Continuing Your Education

   In a world of excellent, innovative EMS educators, Heather Davis stands out. A registered paramedic with a master's degree and 20-plus years in EMS, she is a familiar face at state and national EMS conferences, bringing a unique spin to the educational realm with presentations like "Movies that Teach," "Student Discipline" and "Leading from the Heart." Davis is currently program director for the UCLA-Daniel Freeman Paramedic Education Program and was previously education program director for the Los Angeles County Fire Department, where she managed primary EMT and continuing education programs for more than 3,000 EMTs and paramedics. She sits on the board of directors for the National Registry of EMTs (NREMT) and was previously on the board of directors for the National Association of EMS Educators (NAEMSE). I recently spoke with her about her thoughts on the state of EMS continuing education.

   In the twilight of what occurred in Massachusetts and New Hampshire with large-scale falsification of continuing education records, do you think recert classes are pointless, or just poorly executed? Or, is this more a student-based issue?

   It has been said that you cannot add value until you first have values. I think part of what has gotten the state of EMS continuing education where it is today is pressure from consumers to get students out faster; to hurry up and get it done quickly and cheaply. You get what you pay for in almost everything in life. If you buy poor quality, it won't hold up, it doesn't last and it doesn't work the way you want it to. Nothing could be truer of healthcare providers. I don't think we make jerks, incompetents, narcotic abusers and arsonists. We hire them. Garbage in, garbage out. The first thing agencies need to do is work with human resources to recruit, test and hire quality human beings who have potential and are willing to learn. Duke University basketball coach Mike Krzyzewski says in his book Leading With Heart, "Pick coachable kids." He says he'd rather have average players who are good people, motivated, hard workers with a respect for authority than great players who are punks. You have to look at who we are recruiting into the profession.

   Do you think EMS does a less-than-stellar job in public image? How can we give the public a more balanced representation of what we do?

   One of my favorite stories involves Mike Metro, deputy chief at L.A. County Fire Department, at a high school career fair, with a color display rolling footage of the Malibu fires and the Top Gun anthem playing in the background. You could see kids coming from all over the gymnasium, leaving the lawyer and electrician tables and all the rest, heading over to the fire department table. One of the kids, wide-eyed and obviously impressed, asked, "Is that what you really do?" Chief Metro thought to himself, "No, what I really do is hold hands, put people back in bed, bandage wounds and cure hurt feelings." But those images were conspicuously missing from the display. Then we all act surprised when we have to draft our employees into paramedic positions, or when they leave the profession after just a couple of years. We all know the No. 1 reason we get complaints is for the way our folks act and talk to patients and bystanders. We rarely get a complaint when we've given the wrong drug or made a patient-care error. The way we talk to patients, their families and bystanders is about attitude and loving the job we do, so our training has to reflect that, insist on that. If you would be mortified by what some of your students might say to a patient, don't let them talk like that in class, to you or to each other. I really feel that young people these days do not have a "work image" and a "casual image." I think that "what you see is what you get," meaning the way they act and communicate in class is very much what you can expect on the job, at the hospital, etc. So the standard in class must be very high. My experience has been that if you set the bar high, people will rise to the occasion. People want to belong to something bigger than they are. If you offer high-quality education, people respect that, and you simply do not cater to a department or employer who wants you to do less. You have to help them see that anything worth doing is worth doing well. If you are going to do ACLS training, do it well. Don't offer some bastardized version that only includes the parts you think you need. Help them see that shortcuts taken on the training side will result in dollars lost elsewhere, in QI fallouts that must be investigated, employee turnover, or a catastrophic error that results in a huge payout. It has been my experience that you can do things well for many years for less than the cost of a single catastrophic mistake.

   Do you have any concrete step-by-step direction for EMS educators to make recert classes more applicable and tied to what providers see in the field?

   There are many fine educational programs that develop and execute high-quality continuing education; however, I think there are many more that are running students through a review process that simply rehashes what they should already know. Keep in mind that relearning only gets us to where we were supposed to be in the first place. Unless you are doing true continuing education, you have no opportunity to improve your workforce's fund of knowledge. Unless we continue to grow and learn and change our practice with the changes in science, as an industry we are doomed to remain stagnant in our development as a profession. Much of this responsibility rests with the educational institutions providing the education and training. There must be a philosophy of "do everything." The goal of education must be a change in behavior. It's one thing to know, but providers must be able and willing to DO as well. The only way to know what they can do and will do is to see them do it. That means no faking and no talking their way through an assessment.

   What can EMS educators do to realistically convey the realities of the EMS profession to students?

   If you want to know if they can get the right dose of Versed for a seizing kid, you'd better hand them a bottle of Versed and have them pull it up for a seizing manikin that has a weight. Let them figure out the weight, measure on the Broselow, do the calculation, and then actually draw liquid into a syringe and check to make sure it's right. In this emerging culture of patient safety, there has to be a focus on knowledge, ability and attitude. It takes all three to make a safe environment for our patients and to keep the environment safe for EMS to continue taking care of patients. Yet, we've all attended classes where you are supposedly doing an assessment and you ask the evaluator, "I am checking a pulse; what do I feel?" and the evaluator dutifully answers "100, strong and regular." Or, "I am checking distal PMS. Do I have pulses?" yet the shoes are still on and there's clearly no way you are checking distal pulses or sensation, and nobody makes you do it. If we want to improve performance and start limiting the number of mistakes in patient care, we have to practice like we are going to perform. We have to make students actually DO everything. I know it's inconvenient, labor intensive and kind of a hassle, but guess what? Our patients don't get to choose us. They get whoever shows up when they call 9-1-1, and I happen to think they are worth our best effort every time. I'd like for "minimum standard" or the "least common denominator" to be someone we are all proud of, someone who is safe, competent and will consistently do the right thing. Then maybe we can start talking about building judgment and leadership.

   Raphael M. Barishansky, MPH, is program chief of public health preparedness for the Prince George's County (MD) Health Department and a member of EMS World Magazine's editorial advisory board. E-mail rbarishansky@gmail.com.