COVID-19 and EMS Training/Recertification: A Virtual Roundtable

• Tom Bouthillet, battalion chief of EMS, Hilton Head Island Fire Rescue (S.C.);
• Ben Kaufman, captain and acting battalion chief of emergency medical and integrated health services, Montgomery County Fire and Rescue (Gaithersburg, Md.); and
• Gregory Alan Torrescano, EMS training captain, Chatham Emergency Services (Savannah, Ga.).

Here’s what they had to tell us.

EMS World: How has COVID-19 affected EMS training and recertification in your department?

Torrescano: COVID-19 has created difficulties in both training and recertification. It has increased the difficulty of recertifying employees. We now ask employees to set up appointments instead of using a batch method to complete certification. We’ve had to increase the number of refresher classes to help limit class size while still providing sufficient continuing education to our employees.

Kaufman: Initial paramedic training has been uniquely impacted. In March we had 28 students in the program, all of whom had completed didactic training and were in clinicals. Then all six hospitals that serve as our clinical sites stopped allowing students. Our department also restricted apparatus staffing to a minimum number of personnel, which eliminated ride-alongs and limited paramedic students to only our eight paramedic chase units.

Only eight of the 28 students had completed enough clinical hours to sit for the NRP exam, so they continued their training in a residency status, which involves managing patients while supervised by a preceptor. Training for the other 20 students was suspended for about three months. I believe at least one student withdrew from the program during the downtime, but I don’t know the whole story.

Recently the department modified the staffing restriction so the remaining students could resume field clinical hours. The hospitals are still not allowing ALS students. Our training academy personnel are also building interactive simulations to enhance initial ALS training.

Bouthillet: Most of the EMS training since February has been about COVID-19. Back then it was “novel coronavirus.” We all had a lot to learn about infection control and donning and doffing personal protective equipment. There’s a lot of misinformation out there, so it’s important that professional EMTs and paramedics get the facts.

We recertify through the NREMT’s NCCP program, and our department teaches a five-day refresher course in October each year. Because we have three shifts, it means we deliver 15 days of instruction, plus makeup days for excused absences. This year we’ll be looking at options to teach the didactic portion remotely so we can maintain social distance.

What changes have you made to training and recertification to make them COVID-19-compatible?

Torrescano: We’ve had to limit class size to comply with state guidelines. We’ve rearranged our classrooms to maintain social distancing. We’ve decided to delay the start of initial education courses for both EMTs and paramedics

Kaufman: Initial EMT training was completely suspended. I believe they are planning to resume with modified practices.

Bouthillet: By now most of us have learned to adapt to a digital environment, and it looks like the NREMT has temporarily removed the limits on distributive education. That’s important because we’ve never attempted virtual instructor-led training in a way that meets the F5 requirements of NREMT. Who knows? Maybe we’ll be able to teach the didactic portion only once this year and record it! That would be really nice.

Business has been using online sessions to replace in-person interactions during COVID-19. What are your thoughts about this option’s pros and cons?

Kaufman: At our department recertification classes have been moved completely to Zoom meetings. We’ve had overwhelmingly positive feedback about this, and our academy is considering this format for all recertification training. There is no in-person requirement now, but I believe we will need to incorporate an in-person skills day down the road.

We rolled out a new video laryngoscope in the middle of this crisis. We recognized the need to improve safety during intubation to reduce the risk of disease transmission, and we acknowledged and accepted the risk of in-person training. So we first held Zoom sessions for equipment familiarization, then multiple trainers per day travelled to work sites to conduct individualized hands-on training while maintaining physical distancing precautions. More than 250 people were trained in about two weeks.

Bouthillet: Certain things, like high-performance CPR and suction-assisted laryngoscopy airway decontamination (SALAD), need to be in person no matter what. However, we can limit the class sizes or bring the manikins to the fire stations to limit the number of employees in close contact with one another.

Torrescano: Most of our courses have a hands-on component that require in-person training. While virtual online sessions are used as a supplement to education courses, they cannot replace the need for in-person training. We already utilize a live feed that’s recorded to allow students to interact virtually or review the class later.

How do you foresee your department’s EMS training and recertification process changing in the current pandemic environment and beyond?

Torrescano: We will take a more technology-centered approach to our training and recertification process. We will increase the digital footprint of our initial and continuing education courses.

There will be more digital homework and quizzes. We will increase the number of opportunities to learn digitally.

We’re an adaptable company and can respond quickly to our changing environment. We’ve been able to provide service for our community while making necessary changes to protect our employees and the public during this epidemic.

Bouthillet: We expect changes with an increased focus on online sessions, but we don’t think it’s going to be much of a problem. In fact, it might be a time-saver if NREMT doesn’t reinstate the limits on distributed education until the end of the pandemic.

Kaufman: We’re not quite certain what the future holds, but we know that EMS training won’t look the same as it did pre-COVID.

Without bragging too much, the personnel of Montgomery County Fire and Rescue have already responded with a tremendous amount of resilience and understanding as we “changed the rules” on a daily basis during the pandemic. We’ve learned a ton and look forward to sharing our experiences.

James Careless is a freelance writer and frequent contributor to EMS World.