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Training EMS personnel to drive: What are we thinking?

Driver training is inadequate to the challenges of operating an ambulance and we need to devise a strategy to improve training and reassessment


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Recently, a new risk management director joined my organization, and he had prior experience that included police, fire, and EMS. Working with someone who knows his way around our business is a very nice change – mostly. The qualification comes from the fact that he can ask some hard questions.

Of course, some of his difficult questions involve examination of our driver training program. And when I tried to answer them, my answers sounded, well, a little lame. So I went out to my colleagues on the National EMS Management Association (NEMSMA) list server and a few other sources, and I asked about their programs and processes. A few colleagues replied with answers that also sounded a little lame and the vast majority of responses were in the nature of “let me know what you find – we’ve been thinking about that question also.”

As industry leaders gather at EMS Today, it seems like a good time to have a face-to-face discussion with colleagues, and share best practices for training EMS providers to drive ambulances. This topic is too important for managers to keep to themselves.

The current state of paramedic driver training for ambulances in the United States, based on my informal surveys, is that we have a variety of short courses that typically involve some classroom discussion, followed by some limited “maneuvering” activities and behind the wheel practice in “cone courses.” Some of those short courses include:

  • Coaching the Emergency Vehicle Operator-3 (CEVO 3 Ambulance): a six-hour classroom-only course from the National Safety Council. The course provides for an optional one to two hour “cone course” to address vehicle maneuvering. There is no on-highway practice requirement.
  • CEVO II Ambulance Online is four hours of online instruction.
  • There are a variety of courses using the “EVOC” or emergency vehicle operator course rubric. There does not seem to be a standard description for what EVOC includes.

In general, EMT and paramedic schools do not teach ambulance driving – that responsibility has been pushed to the employers. Most employers do not have the expertise, facilities or equipment to conduct appropriate driver training. Most agencies do some familiarization driving, followed by a “check-off” by a field training officer (who usually is not a qualified driving instructor). Fewer still require any sort of periodic re-evaluation of their paramedics that are driving ambulances, and those that require re-assessment do not require evaluation by a qualified instructor.

In short, our approach to ambulance driver training is “hear no evil, see no evil.” We take people who may have driven nothing heavier than a 2,700 pound economy sedan, put them behind the wheel of a 14,000 pound or 21,000 pound ambulance, and hope for the best. In the thought first attributed to Rudy Giuliani in 2008, “Hope is not a strategy.” As an industry and a profession, we should do better than this.

Driver training in other professions

In the U.S., our law enforcement colleagues typically spend 40 to 80 hours or more on driver training. The New York State Police require 100 hours minimum and the fact is that law enforcement officers drive cars, and don’t have to back up on every call.

The fire service requires extensive driver training, after an individual has specific experience as a firefighter. Not every firefighter is required to be certified to drive, and training and qualification is required for each and every vehicle type and size.

In the United Kingdom, ambulance driver training requires several weeks of training, on the road, including a special “blue light operator” course prescribed by the Association of Chief Police Officers. This course requires extensive on-road operation including driving with emergency warning systems. Watch a video of blue light driver training:

Searching for specialized ambulance driver training

I searched for private schools that I could send people to, to learn how to become legitimate, hands-on, emergency and ambulance vehicle driving instructors. While I found a plethora for police, fire, security, and dignitary protection, I found none for ambulances or EMS non-transport vehicles, such as quick response SUVs and pickup trucks.

Nobody talked to me about using high-fidelity simulators for training personnel for ambulance driving. Even the Ice Road Truckers have to qualify on a simulator every year before they drive north on the ice road) or Skid Car training to improve driving on ice, snow, or rain-covered roads. For an eye-opener, check out this video of Bend Fire & Rescue training on a skid truck:

So what are we doing, folks? EMS personnel are hurt every day in preventable vehicle crashes. We don’t really train them or evaluate them for driving proficiency. We spend next to zero time training our drivers, then we send them out on the road to run hot and cold calls, with and without patients in the back. We conduct driver training only on bright sunny days, yet we expect our people to operate under emergency conditions, during the day, at night, in rain, snow, and wind. And we wonder why we have crashes where people get hurt?

Collaborate to develop actual strategies and meaningful answers

As you visit with EMS colleagues at EMS conferences, participate in online discussions, or develop training programs share your strategies for improving driver training for EMTs and paramedics.

There has to be more to our driving strategy than lame answers and hope.

Skip Kirkwood 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.