Top 10 ways to ruin a good EMT

Avoid these mistakes to onboard EMTs who will thrive in EMS, and give their all to your agency


The cost of replacing a medic, both financially and in time invested, is steep. Finding and hiring promising candidates is only one piece of the staffing puzzle. In an EMS1 Special Coverage Series, "Year One: Creating a career path for new EMTs," learn how to onboard team members to set them up for long-term success, through the first 90 days, the first 6 months and beyond. 

It seems I encounter more salty rookies these days than ever before. They’ve perfected the eye-roll long before they’ve become proficient with the hand-hold. New EMTs shouldn’t be salty; they should still be starry-eyed, with the look of “I can’t believe they actually pay me to do this!” wonder.

Perhaps it’s the stress of the pandemic and continued staffing shortages that taints new EMTs so quickly, or, perhaps, we’re ruining them ourselves, giving them all the reasons they need to fulfill that dismal EMS career expectancy prophecy of five years. There are plenty of mistakes EMS agencies make that can ruin a rookie EMT who would otherwise make a career-long asset to your agency. Here are the top 10 mistakes I’ve seen:

1. Rush or shortcut the onboarding process

"Hire your newest, rawest EMT with the notion that you are grooming them to be operations manager one day. Few of them will make it that far, but you’ll create better EMTs and employees along the way," Grayson writes. (Photo/George Washington University)

The onboarding process, whatever it is at your agency, is supposed to give your new hire not only the tools to succeed at your agency, but in the EMS profession. Those first few weeks are crucial to the development and maturation of a new EMT, and we need that time to both properly evaluate their character and skills, and to teach them the culture of your agency. Yes, even with the current staffing shortages.

2. Pair them with an object lesson rather than a mentor

Typically, a new hire at an EMS agency is plugged into the most pressing staff opening. EMS managers fail to recognize why there always seems to be an opening on that particular truck – because the other crew member is a medic or EMT who none of your existing employees are willing to work with. These medics are cancers – perhaps not yet so malignant that they need excising – yet, if you pair them with impressionable rookies, they’ll infect them too.

3. Throw them into the overtime meat grinder

You’ve got new EMTs with enthusiasm, stamina and bare apartments furnished with  ratty futons and milk crates. Enticed with the prospect of unlimited overtime, they believe they are invulnerable to physical and emotional fatigue, but the data on fatigue’s contribution to mental errors and ambulance crashes says otherwise. These new EMTs  love those fat overtime paychecks … until they don’t.

Too much overtime means burnout sets in earlier than it ever should, and soon those new EMTs are seeking greener pastures and less work, and taking all the mentoring and training you’ve invested with them. Seasoned EMTs and medics have learned their limits, and know when to say “no,” but EMS managers should protect the new EMTs from themselves. Pay them a better wage to begin with, and you’ll retain employees better. A stable workforce is cheaper in the long run than paying more overtime and working EMTs to death.

4. Evaluate more than you mentor

Your pre-hire process should be where all the evaluation occurs, before you tender a job offer. If they’re wearing your uniform and riding your ambulance, they should have already proven themselves worthy of representing your agency. Now is the time to mentor, guide and coach, to give them the tools to thrive and advance at your agency. Every call should be a learning experience, not a make-or-break referendum to see if they’ve “go what it takes.” Hire your newest, rawest EMT with the notion that you are grooming them to be operations manager one day. Few of them will make it that far, but you’ll create better EMTs and employees along the way.

5. Be intolerant of mistakes

EMS1 columnist Nancy Magee’s mantra in hiring people is, “Hire for attitude, train for ability.” Mistakes are going to happen; that’s a given. But people with the right character traits and attitude are better able to learn from their mistakes. That learning will occur organically with a good mentor, as long as you don’t punish mistakes. The current in vogue term for it is “just culture,” but it really boils down to this: treating people right.

6. Tell new EMTs they need to “harden up

Empathy and emotional connection with your patients need not be a recipe for burnout and PTSD for the new EMT. Hardening makes you brittle, and brittle people break. A better way is to teach and model emotional resilience. Show the new hire that it’s OK to be affected by a bad call, or even to cry … afterwards. As long as they know how to utilize the resources that will help them heal, they’ll bounce back. Those resources are you, their peers, their support system at home and even professional counselors. Make sure they feel secure enough to use them.

7. Make them “pay their dues

Tuition: check. Exam: check. Successful job interview: check. Those are the only dues that need to be paid. I know it can be grating to listen to a rookie with five minutes of experience opine on everything that’s wrong with EMS, but making them prove themselves worthy before being allowed to speak is not the way to temper their immaturity and enthusiasm. Instead, welcome them with open arms, teach them the positive elements of your agency’s culture, and how to resist the negative elements. Perhaps they’ll survive with their enthusiasm and humanity intact, and you’ll find yourself with allies in changing agency culture for the better. Who knows, you might even rediscover some of your lost enthusiasm and humanity yourself.

8. Allow hazing

It’s often said that one person’s harmless prank is another person’s hostile workplace environment. There’s a bright line between actions that ease tension and build camaraderie, and those that foster shame, humiliation or personal injury, and only the willfully ignorant or cruel cannot see that line. Bullying and hazing have no place in EMS, or anywhere else.

9. Make sure the only feedback they get is negative

Training someone centers around fostering an environment that makes it easier to do the right thing, and then praising the trainee for doing it. Practice as an EMT will give your new hire more than enough negative reinforcement. Along the way, you need to search for reasons to say, “Good job, we’re proud of you,” as often as possible. It worked for me training retrievers 25 years ago, and it works on EMTs today.

10. Have a different set of rules for managers and supervisors

Every member of your command staff needs to understand that rank hath its privileges, but rank also hath its responsibilities, and the latter usually outweigh the former. If your supervisors practice responsibility upwards, they’ll cultivate a group of subordinates who will break their backs making their supervisor – and by extension, your agency – look good. Practice servant leadership rather than bludgeoning your subordinates into submission with the policy and procedure manual.

Avoid these mistakes, and your next new hire might just become a shining ambassador for your agency for years to come.

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