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EMS News in Focus
by Arthur Hsieh

‘Realistic’ EMS training must avoid real danger

When training sessions are thrown together without much thought, it puts student safety at risk

By Arthur Hsieh

“Train as you work; work as you train.”

If you subscribe to that philosophy, then you know that safety is a major concern in the training arena. Given the number of injuries that EMS workers sustain while on the job, it’s essential that good safety practices are instilled at every training opportunity.

That would have been wise advice to follow in the case of an EMS instructor who set off a CO2 grenade and blew out the eardrum of an EMT student. While I understand why the instructor used an explosive device to create a more realistic scenario, it’s how he used it that makes my educator bones shiver.

For one, it’s clear the student was too close at the time of detonation. Was there a safety officer on site? Was the detonation in a closed room, amplifying the concussion? More importantly, was this done routinely during this lesson, and this is the first time there’s been an injury?

Regardless of what discipline the instructor receives, I’m hoping that a serious debriefing of the situation will identify any major system issues that allowed this to happen in the first place. 

Unfortunately, too many instructors and providers don’t take training seriously. Training sessions are often trivialized and thrown together without much preparation or thought. It sends a message that what we do isn’t important.

Nothing could be further from the truth.

Be it better chest compressions, the accurate placement of a needles during an emergency cricothyrotomy, or the empathetic manner we display to reassure a patient, what we do matters in both big and small ways. 

Keeping students safe is one lesson the training community needs to make sure it learns.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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Paul Garcia Paul Garcia Tuesday, April 29, 2014 3:02:43 PM wow way before the safety officer issue there should of been a risk assessment complete. I don't agree with this type of training aid.
Colin Palmer Colin Palmer Tuesday, April 29, 2014 8:07:31 PM I think that we see too much of this in the EMS education world. I've witnessed everything from over-the-top mental health/distraught family member role-play/acting to scenarios that "evolve in complexity" based on the evaluator's personal feelings about a student/candidate. It is unfortunate to say, but we did it to ourselves. We (EMS) took a cue from our closest related industries (at least from an operational environment stance), fire and law enforcement. Both of those industries have a strong culture of "live fire" training and have developed a good (in most cases) system of safety measures to prevent injuries. Also, performing live-fire exercises on the FD and LE side is fairly inexpensive to sustain, once a moderate budget has been spent on initial implementation. The EMS side isn't so lucky. Medical training equipment starts out expensive and stays that way, pretty much throughout the life-cycle of that equipment. This cost, coupled with the fact that EMS training "done right/done best" requires a respectable sized staff and a quality facility will place top-tier EMS training out of the grasp of all but the largest, nation-wide organizations. Now, contrast that with the FD and LE side. An FD could likely build a pretty sweet fire training ground for roughly the same cost as one or two high end medical simulators. The LE side can reclaim just about any warehouse or commercial property and convert it into a full-blown simunition wonderland for less than the cost of a single top-end medical simulator. If we add to that the fact that many EMS educators come from a background in the fire service (as well as some from the LE side) and you have a situation where instructors carry over what they know well (live-fire training), but have failed to recognize that their new target audience has neither the expanded training nor the right PPE to work in that live-fire scenario. I've even seen cases where an instructor with good intentions, but no military or LE experience, has set up convoluted attempts at "live-fire" training (with the associated hardware, usually borrowed "from a buddy") so as to make training "more tactical". As I was reading the above article, I thought to myself "If we had pyro on site, I totally could have seen 'so-and-so' do that...". The short version? I think this would have been completely OK for training if the scenario was germane to meeting the stated educational objectives and the student was properly equipped with suitable PPE for the environment. Without knowing all the details, I can't say if that is the case or not. What I can say is that I'd be pretty unhappy with the quality of training if someone was throwing flashbangs at me during mega-code practice all willy-nilly and such. Okay, the last part was a little tongue-in-cheek. Please don't throw flashbangs at your students.

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