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Coach or cannibal with rookies? News

July 19, 2012

The Ambulance Driver's Perspective
by Kelly Grayson

Coach or cannibal with rookies?

Since when is being treated like a leper a time-honored and sacred rite of passage?

By Kelly Grayson

Rookie EMT: It's the other white meat.

One of the legends of the Greek philosopher Diogenes is that he often carried a lamp around in the daytime, searching in dark crevices and alleyways for an honest man. He never found one.

I sometimes feel the same way when reading an EMS social media comment thread. While the Internet allows access to information at the speed of thought, ignorance travels just as fast, and sometimes the signal-to-noise ratio is distressingly low. Mostly I skim the threads for the comments of a select few whom I know always have something insightful or constructive to say and ignore the rest.

Yeah, I know it's probably intellectually dishonest, but it keeps my head from exploding.

Reading one of those comment threads the other day, I was reminded that the cannibalistic approach to mentorship is still alive and well in EMS. Frequently, an EMS rookie will post a request for advice, something along the lines of, "I'm a new EMT with Podunk Volunteer Ambulance Corps, and I'm having a problem fitting in with the older members of the squad," or "I just ran a really bad call the other day, and I'm having problems dealing with it. How do I get past it?"

And I was appalled at the number of comments that were some variation of, "Harden up, cupcake."

Really? Forty-plus years into this profession, and we're still eating our young?

I'll grant that EMTs need to develop a thick skin as some measure of psychological protection against job stresses, but is it really necessary that a new EMT harden up to fit in? Why shouldn't some of the older, more seasoned EMTs learn to soften up? Since when is being treated like a leper a time-honored and sacred rite of passage?

After all, that's one of the best things about a rookie — you get to vicariously experience EMS through a fresh set of eyes. They remind you of all the good things you've forgotten about EMS, all the things you take for granted after the grind has beaten a little of the humanity out of you.

We don't need to crush the idealism of our rookies. We need to harness it.

I've often mused that EMS would be better served if we stopped recruiting adrenaline junkies and trying to teach them compassion and started recruiting compassionate people and teaching them to function under pressure. The first step would be to ditch this notion that cynicism is desirable.

It may be inevitable, but it is never desirable.

The dictionary defines preceptor as "an expert or specialist, such as a physician, who gives practical experience and training to a student, especially of medicine or nursing."

That "practical experience and training" encompasses volumes of volumes of tradition, science, art, wisdom and BS. It is the lore of our profession. The good preceptor passes on the collective wisdom — and sometimes, inadvertently, the BS — of our profession to the next generation, and I mean all of it; what EMS was, what EMS is and what EMS should be.

Pay particular attention to that last part: what EMS should be. In that way, we are all preceptors. If you want to know what a preceptor really does, you have to go back to the root word:

Precept: [pree-sept] - noun

  1. A commandment or direction given as a rule of action or conduct
  2. An injunction as to moral conduct; maxim
  3. A procedural directive or rule, as for the performance of some technical operation
  4. A law

All four definitions are important. All four have direct bearing on our practice as EMTs. They encompass our traditions, our attitudes and our expectations of proper behavior. They are our professional ethos. The role of the preceptor is to be a steward of our profession and, in so doing, prepare the next generation of EMTs to be stewards of the profession as well.

So why is it that many preceptors only pay attention to no. 3?

My sweetheart works for an EMS staffing agency, and she has a mantra: "Hire for attitude, train for ability." She recognizes that of all the skills that a good EMT possesses, the so-called "soft skills" are the hardest to teach.

Learning how to board a patient, apply a traction splint or auscultate lung sounds is a matter of repetition. EMT class should have accomplished that before they reach the streets, but even if it didn't, it's still a relatively simple matter for a good partner to correct any deficiencies.

What is far harder is to instill in a new EMT is the right attitude, and doing that requires someone far more valuable than an EMS instructor or a field training officer.

It requires a mentor.

In your moments of greatest stress and indecision, whose advice do you crave? Who do you first think of when you want to share the elation of a professional triumph? When you feel beaten and discouraged, whose voice whispers your mental pep talk? Who plants the metaphorical foot in your behind when you need the motivation?

Right now, you're probably smiling, thinking of just such a person: Your mentor. The best part is mentoring doesn't require any special training, an extra stipend or a job title. It just comes by setting an example for the next generation.

And the first step is realizing that you can season the new meat without needing to eat it afterwards.

About the author

Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (, or email him at

The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Michael Hatfield Michael Hatfield Thursday, July 19, 2012 3:56:58 PM Well said Mr. Grayson, well said.......
Renee Roberts Renee Roberts Thursday, July 19, 2012 3:58:42 PM This is exactly why we don't do that in our company. Each of our lead EMTs and supervisors is expected to treat and educate new staff appropriately. The new guy or girl is not relegated to crap duty. We do have fun with the new ones, don't get me wrong, but we mentor and work side-by-side with a new EMT.
Donna Plumley Brubach Donna Plumley Brubach Thursday, July 19, 2012 8:51:46 PM I was just fired from a local ambulance service because I was not an adrenaline junky, never got flustered at scenes, patient skills were good, reporting was good, but because I could not get my trainer to like me. Yelling at me for changing lanes, (on the way back to base), yelling at me for trying to take a pts belongings with her, yelling at me for jostling him in the back during the ride to the hospital. All of those were in front of, either FD, PD, or hospital staff. And when he couldn't get rid of me for any other reason, he lied and said I turned in front of oncoming traffic. And at my termination meeting, they actually said, he IS hard to get along with..... When I had asked for a different trainer, they said no. Eating our young? Oh yeah. And the other people in my class had trainers that actually taught them stuff instead of sleeping in the back between calls....I'd hear them on the radio laughing, and was so trainer literally humiliated/embarrassed/harassed me every chance he got. The entire class was warned about him, and when I found out I was assigned to him literally 8 people told me I was screwed. Like I said, I tried to trade, they wouldn't do it. I've worked ambulance before, and it was always fun, interesting, heartbreaking, and at the end of the day you went home feeling you'd done some good. From the day I got in the unit with him, it was not that. Sorry, I'm still a little touchy about it, and got on a rant.....
Greg Mills Greg Mills Thursday, July 19, 2012 9:00:19 PM So true. Would requiring higher levels of education help fix this -rampant- problem?
Kelly Grayson Kelly Grayson Thursday, July 19, 2012 9:34:08 PM No, but offering a preceptor training program and selecting preceptors based on factors other than clinical skill mastery or time in service would be a start. That, and attracting better people to EMS in the first place. Teaching EMT's to better evaluate the soft skills is first accomplished by hiring more people with the soft skills in the first place.
Andres Pedraza Andres Pedraza Friday, July 20, 2012 7:45:38 AM Have you considered that perhaps it is the most cynical, hardened and abrasive who are also the most vocal on social media? If you research the psychology on the internet, and in particular look up analysis of what is commonly known as "flaming", you will find that electronic communications seem to bring out the worst in people. It has mostly been blamed on the "facelessness" of the medium, where people don't have the advantage of immediate feedback that comes from more direct interaction as well as the distance provided by the conduit. After all, some of the things commonly said online would earn someone a punch in the face if said face to face. I am going to go out on a limb that much as electronic communications seem to make nice people mean, they certainly make mean people meaner.
Halim Hasan Halim Hasan Friday, July 20, 2012 1:11:25 PM Well said. As a new EMT myself, I hope not to experience this, because while I am new, I'm not naive and don't take crap. I can take criticism, but not someone elses BS.
Doug Hawkins Doug Hawkins Friday, July 20, 2012 1:18:27 PM Mr. Grayson, I am one of the lucky EMT's that have a wonderful mentor program in a strictly volunteer station. I have had paramedics/EMTs act this way around me, was completely apalled at their attitude as me being a "Green Horn". Eventually I understood to ignore them and only work with them as a professional, but my local station I can THANKFULLY say, has actually called me up and met with me out of nowhere, just to make sure I'd been doing okay. I'm going on a year now, and am still lucky to have these people behind me. I want to say a loud THANK YOU, to all those EMS professionals that take care of their "Green Horns".
Eric Doc Liddy Sr. Eric Doc Liddy Sr. Friday, July 20, 2012 2:32:18 PM Kelly, You know me and my background and what I deal with. The one thing you mentioned, JUST hit home with me and it's even something that I FORGOT! Mentoring. The single word that nest fits. As a senior Firefighter/EMT with a suburban Detroit department, we were mandated that we mentor ALL of our newly certified and licensed personnel. MANDATED! Thanks for jarring my own memory for what it is we should be doing. Sometimes it takes just one word to free us "hardened" old timers from the one tracked mind mentality that we all seem to develop over the years. I believe in the FTO program...having been one some years ago. It truly does work and even though I haven't upgraded to Paramedic yet, I have seen so many over the years become Paramedics and Nurses and I am proud of that. Your article has definitely has reopened my eyes.
Timothy Tremain Timothy Tremain Friday, July 20, 2012 3:56:10 PM What an excellent article! I have preached that for many years.
Lauren Klusmeier Lauren Klusmeier Saturday, July 21, 2012 7:01:18 PM Compassion is hard to find in people and the ones that are compassionate have a hard time in healthcare. As a new EMT waiting to be hired, I hope I keep my stong sense of compassion and understanding. A reason I am in EMS is because of compassionate EMS workers, and some that were cold-hearted. I want to be better than them. Plus my EMS teacher that told the class I was in if we couldn't cry with our patients, get out! lol.
Diana Sprain Diana Sprain Monday, July 23, 2012 11:00:26 AM I've always tried to be decent to my trainees. Bottom line - I want them to pass the training & probation for purely selfish reasons. Once they are on their own, it's one more person available to cover for me to get a day off and a partner I may work with who knows what he or she is doing. Taht won't happen if the rookie quits during the training phase.
Judy Wamzmom Wamser Judy Wamzmom Wamser Friday, July 27, 2012 11:21:47 PM I never found a "call" half as stressful as a loud and critical partner. They fluster people a lot more then they help people.
Hannah Rae Hannah Rae Monday, July 30, 2012 5:04:20 PM I so appreciate this. I don't know how many times I've heard references about new EMTs being dubbed "too nice" or "too patient" by cynical persons in ems that would rather put their nervous energy into criticizing those with great potential rather than bettering themselves, or better yet, encouraging the next generation.
Kathi Hill Kathi Hill Saturday, August 04, 2012 12:05:46 AM As a new paramedic student, I can tell you that frosting students is almost mandatory...many preceptors are merely serving as bad program does not tolerate treating patients with anything less than compassion (not hard for me) yet they allow us to be precepted by medics in career departments who treat patients (and students) like they are something they stepped in; their only goal is dumping their patients on a hospital crew and getting back to the station. They expect that we are already medics, and teaching anything to us is absolutely not happening. In other departments, we are overwhelmed by the help we get, both by the medics and the EMTB's...they encourage, support and cheer for any successes...after 10 years in the military it seems to me to be a leadership deficiency. I teach all the EMTB's in my department to support me by being able to replace me...I guess I just don't understand what the possible positive result can be in treating students like shit...we are taught in our program that we are responsible for bringing up the next generation of medics as well as educating our EMTB's....
Donna Statkus Donna Statkus Saturday, August 04, 2012 6:15:33 AM It must be a universal thing - that was my experience as a paramedic student as well and eventually it overshadowed my career as a medic. I moved on, but truly missed the job I really loved. I hope it turns out more positive for you!
Matt MacDonald Matt MacDonald Sunday, August 05, 2012 4:36:02 PM Thanks for this Mr. Grayson. I could not agree more. Reading some of the comments, I'm angered at the experiences of some of the new students. As a preceptor, my rule number one is "be nice"! You can be the most technically proficient medic in the world, have the medicine down cold but if you cannot connect at some level with your patient, it will have been a cold experience for the patient. If you are sufficient at the medicine and can get your patient to feel a measure of comfort, trust or even get them to smile...then you've won. Every time. I believe that the most important thing we can do with patients is make them feel cared for. How are we, as senior medics, supposed to pass that on without making our students cared for as well? No, I'm not saying that we let insufficient students through. I am saying that we should invest ourselves in a students success. Isn't that what we're there for? To help them succeed?
Teri Lynne Miller Teri Lynne Miller Monday, August 06, 2012 2:38:37 PM "Hire for attitude, train for ability." Amen.
Taylor White Taylor White Thursday, August 22, 2013 5:27:54 PM I love this article! Kelly, I so wish that I could have preceptors that think the way you do. Most preceptors seem to view precepting as a burden rather than a joy. I only had 2 preceptors (out of at least 10-15) that gave me feedback other than "keep studying and get more experience." Lately I have been feeling disenchanted with EMS (I've only been a Basic for about 4 months) due to my real-world experiences and the "real-world" EMTs I've seen. This article and the comments give me some hope that I wasn't completely wrong in thinking that EMS is populated with passionate and skilled professionals.

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