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Is it time to rethink training priorities?

Time allocation for EMS training is illogical and will increasingly be used to support accusations of negligence and liability


Counterintuitive. Nonsensical. Illogical.

Those are some of the terms that come to mind when I see the training schedules at so many dual-function Fire/EMS agencies.

Let me explain…

I recently ended an administrative trial wherein my client, a firefighter/paramedic, was terminated for allegedly providing patient care that was below the department’s established standards. At the center of the trial was the issue of the ongoing training firefighters/paramedics receive.

Throughout the trial, senior officers of the department, including the Chief, preached on and on about how the department is committed to providing only the best patient care; how their paramedics are held to a higher standard; how they are committed to serving the community with the highest level of blah, blah, blah.

On cross examination, however, I asked each of them the same question:

“How many hours a day does each firefighter (and firefighter/paramedic) spend drilling on firefighting technique and equipment?”

Each of them answered proudly that every firefighter/EMT and firefighter/paramedic, regardless of assignment, spends at least three hours each day practicing firefighting skills and/or rehearsing the use of various firefighting equipment; hoses, ladders, saws, and other firefighter equipment.

Through further questioning we determined that, based on a 10-shift work month, each firefighter/paramedic, regardless of assignment, spends at least 30hours per month drilling, practicing, and/or rehearsing firefighting skills & equipment. That’s at a minimum 360 hours per year of firefighter training.

Each of them exhibited the same proud grin at how well trained their people are.

For each of them, however, that smug grin quickly turned during the next question:

“How many hours a day does each firefighter/paramedic spend drilling on patient care related techniques, skills and tools?”

Each of them, knowing what was coming, squirmed as they responded with the truth that the department only offers three hours of patient care related education per month. That’s roughly a maximum of 36 hours of paramedic training for the entire year.

And when the testimony went on to show that patient care related calls account for more than 80 percent of their call volume and fire related calls less than 20 percent, I could see each of them deflate on the witness stand.

Then came the most painful question:

“How can you truthfully say that you are committed to providing the best patient care when barely 10 percent of your training addresses patient care, which constitutes over 80 percent of your department’s calls?”

None could answer that question cogently.

National perspective of fire/EMS agencies

I have seen and worked with fire/EMS agencies all across America and the 10:1 ratio of ongoing firefighting training to EMS training is pretty consistent, which begs the question: Don’t they get it?

Excellence is the product of practice. How can any rational person look at a 10:1 training ratio and declare themselves committed to the highest level of care? How can an agency neglect training on the most significant aspect of the business and then be surprised when issues of negligence and liability arise?

The source of the woe

Once again, it seems that the various old-school-stuck-in-their-ways cultures of which EMS is comprised are having difficulty catching up with the times.

Well, here’s the bad news: the law is not going to wait for agencies to figure out that living in the past compromises the future.

More and more, providers are being held to higher (legal) standards of care without the appropriate support from their employers. That is, medics are being investigated and sanctioned at a more aggressive rate than ever before over smaller and smaller clinical infractions.

Wake up call for EMS leaders

To get with the times, agencies need to spend much more of their allotted training time – if not fully reversing the ratio altogether – practicing skills like 12 lead EKG application and interpretation, assessment algorithms, and intubation or advanced parenteral route access, for example. The list of available and important topics is as long and diverse as the local scope of practice.

On the other hand, agencies that resist this reality cannot be surprised to discover that their care is generally substandard, for which there can be grave legal consequences.

Culture shift: the collateral benefit

I predict that any agency that emphasizes drilling on patient care more than firefighting will very quickly see a shift in the culture from EMS apathy to EMS.

That culture shift should be a welcome bonus; the key benefit being finally providing the superior care about which you already brag.

Yes! It is time to rethink EMS training

Yes, there will be some resistance at first. I think that’s great. Resistance is the surest way to quickly identify those who are not committed – they will require the most work. If they are not willing to do the work, then maybe they don’t belong. (I say “maybe” to be polite)

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