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Home > Topics > EMS Management
August 19, 2014
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by Skip Kirkwood

4 ways to train your EMS staff like a tier-one, elite force

With a little effort, high-level training often associated with special forces can be in reach for EMS agencies

By Skip Kirkwood

Since the demise of Osama Bin Laden, and for some years before, the so-called tier-one military units have been the subject of wide discussion.

The tiers actually refer to funding priorities, but the phrase has become equated with highly proficient and highly trained — including the Army’s Rangers, Green Berets, and Delta units; the Navy SEALs; the Marine Corps Force Recon units, and the Air Force Pararescue units (PJs). I’d also include units like the FBI’s Hostage Rescue Team, the Secret Service Counter-Assault and HAMMER teams and the special operations units of some of our better law enforcement agencies. 

I admit to a certain jealousy of these high-end units; they actually have time and money built into their budgets and work schedules to do training — not as an add-on, but as a core part of their jobs. This is as it should be, for them, and for us in EMS.

Tier-one training involves a constant, purposeful cycle of honing existing skills and building new ones. The goal is proficiency: expertise, not minimum competence. Organizations that incorporate tier-one training have cultures centered on being the best — something that may be a reach for many in EMS. 

But they are also living proof that low salaries are not an excuse for mediocrity. The typical first-term special operations soldier or sailor might command an annual salary of $28,000 or so, all the while risking life and limb at a pretty high level.

Why we balk at EMS education

I was recently engaged in several lively discussions about EMS continuing education. One was on social media, where managers and educators were bemoaning the lack of enthusiasm displayed by medics for their offerings; another was with some EMS folk from my own organization.

Nobody seems to see the value in EMS continuing education, at least not the way that we do it today. It’s just a legal requirement, something to be endured. Why, I asked? 

The answers were revealing:

  • Repetitive re-packing of didactic knowledge, sometimes information that contradicts contemporary clinical EMS practices.
  • Out-of-date material.
  • Lectures delivered by “PowerPoint readers” with no instructional ability or credibility.
  • Too much sitting, not enough action.
  • Programs appear thrown together at the last minute without much thought.
  • Not challenging. Just mandatory — and if it wasn’t mandatory, nobody would attend.

So what can we do about this? Can we experience tier-one quality training in EMS?

I would submit that we can, if we want to, and if we are willing to expend some effort. Here are four steps to making that happen.

1. Learn from the best

EMS educators should make the effort to visit “the schoolhouses” at Fort Bragg, N.C., or Kirtland AFB, N.M. This is where special operations medics for the Army, the Navy, Marine Corps and Air Force are trained.

We’re not looking for their battlefield medicine (although that might be useful); we’re looking at the training environment and educational methodology.

2. Explore training in civilian tier-one operations 

For example, let’s look at urban SAR training with Virginia Beach’s well-known VA-TF1 unit. Let’s go to Beltsville, Md., and learn about Secret Service training, or to New York City to look at in-service for the NYPD’s renowned Emergency Services Unit (ESU).

Or maybe we could go to Texas and visit the Border Patrol’s BORSTAR search and rescue unit; or to Jenny Lake, Wy., to observe the National Park Service’s rangers in training.

3. Visit non-military EMS educational programs

Let’s seek out, identify, and visit non-military EMS educational programs that are noted for doing things in a new and different way — or perhaps an old and different way. At Moreno (formerly Riverside) Community College EMS Academy in California, Director Chris Nolette, past president of the National Association of EMS Educators, runs a demanding program whose students are highly prized by local EMS agencies upon graduation.  

We could also interview the faculty at The U.S. Park Police’s Counter Narcotics and Terrorism Operational Medical Support, who deliver the well-known tactical EMS program in a first-class manner. Perhaps the folks at the International School of Tactical Medicine, another civilian tier-one continuing education program, also have methodologies we could learn from.

4. Consider the approach

Let’s think about our approach to EMS education, both pre-service and in-service. Instead of simply seeking to fulfill the minimum legal mandates, let’s adopt the philosophy of our tier-one contemporaries.

Let’s build our programs to turn out highly proficient, highly motivated medics, who are proficient in their craft, and able to provide high-quality service even in the most difficult of circumstances.

Is this too much to ask? I don’t think so. 

With a little imagination, partnering (tier-one training is not a one-person show), planning, some borrowing, and a bit of effort, it is entirely possible to turn that bland, barely-tolerated training cycle into something that is challenging, interesting and might even improve the level of care to our patients.

Instead of the dreaded and time-wasting “skills check-off and verification” process in a break-out room, what if we gin up a scenario where a patient must be assessed and then appropriate treatments (which just happen to be the skills that we are testing) must be performed.

Never mind the breakout room and never mind the doing it one at a time — that’s not how we do it in the field. We work on whole patients and we work in teams. 

Sure, some of the facilities may be beyond our reach, but it is entirely possible to provide a realistic patient care environment, perhaps in your local fire or police training facility. Even an empty school or vacant shopping mall can provide a great training environment.

About the author

Skip Kirkwood currently serves as the Director and Chief Paramedic of the Durham County, North Carolina Department of Emergency Medical Services. He has been involved in EMS since 1973, as an EMT, paramedic, supervisor, educator, manager, consultant, state EMS director, and chief EMS officer. He is a past president of the National EMS Management Association, is a vigorous advocate for the advancement of the EMS profession, and a frequent speaker at regional and national EMS conferences.
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Kellie Gust Kellie Gust Wednesday, October 01, 2014 9:45:56 AM Much needed

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