When new recruits graduate from the police academy, they aren’t simply given a badge, a gun and a patrol car and told to hit the streets. Instead, they go through a systematized, standardized period of field training, during which they’re paired with a more experienced officer and have to pass a series of tests proving they’re ready to operate solo. Those who fail to meet certain standards are shown the door.
Likewise, many of the nation’s fire departments have a long tradition of field training for rookie firefighters involving both classroom and real-world tests.
In EMS, the tradition of field-training newbies isn’t nearly as strong — and in some places, it amounts to little more than a brief orientation, says Troy Hagen, director of Ada County Paramedics in Boise, Idaho, who also serves as a Department of Transportation appointee on the National EMS Advisory Council. Too often, he adds, recent graduates of EMT or paramedic school are hired and given the keys to the ambulance the next day.
“Everyone in EMS knows that paramedics are not ready to go to work and start seeing patients independently right after they get out of school,” Hagen says. “Paramedic school teaches you about medicine. But there is a whole lot more to a paramedic’s job than medicine. Paramedic schools don’t teach you anything about the operations side of EMS, how to get along with others or leadership.” (The same goes for EMT school, he adds.)
The list of what isn’t taught at school is lengthy, agrees Skip Kirkwood, chief of Wake County EMS in Raleigh, N.C., and president of the National EMS Management Association. For instance, specific information on working at a particular agency isn’t included.
- How do you talk on the radio?
- How do you navigate?
- Where are hospitals located?
- What are the hospitals’ destination protocols?
- What standing written orders are specific to that agency?
- Other missing information includes what it means to be part of a particular agency. “What are the philosophy and the values of the organization?” Hagen says. “What are the expectations of an EMT or paramedic representing this organization?”
And while it’s typical for paramedic schools to require 240 hours of field internships, few graduates come out with enough real-world experience to be trusted on their own at first, according to Hagen. “We call it ‘the gap,’” he says. “It’s that distance between what you know as a certified EMT or paramedic coming out of school and becoming a valuable employee within an organization.”
FTEP gets EMTs and paramedics ready
To bridge that gap, Hagen and Kirkwood are taking a page from law enforcement. Using a field training program pioneered by the San Jose (Calif.) Police Department, the duo has adapted it to EMS to create the EMS Field Training and Evaluation Program (FTEP). The program provides a framework for EMS agencies to get new hires ready to become productive members of the staff, including teaching agency values and expectations and making sure new hires have the knowledge and skills to handle difficult patient situations and the right attitudes about provider and patient safety.
A thorough field training program runs the gamut from making sure new hires understand proper grooming to knowing how to use every piece of equipment found on their ambulance to being able to communicate with patients. “You might be able to start an IV well, but how about talking to a 90-year-old grandmother versus a 21-year-old drunk subject in a bar?” Hagen says.
While the goal is to produce more qualified, more successful EMS employees, an FTEP is also designed to be a “legally defensible” means to weed out new hires who are not performing up to standards, says Kirkwood, who is also an attorney. A good FTEP will include multiple tests and evaluations by several members of the EMS staff, all of which are meticulously documented. “If you’re going to make passing field training a condition of employment, you can’t just make it arbitrary and capricious,” Kirkwood explains. “You have to treat people fairly, which is why it’s important to have a structured program that everyone has to follow.”
To share what they’ve learned with the profession, Hagen and Kirkwood worked with NEMSMA to create a two-day orientation course. Called “Developing and Managing an EMS FTEP Program,” it is designed to provide a comprehensive roadmap for managers and supervisors who want to implement such a program in their own agencies. “The reaction to the course has been enthusiastic,” Kirkwood says. “Participants clearly embrace the need for such a program.” (See “NEMSMA’s EMS FTEP Course Provides a Roadmap for Managers” at left for more about the course.)
FTEP is a common vision
Although Hagen and Kirkwood developed the curriculum for the FTEP course together and are the principal instructors, they arrived at the need for an FTEP in their own agencies independently. Years ago, Hagen worked as a volunteer reserve deputy for the Ada County Sheriff’s Office, which had an FTEP. “I thought, Why aren’t we using this in EMS?” he says. Ada County EMS implemented its own in 1996.
In Ada County, training a new paramedic lasts from three to six months. Topics covered include mapping and navigation, such as understanding how to read mile markers, where the major thoroughfares are and how the county is laid out, followed by time in the vehicle navigating practice runs; a four-hour classroom session on emergency vehicle operations and driver safety; a four-hour road course on driving an emergency vehicle; classes on medical protocols, policies, equipment and procedures; and a skills lab, during which new hires practice all procedures they may be called on to perform in the field.
Phase one of the new hire academy, which is taught by field training officers, runs 48 hours a week for three weeks. From there, paramedic trainees have to pass several written and practical exams.
After passing the exams, the new hires spend about a month riding with their field training officer (FTO) and another paramedic in an ambulance. Gradually, they are asked to take on some roles, such as mapping, driving or patient care. Once the FTO decides a new hire is ready to practice on his or her own, the new hire enters into the third phase: The third person in the ambulance is dropped, and the field training officer and the new paramedic work as a team. Phase three usually lasts at least six weeks.
After the field training officer is satisfied with the trainee’s performance, the new hire is teamed up with another FTO for a two-week evaluation. The final step is a simulation lab, in which the medical director runs through scenarios and evaluates the paramedic’s performance.
Kirkwood also has a law enforcement background, having worked as a reserve deputy sheriff in Oregon in the 1990s. As the state EMS director there, he led a statewide initiative to adapt and adopt an EMS field training program based on the police model. He did the same in Wake County, which implemented an FTEP about seven years ago. As he puts it, the goal is “turning paramedics into Wake County paramedics.”
Kirkwood’s field training program shares many similarities with Ada County’s. The goals are two-pronged: to train new paramedics, and to protect current workers by making sure whoever they are partnered with has the skills and knowledge to behave and perform in a safe manner.
One Kirkwood twist: When the field training officer signs off on a new hire, he or she signs a statement that reads: “I would not object if this person showed up at my house to take care of myself or my family at a time of critical emergency.”
Spreading the word of FTEP to EMS leaders
The idea of sharing an FTEP with the EMS community at large through a course occurred to Hagen and Kirkwood a few years ago. The two were serving on the NEMSMA board and were chatting at a conference. They realized each had, independently from the other, orchestrated very similar programs in their organizations. They decided they should create a formal presentation for their colleagues at other EMS agencies, which eventually developed into the FTEP course.
It’s still unclear if FTEP will become as commonplace in EMS as it is in law enforcement. One of the big obstacles is that training costs money — and, as everyone knows, EMS is under intense budget constraints. “You sometimes get the ‘warm body in a seat’ mentality,” Hagen says. “Some organizations may not be willing to spend all this time on training. When I tell people this training could take up to six months, they say, ‘I’m lucky if I can get three days.’”
Yet Hagen believes the training pays for itself. The process helps with recruitment, injury prevention, safety and retention, he says, pointing to the fact that Ada County paramedics take pride in the fact that they made it through and know their employer has invested in their training.
“The feedback from employees is phenomenal,” he says. “They know that when they are done with the process, they are ready to go. The ones who don’t appreciate the process are the ones I have the most concerns about.
“I sleep very well at night knowing our people are very competent,” Hagen adds. “This is our standard. Our employees know if that person is going to be their partner, they went through this process, too. Our retention has vastly improved since we put in this rigorous standard.”
In their travels teaching the FTEP course, Hagen and Kirkwood have come across a few agencies that are using their own version of FTEP, and interest in the courses has been high at the various conferences where they’ve presented. “We set our own people up to fail if we don’t have a good process in place,” Hagen says. “Hiring somebody, throwing them the keys and saying, ‘Good luck out there,’ isn’t a good way of doing things. What this process does is make sure you do everything you can to make sure they are as competent as possible.”
Hats off to San Jose Police Department
In the 1960s, the San Jose (Calif.) Police Department offered little formal training to new officers before sending them out in a patrol car on their own. In 1971, leaders at the department created the Field Training and Evaluation Program, based on a military training model, according to the San Jose Police Department’s website. The program paired a new officer with a veteran, who offered training and mentoring in a structured 14-week program. Soon after, the California Legislature began to use the San Jose model as a state standard for police training, and today the program is in use across the nation.
