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EMS training is designed to build competence, but it rarely captures the complexity, unpredictability and resource constraints of real calls.
We asked EMS1 readers to identify the biggest gap between what they were taught and what they face in the field; their responses identified three areas where the deficits are deeply felt:
- How to interact and engage with patients on scene
- Hands-on training in scenarios that mimic the chaos of the field
- How to deliver death notifications to family members
Have something to add? Share your thoughts.
Patient communication, compassion and support
On-scene interactions with patients were one of the most cited training gaps by readers, including how to engage in small talk during exams, how to maintain a calming presence and engage with concerned family members:
“Teaching new recruits how to ‘care’ for their patients when they treat them. Reassuring hands, calm, soothing voice. Be personable. Add a little humor to ease the patient’s nerves.”
“Compassion. It must be the emphasis on caring for the patient and their family. Without it, we all fail. Yet, compassion has to be taught at home from the parents as children learn and grow into teens. Very few learn compassion in school or as adults, but it’s one of the most important things we bring, or should bring, to patient care.”
“In the field, you’re dealing with real people with real problems. Talk to them. Don’t get so caught up in what to do, you ignore who they are.”
“The human factor — yours and that of your patient. Fear, pain, uncertainty, humor and the sense of pride in a job well done. Forgiveness for what is beyond you and what you cannot do.”
“Learning how to talk and how to relate to people. Small talk is a treatment. Talking to families, parents and that psych patient are all skills.”
“Teaching students how to develop rapport with strangers and control a conversation through an assessment. If they can’t do that, they really aren’t good clinicians.”
Hands-on training
In their comments, readers also zeroed in on a lack of hands-on training in scenarios that mimic the chaos of a real scene:
“In-house, hands-on training: touching the vent, intubation dummies, touching the vent some more, drug dose calculations with titratable drugs. I understand this should be self-taught but not everyone is self-motivated, so I think the company should push for every shift change, doing a little bit of drug dose calculation/formulas, and then weekly putting hands on a vent and doing vent training. It should be up to the supervisor to rotate through different stations and make sure people are putting their hands on these objects. Quarterly you could do intubation training, unless you have enough dummies to go around and then you can make that every shift change as well. I think it’s something that flight does very well that we do not as ground pounders.”
“I always felt during my training they didn’t do a really good job of harping on the importance of the subtle things, like a properly dynamic patient assessment or how to use the equipment you interact with every day. I can’t tell you how many times people didn’t apply a C-collar correctly or properly use a stair chair. I’m referring only to when I was in school for this one, but it always felt like they didn’t take our hands-on scenario training seriously. It always felt like a bit of a joke.”
“Doing the reps isn’t enough. Rehearsing what happens in normal-to-nightmare scenarios with your partner or your crews is critical so everyone understands that a crashing airway triggers an almost reflex like process, while also understanding this is the pivotal moment that we must catch the small details that could make a difference. Reflex movements, but not checking our brains at the door. It would be easy to say, ‘Well, they will just have to see it to experience it,’ in some cases. That’s not an excuse for shoddy training or lazy preparation.”
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“The training scenarios don’t offer the true expectations of the provider in action. It instead offers the comfort that ‘someone’ will still prevent them from ‘failing’ the pt. vs real experience which forces critical, independent thinking and action. Truly becoming an expert in skills as simple as basic assessment and reading beyond just what is ‘told’. That anticipation of impending danger or trajectory change.”
“In training scenarios, you do everything step by step according to the algorithm or list. Real calls are more dynamic, with lots of things happening simultaneously. I have seen people do well in school who struggle in the field because they can’t multitask and direct a lot of actions happening at once with their team.”
“The difference is in school you are not taught how to work out in the street or field. Every single medical or fire call was different. I was lucky; right after I got my EMT and medic card I was mentored by guys that had 25 years of experience.”
Death notifications
EMS1 readers also identified the lack of training around how to compassionately deliver the news of a patient’s death to the family:
“No one trains you for telling someone their young child or their spouse of 50 years is deceased.”
“Trauma training on the messiness of the human condition.”
“The social work aspect of it.”
“Death. Care. How to talk to the family; that conversation should start BEFORE efforts are terminated. That family should be able to see resuscitation efforts as long as they’re not impeding.”
“Techniques for speaking with those who had just lost a loved one.”
