How many field training officers should an EMS agency have?

It's better to decide how many current employees would make great FTOs instead of letting the number of new hires determine the number of FTOs needed

Skip Kirkwood is the chair of EMS-FTEP Program of the National EMS Management Association. The question, "How many FTOs does an EMS agency need" was first asked on the NEMSMA email group. Skip's email answer was adapted for this article. Got another EMS-FTEP question? Skip can be reached at and selected questions will be answered in this forum.

By Skip Kirkwood, M.S., J.D, NRP, FACPE

"How many field training officers should an EMS agency have?" is probably the most-often asked question of established EMS field training and evaluation programs. It is also the least-often answered question.

EMS executives, training officers and operations chiefs want to know if there should be a certain percentage of the workforce that is designated as an FTO.

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 )

Unfortunately, there is no easy, hard and fast answer to the question. It is especially important to understand and review the basics of EMS-FTEP.

What are field training officers?

FTOs are the agency’s specialists in on-boarding new field personnel. Their job is to bridge the gap between what a paramedic (of any level) learns in school, and what they need to be successful in their particular EMS organization. 

This work consists of both answering agency-specific questions, like “How do we do patient care reports here?” or “Where does that timesheet go?”, and filling in gaps that occurred or have developed since paramedic school. Yes, FTOs find themselves having to teach 12-lead interpretation, or bag-valve-mask technique. 

To accomplish their job, FTOs use these program-specific tools:

  • Standardized evaluation guidelines
  • Phased recruit training manuals – a specifically-designed task book
  • Daily observation reports

How are FTOs NOT used?

Field training officers are NOT individuals who are assigned paramedics with disciplinary or clinical problems. FTOs are not partnered with tenured employees needing remediation. 

In fact, using FTOs for these purposes is one way to damage an otherwise-effective field training and evaluation program. FTOs are not QI staff. They are operational medics, under the supervision of the operations division leadership.

How many FTOs are needed?

Most organizations enjoy a certain amount of structural certainty – usually represented by the org chart. This document lets everybody know who fits where in the chain of command and how many of each position classification exists within the organization.

Since FTOs are different than staff paramedics. It should be easy enough to devise a ratio.

Not so much. After a number of hard lessons learned, most of the experienced EMS-FTEP programs have learned to approach the problem – how many FTOs are needed – from exactly the opposite direction. They titrate the number of new hires to the number of FTOs that the organization is confident in fielding.

Attempts to push too many new paramedics through the new hire pipeline (particularly by allowing people who should not be FTOs to function in that role, in order to increase the capacity of the pipeline) have been shown to have long-term, near-disastrous consequences. The worst consequence, one that is not immediately evident, is that this approach destroys the credibility of the program with the existing workforce. The name of the program changes from "Field Training and Evaluation Program" to "F*&^ This, Everybody Passes."

Who are good FTO candidates?

An FTO is the person you want future employees to be like. The selection of FTOs is a critical process and one in which the medical director (or very trusted surrogates), as well as organizational leadership, ought to play a key role. Individuals selected to be FTOs must be employees who:

  • Are the kind of role models that the organization wants to put forward.
  • Demonstrate positivity, compassion for patients and good customer service.
  • Practice the company mission, vision and core values.
  • Are experts in interpretation and application of policy and procedure.

We have known those four traits for a long time. The additional trait, one many EMS-FTEP agencies learned the hard way, is this:

Not just because the book or the protocol says so, but because they know the pathophysiology and pharmacology enough to explain the why at the paramedic level. If this is not true, the program begins a downward spiral that ends, at best, in a need for a re-boot.

This has become particularly necessary as the distance between paramedic school and what is needed in the field increases. It is up to the medical director to insist on this FTO expertise and to devise the processes by which paramedics who meet this standard will be identified.

What are common FTO and EMS-FTEP mistakes?

Some mistakes that agencies have made requiring an EMS-FTEP re-boot or to blow up the program and start over include the following:

1. Using people who have not completed a basic FTO course as FTOs 

One agency I know of used people who had completed the agency’s FTEP as acting FTOs because they suddenly had more new hires than available FTOs. These FTAs had not embraced the program and did not understand the role of the FTO. Some had themselves been trained by not the best FTOs and passed along the bad practices that were used with them – to the detriment of the program.

2. Allowing people who are not excellent clinicians to be FTOs 

An important element of the success of EMS-FTEP is the credibility of the FTOs. If the rest of the workforce does not respect those assigned as FTOs, the program will be regarded as a waste of time or a hoop to be jumped through. This negative sentiment will be communicated to newly hired personnel who will feel that they are wasting time or not being treated with respect.

3. Forcing people to serve as FTOs 

This can come in several forms, including outright force – being ordered to be an FTO, to more subtle methods, such as requiring FTO experience for supervisory promotion. Being an FTO is important and hard work and should only be undertaken by those who want to do the work. A reluctant FTO will not invest the energy or develop the bond with the candidates to successfully do the job.

How many current employees do we want as FTOs?

So, in the inevitable staffing battle that is fought in many EMS organizations – if the question comes up, "How many FTOs should we have?", the agency leadership should pause and carefully consider re-framing the question. Instead of, "We need 20 new employees every quarter, how many FTOs should we make?", the analysis should start with, "How many current employees would we want to make FTOs?" 

Then, after considering the possibilities and evaluating the willingness of those excellent employees to be trained and to serve as FTOs, pick a number of FTOs.  That number will guide the number of new hires that can be handled at any one time.

In the long run, the organization will be better off, having titrated the number of new hires to the available FTOs (giving due consideration to some downtime in between candidates), rather than selecting enough FTOs to meet the needs of the anticipated personnel pipeline.

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