louis Gonzales: Other things that anyone would like to share, otherwise we will close it to you and trying to read the last couple of things.
Louis Gonzales: I like that idea about collaborating it's great to collaborate with your local children's hospital, especially if they have a Sim lab that's awesome.
Louis Gonzales: You can use that it's it certainly.
Louis Gonzales: Can maybe reduce your costs, and you have access to great training facility so that's that's Nice.
Louis Gonzales: All right, well, I appreciate everyone's time Michelle did you have anything else you wanted to.
Juliana Soriano: Add it.
Louis Gonzales: To any last minute thoughts for us.
Louis Gonzales: Okay.
Keito Ortiz Training Coordinator PHC: You know how to tournament Mike I apologize.
Keito Ortiz Training Coordinator PHC: hey guys listen, a lot of stuff which said today i'm going to look up the kirkpatrick model I heard of it, I remember hearing it.
Keito Ortiz Training Coordinator PHC: In the class and i'm loving it, so I was looking up on my other screen could, thank you for that information but listen, I gave my email installations air contact me and i'll gladly help anybody.
Keito Ortiz Training Coordinator PHC: Again i'm i'm pack because I want to be the pack, not because I chose to be because I have to be, I want to do it, and I feel that again.
Keito Ortiz Training Coordinator PHC: If you're a parent, you have the responsibility to educate other Eros providers in your community, especially if you live in your Community so good luck everyone, I have a healthy health half healthy happy and healthy safely.
Louis Gonzales: Thank you, Peter Thank you everyone, and we will see you next month, if not later this month at the.
Louis Gonzales: coaching session I sorry I forgot the date I think it's the 16th somewhere around there Thank you much.
Louis Gonzales: that's all we have for today.