In the government sector, there’s a concept known as “the plenary police power of the state.” This means that the state has the authority to do things to generally protect the well-being, and health and safety, of its citizens.
One of the ways states use this is through the enactment of laws and regulations. The “police power standard,” as seen in licensing statutes and rules, is “the minimum level of knowledge and skill needed so that the regulated profession doesn’t constitute a threat to public health and safety.” It’s a floor. It’s a minimum standard. In the academic sense, it’s a grade C- (or 1.7 on a 4.0 scale).
Unfortunately, in the world of EMS, these minimum standards often turn into a maximum, or a ceiling, once they leave the state capitol. If the minimum number of hours for a paramedic course is set at 1,000 hours, then paramedic programs at educational institutions often get a budget for 1,000 hours and not a minute more.* Therefore, the floor becomes the ceiling. So take a 1.7 standard, graduate a 1.7 student, you’ve got a 1.0 new licensee. Is that person really ready to staff your ambulance? Do you want that person showing up at your house when a loved one is critically sick or injured? Probably not. If you’re a responsible EMS agency leader, you’re aware of this gap and understand that your agency must do something about it.
*Author’s Note: Throughout this article, we use the term “paramedic” to mean any level of EMS provider who responds to emergency calls and provides medical care and/or ambulance transportation. This use is consistent throughout National EMS Management Association (NEMSMA) publications, with our colleagues in Canada and with the International Paramedic movement.
Filling the Gap
So what should we do to fill the gap between the knowledge, skills and effective traits that EMS providers have when they first arrive, and those we’d want them to have when they staff a unit in service on their first shift?
Does your organization approach this question in a manner that will help the new employee? Do you teach the needed (and missing) knowledge, skills and behaviors necessary to protect the provider and your organization, and help to ensure compassionate, clinically excellent care for the patients being served?
This problem is not new or unique to EMS. The law enforcement community, which is driven much more by litigation, began to confront this same issue in the mid-1960s, when societal demands on law enforcement began to change, workforce challenges surfaced and community expectations increased.
What had been a casual, mostly on-the-job training environment needed to change. The law enforcement community took a close look at their training and operational practices and made the following observations:
1. If you don’t adequately train new employees, bad things happen.
2. If bad things happen, you get sued.
3. If you fire people who want their jobs, you get sued.
They adopted a system: the Field Training and Evaluation Program (FTEP), which originated in 1976 in San Jose, Calif., and spread throughout the U.S. It’s now required for police officer certification in many states and agencies.
The “Bible” of the FTEP program is the book The Field Training Concept in Criminal Justice Agencies, by Glen Kaminsky, which states that an FTEP requires the following:
- >> An identified set of competencies that a new police officer must be able to perform before being released for independent duties;
- >> A reliable and valid process by which the new police officer is coached, taught and evaluated;
- >> Standardized documentation of performance and progress, using valid and reliable tools; and
- >> Formally trained field training officers, supervised by a hierarchy that is properly trained and understands and supports FTEP within the agency.
Is there anything in this list of requirements that isn’t applicable to an EMS agency?
Approaching the ‘Gap’
EMS agencies have several approaches to training new employees. One way of thinking, often expounded by EMS managers, is , “They have a state license, so they have been taught what they need to know.” Agencies with this attitude give them the keys to an ambulance, or just a small orientation, and send them out on a rig.
Another line often heard is, “We’re not sure what they know, so we assign them with an experienced medic to teach them the ropes.” The problem with this approach is that most of those folks have not received any formal training in how to teach, evaluate or perform employee development.
Finally, the last common way of thinking is, “We need to be sure that they know certain things, so we’ll give them an orientation manual and let their preceptor work through it with them.” This approach assumes that what new employees are lacking is psychomotor skills, which may be part—but only part—of the problem.
None of these approaches is sufficient. If you use an “on the job training” process for making employment determinations, that is a “test” pursuant to EEOC guidelines. So it must be a valid and reliable test. If not, it has an “adverse impact” on anyone, substantial liability could result.
Some agencies have what they call a field training officer (FTO) program, although many of those programs lack the essential elements of a valid, reliable program. If you ask the medics, “Can you identify the hard FTOs and the easy FTOs?” If even one says “yes”, your system isn’t reliable because it doesn’t have a universal, identifiable standard for passing or failing the process.
In the mid-1990s, a number of EMS leaders discovered the law enforcement FTEP program During the intervening years, several EMS agencies built an EMS version of FTEP.
Discussion among NEMSMA members revealed a perception that “the gap” was not only a real issue, but also an issue that was widening. So in 2009, multiple agencies came together to take the fledgling EMS-FTEP program and make it standardized and available throughout the EMS community.
EMS-FTEP consists of two educational programs, the first of which is “Developing and Managing the Emergency Medical Services Field Training and Evaluation Program.” This program is directed at senior EMS executives and chief officers, training chiefs and other middle managers.
This 24-hour management program requires 2–2.5 days of instruction and educates participants on the need and basis for quality, essential elements (standardized evaluation guidelines, daily observation reports and the recruit training manual) and how to develop them. It outlines how to select, train and supervise EMS FTOs; the legal aspects of EMS-FTEP; and the role of supervisors, managers and executives in ensuring the success of the program.
The second program is the “Basic EMS FTO Course.” This course is designed for EMS personnel who are destined to serve as FTOs in their EMS agencies and for first-line supervisors who will have daily oversight of FTOs and their medics-in-training.
It lasts 3.5 days and includes the essentials of teaching, coaching and remedial training strategies, how to work with employees from different generations, use of EMS-FTEP tools, paramedic/trainee/patient safety, provision of feedback, documentation of performance, and ethical and legal issues involved in field training.
The third FTO component, currently in development, is an FTO program accreditation process. EMS agencies that develop and operate field training programs meeting NEMSMA’s EMS-FTEP program standards will be recognized as meeting EMS-FTEP accreditation standards.
Wrapping It Up
Responsible EMS agencies must identify what’s missing in the gap and take steps to fill in that gap. NEMSMA’s EMS-FTEP program will help agencies develop, implement and evaluate a sound, legally defensible program that will make sure employees are ready when they “hit the street” to provide service to their community.