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FTOs Are an Underutilized Resource


How would you improve EMS nationwide?

I outlined a six-point plan for improving EMS nationwide in the September JEMS article"Of EMS, By EMS, For EMS." One idea that generated a lot of interest was my call to make the Field Training Officer (FTO) role dynamic and proactive. An FTO should be an "approachable, positive professional, always available on an ongoing basis to those personnel who feel they would benefit from additional professional development and mentoring, thereby ensuring that deficiencies are corrected before they manifest in patient-care issues."

Given the responses I've received, I apparently struck a chord regarding the need to bridge the gap between current EMS reality and the high level of proficiency and professionalism that eludes many agencies. One plan for achieving this goal focuses on expanding the role of the FTO to include, among other things, mentorship.

FTOs are in a unique position to benefit their agencies. Typically, they have learned over the years of what's effective in the field. Their interaction with newer employees can provide the opportunity to learn and understand new assessment, diagnostic and treatment modalities. A coordinated program of ongoing professional development can help give providers resources for optimizing their capabilities.

Acheiving the Goal

Through implementing a program of employee outreach, a high level of performance excellence should be achievable in a much shorter period of time than with a standard hit-or-miss approach. The following six-point plan can help guide agencies into realizing the goal of optimum employee development:
  1. Develop formal mentoring programs.
  2. Regularly rotate field employees into three-week partnerships with FTOs.
  3. Require FTOs visit crews and conduct an hour of education or training daily.
  4. Request FTOs develop training curricula and teach classes in their area of expertise.
  5. Expand the FTO program„to allow full-status employees to enroll in the program at will.
  6. Encourage FTOs affiliate with each other to exchange ideas.„„

Formalize Mentoring Programs

In many professions, there's an implicit understanding of the need for the more experienced practitioners to take newer members of the occupation "under their wings," in order to ensure that they fully develop into competent professionals. This tradition of mentorship is common in other disciplines, such as business, law and the sciences, and emerging in some fire and police agencies as well.

EMS agencies should develop formal mentoring programs to establish an initial relationship between new field employees and FTOs, preceptors or veteran providers.

Under this model, field providers initially develop a relationship with an FTO during the orientation/training process. If the fit between the FTO and the trainee appears conducive to further professional development, then the relationship may be continued. If it doesn't appear to be working, then the trainee may be assigned to another mentor.

Check out the resources below for several effective models for mentorship programs that might work in your EMS agency.

Schedule FTO Rotation

The opportunity for a provider to both observe and work with a highly experienced veteran during a medical emergency, as opposed to simply being observed and evaluated, would be an invaluable experience. FTOs should accept regular field employees to be rotated into a partnership with them in addition to their FTO duties.

For example, every employee might do one three-week rotation annually. The purpose is to allow field providers to work with the FTO in a hands-on environment rather than as part of a formal process for evaluation, training or remediation.

Bring the Education to Them

Regular, ongoing training has long been a tradition in the fire service. Private and non-fire based EMS should incorporate a training regimen based on this model. With an FTO making regular rounds to stations/posts, EMS crews have the opportunity to participate in a dynamic, interactive educational process during every shift.

The most important topics for training should be those high risk/low frequency skills, such as needle thoracostomy, needle or surgical cricothyrotomy, transcutaneous cardiac pacing, and pediatric drug calculation/administration. Educational topics could include patient assessment methodologies and working diagnosis formulation.

Create More Teachers

An in-house educational program centered on topics of interest for employees should be concurrent with the development of a daily education and training program. Provider agencies should contact their regional/state EMS regulators to become certified continuing education providers and offer continuing education hours to employees that attend in-house education.

Include Veteran Employees

Encouraging full-time veteran employees, who have long since completed their initial training and orientation, to establish a long-term relationship with an FTO would be a departure from a traditional mentorship program. It would allow veteran employees who want to advance their knowledge voluntarily to take a step in furthering their careers. This idea expands the model of the regular rotation to allow more rigorous focus on specific areas of concern or interest specifically between two top-level professionals.

Encourage Collaboration

Facilitate the exchange of ideas on curriculum development and training scenarios between FTOs. Providers who have been at the top of their profession for a long time would benefit from a fresh perspective, and such an interaction would enhance their own performance as an educator, mentor and practitioner.


The FTO is perhaps the most underutilized resource in EMS provider agencies. Consider expanding the role the FTO plays in your organization to include some of the functions outlined above. Doing so will improve the professionalism of your organization, create more confident and capable field providers, and greatly enhance the capability of your agency to deliver optimum EMS to the community you serve and to those who matter most: your patients.


  1. FireChief.com: "Mentor program develops with new recruits."„http://firechief.com/mag/firefighting_mentor_program_develops/
  2. The City of Fontana: "Mentoring Program."„http://www.fontana.org/police/programs/Mentoring_Program/Mentoring_program.htm
  3. City of Kent, Wash. "Police Department Mentoring Program."„www.ci.kent.wa.us/police/index.aspx?id=9956„„

Mark Rock, BA, NREMT-P,is a graduate of the University of Oregon and did post-graduate work at Portland's Neurological Sciences Institute. A member of the JEMS EMT and Paramedic Advisory Committee (EPAC), Rock practices as a paramedic in Ventura, Calif. Contact him at„ems4usa@gmail.com.


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