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Putting Online Learning to the Test


      At fire and EMS services across the nation, two things seem to be in short supply: time and money. Yet, even as departments come under pressure to trim already-tight budgets, demands on EMTs and paramedics to complete time-consuming refresher and continuing education courses hasn't let up. It's a burden shared by their employers, who are responsible for making sure EMS responders are properly trained and ready to deploy.

   For employers who provide the courses to their personnel, training costs associated with instructors, overtime and fuel costs are just some of their concerns. Another is scheduling classes for staff spread out geographically and working different shifts.

   Fortunately, there's an option other than face-to-face instruction to assist in getting the required courses completed in a timely, cost-efficient manner—one that doesn't necessitate having everyone drive to a classroom at a specific time. By harnessing the convenience and portability of the Internet, online learning delivers classroom materials to the workplace or home, saving both time and money.

   "Regardless of agency type or size, it's expensive to organize any kind of learning where delivery has to be in a classroom," says James N. Eastham, Jr., ScD, chief executive officer of CentreLearn Solutions, one of the largest providers of online learning for EMS. "You may have to pay overtime, facility charges and instructors. You may also have to teach the class multiple times to accommodate everyone. It's not very efficient. But a lot of these issues can be avoided by providing the class online."

   Recent research bears that out: According to a 2009 survey of about 400 EMS agencies conducted by RFG Research, which specializes in tracking trends in emergency response, EMS managers who have incorporated online learning into their training efforts overwhelmingly say it has helped reduce costs. About half of respondents said online learning led to a reduction in overtime at their agencies. More than half (52%) said online learning had reduced instructor costs, while about the same number said online learning resulted in decreased fuel costs.

   In the same report, researchers found that the number of overtime hours saved was substantial. Three-quarters of respondents reported savings of up to 500 hours a year. About 44% reported saving more than 500 hours, with some larger departments reporting savings of up to 10,000 hours.

   Online learning has become so crucial to training efforts that only 17% of respondents said they would reduce online training if significant budget cuts were imposed on their organizations, with 27% indicating they would actually increase funding of their online learning programs if budget cuts were implemented.

   Cost reduction wasn't the only benefit cited by EMS and fire managers. About two-thirds reported that the flexibility of Internet-based courses had made scheduling easier, while 86% said being able to have personnel complete training at times that were convenient for the individual and the agency was one of the biggest benefits.


   In 2002, Kenneth Sternig, program director for Milwaukee County EMS, turned to online learning to help solve some of the logistical and cost issues of providing continuing education to more than 300 paramedics. In Wisconsin, 22 of the 72 hours of continuing education classes required every two years can be done online (the numbers vary by state).

   A cost analysis determined that online learning is saving Milwaukee County EMS about 30 hours of overtime per paramedic per year, says Sternig. With an average overtime pay of about $45 an hour, that translates to $1,350 per person each year, or about $472,500 annually—savings that far exceed the approximately $49 per year per student Milwaukee County's commercial online-learning vendor charges.

   That vendor, which specializes in online learning for EMS and fire departments, also automatically tracks the progress of each member, maintains records and stores certifications. According to Sternig, this has helped cut down on paperwork, free up instructors and let managers take on other responsibilities and quickly run reports about each staff member's progress. That additional efficiency has "definitely resulted in cost savings," he says.

   Cost savings alone, of course, can't be the only factor. Speed and flexibility matter, too, says David Page, MS, NREMT-P, an EMS instructor at Inver Hills Community College in Inver Grove Heights, MN, and a faculty member for the National Association of EMS Educators instructor course. "Online education has a great role to play in EMS—we need education that is rapidly deployed when something like H1N1 comes along," Page says. "We need to be able to adapt to changing circumstances and not wait a year before we get the next update."

   Ease of scheduling and the ability to ensure a consistent message were two of the reasons that Orange County EMS in Florida turned to online learning seven years ago, says Dave Hawley, project coordinator in the Office of the Medical Director/Orange County EMS. Orange County EMS provides educational support for 11 agencies representing about 2,100 first responders serving a 500-square mile area. When all learning was done face-to-face, "It could take months to get one lecture out because of the size and demographics," says Hawley.

   In addition, before online learning, quality was difficult to ensure, Hawley adds. "We wanted to make sure the message was the same, which you can't do unless the same [instructor] goes to every single station at every agency and hits every person, which is almost impossible. Online learning absolutely allowed us to do that. We believe it enhances EMS."

   Orange County EMS's instructors, along with emergency physicians from the region's trauma center, use an off-the-shelf online learning management system to store and distribute narrated PowerPoint training presentations, self-assessments, quizzes and other materials, supplementing the system's existing library of more than 200 courses that cover all areas related to recertification. Archived materials can be used again and again, Hawley says, making the most of the initial time invested to create the materials.

   Orange County EMS takes advantage of its online learning system for more than just education. "We use it for protocol updates, medical director bulletins and case studies from the regional trauma center," says Hawley.

   Even agencies that don't pay overtime to staff members receiving continuing education find benefit in online learning. Life EMS, a private ambulance service that covers a 3,500-square-mile area in western Michigan, gives each of its 400 paramedics and EMTs an education allotment that covers some, but not all, of the classes needed to maintain their certification, says Brent Walker, Life EMS's director of health and safety. Since 2005, a bank of commercially available online courses has also been provided at no cost to employees.

   "We look at this as a benefit to our associates," says Walker. "The company pays for them to obtain unlimited credits through the system. They can go online and acquire the presentations whenever they want to—it can be 3 o'clock in the morning or 3 in the afternoon."

   Still, online learning was never intended to fully replace classroom learning, but rather to supplement it. At Milwaukee County EMS, for example, paramedics and EMTs are required to watch online instructional presentations about new drugs or protocols prior to meeting face-to-face. In-person meetings are reserved for questions and to reinforce the information already learned.

   "Prior to using online learning, our continuing education meetings would have hundreds of people in a room at the same time, and paramedics would say they missed something or they couldn't hear," says Sternig. "Now they feel more comfortable when it's time to activate the new procedure."

   Transitioning to the new system wasn't without challenges, however. Initially, staff resisted losing the overtime pay associated with in-person training. Others had difficulties because of outdated computers or lack of computer savvy, though that issue is rapidly fading. "A few were kicking and screaming in the beginning," says Sternig. "Now, online learning is well accepted."

   Online learning is also gaining popularity in systems where employers do not provide or subsidize continuing education, leaving EMTs and paramedics to pay their own way.

   "EMTs are among the least paid in the whole healthcare field, yet they have some of the most time-consuming requirements for recertification, and often they have to pay for it themselves," says Lou Durkin, MD, chief of emergency medicine and EMS director at Mercy Medical Center in Springfield, MA. To help meet that need, Durkin launched in 2001 as a more efficient, lower-cost alternative to in-person training. Students on took 200,000 credits in 2008, a number that jumped to more than 500,000 credits in 2009.

   "I think online learning is going to become pretty universal," Durkin says. "Harvard does classes online; everybody does it. It's been proven beyond a doubt to be every bit as effective as sitting in a classroom."

   For adult learners, many of whom are juggling the needs of families with work responsibilities, the value of being able to take courses according to their own schedule will also likely grow, adds CentreLearn's Eastham. "Generally speaking, adult learners are motivated to learn as efficiently as possible, in a way that fits their lifestyle, maximizing the flexibility of when and where the training can take place," Eastham says. "When you add in the special considerations for EMS and fire responders, such as around-the-clock schedules and the requirement for rapid updates, online learning is really a perfect match for those needs."

Distance Education Resources

   The following companies offer distance-based education. For more resources, visit

   24-7 EMS

   24-7 FIRE














Checklist for Evaluating an Online Learning Provider


   There are dozens of companies that offer EMS online training, many of which employ some combination of text, slides, video and audio. How interesting and engaging is the material? Is it presented in a way that will hold the attention of adult learners?

   What is the source? Some online learning providers serve a variety of professions, while others focus exclusively on serving EMS or fire departments.


   The quality of the educational materials available online varies, says instructor David Page, so choose carefully. If you're meeting CE requirements, be sure the materials you choose are accepted by your state, region and/or the National Registry. If you're an instructor or manager, look for tests and evaluations that ensure students have actually learned something they can apply in the field, suggests Page. Also consider the amount and variety of materials available, and how often new materials are added. Finally, look for CECBEMS-approved materials—especially if your personnel are recertifying through NREMT.


   Costs typically depend on the type of materials being offered and the sophistication of the system that delivers them. Popular models include:

   Free: There are some good online EMS training materials available free of charge, including podcasts at iTunes (just type in EMS in the search bar) and courses for NAEMT members through NAEMT. Free webcasts are also available that offer CE credits.

   Pay per view: This option works well if you just need a few hours of CE to meet a requirement, especially at the last minute.

   Unlimited use: Similar to pay per view (and often offered as an option by companies that offer pay per view), but allows unlimited access to a library of courses, typically for an annual subscription fee. This option is good for individuals who plan to make heavy use of the system. Group plans may be offered as well. These can be a good option for volunteer organizations that need ongoing access to training materials.

   Learning management system (LMS): These group plans typically offer access to a preloaded library of lessons, plus administrative tools such as tracking, automatic distribution, alerts when members are missing credits or are about to have certifications expire, and the ability to upload custom materials. Fees are typically per user and renew annually. Startup costs may be involved. For larger organizations, a custom contract may be available.

   Full-service LMS: In addition to the features of regular LMS plans, full-service providers offer expert assistance from technical and educational specialists in converting your training materials for online delivery, saving administrative time and ensuring high quality. Typically these are available for an additional annual fee.


   SCORM is a set of technical standards followed by major e-learning publishers. Choosing a SCORM-compliant learning management system ensures that your LMS will smoothly import e-learning packages that adhere to the standard.


   Not all states currently accept electronic course-completion certificates, but the number that do is anticipated to grow. Automatic reporting greatly relieves the paperwork burden and reduces the chances for errors. If you send records to the National Registry, look for a system that automatically generates completed paperwork on official NREMT forms for your medical director's and training officer's signatures.


   If your department's needs go beyond online classes only and you want a more complete online learning management system, be sure to compare such features as student surveys, instructor evaluations, automated scheduling, etc. Also, look for the ability to share content with other agencies that use the system, which is a great way to get more bang for your buck that not all online learning systems offer.

   Jenifer Goodwin is associate editor of the newsletter Best Practices in Emergency Services.

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