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May 2005 Letters

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Mail: EMS, 7626 Densmore Ave.
Van Nuys, CA 91406-2042

Method Wars

I am compelled to write by both the Jeff Price article, Turning Paramedics Into Firefighters in the August 2004 issue, and readers’ responses to it in the February 2005 issue. I am one of those medics who joined the ranks of career firefighters (in my mid-30s), eventually teaching EMS classes to fire department recruits and on-shift personnel.

I have seen the gamut of good and bad behavior in recruits, which appears to me more predicated upon individual personality and motivations than such factors as age, experience or education. The existing EMS certification level seems to have minimal, if any, effect on classroom behavior.

I am concerned with the methodology the two disciplines use. EMS typically uses the andragogy approach and the fire service employs the “military model” of “break them down, then build them back up.” As a certified EMS instructor, I am repulsed by the paramilitary approach of berating recruits in the name of education. Since none of my fire instructor colleagues were ever in the military, I suspect their training method is based as much on boot camp scenes in the movies as on their own recruit experiences.

I have heard secondhand that the military actually utilizes a wide variety of training methodologies—empirically evaluating the desired motor skill or psychological behavior and the circumstances under which it will be used, then utilizing the appropriate training method to accomplish the objective. For example, boot camp is conducted differently from H.A.L.O. (high-altitude, low-opening parachute) training. However, I am unable to find a succinct source that describes modern military training methods. Can anyone clarify what the actual model is, and justify its specific use in the fire service? Additionally, are there any scientific studies on the effectiveness of paramilitary training in the fire service in comparison to the andragogical approach?

Fire Lt. Wendell Howard, EMT-P


I have just reread Thom Dick’s description of a nursing home (EMS Reruns: Maggots: Are You a Medical Advocate For the Elderly? September 2004), at which the responding crew found horrific conditions. They were disturbed by what they saw, but had no idea how they should attempt to alleviate these conditions.

There is a federally mandated program of state-funded volunteer organizations called Ombudsmen. Their mandate is to see and report poor or illegal conditions in skilled nursing homes and adult homes.

Here in New York City, this program is conducted through the New York Foundation for Senior Citizens, New York City Substate Long Term Care Ombudsman Program. The address is: 11 Park Place, Suite 1111, NY, NY 10007.

In other communities the name may vary, but the word ombudsman is probably part of it. Contacting the New York office might be one way to find your local organization. You could also try searching the Internet for references to Ombudsman and your state.

“Ombudsman” is from a Swedish word meaning “advocate,” and the volunteers serve as advocates for the residents of these long-term facilities. They are trained and certified with the legal authority to visit and view conditions in all parts of the building, as well as to talk to residents, answer questions and listen to complaints. When they see things that are not in the best interests of the residents, they can do a number of things. Sometimes, it’s only a matter of calling attention to problems the administration had not been aware of. Other times, the ombudsman will report problems to his supervisor, who will then notify the appropriate agency to have the condition corrected.

These programs are always looking for volunteers. If you know anyone who has a few hours a week, please suggest they find a program and get involved. The resident who needs help may someday be you or your loved one. My mother has been a nursing home and adult home ombudsman for 12 years and has found it very rewarding.

Richard C. Berger, EMT
Belle Harbor, NY

Stressed Out

The following comments are in reference to Mike Smith’s excellent Beyond the Books article, Check Your Fabric in the January 2005 issue. I cannot begin to explain how Mike hit the nail on the head when he described the two types of stressors that one faces in the EMS profession: the single-incident stressor as experienced by the captain in the article and the multiple day-to-day stressors. Either one can cause an individual to leave the profession, but I believe the multiple stressors that occur daily are more difficult to deal with and resolve because they are diffused and hard to identify.

Knute Mlott, EMT-P
Onslow County EMS, Jacksonville, NC

Mike Smith responds: I would certainly agree with you relative to the danger of day-to-day stressors or what you term multiple stressors. Because they may seem “small,” it’s easy to ignore them. In truth, they just take longer to add up and take their toll in comparison to those big hits. Thanks for the positive comments and for taking the time to write in and share your thoughts.

Mothers Against Dork Driving

I want to thank you from the bottom of my heart for Thom Dick’s Vehicle Ops article Driving Like Dorks: Why Are We Killing Ourselves? in the January 2005 issue.

I am an EMT and have been scared to death on at least five or six occasions. In fact, most of my apprehension on a call is not due to a “possible encounter” upon arrival to help the patient, but rather just getting there (and back) safely.

I had worried that I was being overly critical of my coworkers, but the article calmed that fear and helped me realize there was indeed a problem. It also made me realize it was irresponsible of me not to speak up to protect my life and my patients’ lives, preventing further tragedy for their (and my) families. I have children and a husband to whom I desperately want to come safely home after my shift.

With any luck (and a strong voice), I hope to coordinate a driver-training course within my department. I’m not sure how I will address this, as I am fairly new here; however, I know it needs to be done. Any suggestions you have for a tactful way for me to handle this will be much appreciated. Unfortunately, being new and female, I am a little hesitant. I don’t want to make waves; I just want my corner of the EMS world to be a little safer. Any advice is welcome!


Ed’s Note: If readers have any advice for this EMS provider, please e-mail

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