When I was a kid, a machine that dried clothes was only for rich people. My mother and grandmother would haul our wet laundry outside and hang it on a clothesline in the backyard to dry. This worked fine, until our pet dog, Prince, developed a bad habit of yanking the wash off the clothesline and into the dirt.
My mother decided to train the dog to stop yanking clothes off the line. She hung a blue kitchen towel on the line and waited for the dog to jump up and grab it. Each time Prince jumped to get the blue kitchen towel, she'd whack him on the behind with a rolled up newspaper. After about a week, he learned not to yank down the towel.
Feeling confident in this training, my mother hung up the wash, which included the blue kitchen towel, and left to do some grocery shopping. When she came home, the clean clothes were scattered around the yard. The only thing left on the clothesline was the blue kitchen towel.
This childhood memory reminds me that not only is it important to train and educate our workforce, but it's important that we train them right. Teaching incorrect information or focusing on the wrong thing is ineffective and can actually be damaging.
No Train, No Gain
In my travels around the country, I've talked with members of EMS agencies that don't provide training or educational classes. Everything their employees learn is on the job. This approach is a terrible mistake. Think about sports: When football players line up on the field on Sunday or Monday night, it's not the first time they've touched the ball since their last game; they've scrimmaged, practiced and mentally prepared for the game all week. Otherwise, they'd be off in their timing, strength, endurance and quickness, as well as more prone to injury.
The same is true for EMTs and paramedics. If you haven't run a cardiac arrest in more than six months, running one at 3 a.m. between a bed and a dresser isn't the time or place to practice.
Another common mistake is to use relatively young or newly promoted supervisors in the training academy, particularly if they have to re-train seasoned veterans. These personnel are the lowest in the pecking order, and nobody else wants to be on an eight-hour shift. The result is a department with the youngest and least-experienced people teaching those who have years of firsthand knowledge and training to their credit.
In this environment, training often results in people just going through the motions. The problem is that the continuing education of EMTs and paramedics is not only necessary in most states for recertification, but it's essential to the development of necessary skills and proficiencies of your personnel.
One Form or Another
We're all familiar with the traditional didactic method: the lecture. But how about mixing it up? Try assigning each student a small part of the curriculum to teach to the rest of the class. As the saying goes, "What I hear I forget; what I see I remember; what I do I understand." What better way for EMTs and paramedics to learn and truly understand material than to do the research, prepare for the class and actually teach it?
If your training budget is sizeable, you're probably already using simulation devices and software. Some computerized simulators can run in excess of $40,000, but they're great tools for either initial training or evaluating.
Another methodology is called "training in context." This method combines all the tasks of an emergency into one exercise. For example, instead of training separately on airway management, IV establishment or cardiac monitoring, you combine them in one exercise. During a simulated cardiac arrest, you can assess various skillsƒbasic and advanced airways, reading ECGs, pharmacology, ALS protocols, IVs, etc. You can even train as a team using this type of exercise. Afterward, trainers critique the event and offer constructive feedback to the providers.
Waiting for the actual event to happen and then practicing or training on the spot isn't in the best interest of our patients. Every EMS agency should have a formal program to ensure providers are at the top of their games. Only when a formal training program is in place can we really say our personnel are delivering the best care possible in our communities. JEMS
Gary Ludwig, MS, EMT-P, is a deputy fire chief with the Memphis (Tenn.) Fire Department. He has 30 years of fire and rescue experience. He's chair of the EMS Section for the International Association of Fire Chiefs and can be reached at www.garyludwig.com.