Walter S. Adler
Chief-of-Staff, G.C.C. Inc.
140 Nassau Street 7C
New York, NY 10038, USA
To whom it may concern,
Good day, here are some short answers to the basic, but crucial questions posed to accompany the more extensive briefings we are sending.
- How many students can be trained at a time?
With a ground a staff of a paramedic, an EMT, a teacher and two local nationals not necessarily but preferably with some teaching/ medical experience; we can train 40 students at a time over 246 hours, approximately 3 months. This presumes the students have no prior medical training and do not necessarily speak English. A larger number of indigenous national support staff, i.e. your organization providing more adjunct instructors (nurses, doctors or combat medics); the non-indigenous (extra-national) staff could train 80 students in the same period of time if a night/ day class was organized. The ideal ratio of students to instructors is 5 to 40.
- What group will be the recipient of the training?
The EMT course is designed for both civilian and military use. Therefore given the context of the ongoing Syrian civil war and the complexities of Rojava; we recommend a mixture of front line combat medical personnel, ambulance workers, hospital staff as well as civilians be selected to participate, but we place those policy preferences on your local leadership. We will be throughout the course identifying the top students and working with them to make the programs replicable past the departure of the GCC unit. If it is in the interest of the sponsoring organization we can tailor additional sessions of the course to the personnel likely to engage in military defense operations with an emphasis on the practical skills over the strictly medical curriculum.
- Would the students require any prior medical or educational background?
No, none is required or encouraged. This course is designed to rapidly make civilians professionally proficient in basic life support, prehospital care.
- What is the age range and gender demographics?
Students should be 18 years old and be approximately half male, half female.
- How big does the class room space need to be?
The classroom should allow 40 students to be seated in front of a power point projector with the ability for them to take active notes in note books. It should be shielded from the elements as best as possible and should be able to have the desks quickly cleared for drills where the 40 students are broken into units of 5-10. The power point projector requires the room to be relatively dim when lectures are being given. Electricity is required for 4-6 hours each day. A white sheet can be used as a projector screen, we can acquire and move a projector device into the country if none is available. There should be mats or drop rugs to allow students to be supine on the floor for drills and assessment training. There needs to be an open space near the class room, indoors or outdoors where the students can drill in the practical skills; a space double or triple the size of the classroom. There should be a ready source of hydration available to the students.
- For how many hours a day/ days a month will the training class run?
A standard class of 40, morning, afternoon or evening will be between 4-6 hours per day, 4-5 days a week for approximately 3 months (246 hours of training). About half of this time will be spent in a medical/ trauma lecture and half as practical skill drills and hospital rotations.
- What materials/ equipment will be needed?
1 classroom for 40
1 medical facility for observational rotations
1 open space/ field for drills
40 Stools/chairs/desk table space
1 generator/ fuel to operate it 4-6 hours a day/ 4-5 days a week/ 3 months
2 large tarps
2 extension cord cables
2 external hard drives
2 power strips
2 power point projectors
2 lap top/ desk top to connect the projector to the slides
5 large drop mats/ rugs for drills on the ground
4 equipment boxes/ gear bags
- Printing black and white exams (1 a week) (12 weeks) (4 pages) =
Approx. 1,920 pages.
- Printing skill sheets (8 skills) (40 students) = approximately 320 pages
- Printing final exams (20 pages) (40 students): 800 pages.
Printer ink to accommodate printing of exams and skill sheets on a weekly basis
Reams of paper needed to accommodate above need.
For each of the 40 students over 12 weeks an estimated 3,200 pages of exams and materials will need to print which serve as their primary review and preparation tool. The only way to reduce this kind of print volume to take exams off the screen which is time consuming, or institute a different testing system involving rote memorization fill in exams. We are flexible and accommodating to the pedagogic variations best suited to our students.
Some of this equipment can be produced or procured in country, please consult with us further about what will be completely unavailable.
Essential Moving and Assessment Equipment
10 blood pressure cuffs
10 penlights/ small flashlights of any kind
5 boxes of examination gloves
5 carrying stretchers
2 long boards (rigid body sized boards w. handles)
2 stair chair devices
5 cervical collars
10 CPR pocket face masks
10 Bag valve masks
5 CPR mannequins/ could be substituted with a large bag of rice.
5 OB-Delivery kits (sterile sheets, 2 clamps, sterile cutting tool, suction bulb)
4 portable oxygen tanks/ could be substituted with liter sized plastic bottles.
4 oxygen regulators/ impossible to substitute
4 non-rebreather masks
4 nasal cannula oxygen lines
4 sets of oropharyngeal airways/ bend metal spoons
4 sets of nasopharyngeal airways/ impossible to substitute
Dressings & Splints
10 short splints (size of forearm)
10 long splints (size of leg)
5 boxes of triangle cravats
5 boxes of 4×4 dressings
4 boxes 5×9 ABD pads
2 boxes of 2 inch tape
2 boxes of 1 inch tape
1 box multi-trauma dressings
1 box of duct tape
- What must be provided for the foreign instructor staff?
GCC instructors require the following things from the hosting organization.
- A mutual aid contract specifying the stakeholders, their roles and obligations to each other.
- Contacts or support to assist the team in transport from Irbil to the Rojava border.
- Pick up at the border and facilitation of transportation to the site of training
- Basic and secure location to sleep, wash and rest.
- 3 basic meals a day.
- A regular provided source of hydration.
- Periodic access to internet
- Extraction to the border and assistance in crossing back to Irbil.
- What translation activities must be provided?
There are approximately 43 power point slide presentations that must be translated before or during the course into Kurdish or Arabic. There are 12 exams that must be translated and 8 skill sheets. As none of the GCC instructors speak Kurdish or Arabic there must be at least 2 full time bi-lingual instructors on site, at all hours of instruction to render short spurt translation (burst per sentence) of what the EMT and Paramedic are saying. The course should be taught off the slides by these same 2 local national bilingual instructors. When a more detailed question emerges the foreign national EMT or Paramedic will assist in expanding on the topic. The third member of the foreign team an educator will be constantly working with staff and students to improve and modify teaching methods. The work load on the local national teaching staff is immense. They must teach a course in a second or third language while working to translate slides and materials. This translation process is essential to indigenous control of replication, ideally more than 2 instructors should be employed by the sponsoring organizations, agencies, governmental, non-governmental and social movements enrolled in the mutual aid agreement. The actual calculated GCC cost to implement a year of courses, four rounds of EMT training for 160 EMTs is approximately 500,000 USD. Due to the unique and exceptional circumstances of the civil war, the Rojava governate as well as GCCs broad sympathies with your people we are waiving all normative salaries. To carry out a three month course where your organization will then possess ability for replication will require a sturdy coalition of actors in mutual support and the rapid ability for you to translate the materials. This is by default going to be an operation and implementation based heavily on confidence building and trust.
- Who will ultimately certify, credential and take responsibility for the newly trained EMT personnel?
Following a procedural modal established in the Republic of Haiti; the ultimate authority over the newly trained EMTs is a nationally licensed physician in the countries ministry of health and other doctors who employ and deploy these EMTs.
The majority of the EMTs in the Rojava context will be likely deployed as combat medics and rearguard ambulance operators as well as technicians in hospitals to support existing nurses and emergency room physicians.
Whatever medical body funds and operates your healthcare system will ideally over time replicate this course using the materials we provide modified for the local contexts and epidemiology.
Certification has to occur through the primary implementing body, the group hosting the training and facilitating the class. In the Haitian context this was a major NGO Project Medishare controlling one of the biggest hospitals in the capital and Haitian American Caucus a Haitian civil society organization. The ministry of health is still evaluating the EMT title to this day, and allows EMT employment but due to the Haitian context is not overseeing the EMT training process.
Credentialing has to occur through government so once certified a political representative must push to recognize this title in country.
In practical terms these 40 new EMTs should be absorbed as needed into existing groups in the coalition with one particular group assuming ongoing training operations.
In the Haitian context and in the context of most developing nations the EMTs will either seek employment at hospitals, NGOs and ambulance groups. In the Rojava context most of these students will assume positions of prehospital care as needed in the ongoing defense of the country.