The Kids are Alright – A Follow Up

Last week, we talked about the problems and challenges presented to us by the young work force that some EMS leaders are having a difficult time adapting to dealing with.  I have been giving a great deal of thought to what the solution to this problem is, and I cannot help but feel that it is evidence of a need to change how we train.  No, I am not talking about adding hours to an EMT class, or teaching CEU classes on how to be what some would consider a better employee, I am talking instead about changing how we utilize our field trainers.

Any EMS service that cares about what happens in the street, and cares about how their patients and customers are treated has established some form of a field training program, usually staffed by experienced employees who are initially shadowed by and then later evaluate the new EMT or paramedic to make sure that they are ready to be cut loose and released to practice their trade on the unsuspecting public.  I have seen many different methods used over the years from a group teaching approach, or a one on one tactic where the new employee spends all of their time with one FTO.  Others use a system where the “student” is bounced around from preceptor to preceptor to prevent them from picking up just one person’s bad habits.  They each have their own merits and shortcomings, but the real testament to their effectiveness is what we do with our FTO’s and their new employees once all of their requirements have been met.

Far too often in too many systems, employees finish up their precepting time and they are given the “okay” to hit the streets.  From there, they are on their own.  They might get a follow up six months or a year out to say “good job, keep it up” but beyond that the contact is minimal.  Maybe what we need is to establish a stronger bond and relationship between field trainers and new paramedics or EMTs and instead utilize them as mentors.

When there is a problem in the field, we have many places to turn.  We can pick up a radio and call for medical direction, or summon a supervisor to the scene, but those two options do not always fulfill all of our needs, especially when those needs are more personal.  When dealing with the stressors of the field, or the nuances of a system and how it works, I feel that many people would benefit from still having that mentor to turn to in the form of the person who the spent those first few weeks (or in some cases months) tagging along with traveling from call to call.

While I feel progressive discipline has its place in the business world, when I was a supervisor I always looked for another way to deal with a problem, unless of course, that employee did not give me any other choice but that to deal with it.  Falling back on values like STAR CARE or reminding people of the need to “do the right thing” and think about their actions always seemed to be an effective tactic for me.  Of course, there were those situations where one reaches the end of their rope, and the only answer was to put pen to paper and run a problem up the chain to the next level, but for me that was always a last resort.

Again, here is another place where having a mentor instead of a field trainer could benefit both the employee and the system.  If a system’s leadership had the means to go to a mentor and say “Hey, Bob is having a tough time with ‘XYZ’” and allow that mentor to talk to them and try and straighten them out from a more appropriate angle than a supervisory one that might be forced to take action.

While this approach might not be appropriate in every instance, it could surely promote a more positive relationship throughout a service and could help deal with some of the interpersonal problems that seem to arise in EMS.  We are, after all, a field that is made up of people with very strong personalities.

While it might seem like I am just advocating a title change from Field Training Officer to Mentor, I feel that the mindset and toolbox utilized for each of these positions are completely different.  Instead of creating an FTO system that allows us to train and prepare employees for the field, let’s strive for one that creates a relationship within the system and gives them a better chance of achieving the positive experience that we want them to have.

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The Kids are Alright

One of the unfortunate things about having a new job is I fall at the bottom of the list when it comes to using vacation time.  With the days off that I could get I was forced to miss the last day of EMS Expo in Las Vegas this year.  While following on Twitter though, I caught Greg Friese commenting on a panel discussion by members of the National EMS Management Association (NEMSMA for short) during a program called “The EMS Situation Room: NEMSMA Administrators, Managers, and Chiefs Forum.”  To sum up the discussion simply, the focus of the forum turned to what we will refer to as the “youth movement” in EMS today.

As a former supervisor for a service that likes to populate itself with lesser experienced individuals, it has become clear that the work force is changing, and it seems like some of the “old guard” is having difficulty dealing with a lot of the new attitudes and changing needs of the work force.  The entire topic is something that has certainly raised my eyebrow, and it is really something that we need to look at from the first day of EMT class moving forward to someone’s last day with an EMS service.

When I was in Washington, DC this year for EMS Today, I was on a podcast hosted by Dave Aber where the panel included two of my paramedic instructors from Springfield College.  One of the main topics of discussion was the changes that they had witnessed in their student population over the years.  Fifteen or twenty years ago, when paramedicine was still in its infant stages, most of the student body was made up of people who had been practicing EMS for a number of years.  The vast majority of paramedic students were street smart, seasoned adult learners.  We staffed ourselves from the inside using people who were already integrated into the system and had a strong foundation and framework to help them through class.  As time has gone on though, both the work force and the pool of students have gotten younger and less experienced.  They are more of what people would consider a traditional student base.  Educators have been forced to adapt, and for the most part they have done well.

From the middle management supervisor stand point, I used to joke a lot that I should pack up all of the management books that I read and move on to reading parenting books.  The needs, wants, and desires of the younger generation have changed, significantly, and as a result, the way that those of us stuck in the middle had to deal with them changed as well.  Whenever one must deal with a workforce in their early and mid-twenties, there is always going to be that heavy focus on a social life.  Many in our field for whatever reason don’t understand the need to achieve balance between that and a professional life and it is up to us to help them through that.  It is part of being a professional, and encouraging professionalism within our environment.

Now, from the medical side, there has been a lot of talk about evolution.  We have changed how we run cardiac arrests.  We have added treatments, augmented how and when we do them, and we expect them as dedicated medical professionals to step up to the plate and do what is best for the patient.  Most of the time, they do exactly that, but sometimes people buck back with a “well, we’ve always done it THIS way” speech.  When they do that, we work with them, reeducate, and remediate them, and do what it takes to show them that we understand that this is a change, but there is a reason for it, and that reason is because it is what is best for the patient.

Much like the field provider learning to adapt to those new treatments, our leadership must adapt in turn to the people that they hire.  The attitude that educators, supervisors, and medical directors need to adopt is one that is largely be driven by “give and take.”  We need to make sure that we work with them, and we allow them to adapt to change rather than taking a “do it because I said so” approach and essentially jam change down their throats.

I feel like management and leadership today needs to be mindful of this, and just like the young EMT who needs to adapt to a new treatment modality, they need to adapt to the needs of their workforce.  It’s like a pyramid.  A few managers and supervisors provide for many EMTs and paramedics who then are expected to provide for an even larger patient population.  When it comes to patient care, their role is one largely of oversight, but when it comes to dealing with their workforce, that is where they need to make sure their focus lies.  The crop of EMTs and paramedics that are on the streets today are the ones that we need to care for and cultivate in hopes that they actually want to make a career out of this industry, and someday step up to the plate, step off the streets, and take the reins.

Sitting back, and saying, “I don’t get these kids” or shaking your fist at them in hopes that they get off your lawn, or magically grow up is unrealistic.  We can no longer rely on the hands off approach to management that many systems utilized fifteen or twenty years ago, at least for now.  Someday though, these “kids” will grow up and be the self-sufficient group that we want them to be but for the time being, we need to work with them and try to understand their personalities and needs.

Perhaps what we need to do is start focusing on the long term and structuring an industry that encourages personnel to make a career out of EMS rather than allowing them to use it as a stepping stone for something they perceive as being a loftier goal.  But I think that is a topic for a different post at a different time.

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The Importance Of A Smile


So simple and yet so very powerful. They alone have the ability to break through indifference, warm the emotions of others around, and when used at the right time can influence what others will do. Smiles are relatively cheap in comparison and virtually every budget is able to afford as many smiles as you need.

smiling blondeSmiles are one of the most important tools that you will have as both a provider and a leader when dealing with people from all occupations and social classes. Provided that our happiness in life will depend largely on how we interact and manage a connection with others, a sincere smile is the most effective way to establish a relationship and build a rapport and compatibility with others. A smile will maintain the attention of the person you are speaking to, helps boost openness through body language, helps reassure the other person of your attentiveness to what they are trying to communicate, and genuineness at being willing to help or aid them.

Smiles are also a true mood changer. Feeling negatively or being in a bad mood often results in similar body language such as frowns, furrowed brows, scowls, and lower lip biting. Consciously choosing to smile instead of displaying the aforementioned negative characteristics has the power to change the mood of yourself and those around you who may also be having negative feelings. Smiling in these moments will help lift your own spirit, improve your outlook on the situation, and lead you to making positive decisions using good judgment that is no longer tainted by the negative atmosphere.

Want to know the best part about a smile? Everyone has one, including you! Use it to your advantage in reaching your goals with others.

What Drives People To EMS?

What motivates someone to come into EMS?

After unscientifically scouring my notes from hundreds of interviews with prospective new employees, the vast majority who are looking for their first job in EMS, here are the top 3 answers provided:
Great Career Ahead

  • I want to save lives
  • I want/like to help people
  • I want a career in the medical field doing (insert something OTHER than EMS here) and EMS is a great place to start, or so I’ve heard

Looking at that list, let’s take a moment to be honest with ourselves about how likely each of those things are.

The Life Savers

In July of 2011 the Centers for Disease Control and Prevention (CDC) published a report on Out-of-Hospital Cardiac Arrest (OHCA) Surveillance(1). The report is derived from 31,689 OHCA cases submitted from locations throughout the country. The overall survival rate through hospital discharge was a mere 9.6%.

Now if the police department only enforced 10% of the laws and the fire department only extinguished 10% of the fires, could they claim that they are doing a good job? If McDonald’s only served their food fast only 10% of the time, could they claim that they are fast food?

The answer is no. So why do we continue to perpetuate that we save lives when statistically in any other industry, public service sector, or healthcare we would be considered a failure? Is “saving lives” the only thing we do?

I’m sure some of you are going to argue that the statistic above is because of how response times are measured and we only need to drive faster. Perhaps you’ll argue that rural areas cause longer times in general and so everyone should be forced to move closer. There can always be the argument made that those arrests include other variables of which we have no true control.

To those of you who wish to challenge the 9.6%, I offer that the Utstein Survival Report for OHCA Events Witnessed by a 911 Provider(2) has 3,367 OHCA cases submitted. Out of those 3,367 cases there was a total of 625 discharged from the hospital alive for a whopping 19%. Even with response time removed from the equation our percentage only increases by 10%.

The fact is that while we may tout ourselves, allow others to believe, and recruit under the guise of being lifesavers the cold hard statistics show that we are, at the very least, deplorable at doing it. This is a hard truth that those who come to EMS in order to be “Lifesavers” have trouble handling. Their expectations are never met, they often become bitter and burned out leaving EMS angry at the professionals who continue on and at the perceived deception they have fallen for. Sometimes they don’t leave but rather vent their frustration and bitterness out on others, including patients.

The Helpers

The other day I received a complaint from a woman about where one of my crews had chosen to park. They were in front of a clinic building just posting for a call when she asked them to move so she could park there and pick up her mother who had issues ambulating, was frail, and required assistance. The crew explained to her that she couldn’t park there because it was “Ambulance/Ambulette” parking only, which was the truth.

The woman exploded emotionally and verbally to the crew. One of the crew members, fearing for his safety from an angry woman, ran across the street to get the local law enforcement involved. Surprisingly to the crew, although not to myself, they really did nothing to the now more enraged woman other than ask her to back her vehicle up so the crew could respond to an assignment they had received while this was unfolding.

As expected, the woman called to complain. When I asked the driver, who the woman had specifically singled out in my conversation, as to why he didn’t just move the ambulance he cited the signs. I inquired if he was moonlighting as a Parking Enforcement Agent, to which he denied being empowered to enforce parking regulation. When I asked him why he didn’t move the ambulance to help this woman out, he said it was because she wasn’t a patient. He also didn’t recognize that the simple act of moving the ambulance, although it may have been inconvenient for him to do so, was helping someone.

I’m always intrigued by people who say that they want to “help others.” I think that if that were truly the case then they would have joined a mission or an order where vows of poverty and service are above board, open, and mandatory. Of course EMS may be the right place for them because they take those vows without knowing it, but I often wonder why they choose EMS as that venue. Some of them, upon further prodding, recall a time when either they or a loved one were helped by an EMT or a Paramedic. It was that display of compassion, caring, and empathy that motivates them to come to EMS.

I often find myself trying to explain that a desire to “help others” does not necessarily mean EMS is the right place for a person. The fact is I can walk out in jeans and sneakers with a sandwhich board that reads “FREE DIRECTIONS’ and an iPhone with Google Maps installed, go to Times Square, and help the gazillion people who are lost from using Apple Maps. I’m helping people just as much, but I’m not required to have a certification or an ambulance to do so.

The Medically Oriented

There are those who in the course of their lives are looking for something satisfying to do and the idea of working in healthcare is appealing to them, but they remain unsure. The best way to ensure that this is the sort of work they want to do is to get an entry level position and give it a test run. A number of these people choose EMS to test the healthcare waters.

This can be seen as both good and bad. It is good because their time spent in EMS will give them an idea what they are in for should they continue down the path of nursing, becoming a physician’s assistant, or even on the road to medical school. It can be bad because EMS ends up as a training ground for other professions and is constantly under the strain of a brain drain.

We need to be ready to constantly challenge these providers with new and interesting information, techniques, processes, and procedures. They are the Hungry Hippos of formalized education demonstrated in real world scenarios. While its true they may choose to move on, hopefully their experience will be positive enough that they will at least keep some level of involvement with EMS.

So What Do We Do?

There are so many debates about ourselves. Are we Public Safety or Healthcare? Should we be referred by our certification level or should one title encompass us all? Are we truly pre-hospital care providers or healthcare entry point providers? Do we save lives and if not (which I think I’ve already demonstrated through citation) then what do we do?

The truth is that we change lives. Fundamentally at our very core we are agents of change for the millions that call us each year, not necessarily being able to increase the quantity of someone’s life but rather always working to improve the quality of it. We need providers who are motivated to be agents of change for the better to those who are unable to do it for themselves. We need leaders who understand that motivation, embrace it, encourage it, foster it, and are willing to help it grow.

Motivation is an important factor to any organization. It is important that we identify the motivations of our providers and foster their growth using what we know about their motivation to challenge them both professionally and personally. Engagement and stimulation will help their performance thereby helping you as their leader and ultimately helping the agency as a whole.

Not sure what motivates your providers? Well then ask.


1. Centers for Disease Control and Prevention, July 29 2011 Out-of Hospital Cardiac Arrest Surveillance on the Internet at (visited January 6, 2013)

2. Utstein Survival Report Page 3 Cumulative Data October 1, 2005 – December 31, 2010 on the Internet at (visited January 6, 2013)