This should go without saying, but the foundation of any premier service provider is a strong initial and continuing education program. Unfortunately, in emergency medical services (at least in my experience) this seems to be forgotten in lieu of getting bodies on the trucks, not wanting to pay for training hours, or giving in to the generalized demeanor that “I don’t need / want to go to training.” As a result, training budgets are slashed and makeshift programs are developed to “prove” that training is indeed occurring. If we intend to fully prove ourselves worthy of a permanent seat the public safety & health care tables, we need to redirect off this path, and soon.
Initial training & orientation
All states require successful completion of a delineated course before awarding certification as an EMS provider. But does this course offer everything one needs to know to be a competent and successful provider? I would argue no, it does not. These courses provide the bare minimum needed to advance into real-world training programs established by ambulance services.
You cannot realistically expect someone who just graduated from EMT school to understand the nuances in symptoms and treat appropriately. Even if you’re working with a relatively small differential diagnosis schematic, it takes experience in actually encountering and treating patients to accurately differentiate patients with vastly similar, yet minutely different, complaints.
Take, for example, a patient presenting with altered mental status, flaccidity, and slurred speech. Unless you get a complete patient history, or in the absence of that find clues to the patient’s daily insulin regimen, the potential for misdiagnosis is significant. Take it from one who’s done it.
Ambulance services need to review their initial training requirements to be sure the EMTs they’re bringing in exhibit core competencies, obtain real-world experience (more than a couple of patients), and are able to demonstrate clear decision making in complicated situations.
This is much more than the annual blood borne pathogens and HAZMAT refresher courses, which in all truthfulness should fall under recurrent education. Continuing education, when applied appropriately, provides a basic review of the topic, then expands upon that foundation to provide a growth in understanding and application in a real-world setting. In my experience, this includes didactic as well as kinesthetic components whenever possible and always when discussing updates to skill application.
The trick to continuing education is to strike a balance between what providers want to know and what they need to know. For example, many providers will chomp at the bit for juicy trauma pictures presented by a local ED physician but won’t budge when presented with an opportunity to discuss how to incorporate better documentation into their practice.
This is where the imagination of an instructor is key: how to draw in the average EMS provider who is knowledgeable and capable of performing their job, but who also could use a boost to his or her application of that knowledge and skill. An instructor needs to be able to make an enticing presentation that delivers the message while simultaneously assuring the provider that his or her time is well spent.
This is just a scrape of the surface when it comes to developing training programs. Future posts will provide additional detail on the successes and opportunities for improvement based upon my past experiences in this field. Stay tuned!