Whether your system is urban or rural, inner city or suburban, the true essence of being a paramedic can be found in the basic building blocks instilled early in a paramedic's training. The foundation for that training can begin as early as grade school, with health and safety classes, and growing into a more technical interest in junior college EMT training, to on-the-job investment training that can include EMT BLS-ALS bridge training, then into a paramedic program, and finally into practice as a certified, licensed paramedic. Or is this just the beginning?
Your EMS system doesn't have to be huge, well funded, super-sophisticated or highly advanced for the development of a comprehensive education and training plan for your EMT and paramedic workforce to participate in and advance their practices and knowledge. The incorporation of a simple education and training plan brings a message of unity and uniformity to the manner EMS is practiced in any community. The methods become part of standardized practices across your system, bringing common ground into often chaotic situations, no matter what part your EMS personnel are playing -- first responders, EMTs, paramedics, nurses or other prehospital health professionals.
From the Beginning
Quality starts on day one. The system training coordinator or clinical educator is encouraged to have a keen interest in seeing newly hired EMTs thoroughly mentored into their BLS positions, usually by more senior EMTs. In addition, a co-mentorship program allows both crew members aboard an ambulance can help each other study and learn during the course of a normal work shift.
Many of these EMTs will move into or up to an ALS system that staffs an EMT/Paramedic crew configuration, and the EMT will require some extra on-the-job training to transition into the ALS system. That's where an EMT BLS-ALS bridge program can be valuable to implement. Soon enough, the EMT will enter a paramedic program, graduate and return, ready to take on the new role. The development and institution of a formal paramedic field training program is the key to establishing a common platform for all system paramedics to practice their trade.
The basics of a paramedic field training program are simple:
- Provide medical oversight through direction from a local medical director and/or EMS quality assurance/quality improvement/education board or committee;
- Provide core training with standardized curriculum specific for your EMS system that encompasses local, state, and national protocols and guidelines;
- Provide specific training, often embracing the scope of local paramedic practice, relative to policies and procedures in relationship to the equipment being used in the EMS system;
- Provide an opportunity for new paramedics to practice tactile skills, within the guidelines of local protocols, through scenario-based evaluations (e.g., mega-codes), with concurrent reinforcement of newly introduced material; and
- Provide a written evaluation to measure the comprehension of material for the new paramedics and CEUs appropriate for the material delivered.
Field Training Officers
After this training is completed satisfactorily, the new paramedic enters a period of actual field training with an experienced paramedic field training officer (FTO). The FTO should have a wealth of experience in the local system, including experience training new people. FTOs should have the experience training paramedic interns (students) from local paramedic training agencies, as well as accepting special assignments to teach at the local training agencies or within the EMS system where they work.
The amount of time a new paramedic spends with the FTO can be subjective - not to be measured so much in shifts worked, but in the variety of patient contacts and the evaluation by the FTO of the critical thinking skills possessed by the new paramedic. These evaluations must be reviewed by the field training coordinator/clinical educator and medical director prior to the trainee being released from the field training program.
Each evaluation tool (see below) should include critical points of patient assessment, interpretive findings and interventions, followed by evaluation of the trainee's ability to properly re-assess the outcomes of the interventions and adjust to the changing needs of the patient. Trainees should receive a copy of each evaluation for each patient encounter or incident response, as well as verbal feedback -- criticism or praise -- from the FTO.
The EMS system, including other crew members, should take ownership in the paramedic field training process and participants, encouraging the trainees as well as assisting in training drills and mock scenarios, even if only tabletop exercises are conducted. All team members should assist the trainees in developing team leadership skills and teamwork concepts that help build trust and confidence in the group.
During the training, the FTO should also be responsible for the overall orientation of the new paramedic to the local EMS environment. Policies and procedures should be reviewed and drilled upon, including:
- Code 3 driving practices and laws;
- Local area familiarization and mapping, including hospital orientation and internal mapping;
- Narcotic handling and laws;
- Equipment reviews and tactile drills;
- Advanced airway policies and tactile drills;
- Medical-legal documentation and privacy polices and laws;
- Trauma system, including borders and boundaries;
- Pharmacology and medication administration techniques and safety;
- Handling of biohazards (including sharps) and proper PPE;
- Maintenance of apparatus, including decontamination practices;
- Medical inventory restocking procedures; and
- Review of the continuing education policy and recertification and re-licensing requirements.
Successful completion of the paramedic field training process is achieved after the trainee and the FTO have completed the established curriculum. The trainee will have demonstrated an ability to provide consistent patient care skills and a strong aptitude for critical thinking and problem solving in the same consistent manner. When completed, the paramedic field trainee's overall performance and review of paramedic field training documentation should be thoroughly reviewed by the training coordinator/clinical educator prior to the paramedic being placed on independent duty status. In many systems, a sign-off by the medical director is also required.
Largely, the end product is a quality paramedic who provides an expected level of care based on the fundamental tenets of your EMS system. They will have the instilled ability to function within their scope and protocols and enhance teamwork, with the expectation that they will be providing the same foundation for the next generation of paramedics.
Rick Rod, RN, CEN, NREMT-P, is the training officer for San Diego Medical Services Enterprise.
Contact him at email@example.com
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