Activity Planning for EMS Educators

CPR training with a bag-valve mask.
Shutterstock/Chris D swabb

Confucius said, “It’s not knowing that is important but doing.” It may seem impressive if your EMT or paramedic student can recite arcane facts, akin to a medical version of Jeopardy as everyone stands around the proverbial EMS campfire.

It is a completely different scenario when that same student can react to the presentation, intervene, and save a life. Lesson plans are an essential tool for the EMS educator in accomplishing that task. Regardless of the topic we are teaching, they help us develop the process we are going to utilize to teach.

Many times, we conflate lesson plans with activity plans, and for the most part, they are very similar to one another, with a few caveats. Most of the time, we write activity plans under the guise of a lesson plan. Regardless of whether we are using a lesson plan or an activity plan, we are trying to impart a lesson that will teach a student how to think.

Activity Plans are Important

The importance of an activity plan cannot be overstated. Since the National Registry has unsettled the psychomotor portion of their exam, scenario-based activity plans are essential for the educator to determine if a student has acquired the knowledge they are imparting. It then becomes critical for the student to demonstrate their ability to provide care in dynamic situations.

An activity plan, along with its critical components of lab and simulation, is vital to EMT and paramedic education as it provides a structured, safe, and immersive framework for learning. These elements allow students to develop and refine clinical skills in a controlled environment, minimizing risk to patients while maximizing educational outcomes.

Lab sessions offer hands-on practice with medical equipment and procedures, fostering muscle memory and technical proficiency, while simulations replicate real-world scenarios, enabling learners to apply critical thinking, teamwork, and decision-making under pressure. These experiences bridge the gap between theory and practice, allowing students to make mistakes, receive feedback, and improve without the high stakes of real patient care.

For EMTs and paramedics, where precision and rapid response are essential, activity plans with an integrated lab and simulation ensure that learners are not only technically competent but also psychologically prepared to handle high-pressure emergencies with confidence and competence. Together, they lay the foundation for the transition to the clinical learning environment where they can practice safe, effective, and patient-centered care.

Activity plans are where we, as educators, show our true value. This is where we flex, where we help students develop muscle memory and react in critical situations. One way to distinguish between the two is to look at what the EMS instructor is trying to accomplish.

Planning a Lesson Plan

A lesson plan is meant to provide the instruction or important skills or knowledge so that EMS students can individually and independently demonstrate that skill or knowledge. An activity plan is a detailed guide for a specific activity or task. It outlines the goals of the activity, the materials and resources that will be used, and the steps for completing the activity.1

A lesson on blood administration would include the indications and contraindications and discuss the adverse reactions of transfusing blood. Part of the skill would include having the student describe the rationale and then demonstrate setting up a unit of blood for administration, using blood tubing, and perhaps setting up a warmer.

Activity plans are a little more robust, on the other hand. The elements are the same: the introduction of what we are going to discuss, why this is important, key concepts, and a review of the equipment we will be utilizing.

I would not only have simulated blood, blood tubing, and a blood warmer, but I would have everything I needed to run a call. The expectation is we will use all of these tools or the ones essential to the scenario. 

The activity plan will have increased complexity. In the activity plan, the EMS instructor may incorporate additional experience and elaboration on the information. Scenarios and simulations would have an incredible amount of detail. These actions would have additional opportunities for assessment, evaluation, practice, integration of complex concepts, and developing the generalization of skills and knowledge essential for the transition from the classroom to the field.

Examples

In the blood administration example, all of the adverse reactions may be played out, with the expectation that the student will react to them. We would also incorporate other variables, such as a scenario that would include the criteria for administration, a patient with signs and symptoms of hemorrhagic shock;2 or who initially has Class I hemorrhage, and under your protocol, you may start out giving crystalloids and then progress to whole blood if the patient progresses to Class III or IV hemorrhage.3

For the student and the EMS educator, a well-designed activity plan implemented through your sim lab can be an exhilarating experience for a student. It can challenge all of their senses while they attempt to implement theory with practice. For the educator, it is an opportunity to see if the education they conveyed has been successful.

As a scenario unfolds, it allows the educator to almost look inside the student’s mind, to not only see how they think but, most importantly, how they react. If you record the event, you can stop it at different points, and when you play it back for the student, you can provide detailed feedback on what went well and what needs to be improved.

During the sim lab, when introducing new skills and concepts, you can leverage your activity plan by slowing down the activity, and even stopping it to provide feedback or modeling. This is something that could never happen in the clinical learning environment.

If we had an activity plan where we were teaching about congestive heart failure, we would present patients from Killip Class I to Killip Class IV, incorporating complex patient presentations with extensive medical histories, for example, a presentation where we could not apply CPAP because it would be contra-indicated in a particular patient.4

Challenging Scenarios

We are trying to create a robust set of circumstances that cover different challenging situations that set the student up to react, with success or failure, to complex or critical or crashing patients. This will better prepare them for their clinical/internship encounters.

Lesson plans provide instruction, but activity plans have a variety of purposes, such as introducing topics and motivating learners. We build confidence through scaffolding, layering, or building different skills and techniques, playing off previously taught themes.

Congruence is the main topic here. We can’t have a lesson or activity discussing the advanced life support resuscitation of cardiac arrest without talking about the initial basic life support of airway, breathing, and circulation.

In the lesson plan, the resuscitation of cardiac arrest may start off with a straightforward presentation of a patient in ventricular fibrillation. We would begin with CPR and progress to the use of an AED, arrival and implementation of advanced life support, and post-resuscitation care with transport to a cardiac receiving center. This entire scenario may appear to be very linear.

Well-designed activity plans are where we can be more dynamic; this author had one dear friend who taught a chemistry lab say this is where we get to have fun. When we are writing an activity plan just based on the name activity plan, you know we are going to ask our students to demonstrate and perform skills during a scenario (most likely multiple scenarios: a patient with chest pain/STEMI who proceeds to go into cardiac arrest right in front of you; a patient who presents in unstable ventricular tachycardia, whom you cardiovert, who then proceeds to go into asystole and after a short period of CPR into ventricular fibrillation).

We will also ask them during the encounter to recite the indications and contraindications for a particular medication they need to administer or to identify the rhythm the patient is in; explain what is happening with our simulated patient; categorize if the patient is critical, not critical, or has the potential to decompensate.

Student Feedback

We will ask the student to support their decision for a particular course of treatment. We will try to present a unique patient presentation, one that is realistic but will cause the student to modify the normal course of treatment or perhaps, in real time, develop a response that fits the unique parameters of this situation.

For example, a patient refractory to initial treatment who has a history of chronic renal failure and hyperkalemia where we need to administer calcium chloride or the development of a pneumothorax from barotrauma as a result of ventilation and chest compressions. Patients who need vasopressors or who relapse into cardiac arrest again. We may have a cardiac arrest scenario where the patient is in PEA, and we need to treat a multitude of Hs and Ts.

In essence, the activity plan should utilize every level of Bloom’s Taxonomy,1,5,6 This is essential to the concept of scaffolding. We build on baseline knowledge and skills, developing comprehension and competence as we move forward.

Activity plans are particularly well suited for simulation labs. They are designed to be more interactive and tend to be more adaptable, allowing EMS educators to modify activities in real-time based on student needs, the reactions to the complexity of scenarios, or available resources.

Changing on the Fly

In an EMS setting, an activity plan might evolve based on student performance, such as extending or adjusting a scenario to better meet learning goals.

Many times, instructors present information in ways that appeal to them as an instructor. This is not conducive to the student. We have all seen the instructors who practice “death by PowerPoint,” or the ones who spend all of their time in skills and scenarios that the essential elements of the process and the reasoning behind the material is lost or poorly translated.

If exercises are going too long, EMS students will just shut down from the activity, and an opportunity to impart knowledge is lost. When an instructor focuses on one modality to impart information, whether it is scenario after scenario or PowerPoint slide after PowerPoint slide, we are not reaching the students we need to reach.

Activity plans, just like lesson plans, lend themselves to differentiated instruction. Differentiated instruction has been described as “a method of instruction that takes into account the different learning styles, abilities, and interests of individual learners and groups of learners.”1

Differentiated instruction is an approach to teaching that allows EMS educators to tailor instruction to meet the individual needs of every student. It involves adjusting the content, process, and product of instruction in order to accommodate the diverse needs, learning styles, and interests of learners.

Different learning Styles

We always want to devise education to accommodate the individual learning styles of students, whether they are visual, auditory, read/write, or kinesthetic. That doesn’t mean we write individual lesson plans for each student to teach one topic.1

Instead, we leverage different modalities to present content to our students. For an activity plan focusing on the treatment and management of a patient with STEMI, we will have a presentation or maybe multiple presentations on the pathophysiology of NSTEMI and STEMI, as well as assessment and treatment.

We may have one instructor for one student or one instructor for a few students to review the static strip reading activity of EKGs. Perhaps have your students write a description of what is STEMI or make a TikTok highlighting the key elements of patient presentation. Show videos demonstrating the response and workup by an EMS team to present a model for your students to emulate, all before we proceed into the learning lab to run through simulations with increasing complexity and different patient appearances.

Different Styles

It is never a one-and-a-done information exchange; instead, it is presenting information in a variety of different contexts in order to convey the content.

Archiving your plans, especially your activity plans, is essential for any EMS educator. Activity plans, from a historical perspective, give us a starting point when we teach an upgraded skill or incorporate a new piece of equipment to improve a skill we already perform.

If you have ever used a Cook IO needle and your agency has made the transition to a battery-operated intraosseous drill for IO insertion, for instance. For the new skill, we would dust off those old activity plans and begin to update them.

Those old plans also let us know what teaching techniques worked, but most importantly, what techniques didn’t work, so that we can move on to more productive activities. They provide a blueprint for future educators to follow.

Summary

Activity plans are an invaluable asset for EMS educators, enabling them to go beyond standard instruction and create dynamic, interactive learning experiences that challenge students in real-world scenarios.

These plans are not just about teaching isolated skills but about fostering critical thinking, adaptability, and clinical reasoning, essential qualities for EMS professionals. By scaffolding knowledge through simulations and scenarios that mimic real-life complexity, activity plans empower students to practice, fail, learn, and succeed in a controlled environment.

This approach not only builds confidence but also prepares learners to respond effectively to unpredictable and high-pressure situations in the field.

Archiving and continually refining these plans ensures that EMS education remains adaptive to new challenges and evolving medical practices. As EMS systems incorporate new technologies and protocols, educators can revisit, revise, and improve upon past activity plans to enhance future learning experiences.

Ultimately, well-designed activity plans reflect the heart of EMS education: a commitment to producing competent, resilient professionals capable of delivering high-quality care under any circumstances. Through the thoughtful integration of activity plans, EMS educators contribute not only to the individual success of their students but also to the advancement of the profession as a whole.

References

1. Price, K. M., & Nelson, K. L. (2018). Planning effective instruction: Diversity responsive methods and management. Cengage Learning

2. Donovan W. Ranger Medic Handbook. 4th ed. North American Rescue 2012.

3. PHTLS course manual National Association of Emergency Medical Technicians (US). 10th edition. Burlington, Massachusetts: Jones & Bartlett Learning, [2024]

4. Chapleau, W., Burba, A., Pons, P. M., & Page, D. (2011). The Paramedic Updated Edition (1st ed.). McGraw-Hill Education

5. Bloom, B. S. (Ed.). (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive domain. David McKay Company

6. Armstrong, Patricia. Vanderbilt University Center for Teaching. https://cft.vanderbilt.edu/guides-sub-pages/blooms-taxonomy/

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