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EMS education: Why EMT instructors need to step up News

December 4, 2012

by Mike Ward

EMS education: Why EMT instructors need to step up

They are the key to successful providers in the Educational Standards era

By Mike Ward

Overshadowed by the rush to get paramedic programs CoAEMSP credentialed is the challenge in getting state certified EMT instructors prepared to teach to the Educational Standards.

Model EMS Instructor Template
The National Association of State EMS Officials (NASEMSO) issued an "EMS Instructor Qualifications"1 template in December 2010 that described four levels of instructor:

  • Program Director
  • Lead Faculty/Primary Instructor
  • Adjunct Faculty/Subject Matter Expert/Content Matter Expert
  • Assistant Instructor/Practical Skills Instructor/Secondary Instructor

The role of a Lead Faculty/Primary Instructor significantly changes under the 2009 Educational Standards.

Moving away from vocational training
The process to become a state EMT/Ambulance instructor in the late 1970s was vocational. We functioned as readers of a state approved National Standard Curriculum (NSC) course. The state focus was on correctly completing state forms, closely following the skill sheets and using word-heavy 35mm slides that came with each chapter of the textbook.

The NAEMSO template expects the Lead Faculty/Primary Instructor to demonstrate ability to:

  • Write lesson plans;
  • Write learning objectives;
  • Deliver didactic content;
  • Develop learning evaluation measures.

EMT critical thinking
The National Registry of Emergency Medical Technicians sponsored research to identify successful strategies of high performance training programs. Let's look at four components from "Instructional Strategies to Improve NREMT Pass Rates"2

  • Administer multiple assessments of student progress throughout the class.
  • Assure instructional consistency.
  • Provide clearly defined objectives to students and instructors.
  • Provide immediate feedback for written, practical evaluations to students.

Old-school instructors with extensive teaching experience seem to keep lesson plans and student objectives in their head. The vocational National Standard Curriculum (NSC) was specific in numbers, linear procedures and checklists.

Dan Limmer, an EMT textbook author, points out that the Educational Standards3 eliminates the linear procedures that were a dominant feature in NSC curriculum.

Limmer points out that a better student understanding of physiology and pathology creates a foundation of understanding that allows the EMT to make a complaint-based approach to patient assessment.4

In order to accomplish this, the EMT instructor needs to develop educational experiences that focus on decision-making and not regurgitation of a memorized standardized checklist.

This is a new instructor skillset that is not familiar to many.

Adult problem solving
Adult students thrive on solving realistic, real-world problems. Use of patient case studies is a method to practice compliant-based assessments and link assessment results to determination of patient priority.

Expand beyond the very narrow range of patients situations that the EMT can "do something about." In addition, provide a diversity of patient assessment scenarios that build upon each other and reinforce the pathophysiology concepts covered in the Educational Standards.

Ideally, the student gets an opportunity to do a complaint based patient assessment at every classroom session, two if it is an eight or 10 hour session.

It will take a lot of preparation, but experienced EMTs can do it.

Assess more and different patients
Having a teenaged male student play-act as an 82-year-old female with chest pain is a familiar scene in many EMT classes. The students gain little value in this activity.

Seek out a public clinic or health center that sees a lot of patients. A dozen patient assessments at the free clinic will provide a rich and detailed reinforcement of the learning objectives.

This summer I worked as an assistant instructor in dozens of EMT classes through many organizations and employers in two states. I was also hypertensive.

The hypertension vanished when I was assessed by EMT students who were in final preparation for the state psychomotor exam. Wow, so many 120/80 readings!

Bootstrapping your skills and knowledge
Many of you will need to step up without state or employer support. Of the two textbooks covering the 2009 Educational Standards EMT curriculum, I found this one most helpful:

American Academy of Orthopaedic Surgeons (AAOS). (2013) Emergency Medical Technician Transition Manual: Bridging the Gap to the National EMS Standards. Jones and Bartlett, ISBN 978-1-4496-0915-3.

The best book to develop your educator side is the one developed to support a national EMS instructor training initiative:

National Association of EMS Educators (2012) Foundations of Education: An EMS Approach. 2nd edition. Delmar Cengage Learning, ISBN 978-1111134884.

Full disclosure, I am a textbook writer for Jones and Bartlett and was a paid by Delmar Cengage Learning to review a pre-production copy of the NAEMSE second edition text.


1. National Association of State EMS Officials. (2010 December) "EMS Instructor Qualifications: A Template to Assist States with Implementing the EMS Education Agenda for the Future: A Systems Approach." Accessed October 31, 2012 from

2. Margolis, Gregg S., Jonathan R. Studnek, Antonio R. Fernandez, Joseph Mistovich. Strategies of High Performing EMT-Basic Educational Programs. Prehosp Emergency Care. 2008;12:206–211.

3. U. S. Department of Transportation. (2009 January) National EMS Education Standards. National Highway Traffic Safety Administration. DOT HS 811 077A.

4. Limmer, Dan. (2012 October 31) Lessons Learned in Implementing the National EMS Education Standards. EMS World Expo, New Orleans.

About the author

Michael J. Ward, BS, MGA, MIFireE, NREMT-Basic, spent 12 years as an academic, ending as Assistant Professor of Emergency Medicine at George Washington University in 2012. He treated patients as an EMT (commercial, volunteer and seasonal) and paid firefighter/paramedic and, during a 25-year career with Fairfax County (Va.) Fire and Rescue, worked in every division of the department, retiring as the acting EMS division administrator. Ward is also a textbook author and conference presenter.
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.
EMSEduCast EMSEduCast Wednesday, December 05, 2012 5:41:40 AM "Having a teenaged male student play-act as an 82-year-old female with chest pain is a familiar scene in many EMT classes. The students gain little value in this activity." How did you give your EMT students more realistic patient assessment opportunities?
Mike Ward Mike Ward Wednesday, December 05, 2012 5:59:06 AM Send the students to a "free clinic" or other public health setting where they are allowed to take vital signs and patient histories. A logistic challenge and not always possible.
Bob Sullivan Bob Sullivan Wednesday, December 05, 2012 7:09:54 PM I wish the standards included clinical time for EMT students and a formal clinical internship. In addition to ED clincals, there should be time at nursing homes, dialysis centers, and psychiatric facilities. Students should also be able to demonstrate competence under supervision on real calls before certification, instead of leaving it up to individual agencies to do - or not do - it after.
Thursday, December 06, 2012 7:25:21 AM Good stuff, Mike. Unfortunately, I think your message will fall upon "dead ears." During my years on the planet, I've seen many instructors for all Emergency Services disciplines, not just EMS, who never did another bit of instructor professional development once they attained their initial instructor certification. I'm sure you've see 'em as well. Thanks for shining the light into the dark room!
Diana Sprain Diana Sprain Thursday, December 06, 2012 10:11:11 AM When my husband first received his paramedic certification, it was as a Mobile Intensive Care Unit (MICU) Paramedic. He taught an EMT class at a college for a number of years, utilizing his numerous contacts to make the lab realistic and fun. For the vehicle extritication, he had a local fire department bring a vehicle out to the campus and let the students try doing assessments on a 'victim' who was in a mangled vehicle. Once everyone had a turn, the firefighters would demonstrate how an extracation was done. The fire department also it the afternoon a training experience for their personnel. For water rescues he'd take the students to the campus pool (everyone was instructed to wear bathing suits). They all took turns extricating an injured swimmer. They had to perform rescue breathing on the dummy, while still in the water. Because the region was known for many varities of outdoor activities, he would borrow kayaks, skies, and other outdoor gear. The volunteer victims would wear the equipment, in addition to the moulage. Another person stood by to call out the 'vital signs' during the scenarios and would also call out the victim's status changes - the patient has stopped breathing or the victim now has a pulse. Over the years, a motorcycle was carefully lowered on a victim, another slid under a vehicle, and many had pieces of liver (and other cuts of meat & real bones) applied to their bodies along with tubing (that the victim manully squirted 'blood' to mimic arterial bleeding) worked in to the make-up effects. Props such as police crime scene tape (courtesy of my employer), used bullet casings, and chalked line drawings helped to make scenarios more life like. He even had a couple of volunteers act as nosy or aggressive bystanders. He arranged for a spare ambulance to be at one lab, to allow each student the chance at being in the back of a moving rig (it drive around the parking lot). Students praised his course. He ran in to many prior students in the field who told him his class helped prepare them for the field. Creativity doesn't have to be expensive. I used beat cops in the disaptcher training - having them run in the gym, while calling in phoney foot pursuits for my trainees to handle in our CAD training environment. I made phone calls to my students, letting them ask questions and enter the calls in the training program. I was able to review the events with the trainees and see what went right and what went wrong.
Mike Ward Mike Ward Thursday, December 06, 2012 10:12:11 AM Thanks Bob
Mike Ward Mike Ward Thursday, December 06, 2012 10:14:16 AM Thanks for your post. There becomes significant time and logistic issues when expanding clinical rotations. It would be great if each EMT student could get a set of vitals and history on a dozen different people.
Mike Ward Mike Ward Friday, December 07, 2012 12:02:17 AM Thanks Diana for sharing you and your husband's teaching experiences.
Catie Holstein Catie Holstein Friday, December 07, 2012 9:22:39 AM Bravo Mike. Bravo. Standing ovation from me.
Andrea B Krochalis Andrea B Krochalis Friday, December 07, 2012 8:34:18 PM RUEMT class- read this- we just finished this class, thank you! jackie quesenberry-stilwell
Tayo Love Tayo Love Sunday, December 09, 2012 6:14:50 AM I don't know what to say.
Miguel Flores Miguel Flores Wednesday, December 12, 2012 11:36:01 AM Its rather interesting how instructors are blamed! Mean while the curriculum is dumbed down, Patient care is thrown out the window, because patient assesement pretty much allows almost any one to pass! as per the new patient assesment here in NYS! There are those of us, with experience 15 plus years doing the job, who have seen it get dummer and dummer! Hours are cut, and yet where is the profeciency? How can we as instructors set the standard? Well in my opinon I would contiue to teach the CLinical approach, and during testing the students better had retain working knowledge of what they are doing and why! If we were to go by the sheets alone It would be very scary! LOOK at CPR, how many times has it changed back and forth? the same with ACLS?
Mike Ward Mike Ward Monday, December 17, 2012 6:21:23 AM Hi Miguel, Working backwards ... CPR and ACLS have changed every five years based on research on patient outcomes. Not perfect, but based on paying attention. The dramatic results with uninterrupted chest compressions at a rate of 100 are better make the latest changes worthwhile. The Educational Standards curriculum (2009) reverses the path taken in 1984 by the National Standard Curriculum. New York is not the only one struggling with a non-linear approach to patient assessment. Mike
Steven Kanarian Steven Kanarian Saturday, January 05, 2013 1:58:51 PM Hi Bob, Your desire to learn is awesome. Perhaps you should go into medic or RN program.

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