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Let 'em Loose?: An objective method to help decide if a medic is ready for the street

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One of the greatest challenges a medical director faces is determining when newly graduated paramedics and paramedics new to their service (whom I'll call "new medics") are ready to practice independently in their agency under the authority of their medical license.

EMS medical directors come in many varieties. Some are in the streets day in and day out, some show up annually to conduct skills reviews, and some couldn't be picked out of a lineup by paramedics if their lives depended on it. But what all medical directors have in common is the profound and humbling responsibility of delegating the authority of our medical licenses to our paramedics every day. Ensuring new medics have the competency and skill sets necessary to work under our license is as important a duty as any that's bestowed upon the EMS medical director.

As diverse as medical directors are, so too are the ways in which they determine when new medics are ready to go on the streets. There's no single correct method to ensure a new medic is ready to practice. There are, however, methods that are less than ideal. For example, contrary to„EMS urban legend, running a new medic through a 10-minute ACLS mega code with an arrhythmia generator and using that to evaluate their performance isn't an adequate basis for a medical director to decide if the medic is ready to hit the streets.

Direct field observation is the ideal way for a medical director to assess the„abilities of a new medic. But direct observation is often impractical, and, even when you're lucky enough to hit a call with a new medic, there's no guarantee the call will be of a magnitude that actually allows you to judge their true ability. For this reason, most medical directors rely heavily on preceptors, field training officers and supervisors to provide feedback about new medics.

The process by which new medics are evaluated by their supervisors is unavoidably subjective to a certain extent. Even in my 16th year as an EMS medical director, I'm still looking for a better mousetrap. One of my recent goals was to bring some objectivity into this realm of decision-making. This led to a special form.

The "Paramedic Evaluation Form" (attached to this article) was based on the document used to evaluate emergency medicine residents at the University of Pennsylvania. The commonalities between what emergency medicine physicians and paramedics do made the document a good starting point. The final version, extensively modified to meet the prehospital environment, was developed in large part by Malvern (Pa.) Fire Company Paramedic Supervisor Fred Wurster.

The document gives the supervising paramedic an outline for discussion with the new medic about every preceptored call. It reviews the key components of data gathering, differential diagnosis, management/treatment and disposition. In our fire departments, the completed document (along with a copy of the patient care report written by the new medic) is forwarded to the medical director for further review.

The feedback from our preceptors and new paramedics regarding this new form-based process has been positive. It has significantly enhanced the depth and quality of the knowledge I use to determine when a new paramedic is ready to go on the street.

To implement this process in your own system, start by downloading a printable paramedic evaluation form: 

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