EMS training: The pros and cons of regionalization

EMS agencies, regardless of jurisdictional borders can serve the best interests of patients through joint training programs


By Nathan Sweet

EMS systems across the nation have a tremendous amount of respect for state, county, and district borders or jurisdictions. We defend response areas from "intruders." With annual challenges to maintain the level of services we provide or better yet advance the level of services we provide, are borders that important?

EMS is highly competitive; each agency strives to be the best it can. But often times we place our agencies in silos, maybe hoping if we can do it better than them, we can stand out. Regardless of the decal on our units, regardless of the patch on your uniform we are all in this for one thing, patient care. It harms our profession when one system stands out and a neighboring agency is investigated on the evening news for harming patients. After all, the public does not recognize our different patches or uniforms; to them we are all medics.

All EMS agencies provide or at least require training for their personnel, and most of the time these agencies are overlapping neighboring each other. We each have in-house trainers or contract with the same continuing education institutions for the same classes, but what if we were to set aside our borders, and combine resources to develop regional training programs that cut down on duplicating services, improve interdisciplinary relationships and develop cost-sharing practices?

Pros to a regional training program
Here are five benefits of a regional training program that combines the talents, resources and personnel of several neighboring EMS agencies.                                

1. Regional familiarization
If the entire region is training on triage, when triage matters we all will be on the same page. When it comes time to put our training to work we will have a better understanding of what to expect from each other and a common language for radio communications. The best way to get to know personnel from neighboring agencies is to spend time with them and training is a great purpose to gather everyone together.

2. Shared educators
Currently we overlap the number and qualifications of instructors, which limits the availability of courses. Instead of having each system with an ACLS, PALS and PHTLS instructor, we could have one system specialize on ACLS and AMLS, another focus on PALS and EPC, and a third deliver PHTLS and Advanced Stroke Life Support (ASLS). We have just taken three systems each with their own instructors in three courses, to having three systems with the combined capabilities of teaching six courses.

3. Leadership growth
Regional involvement develops greater opportunities for networking and for people to get involved as educators. Teaching a class of 20 responders is one thing, teaching a class of 200 is another. People will need to step up and participate in coordination of these events, acquiring necessary equipment and resources to teach, communicate and track records. This creates opportunities for a challenging environment that others can learn project coordination and task management skills.

4. Cost savings
Costs are potentially lowered if multiple agencies are participating in the planning and delivery of training. It takes equipment to teach courses, if each agency is sharing this responsibility we all don’t need separate audio-visual systems, simulators and other types of training equipment. A regional training program may be able to use a location that already has and is willing to share their resources for free.

There is also the potential for sharing the role of training officer, as each agency can help support one individual to oversee the regional system and provide the leadership to manage this program.

5. More unique training
When you can get multiple instructors together, there is greater possibility to create more unique training programs and have more personnel available to teach a class. Therefore you can create environments you couldn’t before, like a mass casualty scenario for multiple agencies.

One service may have greater access to buildings, vehicles or other props than other agencies, which now becomes a benefit for every agency involved. My agency has access to retired buses that we use for extrication, triage and treatment practice. In a regional training system this resource could be shared with many more agencies.

Cons to a regional training program
Of course there are going to be issues to face and problems to solve when regionalizing a training program. Here are two cons to a combined training program.

1. Picking a location suitable for everyone
How do you get a whole region to decide on the location for training to occur? Selecting a location based on where personnel live is one option, but making everyone happy, especially those that need to travel further for training than previously, is a challenge.

The frequency of training also matters. If personnel are traveling every month or multiple times a month that has more of an impact than if training was just six to eight times a year.

The facility, large enough for the combined personnel and with the necessary AV set up, to host the training is extremely important. Reach out to local hospitals who might welcome the opportunity to host the training in exchange for a few minutes to talk about the services their facility offers. Some hospitals might provide physicians, critical care nurses, respiratory therapists or other experts to help teach the class. A hospital may also have the technology to simulcast the training to the agencies throughout the region as a lead in to the hands-on portion of the training.

2. Setting aside differences
Cohesion or unity will likely be more of an issue early on as getting various agencies to collaborate with each other is no simple task. Each EMS agency needs to commit to making it work and the leaders of the organization need to be the ones stepping up and showing commitment from the word go. Remember we are in a competitive profession and this could become an issue with inadequate leadership and commitment from the key individuals.

So when was your last joint training and when will be your next? When was the last mutual-aid call you ran with a neighboring department? If you respond with your neighbors more often than you train with them the first step is a simple conversation about initiating joint training. Work to address your common ground areas for training and then build from there.

About the author
Nathan Sweet, Anderson County EMS director, in Tennessee, has been involved with emergency services since 1997 when he started with the U.S. Air Force as a firefighter. He has since served as a paramedic, critical care paramedic, flight paramedic, and supervisor. Sweet is also an active member of the National EMS Managers Association, serving on multiple committees. 

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