The Field Training Officer and Student Preceptor are two different roles. Visit EMSRountable on Blogtalk Radio on March 13, 2014 at 5:30 PM PST to listen! You can call in to join SaltyMedic in a discussion to explore how your training department uses these roles to train up new employees or students in the incipient phases of their EMS career.
Here’s a summary our discussion presented on the Clinical Pinnacle, EMS Roundtable Blogtalk radio on March 11, 2013. If you missed the live show, catch it in the archives here.
If you have recently been appointed into a position where you are responsible for the safety programs in your agency, perhaps these tips and links will help you on your way.
- Research and read any regulations that pertain to safety in EMS. Generally, you’ll find a wealth of information at OSHA, NISOSH (research agency for CDC), the CDC, and your state Department of Labor and Industries websites. Make sure to check with your local governmental agencies as well, they may have additional regulations for topics such as bio-hazard waste disposal.
- Look for free resources on the Internet. There is a great deal of information available on the web in the realm of safety. Because of this, it can be a daunting task and research can become overwhelming so stay focused and take your time. If needed, converse with others and look for interpretive statements for confusing information.
- Drink coffee during this process because you will develop narcolepsy during this process.
Educate yourself in regards to your role and responsibilities.
- One of the most important roles in an EMS agency is the role of the Infection Control Officer. Kathy West, RN gives an excellent series of classes designed to prepare you for this responsibility.
- It is likely your state Department of EMS offers free education for various subject matters regarding safety in your agency. Attend at least annually, this will validate your knowledge and lend credibility to you during times of inspection and accreditation.
Collect templates of safety programs. Don’t reproduce work that has already been done somewhere else. A simple Internet search will turn up a significant number of resources for;
- Accident Prevention Program
- Exposure Control Plan
- Respiratory Protection Plan
- Various other procedures and policies that you’ll need to implement for a complete comprehensive program. (Control of Hazardous Energy, Hazardous Communication Program, Workplace Violence, Fitness and Nutrition for EMS providers, Ergonomics)
Create and establish initial and on-going education programs to meet the regulations and target your agency.
- Include information related to trends in the agency
- Include national and local epidemiology
After you establish your programs acquire data.
- Using your employee on duty illness / injury forms, collect and evaluate the data. Target education to your trends, give rewards and praise for areas that employees are performing well.
Market and communicate to your team.
- If employees don’t know about the programs, they’ll assume nothing is in place or being done about things. Consider regularly scheduled safety emails highlighting some important points in your program.
- Communicate safety information from the industry. Brian Fass is one excellent resource for this.
- Develop incentive programs to target both extrinsic and intrinsic audiences.
- Consider establishing contests for weight loss or fitness milestones.
Collect feedback from your team.
- Use an audience response system in the classroom to engage the audience while giving you information.
- Occasionally use Internet survey’s to evaluate your teams understanding of your programs and perhaps gain insight into their expectations as well.
- Add a questionnaire in regards to the safety programs to your on duty illness and injury program. This is a great way to gain feedback from your crews about the Safety programs and gauge their effectiveness and influence on your team.
Be prepared for challenges in managing and establishing safety programs.
- Communication can be a challenge. Be brief, provide useful information and be consistent and provide convenient means for crews to communicate to you.
- Use a root cause analysis process for evaluating incidents. An excellent model is the Just Culture Causal Analysis
Consider big issues facing the industry and include information in regards to them in your programs and educational content.
- Fitness and nutrition
- Patient drops and gurney use
- Workplace violence (what I specifically mean is combative patients, active shooters, and mass destruction).
Tips to change the culture to promote safety in an organization include;
- Two way communication
- Recognition, incentives and rewards
- Lead by example
- Stay current
Until next time!
Here’s a summary our discussion presented on the Clinical Pinnacle, EMS Roundtable Blogtalk radio on March 25, 2013. If you missed the live show, catch it in the archives here.
I find one of the biggest challenges is to provide education and training that effectively refreshes required knowledge and skills but also continues to build knowledge and provide new information. It seems to me that the providers fresh out of medic school and the providers with the longest tenure that are the most challenging to engage. They have brand new knowledge or years of experience.
As an educator, how do you prepare for a CE session with experienced providers?
Preparation is the key to providing a quality CE session, particularly if you don’t want to deliver content that your audience that will challenge and engage them. Prepare for some didactic, affective and skill promoting activities.
When preparing for a CE session I’ll usually start with reviewing the objectives from the curriculum. Doing this helps me refresh my baseline knowledge and start to brainstorm on potential objectives that I think would be good targets for increasing the depth and breadth of knowledge for my target audience. See the National Core Content and the National Education Standards for reference.
If the topic is a big one such as airway, I’ll focus on building content around subtopic like CPAP, BIPAP, Tracheotomy care, etc.
Reviewing baseline knowledge such as anatomy, physiology is good practice even for experienced audiences. I’ll usually prepare an activity that will engage the group and get their gears turning. I remember once I broke the class up into small groups, gave them each a zip lock bag containing two balloons, a straw, some string, popsicle sticks, toothpicks, gumdrops, glitter, a piece of paper, and some other trinkets and told each group they had 10 minutes to build a model of the respiratory system including the parts I had written on the board. Then they had to use their model to explain how the respiratory system worked. It was fun, refreshing and engaging for the group. As an educator, you’ll learn a lot bout your people by watching the results of these kinds of activities. They are creative, articulate, and when they have fun, they are usually more open to learning.
Here’s a few other things to consider when building content for CE with experienced providers;
- Review and sterilize patient care reports for the topic. Provide a template for a basic CQI evaluation of each chart and have the groups perform their own CQI of the charts and give a report to the class.
- Try a journal review. Pass out articles to the groups, have them read and give a group opinion on the article, etc. Encourage discussion around controversial topics.
- Consider introducing new equipment related to the topic for evaluation and discussion in the classroom.
- Less words, more pictures and videos. Cite your sources.
- When using canned classes such as PHTLS, AMLS, EPC, etc. Ensure you have quality instructors for the content. More on this in future shows.
- Consider guest speakers. Consider a conference call or video conference with a guest speaker that will engage the students with new information or a QA session.
- Consider doing a podcast and using the classroom as your audience.
As educators we are challenged to provide education and training that effectively refreshes required knowledge and skills but also continues to build knowledge and provide new information. As students in EMS you have some responsibility in participating in your own growth. Attend with an open mind and be prepared to learn.
There are more discussions on EMS Roundtable that I’m sure you’ll find engaging. Be sure to check out the site and consider calling into one of the great shows and contributing to the conversation.
Until next time.
The first few steps of developing an agency training plan should include the following;
- Research and review regulatory documents and resources
- Considering the training needs of your agency
- Find out what your EMS Professionals want to learn about
Researching regulatory documents should start at a national level and should include these documents;
The EMS Agenda for the Future This document describes the vision of further defining and refining EMS, pushing the EMS industry from vocational to academic. If you want to know why all of these industry education standards are changing, this is the document to answer your questions. The overall purpose of the EMS Agenda for the future is to;
- Ensure adequacy of EMS education programs
- Update education core content frequently enough so it reflects patient EMS-health care needs
- Incorporate research, quality improvement, and management learning objectives in higher level EMS education
- Commission the development of national core content to replace EMS program curricula.
The National EMS Core Content is the next document and it defines the entire domain of out of hospital practice. It is the universal EMS body of knowledge, skills and abilities expected of our industry. It is the what we should know.
The National EMS Scope of Practice Model is the next document to add to your research. It is directly derived from the National EMS Core Content. This document describe the delineation of provider practice and licensing levels. It is the who can perform these skills. Note that the philosophy behind the National EMS Core Content is to be flexible and to increase the breadth and depth of knowledge for our EMS professionals, so this is why there is more information than what the National EMS Scope of Practice Model may imply is necessary.
The National EMS Education Standards and Instructional Guidelines are the next two documents and they replace the NHTSA national standard curriculum. It is the how and what to teach. It includes the knowledge and skills required at each provider level.
These national documents represent the baseline level of knowledge required of the EMR, EMT, AEMT and Paramedic. The advantages of researching and reviewing these national documents includes;
- Teaching content in coned sessions from these documents may fill in gaps for providers not familiar with the new national standards
- May be used to create bridge courses to the new levels of care as states re-define their EMS levels of care to become more consistent with national standards
If your agency has already addressed the new standards and closed the gap of knowledge of your providers then consider that information from these documents may not necessarily increase the breadth and depth of knowledge your experienced providers will need and desire.
If you use Critical Care Paramedics, Community Paramedics or Registered Nurses, you should be intimately familiar with their initial training coursework and what CME hours those credentials require. Also, consider these providers may hold additional certifications for this level of care such as Flight Paramedic Status or Critical Care Ground Transport Paramedic Certification.
There are a few different CCEMTP programs out there and typically they require 32-40 hours of CME targeted at that level of care in a certification period for renewal. The one I’m most familiar with is the UMBC CCEMTP Program.
Community Paramedicine is a new expanded role / scope for paramedics and the curriculum can vary greatly from place to place. There is no formal renewal process defined yet, however, understanding this role and developing continuing education to target this audience would be necessary if you use this level of care. Med-star in Fort Worth Texas is using this level of care and might be a resource for you.
Coned requirements for RN re-licensure also vary from state to state and may not include requirements for transport nurses. A good resource for you to consider when building topics and content to target this audience is the Air and Surface Nurses Association, CAMTS Accreditation Standards and CAAS Accreditation Standards which also outline educational requirements for Specialty Care Transports. Topics such as IABP, Transport Ventilators, Blood Transfusions, IFT of a POST ROSC pt, High Risk OBGYN, Neonatal care are just a few topics you’ll need to cover in your coned plan for your agency.
Every state has a department of Emergency Management that includes a division dedicated to pre-hospital services. It’s likely any regulations pertaining to initial and ongoing education for your providers can be found on the website for your state’s EMS page. Know what your state regulatory requirements are.
Your Medical Director may have education requirements that he/she requires your EMS professionals to know. Be sure to ping him/her about what they require.
The second step in developing your agency coned plan is to consider the needs of the agency. Perform a needs assessment to determine a micro set of topics that you need to include in your plan. Resources for this could include;
- CQI trends and unusual cases
- New equipment
- Industry or agency safety trends
- Strategic patient care goals of the local EMS community such as;
- Senior fall prevention initiatives
- Cardiovascular / neurological / trauma triage, transport and treatment processes
- Trauma prevention initiatives (Use the CDC or state you reside in morbidity and mortality report for clues on what to focus your efforts on)
- Protocol review
The third step is to consider what the audience wants to more know about. The regulations and agency tell us what they want us to know, but what about what we want to know? There are a few ways to do this;
- Survey your audience using an Internet based survey program. One disadvantage to this method is in my experience, the number of people that completed an online survey is low.
- Survey in the classroom using an audience response system. Consider that this method will only query folks attending classroom and you should also target the providers who aren’t attending class.
- Survey the staff by sending the survey and self addressed stamped return envelopes. This is not the most cost effective solution, but it can work to target those not responding to Internet or classroom surveys.
- Develop an online survey you can put on your website.
- Give classroom participants a few survey questions on a classroom evaluation to complete at the end of classes.
I’ve listed some tips for better acquisition of surveys;
- Make them as anonymous as possible. For example, make a brightly colored box titled SURVEY where the participants can put the survey in the box without having to hand it to someone.
- Place survey boxes or people collecting surveys by classroom exits and have them give out something small for completing a survey.
- Use a multitude of methods to survey your team
- Don’t over survey
- 3-5 questions at the most
- Multiple choice questions
- Post and promote survey results and implement some suggestions asap
Use these three steps to begin the process of developing your agency coned plan;
- Researching and review regulatory documents and resources
- Considering the needs of the agency
- Finding out what your EMS Professionals want to know
Until next time!
When meeting new people one of the first questions usually asked is ”What do you do?” It’s a conversation starter. It’s also a way to classify, characterize, and place our own private judgements on others. This question can be particularly entertaining for EMS providers because upon disclosing our career path the follow up questions will be;
a. “What’s the worst thing you’ve ever seen?”
b. “Can you tell me what this might be?” as they drop their trousers and and bare their a** while pointing to an area of abnormality they want you to evaluate and diagnose.
My standard answer in regards to what I do is, “I live in Seattle, I read all kinds of books, I ride a bicycle and a motorcycle, drive a Mini Cooper, and keep my truck nearly hooked up to a recreational vehicle at all times. I run with my dog and enjoy multi sport events to maintain fitness. I fish in fresh and saltwater for my yummy swimmie friends, I hunt for meat to provide for my family, barter with friends for goods and services, and grow a mighty garden to reduce my dependence on commercial resources. I celebrate the seasons with friends and framily, am admittedly a WOW geek and I work as a Paramedic.”
If I were being introduced to me, the translation of the above statement would look something like; She’s weird, probably has webbed feet and moss growing somewhere on her body (Seattle), intelligent, educated and possibly worldly, (reading), fitness conscious (cycling), likes to take risks, is brave or totally stupid (motorcycles), environmentally aware and belongs to a strange car cult? (Mini Coopers), may be warm and friendly and doesn’t mind drool, or sweat (dogs) and likes competition (multi sport events). Chicks rule, boys drool (hunting, fishing), and what the hell is WOW? (World Of War craft). Most of the time, I get a blank stare, almost like the person can’t assimilate me into their frame of thinking. The point is, others define and categorize us by what we do as a career choice, and by who we are. I’d prefer people know a bit of both.
I was interviewing a candidate for a Supervisor / FTO position this week and during one of his responses he was trying to describe some of his attributes he thought would benefit our team. The candidate was speaking and meant to say professionalism but he actually said professionality. I smiled at him as he corrected himself, and I thought what a gem of a word. Professionality.
Professionality is a term that I believe fits the dynamic I described above, it is what we do and who we are. It implies a relationship between our chosen career field and the other half of our lives. For most EMS providers, EMS is not only what we do, but very much a part of who we are and has greatly contributed to why we are that way. EMS is our professionality.
That brings me to the subject matter I wanted to blog about. Since November of 2011, I have been standing on a precipice of career deconstruction. I work for a private agency which is inherently predisposed to consistent and sometimes drastic changes that are fiscally influenced and driven. The most recent changes have had a drastic effect on my career, purpose, passion, and morale. I have worked here for 12 years, up through the ranks and have a strong sense of loyalty. In return I feel I deserve the stability that a successful career should provide. My core values are challenged on a daily basis and my attitude is a reflection of my fear, frustration, and insecurities caused by transitions that directly impact me negatively. I don’t understand the reasons behind the scenes and can’t seem to rationalize my way through them. As a result, I find it difficult to jump on board and push the new agendas.
It has been difficult for me to to slow down to the pace of people and silence my mind for a moment so I can assess my internal surroundings and determine what influences I can change that are contributing to my current situation. I remind myself, life is 10% what happens and 90% how I react. Primarily, I am influenced by fear of loss, my inability to swiftly adapt to change, and the responses of my co-workers on a day to day basis. Furthermore, I believe my thoughts become actions. Actions create my reality. I no longer wish to be influenced by fear, inflexibility or poor attitudes, least of all my own. I do not wish a self-fulfilling prophecy to come to fruition.
Here is the step by step process inspired by my introspection in looking for a treatment for my boredom and burnout;
1. Determine if you are bored or burnt out. Remember that boredom and burnout lead to complacency. Complacency leads to apathy. Apathy leads to liability. If you are bored, focus on infusing passion into your career thereby balancing in the profession part of your professionality. If you are burnt out focus on infusing passion back into your personal life thereby balancing the personality part of your professionality. It is possible to be both bored and burnt out. If you can’t tell the difference, well, that’s another whole blog topic.
2. To infuse passion into your profession consider the following;
- Refresh the old or take some new education – Catch up on CME or take a new class – Try taking some online classes through Centrelearn, consider a CCEMTP Course or Community Paramedic Course to expand your scope of knowledge and practice. EMT’s consider taking ACLS, PHTLS, PALS, PEEP or any of the advanced card classes. Consider starting an EMS blog, listening, participating as a guest speaker or starting your own EMS Podcast.
- Teach others - Consider obtaining an instructor credential (ACLS-I, PHTLS-I, EPC-I, etc…) or ask to teach an in-house class on an EMS topic you want to learn more about or one that you are very proficient in.
- Develop yourself professionally - Network with other EMS professionals by starting a Linkedin account. Update your resume or CV. Ask for some letters of recommendation. Write and submit an article to one of the major EMS magazines for publishing. Join an EMS professional organization (CECBEMS, NAEMT, NAEMSE) and look for ways to contribute to EMS system changes on a local or national level.
3. To infuse passion into your personal life consider the following;
- Enhance social relationships or develop new ones- Fall in love with your partner again. Send a hand written letter to your grandparents. Spend some quality time with your children. Call an old friend for coffee. Encourage social interactions by hosting an outdoor movie night, BBQ or theme party.
- Take a class unrelated to your career path- Learn a new skill. Motorcycle riding, Muay Tai, painting, yoga, sailing, there are a gazillion things out there to do. Pick one, make like a Nike shoe and “Just Do It”.
- Join and promote a cause - A great way to change the focus from yourself by subordinating your interests to others is to join a cause. Walk or run in a weekend event. Active.com is an excellent resource for active events in your area. Join a cause for a local hospital or children’s charity supporting child abuse treatment and prevention, hospice or homelessness.
These suggestions may seem basic or obvious, but unless you actually implement something, you’ll be standing in the same place in the future that you are today.
I was bored and burnt out and I changed my strategies to infuse passion back into my professionality.
In humble supplication of the approaching week where we honor all EMS , I can’t help but reflect on my own grass roots start in the industry and my motivation to continue my journey as an EMS professional.
As a little girl, I didn’t dream of being a Paramedic. I dreamt of being a lawyer. It’s hard not to laugh at that sentence after reading it. My social temperament leads me to believe I made the better choice. I wasn’t sitting on the edge of my seat during episodes of Squad 51, or following a long family tradition of Fire and Rescue glory.
I was lying in a hospital bed in a desperate moment in my life during a severe depressive episode as a teenager, having my turn with an attempted ”call for help”. I was visited by the Fire Chief of the local fire department. I did not know him at that time, but for some reason, he felt the desire to come visit me after he and his crew treated and transported me to the hospital. He had the typical Fire Chief look, the salt and peppery hair, the crows feet around eyes that looked as if they have seen a thousand years of war, the thick mustache that followed the natural downward curve of his mouth, and a silent strength. He sat next to my bed with his elbows on his knees holding his hat in his hands, and in the most non-judgemental way he asked “Do you want someone to talk to?” When I met his eyes I remember being overwhelmed with compassion. It just flowed from him. Warm, comforting, secure, safe, endless amounts of compassion. He could see right through me. He could see the kind of pain you can’t see. He could see all kinds of things that I couldn’t see. His unique wisdom and random act of kindness, reaching out to another human being in pain, was a defining moment in my young life. A secret door had opened and I was about to walk through it. To this day, I am 100% confident that compassion from a complete stranger saved my life in a literal and directional sense.
A year later, as a junior in high school, I was a small but mighty participant in the cadet program in his fire department. I was sporting the blue fire and rescue t-shirt with levi’s, riding on a red fire truck, and attending every single class I could sign up for at his volunteer fire station. I wore my tennis shoes inside my bunker boots, had to roll the sleeves of my bunker jacket up to a three quarter length so I could at least appear to have arms , and could bend the fingers of my firefighter gloves in half while they were on my hands. I had to wear three (3) nomex hoods to keep my helmet on my head and there was a great secret to how I kept the three quarter boots upon my tiny little frame. Lastly, no noob is complete without the mighty Bat belt and mine was full of enough tools to take me straight to the bottom of a swimming pool if I should fall in.
Years later now, I have no trouble fitting into gear anymore and I’d like to think that is a result of improvements in our gear and not the damned side effects of my severe chocolate addiction. Today my Bat belt consists of pen(s), a multi tool, my pager, and my twisted sense of humor. But moreover, I find myself reflecting and writing about experiences that EMS has offered me. I’m almost forty (40) and with my degree from the University of Life, I’m beginning to tap into that stream of wisdom, the kind of knowing that my Fire Chief was so demonstrative of. I know that only life experience can give you the key to open any secret doors upon this land and I know that the universe “annies” up and continues to challenge us to learn and grow. The EMS path has been and continues to be fraught with experiences beyond my wildest imagination. I have a new kind of understanding. Maybe someday I can stand on the same platform that our Chieftains stand upon and like my Chief, recognize the kind of traits in people that EMS finds worthy. I hope to motivate, direct, and inspire those people to follow me into this weird, chaotic and beautiful land.
I did not stumble upon the EMS industry because of my incident and I don’t feel that I was ”called” to it. I feel like it was “called” to me.
I see EMS as a living, breathing entity. It has a heart, an intelligence, and a soul. It lives within me.
The heart of EMS is comprised of its people who together provide an unlimited well from which compassion and comfort flow for human suffering.
The intelligence or brain of EMS is the vast amount of experiential knowledge and skill that healers acquire and share through desired and undesired lessons and experiences.
The soul of EMS is comprised of the collection of wisdom and emotional intelligence earned by EMS professionals who witness first hand the trials and tributes of life. It is knowing what the primal scream of loss sounds like. It is knowing what face to face contact with mortality is really like. It is experiencing the joy that a new life or second chance brings. It is as much pulling someone from the jaws of Death as it is delivering someone to the jaws of Death as gently, comfortably and kindly as you can while humbly accepting the inevitability of the cycle of a human life. It is witnessing, accepting and appreciating the seasons of the heart of mankind, just as we witness, accept, and appreciate the seasons of the lands we live upon.
EMS is a new kind of sight into humanity, like a newborn when first opening his/her eyes and taking a look around a big new world.
EMS is a large part of my ego. It is my security and has strengthened my sense of survival and belonging to something bigger than me. It is my insecurity, my understanding of how vulnerable and temporary I am, my fear of the mistakes I could make, that if I’m not good enough, I might hurt someone.
EMS is my home, whereby sharing emotionally charged experiences and the nuances of twenty four hour shifts with my team mates my human spirit is challenged and nurtured. EMS teaches me that family is not purely born of blood. These people drive me to work harder to succeed, to be a better person, and to remember to heal myself so that I can in turn heal others.
EMS is my church. I am the closest I’ve ever been to a divine source of energy while watching life or death occur right before my very eyes. A much more profound religious experience than having religion delivered to me by other… conventional means.
EMS is my reality where I experience people at their worst and people at their best. It is my faith that although seemingly witnessing more of the darker side of human nature, the human condition will always be in balance. I have learned that we all ride the great arm of the Grandfather clock forever crossing back and forth between good and bad. Somehow knowing this assures me that it is okay to come up for air now and then.
EMS rolls up it’s sleeves and gets in the thick of it, not because of some insane need for a heroic title, or recognition but because it must be done, and we just do it. We are the Keepers, Guardians, Healers, Protectors, and Warriors for sick and wounded people, their property, and our environment.
EMS isn’t a “calling”. It’s not some “thing” that you join or participate in because of some intuitive or curious leap into an amazing mechanized tool box of tricks.
EMS is a gift. And if Life finds you worthy of that gift, you become a part of it and it becomes a part of you.
EMS is the front row seat in the human experience.