By Nicholas Nedza, MBA, FP-C, CCP, NRP, EMT-PM, CHEC-II and Loren (Lee) Ridge, FP-C, CCP, EMT-PM, NCEE
Emergency medical services (EMS) is a profession finding its own way from the days of simply providing transport to a hospital to what is now essentially an extension of emergency departments. EMS has truly found a place in the proverbial House of Medicine. With that, the time and responsibility of progressing and improving as an industry has come.
Part of that growth has included moving away from the tired and inappropriate adage, that’s the way it has always been done. The industry has begun to embrace, albeit slowly, the idea that we need to back up what it is that happens in the prehospital and interfacility care space with science. To accomplish this, research needs to be a part of the culture as well as the need to continue to educate beyond the training facilities.
Gaining a certain number of continuing education hours (CEHs) based on certification level is a necessary requirement, but often seen as a chore met by attending a class to check a box. Instead, CEHs should be viewed as continuous or continual education by EMS providers, medical directors and service directors. CEHs are an opportunity to grow as a provider and do better for the patients.
Throughout the history of EMS, there has been the observation that EMS providers, who are genuinely saving lives, make next to nothing compared to professional athletes, who in addition to the higher pay have notoriety.
The main argument against this is that athletes generate tremendous amounts of revenue and so should be compensated accordingly. Another argument is they are super specialized and gifted beyond what the average person could do. Is that not also true of EMS providers? Do those in ambulances not do things that the average person couldn’t fathom?
What is different about athletes, specifically the top tier athletes, Michael Jordan, Kobe Bryant, Caitlin Clark, Tiger Woods, etc. is that they spend hours every day practicing. They will shoot or hit hundreds of shots a day, despite already holding records and being at the top of their sport.
Why then, if EMS providers are doing things to save people’s lives is there such a struggle to practice the skills? Some of the highest acuity skills are only practiced once a year to meet a competency requirement, due to the low frequency of use with real patients. Every fire department, even the volunteer departments, will pull and charge lines once a month. Why don’t paramedics intubate a mannikin or demonstrate electro-therapy once a month?
The answer to these questions all lie with an EMS educator dedicated to each EMS service. The value of an EMS educator to a service cannot be underestimated. A position such as this is a responsibility for ensuring engagement with all the members, at all levels with what is current in emergency medicine and ensuring skills of each person on the roster.
It is a great role for an experienced provider who is closing in on the end of an EMS career and wants to stay engaged and help usher in the next generation of providers. Keeping provider’s education records and maintaining a schedule of when certifications expire should be a part of the position, but it would be limiting to stop at that.
EMS educators should seek to keep providers engaged with learning opportunities. These learning opportunities take many forms, whether this be formal education at a meeting or informal questions and activities to engage critical thinking daily. Critical thinking is a necessary skill for EMS providers, but it cannot be taught, only learned or honed from experience. Practice improves this skill making it necessary for the Educator to engage in simulation and present real-life scenarios.
Importantly, the educator needs to remember that the majority of times when hoofbeats are heard it is the result of a horse not a zebra. Complicated scenarios can teach providers and help build critical thinking, but most intubations are not done upside down with the patient suspended in a car seat.
Care in the prehospital world is not routine nor is it the same from situation to situation, but the basics are. The skill of auscultating a blood pressure in crew quarters is the same as auscultating a blood pressure in a ditch on the scene of a car accident, just like the skill of shooting a free throw in an empty gym is like shooting in front of tens of thousands of people in a hostile environment.
If mastery is neared with no pressure, then when pressure is applied, or things do not go as expected the provider will be more capable of adapting. Being able to adapt and make quick decisions comes from the ability to think critically and have a firm grasp of the basics.
Service directors, when hiring an educator, should seek to find someone who wants to see the providers grow and understand that every interaction is an opportunity to teach. Educators, and providers for that matter, should also understand that learning comes from mistakes. During the educational sessions is where mistakes should be made.
If the environment has been created appropriately, mistakes should not be approached from a punitive perspective, but as a chance to improve. No matter how long someone has been in EMS, they should feel comfortable enough to indicate that they do not feel confident with a skill or an aspect of emergency medicine. Educators should never make anyone feel as though they can’t ask a question or they should know something.
If everyone thinks back to the first time they asked a question and were made to feel stupid, they would know how someone’s response in that moment is so pivotal. It is human nature to have some pride and embarrassment, it should be an Educator’s nature to support everyone in their insecurities and help them feel comfortable asking for help.
An EMS educator, someone who can put themselves in the boots and EMS pants of those in the service, makes everyone better. This position will continue to become more valuable in the profession as services seek to provide better and more complete patient care to each patient.
Each EMS service is required to have a medical director and a service director, but should it not also be required to have someone who will keep the service and the profession moving forward?
About the Authors
Nicholas Nedza, MBA, FP-C, CCP, NRP, EMT-PM, CHEC-II, is the Ambulance Department manager at Waverly Health Center, in Northeast Iowa, and host of the EMS: Always There to Serve Podcast produced by Waverly Health Center. Nick is a former flight paramedic at UIHC’s AirCare.
Loren (Lee) Ridge, EMT-PM, CCP, NCEE, FP-C, is currently the unit-based educator for Waverly Health Center’s Ambulance Department. Lee has been a paramedic for 40 years and has served as a paramedic on both volunteer and career services, a flight paramedic, full-time educator, conference presenter, contributing author and a simulation specialist.
