When new recruits graduate from the police academy, they aren't simply given a badge, a gun and a patrol car and told to hit the streets.
Instead, they go through a systematized, standardized period of field training, during which they’re paired with a more experienced officer and have to pass a series of tests proving they’re ready to operate solo. Those who fail to meet certain standards are shown the door.
Likewise, many of the nation’s fire departments have a long tradition of field training for rookie firefighters involving both classroom and real-world tests.
In EMS, the tradition of field-training newbies isn’t nearly as strong—and in some places, it amounts to little more than a brief orientation, says Troy Hagen, director of Ada County Paramedics in Boise, ID, who also serves as a Department of Transportation appointee on the National EMS Advisory Council (NEMSAC). Too often, he adds, recent graduates of EMT or paramedic school are hired and given the keys to the ambulance the next day.
“Everyone in EMS knows that paramedics are not ready to go to work and start seeing patients independently right after they get out of school,” Hagen says. “Paramedic school teaches you about medicine. But there is a whole lot more to a paramedic’s job than medicine. Paramedic schools don’t teach you anything about the operations side of EMS, how to get along with others or leadership.” (The same goes for EMT school, he adds.)
The list of what isn’t taught at school is lengthy, agrees Skip Kirkwood, chief of Wake County EMS in Raleigh, NC, and president of the National EMS Management Association (NEMSMA.) For instance, specific information on working at a particular agency isn’t included. How do you talk on the radio? How do you navigate? Where are hospitals located? What are the hospitals’ destination protocols? What standing written orders are specific to that agency?
Other missing information includes what it means to be part of a particular agency. “What are the philosophy and values of the organization?” Hagen says. “What are the expectations of an EMT or paramedic representing this organization?”
And while it’s typical for paramedic schools to require 240 hours of field internships, few graduates come out with enough real-world experience to be trusted on their own at first, according to Hagen. “We call it ‘the gap,’” he says. “It’s that distance between what you know as a certified EMT or paramedic coming out of school and becoming a valuable employee within an agency.”
To bridge that gap, Hagen and Kirkwood are taking a page from law enforcement. Using a field training program pioneered by the San Jose (CA) Police Department, the duo has adapted it to EMS to create the EMS Field Training and Evaluation Program (FTEP). The program provides a framework for EMS agencies to get new hires ready to become productive members of the staff, including teaching agency values and expectations and making sure new hires have the knowledge and skills to handle difficult patient situations and the right attitudes about provider and patient safety.
Covering all Aspects of Performance
A thorough field training program runs the gamut from making sure new hires understand proper grooming to knowing how to use every piece of equipment found on their ambulance to being able to communicate with patients. “You might be able to start an IV well, but how about talking to a 90-year-old grandmother vs. a 21-year-old drunk subject in a bar?” Hagen says.
While the goal is to produce more qualified, successful EMS employees, an FTEP is also designed to be a “legally defensible” means to weed out new hires who are not performing up to standards, says Kirkwood, who is also an attorney. A good FTEP will include multiple tests and evaluations by several members of the EMS staff, all of which are meticulously documented. “If you’re going to make passing field training a condition of employment, you can’t just make it arbitrary and capricious,” Kirkwood explains. “You have to treat people fairly, which is why it’s important to have a structured program that everyone has to follow.”