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The best of EMS1 Pioneers: Pearls from the class of 2017

This year’s profiled EMS pioneers shared an experienced perspective on EMS training and education, leadership and opportunities


Kalie Klaysmat treating a patient with a fractured femur.

Courtesy photo


To be an EMS pioneer, you need persistence, longevity and a little luck. But to be an EMS Pioneer and have your career’s highs and lows cataloged by EMS1, a few good stories and a self-deprecating sense of humor surely help.

In 2017, six veteran caregivers who didn’t take themselves too seriously, despite over 250 years combined experience, shared astute observations about our industry’s past, present and future.

You don’t have to be passionate about EMS to be a Pioneer, but an unambiguous commitment to patient care – a prerequisite for anyone hoping to make EMS better than they found it – was certainly evident among this year’s class. Add diverse, somewhat unconventional backgrounds to the mix and you get plenty of material – too much to print in our bimonthly columns, but just the right amount for an expanded look at five provocative topics:

1. EMS education

Winnie Maggiore: “To become an educator, start by volunteering to teach. Find an instructor you like and see if you can help them. Assist with practical exams. Teach an EMT course somewhere.”

Gene Gandy: “Instructors have to master the curriculum. You have to know the information backwards and forwards, in much greater depth than you though you’d ever need. That means you have to do an awful lot of supplemental reading.

“If you use one textbook to teach from, I don’t care how good it is, it’s still just one book. If you said you were going to get through medical school or even nursing school with one book, people would laugh at you.”

Kalie Klaysmat: “I was always troubled by what I call incestuous training. You don’t learn as much if you have the same instructor every time. When I’d set up courses, I’d try to expose my people to a variety of instructors.”

Gene Iannuzzi: “I see students with much shorter attention spans and more immediate needs of gratification. The real issue is that almost everyone in my classes is already looking to do something else within the next few years. They take an EMT course, figure they can do the paramedic thing, then become a firefighter or go on to nursing school. That makes it hard to teach these folks because they don’t see long-term value in what we’re doing.”

2. Managing people

Iannuzzi: “Management is a completely different skill set. You know how we do ACLS training and teach people that the team leader’s job is to stand at the foot of the bed, stroke their chin and go, ‘Hmmm’? Everybody gets freaky about that and wants to jump in and do all the skills. You have to tell them, no, you’re not supposed to do that anymore; you’re supposed to be providing direction to others.”

Bart Walker: “Have patience. Some people want to move up really fast. Once you get to the top, you’re going to be flying a desk for a good portion of your career.”

Klaysmat: “The best piece of advice I ever got was to lead by example. You can’t have a double standard: do as I say, not as I do. You have to walk the walk.”

3. EMS documentation

Gandy: “One thing that seems to be a problem for EMS people is the difference between a fact and a conclusion. When you read most patient-care reports, they’re filled with unsupportable conclusions; for example, ‘Patient is A&OX4.’ That means they’re awake and alert to time, place, person and event, but how did you determine that? Lot’s of times that awake-and-alert stuff is a conclusion with no basis. A good lawyer would rip that to shreds.

“Everyone is mentally competent unless they’re declared otherwise by a court. Even if you’re drunk, you may have lost present mental capacity, but that doesn’t mean you’re mentally incompetent. Failure to understand the difference can lead to poor documentation.”

4. Nurses versus paramedics

Iannuzzi: “The reason bad feelings persist is that neither group understands the other. There’s a very slight overlap in critical care, but mostly, they don’t do the same things.

“The idea medics have that nurses just wait for doctors to tell them what to do is nonsense. In fact, if you’re working in a community hospital, odds are you don’t have lots of doctors around; and if you’re in a teaching hospital, the residents are often inexperienced, which gives nurses more of a chance to get involved.”

5. The nature of EMS

Walker: “We all go through periods when we doubt we made the right career choice. A lot of people start working in EMS thinking it’ll be all glory and don’t realize what they’re getting into: you’re not going to be saving lives 24/7.”

Maggiore: “Self-regulation is one of the hallmarks of professionalism. That’s something the medical field hasn’t done well overall, which is one of the reasons we have so many malpractice suits. I think we need to be better at policing our ranks instead of waiting until something bad happens.

“Each of us has a lot to do with how our industry is perceived by others. Be an innovator. There are phenomenal public-health problems out there. Find some solutions.”

Iannuzzi: “I look at what community paramedicine wants to do – keep people out of the ER, check on whether they’re taking their meds, teach them to live in the community – and I know it’s not as simple as it sounds. Sometimes you have to solve really complex medical, financial, social and insurance problems to keep them safe at home.

“Most paramedics are nowhere near as prepared to do well-care as they think. Good assessment skills are only part of it; you also need to know how to access social services on behalf of your patients and how to teach them about injections, colostomies, feeding tubes and wound care so they don’t have to go back to the hospital for those things.”

John Hultgren: “There are unlimited opportunities to make a difference; you just need to find them. Sometimes it’s helping patients, sometimes their families, sometimes your own people. You have to reach out and make it happen.”

Year four of EMS Pioneers starts in February 2018.

About the Pioneers

Mike Rubin is a paramedic in Nashville, Tennessee. A former faculty member at Stony Brook University, Mike has logged 28 years in EMS after 18 in the corporate world as an engineer, manager and consultant. He created the EMS version of Trivial Pursuit and produced Down Time, a collection of rescue-oriented rock and pop tunes. Contact him at

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