EMS education: Why EMT instructors need to step up

They are the key to successful providers in the Educational Standards era

Overshadowed by the rush to get paramedic programs CoAEMSP credentialed is the challenge in getting state certified EMT instructors prepared to teach to the Educational Standards.

Model EMS Instructor Template
The National Association of State EMS Officials (NASEMSO) issued an "EMS Instructor Qualifications"1 template in December 2010 that described four levels of instructor:

  • Program Director
  • Lead Faculty/Primary Instructor
  • Adjunct Faculty/Subject Matter Expert/Content Matter Expert
  • Assistant Instructor/Practical Skills Instructor/Secondary Instructor

The role of a Lead Faculty/Primary Instructor significantly changes under the 2009 Educational Standards.

Moving away from vocational training
The process to become a state EMT/Ambulance instructor in the late 1970s was vocational. We functioned as readers of a state approved National Standard Curriculum (NSC) course. The state focus was on correctly completing state forms, closely following the skill sheets and using word-heavy 35mm slides that came with each chapter of the textbook.

The NAEMSO template expects the Lead Faculty/Primary Instructor to demonstrate ability to:

  • Write lesson plans;
  • Write learning objectives;
  • Deliver didactic content;
  • Develop learning evaluation measures.

EMT critical thinking
The National Registry of Emergency Medical Technicians sponsored research to identify successful strategies of high performance training programs. Let's look at four components from "Instructional Strategies to Improve NREMT Pass Rates"2

  • Administer multiple assessments of student progress throughout the class.
  • Assure instructional consistency.
  • Provide clearly defined objectives to students and instructors.
  • Provide immediate feedback for written, practical evaluations to students.

Old-school instructors with extensive teaching experience seem to keep lesson plans and student objectives in their head. The vocational National Standard Curriculum (NSC) was specific in numbers, linear procedures and checklists.

Dan Limmer, an EMT textbook author, points out that the Educational Standards3 eliminates the linear procedures that were a dominant feature in NSC curriculum.

Limmer points out that a better student understanding of physiology and pathology creates a foundation of understanding that allows the EMT to make a complaint-based approach to patient assessment.4

In order to accomplish this, the EMT instructor needs to develop educational experiences that focus on decision-making and not regurgitation of a memorized standardized checklist.

This is a new instructor skillset that is not familiar to many.

Adult problem solving
Adult students thrive on solving realistic, real-world problems. Use of patient case studies is a method to practice compliant-based assessments and link assessment results to determination of patient priority.

Expand beyond the very narrow range of patients situations that the EMT can "do something about." In addition, provide a diversity of patient assessment scenarios that build upon each other and reinforce the pathophysiology concepts covered in the Educational Standards.

Ideally, the student gets an opportunity to do a complaint based patient assessment at every classroom session, two if it is an eight or 10 hour session.

It will take a lot of preparation, but experienced EMTs can do it.

Assess more and different patients
Having a teenaged male student play-act as an 82-year-old female with chest pain is a familiar scene in many EMT classes. The students gain little value in this activity.

Seek out a public clinic or health center that sees a lot of patients. A dozen patient assessments at the free clinic will provide a rich and detailed reinforcement of the learning objectives.

This summer I worked as an assistant instructor in dozens of EMT classes through many organizations and employers in two states. I was also hypertensive.

The hypertension vanished when I was assessed by EMT students who were in final preparation for the state psychomotor exam. Wow, so many 120/80 readings!

Bootstrapping your skills and knowledge
Many of you will need to step up without state or employer support. Of the two textbooks covering the 2009 Educational Standards EMT curriculum, I found this one most helpful:

American Academy of Orthopaedic Surgeons (AAOS). (2013) Emergency Medical Technician Transition Manual: Bridging the Gap to the National EMS Standards. Jones and Bartlett, ISBN 978-1-4496-0915-3.

The best book to develop your educator side is the one developed to support a national EMS instructor training initiative:

National Association of EMS Educators (2012) Foundations of Education: An EMS Approach. 2nd edition. Delmar Cengage Learning, ISBN 978-1111134884.

Full disclosure, I am a textbook writer for Jones and Bartlett and was a paid by Delmar Cengage Learning to review a pre-production copy of the NAEMSE second edition text.


1. National Association of State EMS Officials. (2010 December) "EMS Instructor Qualifications: A Template to Assist States with Implementing the EMS Education Agenda for the Future: A Systems Approach." Accessed October 31, 2012 from http://www.nasemso.org/EMSEducationImplementationPlanning/documents/EMSInstructorQualificationsFinal.pdf

2. Margolis, Gregg S., Jonathan R. Studnek, Antonio R. Fernandez, Joseph Mistovich. Strategies of High Performing EMT-Basic Educational Programs. Prehosp Emergency Care. 2008;12:206–211.

3. U. S. Department of Transportation. (2009 January) National EMS Education Standards. National Highway Traffic Safety Administration. DOT HS 811 077A.

4. Limmer, Dan. (2012 October 31) Lessons Learned in Implementing the National EMS Education Standards. EMS World Expo, New Orleans.

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