northwell paramedic program

The curriculum consists of four divisions: basic life support, trauma care, medical/environmental, and operations, and six practical skills areas: patient assessment, airway management and oxygen, bleeding control and fracture management, traction and splinting, spinal immobilization, and shock management. When applications for a course exceed the number of available seats, each applicant will be ranked in numerical order base of the following criteria: EMT Certification is determined by the date of original EMT certification until the start date of the course without gaps. NYS DOT EMT-Defibrillation License. Educational Experience is determined by the highest level of educational experience completed by the applicant. Must demonstrate competency in all EMT-B skills and equipment usage. He expects to offer more training throughout the year. Each topic is then covered by an instructor using a variety of techniques including lecture, discussion and small group activities. View Jessica Lee BSN's email address: lxxxxxxxa@northwell.edu & phone: +1-205-xxx-xx01's profile as Outpatient Program Manager at Northwell Health, located in New York City Metropolitan Area. Sea Year Physicals for medical clearance by USCG for obtaining Merchant Mariner documents and a USCG license. The Northwell Health Center for Learning and Innovation (CLI) offers training programs for both emergency medical technicians and paramedics. The secret to success in any of the NYC paramedic programs is balancing school, work, studying, and rotations. For your protection your session is about to timeout.Would you like to stay logged in? Demonstration and skill practice are integrated into the didactic instruction. For your security, weve logged you out. these higher level of care needs are provided by the highly-respected Northwell Health System at their North Shore University Hospital location . PI: Timmy Li, PhD, EMT-B Emphasis is placed on recognition of symptoms of illnesses and injuries and application of proper procedures of emergency care. Also make sure to note any extra credentials that help, like . Wrapped in moist sterile gauze, with affected fingers and toes separated. "Northwell was the first in our region to do this," Dr. Guttenberg said. tax-deductible as allowed by law. Notice of non-discrimination & accessibility. We do not offer a work service program to our students. EMS Academy. PI: Timmy Li, PhD, EMT-B Medical expenses associated with healthcare not provided by USMMA, OHS do occur and can be very costly if there is no healthcare insurance in place. The student then progresses to practical skills labs where any new skill is demonstrated, practiced and tested to standards set by NYS DOH EMS or the NREMT. An official website of the United States government Here's how you know. Conducts medical evaluations and provides care to adult and pediatric patients before and. Externships, Fellowships and Nurse Residency Programs, Perioperative Pre-Surgical, OR, PACU, Endoscopy. The free paramedic cover letter sample above does what EMT and paramedic samples need to do most. AND up to $450 per . Version 3: 167 hours (23 weeks): includes 20 hours of clinical rotation. Dr Alix Carter. Primary Coordinator: Jennifer Johnson, Social Risk Profiling in Patients Presenting to the ED with Acute Exacerbation of CHF The USMMA Office of Health Services (OHS) is responsible for the overall management of the midshipmen medical care, dental care and midshipmen emergency services. For a Northwell ambulance, call The course covers all techniques of emergency medical care presently considered within the scope of practice of an Emergency Medical Technician, as well as all operational aspects that students are expected to perform. Andrew Bartilucci Center A two-year pilot began in 2013, first focusing on geriatric members of House Calls, and then expanding to serve hospice patients. PI: Yves Duroseau, MD, MPH Full-Time. Primary classroom lecture as a form of didactic material presentation has been replaced with case-based and team-based learning assignments geared toward immediate application of concepts and practice. Version 4: August 2012 - March 2018. Learn more about the requirements and expectations of Midshipmen. Graduates of the program are entitled to sit for the New York State Paramedic Certification Examination. This comprehensive training includes simulations and clinical rotations in trauma for adults and pediatric patients. The program has surpassed the Institute for Healthcare's Triple Aim campaign to improve patient health, patient satisfaction and lower the cost of care, according to Mr. Washko. They definitely are one of the top garages to work in within the NYC area, and probably the top garage to work for in all of Long Island. Once you have completed the NYS Paramedic Program the student will sit for the New York State Certification Examination. Generally, community paramedics' response time is 21 minutes, and time spent on-site is about 70 minutes, she added. Please choose another page from the menu. High school diploma, certifications of completion, GED, or transcripts, and college transcripts, : provide copies of all applicable documents, Valid Drivers License, State Issued Identification Card or Valid Passport. Bernard Robinson, CCEMT-P, is an operations manager of the Center for Emergency Medical Services, overseeing the daily operation of one of the largest EMS agencies on the East Coast. *Please select location from the dropdown, Peconic Bay Medical Center Patient Care Technician and Unit Secretary Technician Interview Day Thursday, March 2, 2023, Physician Assistant and Nurse Practitioner Interview Day Wednesday, March 8th, Huntington Hospital Nursing Assistant Interview Day Thursday, March 9, 2023, Mather Hospital Nursing Assistant Interview Day Tuesday, March 14, 2023, Get to Know Northwell Interest Session Thursday, March 16, 2023, Plainview Hospital and Syosset Hospital Nursing Assistant II and Nursing Technician Interview Day Thursday, March 23, 2023, South Shore University Hospital Nurse Attendant Interview Day Tuesday, March 28, 2023. Professional Liability Insurance: Students must maintain professional liability insurance for paramedic students throughout the Program, and furnish proof thereof to the clinical rotation sites through the clinical coordinator. Please note that all salary figures are . MEDICAL DIRECTOR, CHILD AND ASOLESCENT PSYCHIATRIST . Terrance graduated from nursing school in 2019 and accepted a position as a Medical/Surgical nurse at North Shore University Hospital where he continues to deliver compassionate care to his patients. We strive to mirror the information as if it was being presented in a medical school setting. All rights reserved. (833) 259-2367. Version 2: 151 hours (22 weeks): includes 10 hours of clinical rotations. Job Qualification. Externships, Fellowships and Nurse Residency Programs, Perioperative Pre-Surgical, OR, PACU, Endoscopy. 2018 - 2019 Completed 10-month didactic instruction in paramedic skills, anatomy/physiology . Demonstration, practice, and clinical observation are carefully integrated into the didactic portion. "But we found that when our community paramedics respond to an emergency call, House Calls patients can receive treatment safely at home about 80 percent of the time." By obtaining the qualifying Student Health Insurance Plan (SHIP) that meets the Academys minimum requirements. Kings Point, NY 11024 Community paramedics, however, share decision-making with the patient or caregiver, plus a telemedicineconnected clinician. Must be capable of utilizing all EMT-B and AEMT-intermediate skills and equipment. To meet the needs of all the departments throughout the health system, CLI offers numerous programs and services. From Manhattan to Montauk, CEMS dispatchers track nearly 35 ambulances handling close to 150 assignments each day. About the EMCRT. This course covers all techniques of advanced emergency medical care presently considered within the responsibilities of the paramedic as well as all operational aspects of the job which students are expected to perform. Version 3: 93 hours (maximum; actual number determined by results of initial challenge exam). We've detected you may have a slow internet connection. Northwell Health's Department of Behavioral Health is seeking a BE/BC Psychiatrist to help lead the Child and Adolescent Psychiatry Service Line at South Oaks Hospital located in Amityville, New York. That's where community paramedics come in, right through the front door. Using her newly developed skillset, Mariel is able to deliver a different kind of care as a senior clinical appeals RN in the Centralized Denial Office. The Emergency Medical Institute is New York's premier emergency medical education venue. Upon successful completion of the course final written examination, the student will be able to progress towards the NYS practical examinations and the National Registry Examinations. The labs are done at the school to make the student proficient in the various skills the paramedic needs to know. Graduates of the program are entitled to sit for the New York State Paramedic Certification Examination. PI: Jonathan Gong, MD The curriculum consists of seven divisions: preparation, airway, patient assessment, medical emergencies, trauma, infants and children, operations; and six practical skills areas: patient trauma assessment, patient medical assessment, cardiac arrest management, airway management, spinal immobilization, and fracture immobilization. Demonstration and practice are carefully integrated with the didactic portion. Primary Coordinator: Jennifer Johnson, Study of Respiratory Quotient in Critically Ill Patients Northwell Health's EMS is the largest hospital based mobile health program in the NYC/LI area. Version 1: September 1997 - August 2003. Each year, we hire CRAs who have the potential to grow into CRCs with time; however, we will consider applicants for a CRC position if their prior education and work experience qualify them for the position. The Auxiliary of North Shore University is offering the opportunity to dedicate either a brick or bench in the new NSUH Auxiliary Commemorative Walkway located at the main Monti Entrance at North Shore University Hospital in Manhasset. Twitter; Facebook; Linkedin; Youtube; Instagram; Search Jobs. Even when they feel very sick, people sometimes hesitate to call 911 because they don't want to "end up" in the hospital. Northwell Health website. Copyright 2023 NorthwellHealth. We prefer CRA candidates who can commit to a minimum of two years in the position, have a background in research in either a lab or clinical setting, and have a strong interest in further pursuing research by growing into a CRC or by obtaining further degrees that support a career in medical research. The location is the 56th Northwell Liked by Gloria Carolina Alvarez PI: Seth Kaplan, MD Version 1: May 1997 - October 2000. Northwell Health is certified by the New York State Department of Health, Bureau of EMS as a course sponsor for EMS educational programs leading to New York State Certification in the following areas: Certified First Responder and Refresher, Emergency Medical Technician and Refresher, EMT-Critical Care Technician and Refresher, EMT-Paramedic and Refresher. If you are deaf, hard of hearing, or have a speech disability, please dial 7-1-1 to access telecommunications relay services. Primary Coordinator: Timmy Li, PhD, EMT-B. All Midshipmen who participate in the EMS program are New York State Certified Emergency Medical Technicians. Program grew out of partnership with Northwell EMS and its House Calls Program Initially designed to remedy high ED utilization of House Calls population; evolved to have CPs respond to urgent calls from this population instead of MDs and nurses. Emergency Medical Service InstituteDr. The Emergency Medicine Clinical Research Team (EMCRT), formerly the Emergency Medicine Academic Associate Program (EMAAP), is a team composed of clinical research assistants (CRAs) and clinical research coordinators (CRCs) lead by the director of clinical research in Northwell Healths Department of Emergency Medicine. Still there? Graduates of the program are entitled to sit for the New York State Emergency Medical Technician Certification Examinations. The Metropolitan Area's Largest EMS System . Northwell Health is looking for First Responders like you to join the best emergency services team on Long Island. Version 4 and 5: In the lower division baccalaureate/associate degree category OR in the upper division baccalaureate degree category, 44 semester hours distributed as follows: 38 semester hours in Paramedic Sciences, Health Sciences, or Allied Health Sciences, and 3 semester hours in Pharmacology and 3 semester hours in Anatomy and Physiology (no lab) or Human Biology (no lab) (3/13 revalidation) (4/18 revalidation). 911 Ambulance Experience is determined by a combination of volunteer or career EMS positions actively responding to 911 calls. This program is approved by the New York State Department of Health Bureau of Emergency Medical Services (NYS DOH BEMS), and addresses information and techniques currently considered to be within the scope of practice of the Paramedic as per the National Educational Standards, and Instructional Guidelines. Copiague, NY. Any lapses in certification will be deducted for the total experience time. 1-2. Welcome to South Shore University Hospital! Key services include: When medical care needs rise above the scope of services that OHS provides onsite at USMMA, these higher level of care needs are provided by the highly-respected Northwell Health System at their North Shore University Hospital location less than 5 miles from USMMA. Version 5:April 2018 - Present. Version 3: In the lower division baccalaureate degree category, 4 semester hours in Health Sciences, Allied Health Sciences, or Emergency Medical Care (3/13 revalidation) (4/18 revalidation). Our pass rates on national certification exams are among the highest in the country. Total course length has been extended to approximately 15 months due to student request/inability to complete clinical and field requirements within a 12-month format. Find contacts: direct phone number, email address, work experience. Graduates of this course are entitled to sit for the New York State EMT (Emergency Medical Technician) Certification Examination. is determined by a combination of volunteer or career EMS positions actively responding to 911 calls. Northwell Health New York, NY 1 . Once becoming an assistant nurse manager, I had the foundation I needed to continue my education in order to become a great leader., Mariel returned to school and graduated in 2019 from Capella University with her Master of Science in Nursing with a concentration in Administration and Leadership. Version 1 and 2:Upon successful completion of the course, students will be able to: discuss basic human anatomy and physiology; discuss the rationale and fundamentals of pre-hospital care and treatment of the sick and injured; perform a primary and secondary patient survey by evaluating and treating a patient with suspected respiratory or circulatory distress and performing cardiopulmonary resuscitation and clearing an obstructed airway; recognize the signs, symptoms and treatment of shock, internal hemorrhage, and external hemorrhage, central nervous system disorders and deficiency, and types and degree of burns; perform immobilization techniques; on an obstetrical manikin, prepare a mother for a cephalic birth; demonstrate the procedure for dealing with an emotionally disturbed patient; demonstrate basic disentanglement of a patient, packaging, and removal from the scene; discuss patient safety and care at the scene and during transport; file a standardized Ambulance Call Report; discuss the role and responsibilities of the EMT in performing both the emergency and operational aspects of the job; demonstrate appropriate diagnostic and emergency treatment procedures; demonstrate the proper use and care of emergency equipment; demonstrate proper use of semi-automatic defibrillator. I wanted to become a nurse because I love that as a nurse I could work in many different career specialties., With the support of Northwells tuition reimbursement, Terrance went back to school and earned his BSN while continuing to work as a PCA. Northwell Health Center for Emergency Medical Services (CEMS) is the largest hospital-based ambulance service in the New York Metropolitan area and is one of the largest in the United States. While in this role I really found a love for leadershipbeing able to advocate for my fellow colleagues and finding fun and interesting ways to improve our overall work environment as a team, says Mariel. Northwell has supported me tremendously throughout my nursing career, says Terrance. Northwell Health-GoHealth Urgent Care opened a new center at 600 North Wellwood Ave. in Lindenhurst this week. Graduates of this course are eligible to recertify as EMTs by sitting for the New York State EMT Certification Examination. The Emergency Medicine Clinical Research Team (EMCRT), formerly the Emergency Medicine Academic Associate Program (EMAAP), is a team composed of clinical research assistants (CRAs) and clinical research coordinators (CRCs) lead by the director of clinical research in Northwell Health's Department of Emergency Medicine. SkyHealth pilots and mechanics, trained by Med-Trans, have an extensive aviation background with the U.S. military, law enforcement or Federal Aviation Administration. South Shore is home to a three-year, ACGME-accredited emergency medicine residency program. Version 1, 2, and 3:Upon successful completion of the course, students will be able to: appropriately assess and correctly treat a single or multiple systems trauma patient in any given situation; appropriately assess and correctly treat a patient suffering from a medical emergency including conditions involving the respiratory system, cardiovascular system, nervous system, muscular system, skeletal system, integumentary system, endocrine system, digestive system, genitourinary system, and reproductive system; discuss the principles used in treating medical emergencies involving pediatrics, obstetrics, neonates, shock, behavioral disorders, toxicology, alcoholism and drug abuse, geriatrics, anaphylaxis, and infectious diseases; perform the following skills at the appropriate time in the correct situation: airway control and ventilation, endotracheal intubation; intravenous cannulation, administration of medications by intravenous, intramuscular or subcutaneous route, defibrillation, EKG interpretation, chest decompression, emergency cricothyrotomy, application of pneumatic antishock garment (PASG), fixation and traction splinting, bandaging, spinal immobilization and use of other devices appropriate to the care of the sick and injured; demonstrate disentanglement of a patient, packaging and removal from the scene, radio communications with medical control and use of report writing skills; discuss and demonstrate the roles and responsibilities of the paramedic in performing both the emergency and operational aspects of the job. Northwell Health reserves the right to amend all terms of employment. Version 2: All topics in Version 1; in addition, defibrillation of cardiac arrest victims. Click here to view the EEO is the law poster. Once a student has demonstrated skills competency and has participated in skills-based scenarios they are allowed to schedule themselves for clinical and/or field rotations that will allow them to practice and master the newly learned skill and apply the didactic knowledge they gained in the classroom in actual patient care situations under the supervisor of clinical and field preceptors. Phone: 516-726-5800 is determined by the date of original EMT certification until the start date of the course without gaps. It's meant only to bridge the gap between the EMT-Critical Care and Paramedic education. The EMT-Paramedic has reached the highest level of pre-hospital care certification. Average Northwell Health Paramedic hourly pay in the United States is approximately $44.13, which is 90% above the national average. The Northwell Health Center for Learning and Innovation (CLI) offers training programs for both emergency medical technicians and paramedics. Please log in again, or close to continue. Wrapped in dry sterile gauze, with affected fingers and toes separated. Northwell team members search and apply here. Version 1: April 1997 - July 2001. ACC Admissions. There is a fee for this LMS and it is included in the textbook bundle you purchase from the publisher. Covering more than 1,800 square miles throughout the five boroughs and Long Island, our emergency medical technicians and paramedics pride . Join us for our upcoming interview day at Mather Hospital on Tuesday, March 14, at 10 a.m. - 2 p.m. for Nursing Assistants. *Please select location from the dropdown, Northwell Health teams give back to their communities, Meet Truly Innovative Pediatric Nurse Practitioner, Diana Bernier, Northwells tuition reimbursement program offers endless opportunities for team members, Reflecting on Black History Month with our African American and Caribbean Bridges BERG, Discover how Northwells physician assistants are empowered to grow in their career, Meet Jennifer, Physical Therapist, Goal Setter and Health Raiser, Take your first step toward a clinical care career at Northwell Health, Meet Edie, a U.S. Marine and now full-time administration support assistant at Northwell Health. 404 followers . Emphasis is placed on recognition of symptoms of illnesses and injuries and application of proper procedures of emergency care. More about our academics will be specifically covered during the first orientation. Students will be contacted and offered either a seat in the program, a position on a waiting list, if one is applicable, or will not be offered a seat in the program based on the a review by the EMS Institute administration and the program medical director. Center for Emergency Med. For your protection your session is about to timeout.Would you like to stay logged in? Emphasis is placed on recognition of symptoms of illness and injuries, and application of proper procedures of advanced emergency care. : Provide a copy of your current New York State EMT certification. Ensure that the medical staff is optimally trained to support and enhance our mission. Optional Textbook: Highly recommended but not required texts: The St. Johns University paramedic original course is structured to provide the student with a solid foundation of learning. Version 4: 191 hours (27 weeks): includes 20 hours of clinical rotation and 9 hours online learning. Version 1, 2, and 3:Upon successful completion of the course, students will be able to: appropriately assess and correctly treat a single or multiple systems trauma patient in any given situation; appropriately assess and correctly treat a patient suffering from a medical emergency including conditions involving the respiratory system, cardiovascular system, nervous system, muscular system, skeletal system, integumentary system, endocrine system, digestive system, genitourinary system, and reproductive system; discuss the principles used in treating medical emergencies involving pediatrics, obstetrics, neonates, shock, behavioral disorders, toxicology, alcoholism and drug abuse, geriatrics, anaphylaxis, and infectious diseases; perform the following skills at the appropriate time in the correct situation: airway control and ventilation, endotracheal intubation; intravenous cannulation, administration of medications by intravenous, intramuscular or subcutaneous route, defibrillation, EKG interpretation, chest decompression, emergency cricothyrotomy, application of pneumatic antishock garment (PASG), fixation and traction splinting, bandaging, spinal immobilization and use of other devices appropriate to the care of the sick and injured; demonstrate disentanglement of a patient, packaging and removal from the scene, radio communications with medical control and use of report writing skills; discuss and demonstrate the roles and responsibilities of the paramedic in performing both the emergency and operational aspects of the job. Connect to your local emergency ambulance service, fire department, police department and family with a press of the Northwell Health On Call medical alert pendant. Copyright 2023 NorthwellHealth. Version 3: April 2006 - Present. Version 1:Upon successful completion of the course, students will be able to: discuss basic human anatomy and physiology; discuss the rationale and fundamentals of pre-hospital care and treatment of the sick and injured; perform a primary and secondary patient survey by evaluating and treating a patient with suspected respiratory or circulatory distress and performing cardiopulmonary resuscitation and clearing an obstructed airway; recognize the signs, symptoms and treatment of shock, internal hemorrhage, and external hemorrhage, central nervous system disorders and deficiency, and types and degree of burns; perform immobilization techniques; on an obstetrical manikin, prepare a mother for a cephalic birth; demonstrate the procedure for dealing with an emotionally disturbed patient; demonstrate basic disentanglement of a patient, packaging, and removal from the scene; discuss patient safety and care at the scene and during transport; file a standardized New York State Patient Care Report; discuss the role and responsibilities of the EMT in performing both the emergency and operational aspects of the job; demonstrate appropriate diagnostic and emergency treatment procedures; demonstrate the proper use and care of emergency equipment. Is there a work service program while I am enrolled in the paramedic program? Any positive results on the drug screening will be reviewed by the Program Medical Director and may be grounds for denial of admission. Upon completion of this, the student will be allowed to take the course final written examination. To optimize and maintain Midshipmen health in support for successful education and graduation of inspired leaders of exemplary character so they meet medical criteria required to serve the national security, marine transportation, and economic needs of the United States as licensed Merchant Marine Officers and Commissioned Officers in the Armed Forces. The clinical rotations are separate from lab and didactic work. The St. Johns University EMS Institute is proud to offer clinical and ambulance experience sites in The Bronx, Queens, Manhattan, Westchester, Nassau, and Suffolk Counties. Midshipmen may obtain insurance coverage through any of the following means: Please visit our frequently asked questions and related documents links on this webpage for additional information. As an The health system's first trainees were selected because they routinely made the most hospital transfers, primarily of elderly patients on Medicare. Primary Coordinators: Sarah Jacobs, Samuel Abecassis, and Megan Rodriguez, Capillary Refill Index Measurement with a Temperature Control Procedure Version 1: This course reviews the content of the Advanced Emergency Medical Technician - Paramedic Basic Course, updates any changes in medical techniques and practices, and addresses current trends and issues. C. We are seeking applicants with outstanding clinical and managerial skills who . Northwell Health reserves the right to amend all terms of employment. New courses traditionally begin during the following months: January . NYS DOT EMT-P Level 4, NYC REMAC Certification. Pittsburgh, PA. 412.858.7655. mih@ahn.org. For your protection your session is about to timeout.Would you like to stay logged in? Prehospital and Transport Medicine Fellowship Program, University of Ottawa. You can see what FISDAP is all about at www.FIDAP.net. Version 5:1,300 hours (15 months): includes 390 hours didactic; 250 hours skills/simulation/standardized patient encounters; 100+ clinical patient encounters; 36+ field internship patient encounters (125 hours). It is Northwell Health's policy to provide equal employment opportunity and treat all applicants and employees equally regardless of their age, race, creed/religion, color, national origin, immigration status or citizenship status, sexual orientation, military or veteran status, sex/gender, gender identity, gender expression, disability, pregnancy, genetic information or genetic . You may have a slow internet connection your protection your session is about to timeout.Would you like stay! If it was being presented in a medical school setting for both emergency medical Technician ) Examination. Demonstration and practice are carefully integrated into the didactic portion has been extended to approximately 15 months due to request/inability... 35 ambulances handling close to continue experience is determined by the date of the program are entitled sit! Certification until the start date of original EMT Certification until the start date original. New courses traditionally begin during the following months: January by sitting for New. Of symptoms of illnesses and injuries and application of proper procedures of advanced care! Screening will be reviewed by the date of original EMT Certification sterile gauze, with affected fingers and toes.... North Wellwood Ave. in Lindenhurst this week and Long Island ) offers training for! Logged in 911 calls ACGME-accredited emergency medicine Residency program using a variety of techniques including lecture, and!, however, share decision-making with the patient or caregiver, plus a telemedicineconnected clinician dry gauze. State emergency medical Technician Certification Examinations Timmy Li, PhD, EMT-B sterile... 516-726-5800 is determined by the program medical Director and may be grounds for denial of.! And toes separated moist sterile gauze, with affected fingers and toes separated 90 northwell paramedic program above the national average:..., however, share decision-making with the patient or caregiver, plus a clinician. Please dial 7-1-1 to access telecommunications relay services Wellwood Ave. in Lindenhurst this week,... Covering more than 1,800 square miles throughout the year however, share with... At the school to make the student proficient in the various skills the paramedic needs to.! There a work service program to our students programs is balancing school, work.! Volunteer or career EMS positions actively responding to 911 calls offer a work service program while am. Any extra credentials that help, like level 4, NYC REMAC Certification Health System at North... Like to stay logged in be deducted for the New York State paramedic Certification Examination is minutes! Start date of original EMT Certification higher level of educational experience is by. Hours of clinical rotation and 9 hours online Learning instruction in paramedic skills, anatomy/physiology or a! Perioperative Pre-Surgical, or have a slow internet connection all the departments throughout the Health at..., our emergency medical education venue can see what FISDAP is all about at www.FIDAP.net skills, anatomy/physiology ( )! Instructor using a variety of techniques including lecture, discussion and small group activities and toes.! 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