Administration and Leadership, Training

Enhancing EMS Hiring Processes to Save Time and Money while Improving Patient Care

Issue 8 and Volume 42.

EMS moves at an incredible pace, and the ability to keep up with a rapidly changing clinical landscape requires several different areas to operate in unison.

Recently, Sunstar Paramedics in Pinellas County, Fla., saw demands for transports continuing to rapidly increase, and more than 50 new paramedics were needed to keep up. New employees were being hired, but it was taking too long to clear them and some of the new recruits weren’t meeting Sunstar Paramedics’ high standards.

The recruiting and training process needed to change, and to do so, Sunstar Paramedics took an innovative approach-restructuring its clinical services department that not only resulted in improved recruitment, onboarding and training processes but also enhanced the quality of care provided by new hires.

Online Recruitment

Prior to the changes, Sunstar Paramedics’ recruiters would spend hours sifting through applications and conducting in-person interviews and written assessments. The time spent on these applicants wasn’t productive. Recruiters were often forced to reject applicants who didn’t have sufficient experience or they didn’t possess the appropriate clinical skill aptitude.

Robert Stanley, clinical services coordinator at Sunstar Paramedics, recognized the negative effect of this lost time during the recruitment process, and created a new online assessment to more quickly and efficiently evaluate potential employees. Instead of using an outdated process of in-person, paper tests, Stanley developed innovative online modules allowing Sunstar Paramedics to ask questions geared to the applicant’s current position, such as their proficiency with prehospital trauma life support, ALS and BLS.

The redesigned recruitment process allowed Sunstar Paramedics to assess an applicant’s proficiencies and deficiencies before scheduling an interview, significantly reducing the amount of time spent on application screening. Stanley estimates they’ve saved 2,500 hours of staff time since January 2016.

Changing Perceptions

After the initial recruitment process was redesigned, Sunstar Paramedics began to rework its training process for new hires, implementing a regimented schedule for its training academy with a curriculum focused on the requirements for capstone testing, including:

>> Full assessment;

>> Cardiac arrest and resuscitation scenario;

>> Defibrillating and pacing the manikin; and

>> 150-question test encompassing current protocols and general paramedic-based knowledge.

Not all of the changes were complex. Something as simple as changing the perceptions of the “phase evaluation” days was an important factor in improving capstone results. For example, changing the training location to the same room as the capstone test and using the same manikins during testing and training made new hires feel more comfortable and confident.

The new training academy format resulted in trainees being better prepared and preforming more consistently as they headed into capstone test. It also drastically increased new hire performance: Sunstar Paramedics’ trainees went from a first-time capstone test pass rate of 46% to 100% for 115 paramedics in 2016. So far, in 2017, Sunstar Paramedics’ trainees are averaging a first-time pass rate of 95%. (See Table 1, p. 30.)

Educational opportunities that allow field training officers the opportunity to refine their clinical skills
help ensure they can provide the guidance and mentorship that’s essential to a new employee’s success.

Reinvigorating FTOs

The thorough pre-hire evaluations and strong capstone testing scores allowed Sunstar Paramedics to eliminate reteaching what new hires had already learned in school and training, such as the basics of paramedicine. However, the biggest impact of the reinvented recruitment and new hire training process came from strengthening the roles of field training officers (FTOs).

Sunstar Paramedics reinvigorated its FTO program by offering financial compensation, clinical skill and professional development, and educational benefits, including courses to help them teach others and provide the guidance and mentorship that’s essential to a new employee’s success.

The clinical services department also distributed individual monthly report cards, which provides each FTO with a snapshot of their operation, safety and clinical measures. This vital feedback enables FTOs to better instruct new employees and subsequently provide better care to the community.

In addition to the monthly report cards, FTOs also participate in quarterly meetings separate from usual continuing medical education courses. These FTO-only educational opportunities cover a variety of topics, including cardiology, ventilators and documentation, and are taught by special guests.

FTOs are also now expected to have monthly meetings to discuss their trainees’ performance. Because FTOs and their trainees aren’t always scheduled or stationed together, Sunstar Paramedics provides video conference technology, removing a huge barrier to ensuring meetings are held regularly.

At the end of the year, FTOs are evaluated on the number of employees they’ve cleared and how well new employees are complying with operations. The FTOs are also given performance reviews on their compliance with several clinical and operational areas, including electronic patient care reporting signature compliance, documenting compliance for their CME completion time and meeting attendance.

Restructuring the FTO program lowered costs for Sunstar Paramedics by lowering training and ride time. EMTs and paramedics are now cleared in half the time; new paramedics are now cleared in an average of 75 days, compared to 150 days prior to making these changes.

FTO-only training is held separately from other continuing medical education courses and
enables FTOs to better instruct new employees and subsequently provide better care to the community.

Quality Assurance

The reinvented recruiting and training processes aren’t just more efficient and cost-effective, but new employees are now better trained and are able to more quickly provide high-quality patient care.

As the number of new paramedics increased, the clinical services department also saw an improvement in quality assurance reviews (QARs) for new paramedics and EMTs in the field with less retraining.

The department now boasts 100% QA chart review, which provides real-time feedback to the crews. Trends can be identified as early as the online assessment, and can be used to provide specific education to each employee. The data is also used to create monthly education opportunities or campaigns.

“Feedback is a crucial piece in the EMS industry that often goes unnoticed,” said Sunstar Paramedics Chief Operating Officer Mark Postma. “Paramedics, EMTs and FTOs advance clinically and professionally through the feedback and report cards, but the feedback also lets them know when they’re doing a great job – which isn’t always the norm in EMS positions.”


The recruitment and new hire training improvements and increased feedback has resulted in a cultural shift within the organization with better and more open lines of communication, individual and crew accountability, and a commitment to continuously working on ways to improve patient care.

Restructuring the clinical services department hasn’t just improved internal communications and processes; it’s also enhanced Sunstar Paramedics’ relationships with local agencies. Seven different agencies within Pinellas County have reached out to Sunstar Paramedics and arranged for their employees to go through the redesigned new hire training. This training partnership forges better interagency relationships, allows Sunstar Paramedics crews the opportunity to train with local fire departments and other neighboring EMS agencies, and has led to marked improvements in the EMS culture in Pinellas County.