3 ways EMS leaders make or break paramedic training programs

Selecting the wrong candidates as FTOs or undermining their authority results in ineffective paramedic training, impacting turnover, quality of care and job performance

By Skip Kirkwood, JD

Many EMS agencies realize that new employees, whether new graduates of pre-service paramedic programs or employees with experience in other organizations, are not fully prepared to climb into an ambulance and head out to serve the community.

New graduates of an excellent pre-service paramedic school with an “exceeds expectations” clinical program and field internship have little or no knowledge of an agency’s internal processes, procedures, culture and values. All are important to the success of the employee and the agency.

Ada County Paramedics Field Training Officer, Justin Raney, goes over equipment with EMT B MK Welch.
Ada County Paramedics Field Training Officer, Justin Raney, goes over equipment with EMT B MK Welch. (Photo/Ada County Paramedics )

New graduates from a lower academic level paramedic program may not have learned the essential knowledge and skills of today’s paramedic. They may be weak in pharmacology and pathophysiology or be minimally capable of performing high-risk, low-occurrence psychomotor skills. Even the best paramedic programs don’t teach some core EMS skills. The most notable example is driving a seven- to 10-ton ambulance.

In either case, it is the employer’s responsibility to identify and address any deficits. Most agencies couple this teaching with a period of evaluation, often conducted in the field, by using individuals called field training officers.

Some agencies use formal programs, such as the National EMS Management Association’s EMS Field Training and Evaluation Program (EMS-FTEP). Others use in-house programs with varying degrees of complexity. In the EMS-FTEP program, two end-points are identified:

  1. First, the candidate completes the program successfully, consistently performing at or above standards for a period of weeks and passing all program exit requirements.
  2. Second, if the candidate cannot achieve success, he or she will be separated from the agency, without surprise or acrimony.

Recent studies by agencies concerned with full-time paramedic turnover have revealed that the fully-loaded costs of replacing a single experienced paramedic are substantial – in some places, in excess of $100,000 – if the agency can find paramedics available for hire at all. Every EMS leader needs to minimize those kinds of costs.

Field training programs are essential to an agency’s future success. This is where the culture, the values and the organization’s informal leaders are formed. New employees hear speeches and presentations from senior leaders, but they learn how things really work in training programs, and they emulate their field training officers. It is the FTOs who pass along the culture of the organization and who teach how those well-written policies are actually implemented.

For a senior executive responsible for both keeping ambulances staffed and for providing the quality of clinical care, good FTOs are the key. Your FTOs should be the people the agency wants its next generation to be like. They must be excellent employees and role models, not just long-tenured employees. They must be motivated and dedicated to developing quality new employees.

Here are three ways EMS leadership can undermine an FTEP:

1. FTO Functional termination authority

One of the features of EMS-FTEP is the delegation of functional termination authority to the FTOs using the program. That means, if the FTOs determine that a new employee is not meeting the standards of the agency, and that everything possible has been done to correct the deficits (including documentation of intentional training efforts and a variety of other procedures), the candidate is terminated. This is not easy for many EMS executives who find themselves torn between just staffing the units and addressing quality of care and performance issues.

The most certain way that senior leadership can break a field training program is to overrule the recommendation of the FTOs and FTEP program management. FTOs are instructed in the concept of functional termination authority in their training. They understand (without prompting) that the program becomes meaningless if senior leadership does not support their recommendations.

When “meat in the seat” becomes more important than training and evaluating new employees to the company’s established standards, and non-performing candidates are released to practice without meeting those standards or are sent back for multiple additional chances, the FTOs are undermined and will alter their standards to suit the perceived desires of their leadership.

If the FTO’s sense that quantity is more important that meeting standards, they will forego the standards and pass everyone through the program with minimum effort. As one CEO in an agency that was resetting its FTEP explained, “In effect, we changed the name of the program. It went from Field Training and Evaluation Program (FTEP) to Forget This, Everybody Passes!” Credentialing people not meeting the standards in the interest of filling slots on the schedule is the most certain way to negate any value of a field training and evaluation program.

2. Unity of command

Another issue that plagues field training programs is violation of the principle of unity of command: everybody can have only one boss in the workplace. Because the program contains the word “training,” there is a temptation to want FTEP to be part of the training division or department. This has been shown to be a poor decision many times. Field training takes place in the field:

  • On calls for which the operations division or department is responsible.
  • In ambulances that belong to operations.
  • By FTOs who are part of the operations division
  • Supervised by field supervisors who are part of the operations structure.

Attempting to create a structure where FTOs are accountable to a dual chain of command is not a pathway to success.

3. FTO selection

A third pathway to failure is creating involuntary FTOs. Paramedics who really want to be FTOs should be allowed to serve only after a competitive process which involves vetting for adequate medical knowledge as well as demonstrating role model behaviors over a period of time.

Like anything else of value to an organization, a quality FTEP requires investment of not just money, but also individual efforts. Executives who want their programs to succeed will invest significantly by:

  • Setting clear expectations and standards for their field training program.
  • Providing an adequate classroom orientation or academy for newly hired personnel. Much of what they need to learn is better taught consistently in a classroom by a single instructor rather than haphazardly in the cab of an ambulance.
  • Treating the program as a key element of the agency’s success.
  • Recognizing and supporting the efforts of the FTOs, including providing reasonable compensation to those FTOs.
  • Celebrating the program’s successes, not just candidates moving to the tenured workforce.
  • Providing the necessary time and logistics for the required program meetings and FTO in-service training.
  • Allowing as much of the field training program to be conducted with the candidate in third person status. It is simply not possible to provide adequate training or evaluation when the candidate is in the cab of the ambulance with the FTO in the patient care compartment, or vice versa.

Properly implemented, a quality field training program can help an EMS agency reduce turnover, improve quality of care and non-clinical job performance, and improve the agency’s risk management profile.

About the author
Skip Kirkwood is a project consultant with Fitch & Associates. He has served as an executive, educator, consultant and attorney with a broad range of public safety experience, which, while predominantly in EMS, included law enforcement and fire suppression. He holds a Bachelor of Science from the University of the State of New York, a Master of Science in Health Administration from Central Michigan University, and a Juris Doctorate (with Honors) from the Rutgers University School of Law.

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