School Daze
Original Post Date:March 29, 2008

A big problem with EMS education has long been EMS educators, but the root cause is not that easy to quantify. Nuance aside, the biggest trouble can be lumped into two categories:

*Lack of Current Knowledge, &
*A consistent dilution of the educational process


A study of physicians I read a while back found that most doctors learn very little that is new after they leave medical school. Unfortunately, the same timetable could be applied to paramedics. As they move from the classroom to the field and back to the classroom to teach, they carry the outdated information they covet like grandmother’s pearls to their students but forget to bring a book. That would be bad enough, but the real trouble starts when the students start asking questions that the instructor cannot answer, or worse, chooses to answer incorrectly rather than admit he is uninformed. Students don’t mind a teacher being wrong once in a while, but instructor bullshit is a sure path to student disconnect.

Assuming the instructor is educated; he often assumes his audience cannot be taught, at least not to his level. The unspoken solution to this perceived problem is to simplify EMS science to a point where students can make uncomplicated cause-and-effect relational choices about patient management. That would be alright if we were teaching people to do laundry and when to add bleach. Curtly, the EMS educational system seems designed to simplify information that is not simple. Describing complex pathology as "a bad day" or "a bad sign", or just plain "bad" assumes that the student cannot understand and doesn’t need to know anything else. J.R.R. Tolkien through Gandalf says, "It matters little who is the enemy if we cannot beat of his attack." That is true but does not account for having the tools to repel many different assaults and not having the basic knowledge of when to use which.

There is a balance, and to achieve it requires a revamp of the EMS educational system.

First, and most importantly, our instructors need to be qualified. Simply requiring instructor certifications is to stop short of making sure they have any business at all in a classroom. Experience and current knowledge are the key components of a well rounded educator who can bring useful knowledge to today’s EMT students. This becomes increasingly more important as the level of training increases. Paramedics continuously shout to anyone that will listen that our skills are just as or more advanced than our colleagues in nursing and allied health, but the fact is that we are not educated that way.

Secondly, EMS education should be structured to promote understanding and learning on a level commensurate with the gravity of the conditions and treatment being taught. To make learning "fun" or "easy" should always be secondary to making sure it is complete. The instructional modalities should concentrate on positive reinforcement for good performance that reflects the desire to continue that level of excellence. Door prizes and other carnival-style inducements should be limited. Rather, instructors would do better to recognize high achievers and use them to elevate the whole class. The goal of EMS education is to graduate EMS professionals. The current thinking seems to be focused on making the course as simple as possible so that the everyone can pass the test regardless of effort. To garner respect for our profession is to change the focus to bringing all the students to the highest level before allowing them to graduate. Confidence comes from knowledge and experience, not a test score.

Finally, there must be a greater sense of instructor responsibility. Often, teachers will arrive to class with a "canned" lecture and depend on reading the lesson to their students and allowing them to direct the class. No instructor should ever look at a slide that HE brought to class and say "I have no idea what that means". This glaring lack of preparation translates into a lack of respect that we would not tolerate from our students and they will not long endue from us. Also, presenting instruction, even the most mundane should never be done with the preface of "You guys all know this". Whether it is an initial course or continuing education, it is and should be new material. Telling the average student that they are getting a review is giving them permission to stop listening. If they know they aren’t getting anything new, there is little point in being there at all.

Regardless of my disenchantment with the whole thing, I really don’t believe EMS educators give bad information on purpose. I personally have been a victim of learning administration who valued numbers over actual teaching, an unfortunately prevalent attitude. Bottom line, not everyone was meant to be a paramedic, and the solution for these folks is not to leave them in the classroom.

In EMS, those who cannot do definitely should NOT teach, they should do something else.

Why it matters...
Original Post Date:March 24, 2008

Every profession, every career, every passing of time reaches a point in time, probably more than one when it must grow, retreat or die. Baseball did it after the strikes. Great Britian did it each time another piece of the empire dropped out do to it's own thing. The Beatles backed up to punt when that other drummer quit, and that worked out alright. Bottom line, anything worth doing in history had to eventually be done differently, and EMS is no exception.

If someone wasn't willing, nay...inspired to change, we'd still be hauling ass (quite literally) to the hospital in a hearse. But we aren't because we did evelove, proving if nothing else that we knew how if not when. It is my humble opinion that the when is now.

The science of EMS threatens to leave the practitioners behind, giving us an untidy "cart before the horse" appearance that doesn't inspire confidence in anyone. A big part of why other professionals treat us like we cannot understand complicated subjects like physiology is that we often act like we don't care. Instead, we pound our chests and cite all the thing we can do, all the skills we have have that other, more highly paid professionals do not, and say that if they aren't going to pay us then we aren't going to listen. It's the spite nosejob of all time.

This attitude has to go.

A handful of articulate and educated among us speaks for us, or at least they try to. They say "We need this drug to treat our patients...they will likely die without it" Then, the doctor says "You paramedics still give breathing treatments to patients in heart failure, so how will you figure the new stuff out?" Do you know what our advocates say? Nothing. Cant'. The doctor has them dead to rights and they know it. We still do things like that because we don't understand physiology and that's because we don't think it's important to us. Maybe in it's infancy, EMS was best managed on cause & effect relationships, but not anymore.

Science and medicine have advanced to a point where the best interventions are powerful and specific, requiring the clinician to pinpoint the exact pathology because the wrong treatment would be harmful. Our father's EMS, a science of horseshoes and handgrenades is gone. Driving fast and hoping you get it right is not enough anymore.

Anyone who doesn't believe that should start looking for a used hearse. Maybe two.