The Hands On Approach to Gloves-Off Precepting
by Alyssa Tarvin
A Matter of Degrees:
The Case for Degreed Paramedics
by Leaugeay Barnes, MS, NRP, NCEE, FP-C
Foundations of Education: An EMS Approach
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IN THIS ISSUE
National Association of EMS Educators
250 Mount Lebanon Boulevard
Pittsburgh, PA 15234
Phone : 412-343-4775
Fax : 412-343-4770
Page 2 New Executive Director!
Page 3 Symposium Letter
Page 4 Why Do We Need EMS Research?
A Matter of Degrees: The Case for Degreed
Paramedics - Leaugeay Barnes
Page 8 Treasurer Spotlight
Page 9 NAEMSE Member Benefits
Page 10 Hotel Information
The Hands On Approach to Gloves-off
Precepting - Alyssa Tarvin
Foundations of Education:
An EMS Approach - 3 rd Edition
Page 19 Save the Dates!
2019 Board of Directors
Bryan Ericson, M. Ed, RN, NRP, LP
Linda Abrahamson, MA, ECRN, EMT-P, NCEE
Dr. Lindi Holt, PhD, NRP, NCEE
Dr. Nerina Stepanovsky, PhD, MSN, CTRN, PM
Rebecca Valentine, BS, NRP, NCEE, I/C
Leaugeay Barnes, MS, NRP, NCEE, FP-C
Dan Carlascio, NREMT-P, I/C
Omni Joe Fort Grafft, Worth MS, NREMT, $151 EMS per Mgr night (Rt) from
1300 Houston Christopher Street Metsgar, July MBA, 30 BS to Aug 6, 2019.
Fort Worth, TX 76102
Jill Oblak, MA, MBA, NRP To book your room,
please visit the link to
Sahaj Khalsa, BS, NRP, NM, I/C
below Discount Rate
Dr. William Robertson, or PhD, visit DHSc, the NRP NAEMSE
National Office Staff
Stephen Perdziola, BS
Erin Mihalsky, AS
Laurie Davin, AS
Jared Kallmann, BA
Amy Brooks, BA
Interested in reprinting one of the articles you
find in this publication?
If so, please contact Stephen Perdziola via
e-mail at email@example.com or by
phone at (412)343-4775 ext. 25
www.naemse.org | Educator Update | 1
NEW EXECUTIVE DIRECTOR!
National Association of EMS Educators
Names New Executive Director!
Bryan Ericson, NAEMSE President, is pleased to announce that
Stephen Perdziola (right) has been appointed by the Board of
Directors to the position of Executive Director, effective May 1,
Stephen has been the NAEMSE business manager since 2007.
His responsibilities over the past 12 years have covered areas of
finance, operations, payroll, auditing, symposium planning and
staff management. Bryan stated that Stephen was the logical
individual to move into the Executive Director position. He continued, adding that
Stephen has the experience, knowledge and personality needed to continue the
mission of NAEMSE; which is to Inspire Educational Excellence.
Prior to joining NAEMSE in 2007, Stephen worked as the Assistant Director of Business
Affairs for the Community College of Allegheny County, the second largest community
college system in Pennsylvania, for almost 10 years.
“I could not be more honored to serve, not only the NAEMSE Board of Directors, but
also its membership, in the role of Executive Director.” stated Stephen. “With a great
board and staff to work with, exciting things are on the horizon.”
2 | Educator Eupdate | www.naemse.org
NAEMSE Symposium 2019!
by Stephen Perdziola - Executive Director of NAEMSE
I hope you are as excited as we all are to be heading back to Fort Worth, Texas for the 2019 EMS Educators
Symposium and Trade Show July 31 - August 5th.
For the NAEMSE Board of Directors and staff this is the largest event we work on all year. Along with the
NAEMSE Board, staff and its members, we hope you will be there to take part in it. Why? Because the
NAEMSE EMS Educators Symposium and Trade Show is a one stop shop for educators.
During the 5-day symposium you will be able to network with other EMS educators from around the
country, attend pre-cons and sessions allowing you the opportunity to learn new techniques, and shared
ideas in, EMS Education. You will be able to check out dozens of vendors and suppliers that will inform you
of new and exciting products and services to keep your program competitive in today’s market. In addition
you can look forward to having some fun and socialize at the welcome reception sponsored by NAEMSE,
iSimulate and the Public Safety Group.
This year’s symposium will again allow you to hear updates from NHTSA, NREMT and CoAEMSP. Make sure
you check out the Trading Post event, sponsored by FISDAP, where you will leave with new resources that
you can use in your classroom. The cost is only $35.00. Pizza and beverages will be provided for a one of a
kind networking event.
*For more Trading Post Information, please refer to the right column on page 17 titled “Special Events @ Symposium”
1) Location - Omni Fort Worth Hotel, 1300 Houston Street, Fort Worth, Texas.
2) Discounted rooms - NAEMSE has contracted with the Omni for a discounted room rate of $151.00 per
night plus tax.
3) Registration - NAEMSE has kept the 3-day main registration cost the same from last year - $495.00 for
non-member and $395.00 for member - this includes all meals served in the exhibit hall during
4) Pre-Cons - There are several excellent pre-cons this year being held including the NAEMSE Level 1 and
Level 2 courses. Visit the website for a listing of all the pre-cons available.
5) Travel - There are 2 airports that service Fort Worth area - Dallas Fort Worth Airport and Love Field.
NAEMSE has partnered with SWA for discounted airfare so check out the link at:
https://naemse.org/ page/FlightInfo to see if any flights would fit into your travel schedule.
I look forward to seeing you in Fort Worth, Texas. I will save a seat for you!
www.naemse.org | Educator Update | 3
WHY DO WE NEED EMS RESEARCH?
Why do we need EMS research?
EMS research is critical to validating new and existing evidence-based clinical interventions that are used in
the prehospital setting. Where does it start? In the classroom? How do you as an educator make that
happen? Register today for the NAEMSE Symposium pre-con “Get Your Classroom into Research” and find
This two-day pre-con will be offered at the annual NAEMSE EMS Educators Symposium and Trade Show
August 1st and 2nd in Fort Worth, Texas. This pre-con will be taught by David Page, Dr. Heather Davis, Dr.
Kim McKenna and Megan Cory.
It is our responsibility as educators to teach our students how to answer the questions they encounter in
their practice once they graduate from our programs. Participants in this workshop learn how to
incorporate research into all facets of the classroom and to create a lifetime foundation of acquiring
knowledge for critical thinking.
Visit www.naemse.org to see more about this year’s NAEMSE EMS Educators Symposium and Trade Show.
The National Association of EMS Educators
and the Boys and Girls Club of Tarrant County
Texas Team Up to Save a Life.
NAEMSE is proud to announce its first Community
Outreach Day on Friday, August 2nd at the
24th Annual NAEMSE EMS Educators Symposium
and Trade Show at the Omni Hotel in Fort
Worth, Texas. Joe Grafft, Bryan Ericson, Steven
Mountfort along with MedStar Mobile Healthcare
of Fort Worth will be training 40 teenagers
on the curriculum of “Until Help Arrives”.
Training Beyond the Classroom
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This program teaches various aspects of dealing
with an emergency: how to call 911, stay safe
and care for an injured person until help arrives,
stop the bleed and position an injured person
while providing comfort. They will also be
taught hands-on CPR and AED training.
NAEMSE is looking forward to this new event
and hopes to continue this local outreach at
future symposium locations.
A MATTER OF DEGREES: THE CASE FOR DEGREED PARAMEDICS
A Matter of Degrees: The Case
for Degreed Paramedics
By Leaugeay Barnes, MS, NRP, NCEE, FP-C
We have all seen the national discussions regarding
requiring an associate degree for future paramedics.
The National Association of EMS Managers, The National
Association of EMS Educators, and The International
Associate of Flight and Critical Care Paramedics
published a position paper advocating for degreed
paramedics which provided a catalyst for the national
discussion (Caffrey, Barnes, & Olvera, 2019).
In the last fifty years, EMS has evolved far beyond
the entity envisioned by the National Highway Traffic
Safety administration (NHTSA) under the Department
of Transportation (DOT) in the 1960’s. The name Emergency
Medical Technician clearly identifies the extent of
practice the DOT projected; leaving little doubt to the
amount of education initially suggested. Paramedics
today interpret complex medical information, practice
advanced life-saving invasive procedures, and administer
a variety of potentially fatal medications often
with limited diagnostic information in an unpredictable
setting (National Highway Traffic Safety Administration
One reason often cited for the lack of a required minimum
education standard for paramedics is the nascency
of the discipline however, EMS is in a position
to learn from other healthcare professions as we move
into a future which must be proficient in adapting to an
ever-changing healthcare landscape. EMS’s education
standards, with its multifaceted roles within the community
and significant impact on the public (Institute
of Medicine [IOM], 2007) should not be considered any
differently than other healthcare professions. In fact,
the autonomous nature of its clinical decision-making
(IOM, 2007) supports a higher level of rigor than many
other healthcare disciplines where help is a few steps
The most compelling argument for education is improving
patient outcomes. Ask any EMT or paramedic
their reason for entering EMS and the most frequent
response is likely, “to help people.” Despite a paucity
of EMS specific literature, nursing provides evidence
of a decrease in both mortality and morbidity (Blegen,
Goode, Park, Vaughn, & Spetz, 2013; Kutney-Lee,
Sloane, & Aiken, 2013). Unlike other occupations, EMS
is uniquely positioned within the community to identify
and address healthcare disparities. Education provides
EMS with the knowledge, skills, and abilities to change
the paradigm from reactive to proactive.
EMS has arrived at a juncture; professionalization,
which includes the ability to self-regulate and develop
evidence-based practices, require formal education
standards (Boyleston & Collins, 2012) as advocated for
by the newly formed American Paramedic Association
(APA). This should not be confused with personal professionalism
or the argument of whether an individual
degreed paramedic outperforms or underperforms as
compared to an individual certificate paramedic. EMS
has the opportunity to align itself with all other healthcare
professions enhancing respect. EMS specific research
is an expectation of increasing education within
Recruitment and retention are concerning in an already
strained system (IOM, 2007). EMS loses many of its best
and brightest to other healthcare professions when
they become frustrated and move to pursue greater
compensation and opportunity for advancement (Blau,
Chapman, Gibson, & Bentley, 2011; Blau & Chapman,
2016; Patterson, Probst, Leith, Corwin, & Powell, 2005).
Education can assist by creating opportunities and
increasing compensation (Lemieux, 2014). The need to
continually hire and train new employees adds further
to the cost of operations which may be upwards of
$10,000 each (Kirkwood, 2018). Interestingly, although
most EMS programs are seeing lower enrollment and
are actively recruiting, a majority of nursing and allied
healthcare programs all requiring significant pre-requisites
have waiting lists.
A quick search of the United States Department of Labor,
2018 website confirms the presumption that nursing
and allied health occupations requiring a degree
for entry-level providers are consistently compensated
at a higher rate than those who do not. Colleagues in
occupational therapy (OT) and physical therapy (PT)
require an associate degree for their assistant programs
and their compensation has significantly outpaced that
of paramedics as has that of radiology and respiratory
technicians. The causal effect between education and
increased earnings is well-established across time,
www.naemse.org | Educator Update | 5
A MATTER OF DEGREES: THE CASE FOR DEGREED PARAMEDICS
culture, and occupation (Lemieux, 2014).
Paramedicine education hours and content continue
to increase (National Highway Traffic Safety Administration
[NHTSA], 2000) with most programs meeting or
exceeding the contact hours required in an associate
degree RN program. We are unfairly withholding credit
from graduates of EMS programs that are anywhere
from 1200 – 2000 hours. Graduates who receive a
degree have several long-term advantages over those
who receive a certificate. A degree provides more
opportunities in various venues and higher compensation
(Lemieux, 2014). Personnel who become injured
or burned out have a degree to fall back on rather than
an expired state license and national certification. The
decision to ignore issues associated with compensation
and long work hours is a decision to continue the
decline in the percentage of the population interested
in becoming and staying involved in EMS as an occupation.
It is time EMS evolve from the shifting-the-burden
mentality (Senge, 1990) applying short-term fixes to
ameliorate symptoms rather than resolving the fundamental
problem (Jacobs, DiMattio, Bishop, & Fields,
1998). Currently, several national EMS documents and
philosophies are being reviewed and revised which
will guide EMS into the next decade. This offers a rare
opportunity to inspire transformational and visionary
change and take courageous steps towards confronting
the market failures EMS is experiencing (National EMS
Advisory Council [NEMSAC], 2012).
Blau, G., & Chapman, S. (2016). Why do emergency medical
services (EMS) professionals leave EMS? Prehospital and
Disaster, 31(Suppl.1), s105-s111. https://doi.org/doi:10.1017/
Blau, G., Chapman, S., Gibson, G., & Bentley, M. (2011). Exploring
the importance of different items as reasons for leaving
Emergency Medical Services between fully compensated,
partially compensated, and non-compensated/volunteer
samples. Journal of Allied Health, 40(3), 33-37.
Blegen, M. A., Goode, C. J., Park, S. H., Vaughn, T., & Spetz, J.
(2013). Baccalaureate education in nursing and patient outcomes.
The Journal of Nursing Administration, 43(2), 89-94.
Boyleston, E. S., & Collins, M. A. (2012). Advancing our profession:
Are higher educational standards the answer? The
Journal of Dental Hygiene, 86(3), 168-178.
Caffrey, S. M., Barnes, L. C., & Olvera, D. J. (2019). Joint position
statement on degree requirements for paramedics.
Prehospital Emergency Care, 23, 434-437. https://doi.org/10.
Institute of Medicine. (2007). Future of emergency care:
Emergency medical services at the crossroads. Retrieved
from The National Academies Press: https://www.nap.edu/
Jacobs, L. A., DiMattio, M. K., Bishop, T. L., & Fields, S. D.
(1998). The baccaluareate degree in nursing as an entry level
requirement for professional nursing practice. Journal of Professional
Nursing, 14(4), 225-233. http://dx.doi.org/10.1016/
Kirkwood, S. (2018, January 29). 3 ways EMS leaders make
or break paramedic training programs. EMS1. Retrieved
Kutney-Lee, A., Sloane, D. M., & Aiken, L. H. (2013). An increase
in the number of nurses with baccalaureate degrees is
linked to lower rates of postsurgery mortality. Health Affairs,
32(3), 579-586. http://dx.doi.org/10.1377/hlthaff.2012.0504
Lemieux, T. (2014). Occupations, fields of study and returns
to education. Canadian Journal of Economics, 47(4), 1047-
National EMS Advisory Council. (2012). EMS system performance-based
funding and reimbursement model [Final
Advisory]. Retrieved from https://www.ems.gov/nemsac/
National Highway Traffic Safety Administration. (2000). EMS
education agenda for the future: A systems approach. Washington
D.C.: Department of Transportation.
National Highway Traffic Safety Administration. (2007).
National EMS scope of practice model (DOT HS 810 657). Retrieved
Senge, P. M. (1990). The fifth discipline: The art & practice of
the learning organization. New York, NY: Doubleday Business.
6 | Educator Update | www.naemse.org
A MATTER OF DEGREES: THE CASE FOR DEGREED PARAMEDICS
Patterson, D. P., Probst, J. C., Leith, K. H., Corwin, S. J., & Powell,
P. M. (2005). Recruitment and retention of emergency
medical technicians: A qualitative study. Journal of Allied
Health, 34(3), 153-162. Retrieved from http://www.ingentaconnect.com/content/asahp/jah/2005/00000034/00000003/
United States Department of Labor. (2018). https://www.bls.
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www.naemse.org | Educator Update | 7
PhD, NRP, NCEE
Hometown - Speedway, IN
NAEMSE Board Treasurer
Current Employer - Hendricks Regional Health
Job Title - Lead Paramedic, Community Paramedicine Program
Job Scope - Lead clinician for the team. EMS Educator for the team. Assisting with program development
and community resource involvement.
Hardest Job Aspect - Not being able to help patients who need our help, but do not want our help.
Most Rewarding Job Aspect - Being able to assist patients with navigating the healthcare system and linking
them to resources to improve their quality of life.
Why did you join NAEMSE - Charter member. I feel that EMS Instructors need mentoring and networking
opportunities. Additionally, we should be our own advocates for job security and practice succession planning
for the future of EMS.
NAEMSE Activities/Participation - Regular presenter at symposium. Served on Education, Executive and
Communications Committees. Have assisted with the development of the NCEE examination (NEMSEC
Personal Hobbies - gardening & canning; rescuing special needs animals; running lights and sound for local
Who Would Play you in a movie - one of the munchkins in the Wizard of Oz.
What is your refrigerator never without? REAL butter & Coke Classic.
Thank You Lindi!
8 | Educator Update | www.naemse.org
You belong to a special group of
achievers. It’s a deeply rewarding
experience to be a part of something
so valuable, that continuously gives
back throughout your career and
beyond. You will also have the ability
to join a number of committees, each
with its own distinct identity and
purpose, to help guide EMS Education
toward a brighter future in the
Through the National Association
of EMS Educators’ expansive
community of members, you will
be consistently rewarded with
one-of-a-kind interactions courtesy
of our highly influential
Instructor Courses and Annual
Symposium & Trade Show. Coupled
with access to our expansive
Trading Post (a shared library
containing thousands of documents,
videos and presentations),
joining NAEMSE affords
you a vast web of professional
and personal connections.
A NAEMSE membership means
that you will be able to utilize the
many discounts that are available,
which include: SuperShuttle/ExecuCar,
and 50% off a subscription to
Prehospital Emergency Care
Journal; just to name a few. You
will also recieve special discounted
prices on all Instructor Courses,
significant fee reductions on
Symposium Registration, and
$95 / YR
$85.50 / YR
Credit Card Information
City, State, Zip
Phone Fax Email
Exp. Date /
View Membership Info at www.naemse.org/membership OR by emailing email@example.com
250 Mt. Lebanon Blvd. Ste. 209, Pittsburgh, PA 15234 / Phone: 412-343-4775 / Fax: 412-343-4770
The mission of The National Association of EMS Educators is to inspire educational excellence.
Omni Fort Worth
Special Rates Starting From $151 Per Night
As breathtaking as any West Texas sunset, the Omni Fort
Worth Hotel offers a taste of Texas hospitality. Conveniently
located in the heart of Fort Worth’s exciting downtown, the
hotel is adjacent to the Fort Worth Convention Center and
within walking distance from the city’s cultural centers,
restaurants and nightlife. SPECIAL RATES END JULY 9 th
From July 30 to August 6, 2019 all NAEMSE symposium
attendees will receive a special rate of $151 per night. To
reserve your room, please vist:
Omni Fort Worth
1300 Houston Street
Fort Worth, TX 76102
$151 per night from
July 30 to Aug 6, 2019.
To book your room,
please visit the link to
below Discount Rate
or visit the NAEMSE
Select Guest Rewards
As part of its commitment to providing memorable
experiences all over the world, Omni Hotels & Resorts is
proud to offer their Select Guest® loyalty program and the
DISCOVERY loyalty program. Membership is complimentary.
10 | Educator Update | www.naemse.org
THE HANDS ON APPROACH TO GLOVES-OFF PRECEPTING
The Hands on Approach to
By Alyssa A. Tarvin, NRP
EMS protocols. Observation will quickly progress to
assisting with basic skills and patient communication.
This will rapidly allow the preceptor to determine the
student’s comfort level in the back of an ambulance
and interacting with people.
Excellent. Not just good. Not just great but excellent.
Isn’t that the level of care everyone in our community
deserves? In many departments, everyone is a preceptor.
To think that we are sticking our paramedic students
with any paramedic assigned to the ambulance
for the day, doesn’t make much sense- especially if that
paramedic is not trained to teach or doesn’t want to
teach. I personally don’t believe this has anything to do
with the skills and level of care these paramedics provide;
some just don’t like teaching or are not comfortable
in that setting. Any paramedic can be an excellent
preceptor, but it takes willingness, time, and commitment
– and likely a step outside a comfort zone.
Many departments have also intern programs. My
employer, Burlington Fire Protection District pays up
to $5,000 a semester for the student’s education, and
the student is at the station for a minimum of 24 hours
a week. Most of our students are voluntarily on duty
every third day, going above and beyond their required
time commitment, to gain as much experience
as possible. The launch of our scholarship intern program
coincided nicely with my interest in teaching, as
our shift gained a few paramedic interns. Over several
years I honed this preceptor system, which is systematic
enough to produce consistent successful results, yet
flexible enough for every level student. This program
continues to be a work-in-progress, but I am confident
this system will continue to produce great leaders and
This system allows the preceptor to adapt to different
learning needs of the student, pushes the student to
the highest standard of learning and care, and creates a
method that adds consistency among preceptors.
The System: A Hands-On Approach to Gloves-Off
Day One is the first day the paramedic student and
preceptor are together. This usually works out to be one
full day, or a couple short days, depending on their ride
time schedule. “Day One” includes observation and an
overview of ground rules, departmental policies, and
My ground rules are fairly simple. But one thing I have
learned, is to not assume anything is common sense.
Everything should be explained in detail.
Ground Rule #1: I explain upfront that we see some
pretty crappy stuff in this job, and that the student has
the option to “tap out” if something is too traumatic,
too uncomfortable, too stinky, or too chaotic. We will
discuss and process when we get back to the station.
Ground Rule #2: The patient’s life comes first. I tell
the student that they may get “pushed into a corner”
if the run turns bad and the patient’s life is on the line.
I remind them not to take this personally, and that I’ll
review the circumstances when the run is completed.
Ground Rule # 3: We will respect our patients and their
families at all times, no matter what.
Ground Rule #4: Accept criticism. For this system to
work, the student must accept constructive criticism. I
explain that I am going to be picky. I am going to be annoying.
But I am going to make them excellent. Not just
good, not just great, but we are striving for excellence.
Ground Rule #5: My final, but very important ground
rule is: DO NOT EVER LIE ABOUT A BLOOD PRESSURE.
The reason this conversation is SO important to have
is not about the accuracy of the numbers, it is about
the sense of responsibility it should instill in our students.
The student should recognize that they could
potentially be holding the patient’s life (and my license)
in their hands. I explain that many times, we base our
medications and treatment modalities on vital signs
and I am relying on them to help me gather accurate
pieces to the puzzle to treat this patient appropriately.
This conversation lets my student know that I mean
business and that I am relying on them to be a strong
part of my team- even if their only job is recording a
www.naemse.org | Educator Update | 11
THE HANDS ON APPROACH TO GLOVES-OFF PRECEPTING
We spend the rest of Day One reviewing departmental
policies and guidelines such as uniform policy, expectations
around the station, truck checks, safety vest policy,
and review of the patient care reporting software.
I also discuss with the student the types of runs we
will go to, the types of patients we will encounter, and
how these runs can impact us mentally. During initial
orientation, I have often seen new students sent to the
ambulance to “learn where everything is.” While I understand
the paramedic has other duties to complete
before giving full attention to the student, it is generally
not an effective way of learning the rig and equipment.
I don’t care if my student remembers where the bedpan
and mass casualty bag are on their first day. Now the
emesis bag? Pediatric bag? Oxygen? These are essential
and I go over this personally with the student.
It is so important to establish the right tone for the relationship
with your student. It’s essential that they know
your expectations and that you are consistent with
them. You aren’t their drill instructor, but you also aren’t
their best buddy. Your sole purpose at this point in their
career is to make them an excellent paramedic.
PHASE ONE: SHOW ME YOU’RE A GOOD EMT
In this phase, the student begins performing as an EMT
and will eventually act as the primary EMT. I focus on
teaching assessment in detail, while they are perfecting
their EMT-B skills. The student eventually begins operating
as the primary EMT. Upon completion of Phase
One, the student will be aggressive with assessment,
regardless of run type. On any BLS patient, the student
will be comfortable as the primary care provider. On
critical runs, the student is reliable as an integral part of
the crew. We train our EMTs to spike IV bags, place ECG
electrodes (both 3 and 12 lead) and prepare drugs for
administration when assisting a paramedic. Our EMTs
complete this “ALS-assist” course annually as part of our
continuing education. I review this course with my student
so they know what’s expected of them, and what
they can expect from our other crew members.
Students must be successful at Phase One before moving
to Phase Two. There is no set timeline here because
our EMTs all start with a different foundation. This
system is performance-based, not time specific, so that
at the end of Phase One, each student is in the same
12 | Educator Update | www.naemse.org
PHASE TWO: ASSESS, ASSESS, ASSESS
Regardless of where the student is in paramedic class,
this is where I begin teaching Paramedic-level assessment.
Assessment is one of the most important and
challenging tasks to master in the field, so I focus on
teaching it very early. The newest beginner can learn
assessment techniques that will serve as a great foundation
for their paramedic-level care. I want my student
thinking like a Paramedic before they have the responsibility
of doing skills and managing the scene. Assessment
within this system is split into two levels to allow
for gradual learning. Level One teaches the student all
about focused assessment. I perform my patient assessment
as normal, including a physical assessment.
Once we formulate a primary impression, the student
performs the focused assessment. For example, if a
patient presents with chest pain, I will obtain a history
and determine that the patient is having chest pain
(obvious softball). My student will then ask the patient
to describe their pain, onset, and very importantly,
As the primary care provider, I proceed with my treatment,
explaining my treatment choices to the student
while we transport. I always introduce myself and my
student to the patient and let them know that I will be
teaching while we are taking care of him/her. I have
never once encountered a problem with this conversation.
Most patients actually chime in and ask questions
themselves. Although it really should go without
saying, the teaching comes after patient care. I can ‘do’
and ‘teach’ well, but if a run is more critical, then patient
care obviously supersedes, and we will discuss the run
later. In order for a preceptor to be successful, he/she
must be comfortable talking while doing. It may take
some practice, but it is a skill worth developing.
Level Two focuses on full assessment. As the student
advances in class, they usually start becoming more
involved in assessment in a very natural transition. You
may have to coach your student to start speaking up to
begin the initial assessment. For some reason, speaking
the first word upon encountering a patient and leading
the patient encounter can be very intimidating.
During this phase, the student begins writing the
THE HANDS ON APPROACH TO GLOVES-OFF PRECEPTING
narrative after every run. I will not write the narrative
portion for them. I will, however, provide suggestions
as they learn to write the narrative. I have thought
extensively about this- should I make the students
write these reports knowing they have to write a report
of the encounter for school as well? The answer is yes
because, although it can be a pain to write two narratives,
the student is far more prepared to start working
right away after graduation because they are so good
at documentation and understand what’s expected.
While they are learning how to write narratives, I will be
very picky about language and grammar choices, and
demand a detailed narrative. Essentially, I play the lawyer.
If a third party read this narrative, knowing nothing
about what happened, would they understand that
we treated the patient correctly? Would the narrative
paint an accurate and thorough picture of the patient
encounter? I try to prompt them by asking questions
regarding information they have omitted from their
narrative instead of just correcting it. I often give my
student suggestions and provide examples of how I
write my narratives, but ultimately, how they formulate
their narrative is their choice. During this phase, I continue
to write the rest of the patient care report, so the
student’s focus can remain on improving their assessment
Completion of Phase Two will not end with a perfect
assessment. It takes time to master that skill. This is why
I focus on assessment so early in the system. I believe
this method is so successful in large part because we
begin assessment well before traditional ride-time
would have started. Completion of this phase often
takes the student right up to the point of being “cleared
for skills” in their class. If, however, the student has
mastered assessment prior to being cleared to do skills,
I will eventually become his/her skills assistant. This will
give them a feel for being the lead provider while I perform
skills for them until they are cleared. I will begin
to focus on discussing treatment modalities and most
importantly, the why behind them.
PHASE THREE: SKILLS- PRACTICE MAKES PERFECT
During Phase Three, I allow the student to focus on
their skills. I show them a little grace and allow them to
back off of doing the full assessment. It can be pretty
difficult to juggle both right away, and I want them to
become proficient at their skills. They will begin performing
all ALS skills and will start utilizing our crew
EMT or me for BLS skills. The student learns how to
assertively but respectfully assign tasks to other crew
When we do our regular check-ins (to be reviewed
later), I always ask which skills the student has performed
least, or which ones they still need to perform
for class; e.g., intubation, IO access. I will do my very
best to assign them a skill they need when the opportunity
arises. This requires communication to the rest
of my crew en route to the scene and with the engine
crew when we are on scene. My students know that if I
assign them a skill, they must complete it. Patient care
always trumps any skills checklist.
We have a window behind the captain’s chair in our
ambulance which I utilize on the way to a call to have
a quick conversation with my student and my EMT.
On any critical call, we establish a quick game-plan
while en route. This gives the student the opportunity
to remind me that they need an intubation and gives
our crew a chance to prepare mentally for the call. We
also discuss who is bringing what equipment from the
ambulance. I give updates based on the notes from
dispatch. On any call, I will drill them on their differential
diagnosis based on the notes of the dispatch to
prep for assessment on scene. These interactions may
seem simple, and like common sense, but they make a
huge difference in your student’s comfort level once on
scene - especially on very critical calls. These continue
throughout the duration of the student’s program.
Regarding specific skills, I follow some guidelines, but it
is situation-dependent. Generally speaking, I allow the
student two IV attempts before I try to gain access myself.
When performing an ECG, the student places the
12-lead electrodes and I place the limb leads. I review
their 12-lead electrode placement every single time until
I trust that they have it mastered. I am very particular
about electrode placement, as you and your student
should be. If a patient is extremely critical and needs
something quicker than my student can perform, I will
step in and perform the skill (see ground rules). This is
a rare occurrence, and usually only happens with very
critical pediatric runs. Most students understand and
are almost thankful for the “step-in” in those instances.
During this phase, I don’t expect my student to be
www.naemse.org | Educator Update | 13
THE HANDS ON APPROACH TO GLOVES-OFF PRECEPTING
perfect at their skills. In fact, I don’t really even expect
them to be good. I work with them on every single skill,
until I believe they have gained enough proficiency
that they only need practice. A few of my students have
been extremely hard on themselves when they miss
an IV. If there’s something I’ve noticed that they can
improve on, or any tricks and tips I can offer, I will. But
oftentimes, this frustration comes when the student
has already been starting IVs for a while, and it’s just a
bad streak. I have had students get visibly and vocally
frustrated, use profanity in front of the patient or family
members, or be completely distracted for the rest of
the transport. I usually shoot them a “look” to let them
know that their behavior is unacceptable, and then we
discuss the incident after we transfer care. During this
conversation, I don’t yell at them or speak to them like
a child. I give them some advice on how to let it roll off
their back so they can focus on the rest of the transport.
I don’t badger them, and like any conversation we have,
after it’s over, it’s completely over- unless my student
wants to discuss it more. This issue alone is a big reason
for letting the student just focus on their skills for this
phase. Once the student shows proficiency in their ALS
skills, and the ability to control their emotions if they
don’t succeed at a skill, we begin Phase Four.
PHASE FOUR: INTEGRATION
This is by far the toughest phase for any student. Most
students find the transition to “doing and talking” at the
same time very difficult. This phase is led by your student’s
comfort level and simply guided by you. At the
beginning of this phase, you should take a look at how
much time your student has left in class before they
begin national testing and assess how much progress
needs to be made to meet that deadline. The majority
of my students arrive at this phase at around the halfway
point in class (around month 6).
Phase Four is when our students become paramedics.
The student combines what they learned in Phase Two
regarding assessments with their skills from Phase
Three. Because they are expected to do both at this
point, I will act as a second paramedic for ALS skills only
if necessary. Otherwise, I will act as a basic provider.
This is the first phase that you’ll really back off and start
handing the reins to your student- or at least let them
hold the reins too. But, I do not ‘throw my student to
the wolves’ during this phase.
14 | Educator Update | www.naemse.org
During the initial assessment and gathering a history at
the scene, I allow the student to do the majority of the
assessment. I will insert my own questions if I feel they
need to be asked. By continuing to engage, my student
can learn from those questions and assessment techniques,
which are often learned best by watching other
As we load the patient into the ambulance, I always
have a quick 10-second conversation with my student.
“What’s going on with this patient?” and “What
is your plan?” I offer my coaching at that time if they
need it, maybe a couple of quiz-style questions, and
then I proceed with their acceptable treatment plan.
I’m still reviewing, quizzing, and teaching during the
run when appropriate. I still obtain patient information,
document vitals and procedures as the student is
performing them. I encourage the student to formulate
and document their own primary impression, chief
complaint, and of course, the narrative. The patient care
report gradually becomes their responsibility, based on
how they are advancing. I will call report if the student
is tied up with the patient, because patient care is the
student priority. I try hard to make it possible for the
student to call report, when appropriate. Talking and
doing is a skill the student must be developing at this
point. As we approach the hospital, I ask the student
what they are going to say when transferring care to
the ER staff.
After transferring care, I always ask the student if they
have any questions, and my students should always
ask if there is anything they could do better. Have the
conversation about what to do better if you need to,
but do so in an atmosphere of constructive criticism
and encouragement. Always talk about the positives if
you have negatives to critique. This phase requires an
encouraging preceptor, but one who is not afraid to
perfect this student. Our goal is excellence. The only
way to obtain excellence is to constantly critique and
improve, but keep a balance with positive feedback.
Phase Four ends with a competent and mostly confident
student who comfortably initiates aggressive
assessment and treatment. This student does not miss
things on “cookie-cutter” runs. Your student accepts
criticism well and asks for ways to improve. A student
who is ready to move on from Phase Four connects
the why to the what; they understand the physiology
THE HANDS ON APPROACH TO HANDS-OFF PRECEPTING
behind our treatment. Your student will be motivated
to learn more and continue training. Your student will
think almost as fast as you on complex runs. The student
is able to write the majority of the patient care
report, but prioritizes it correctly. A student who has
successfully completed Phase Four manages time well
in the back of the ambulance, balancing on-scene treatment
and assessment with en route modalities. The
student is starting to grasp scene management- which
can be a very difficult development for those with little
experience as an EMT, but we will continue to master
this during the final phase.
YOU ARE THE PARAMEDIC- THE BIG PICTURE
Phase Five is the hardest phase for preceptors. This is
when we hang out in the background, and let the student
take the reins. You must be extremely particular
during the previous four phases- so you are comfortable
letting go when it’s time. During Phase Five, I make
a very conscious effort to not assist on assessment (unless
the student is missing something HUGE- i.e.: time
last seen normal for a stroke patient), and to allow the
student to process through their treatment plan without
coaching. Our job at this point should be perfecting
our student, chiseling a great product, and making sure
they don’t harm themselves or the patient.
The student will utilize the crew EMT as their EMT. I am
merely an observer, occasionally helping out logistically
when it makes sense. (e.g.: carrying equipment, placing
a blood pressure cuff, performing as directed by my
student if the patient’s condition deteriorates during
transport, providing advice on destination choices if
absolutely necessary, and being available for consult on
out of the ordinary runs).
During the beginning of phase five, I still wear gloves.
The student is writing the entire patient care report at
this point. The student is calling for additional resources
should they deem it necessary. They are choosing
the transport destination, and unless I find it wildly
inappropriate, that is their choice to make. This phase
goes very well for most students who have followed
this system and is extremely rewarding for you as the
preceptor to see your student develop into a paramedic
based on your precepting.
By the end Phase Five, I have removed my gloves and
I sit in the captain’s chair belted in. I am literally there
only to ensure that the student does not neglect care in
a way that would harm the patient or the patient outcome.
Despite the amount of experience and training
you have given your student, they are still going to run
into unfamiliar situations. You are there during Phase
Five if they need to “phone a friend.”
During Phase Five, I do not take over patient care reports.
I’m here for questions and am more than happy
to help, but it is their responsibility. I do not prompt
unless it is something that will directly impact patient
care or anyone’s safety on scene. I do not stop teaching
after the run and I do not stop quizzing the student. I
do not give report or add to the report unless student
has missed something that is detrimental to transfer of
Upon completion of Phase Five, you should have a
Paramedic on your hands. You should have a partner
that you feel comfortable working with. You should
trust your partner enough to say, “get access,” or “you
got the airway?” and know your patient is in the best
hands possible. It is our responsibility to our patients to
create outstanding, well-rounded, excellent care providers.
ADDITIONAL COMPONENTS OF THE SYSTEM
Equipment Checks: Each ambulance should be
checked daily- we know that. I encourage our preceptors
to use this time as a “drill and learn” scenario. You
should touch almost every piece of equipment and use
this as an opportunity to review with and teach your
student. At first this will be a conversation; then it will
become a quiz type interaction. Push your student to
memorize, learn more, and think outside the box. Work
through scenarios in which you would use the equipment
and allow the student to ask questions and formulate
their treatment plan. By Phase Five, you should
have created a student that you can trust to complete
this check the right way, every single time.
Check-ins: Check-ins are sit-down conversations with
your student. Go to the office or a small conference
room, where you can have a confidential, frank conversation.
By making these feel “official,” the student
will take them more seriously, and I think we get better
www.naemse.org | Educator Update | 15
THE HANDS ON APPROACH TO HANDS-OFF PRECEPTING
information to use to build or adjust our teaching style.
This private conversation reinforces to the student that
we are being critical to make them better, not to criticize
them in front of the crew. In the beginning, these
can be monthly. By the end of their program, you will
be meeting weekly.
During these meetings, I point out the things they are
doing well, and I address anything they need to improve.
These meetings are good for addressing things
that they are consistently doing incorrectly, or less than
par. If they are moving too slow in the system, we talk
about what we can each do to speed up their progress.
We discuss particular skills they need to complete
for class, runs they want to see, and runs they still feel
uncomfortable with. These are usually relatively relaxed
and positive sit-downs but don’t be afraid to be blunt
and upfront with your student and their progress.
Your responsibility as a preceptor: Homework is
your student’s responsibility. But I have found it very
beneficial for me as a preceptor to sit down with my
student occasionally and review some of their material
with them. Mostly because the information is
ever changing. Also, because it helps them to see that
excellence in this career means constantly learning and
seeking to improve yourself and the care you provide
for your community. Depending on the opportunity in
your area, another good idea is to attend some of their
classes. The instructors always appreciate the assistance
and it helps to go back to the skill sheets for some skills
that we don’t perform often, or even the ones we can
perform in our sleep.
My recommendations on ride time: Most of my students
have been scholarship interns at my department.
These students are assigned to my shift 24 hours a
week from the moment they start classes. They are typically
utilized in whatever capacity is needed that day
staffing wise, but we try to put them on the ambulance
more often if they are pursuing a Paramedic degree
or certification. I have had profound success with this
method as opposed to having students pop in and out
during their ride time as they hop from department to
department. My recommendation is to take the hundreds
of hours the students are required to ride (500 for
our local programs) and allow them to start chipping
away at them from the beginning of class. The skills requirements
would be the same, and they wouldn’t start
16 | Educator Update | www.naemse.org
until they have been properly trained on those skills.
They would, however, start learning assessment right
out the gate.
Finding a good preceptor at a department that has
any decent run volume is key. Our department makes
around 1,800 EMS runs a year, where neighboring
departments are making as low as 100 and as high
as 9,000. Students should have an allotment of hours
(maybe 50 or 75), which they use to ride in very busy
departments. The experience at these departments is
absolutely necessary, but should not consume their
ride time. This experience at very busy departments
helps their time management, as most busy departments
are inner city and close to the hospital. This
allows the student to really feel what busy feels like
and figure out how to manage that. Oftentimes, the
students go to busy departments and their preceptor
is different every time. It’s just whoever happens to be
on the ambulance that day. Having the same preceptor
who truly enjoys teaching Paramedic students at
a slower department is more beneficial in my opinion
than hopping around to 15 different busy departments.
Disclaimer: if there is an incredible preceptor
at a busy department, then proceed with the system. I
can acknowledge and appreciate the desire to learn a
little something different from a variety of preceptors,
and exposing students to busy departments is a great
way to get this exposure and experience. They can get
a feel for how other paramedics do things and take bits
and pieces from each, just as we all did. You will also
take vacation days and rotate off the ambulance every
once in a while, to meet staffing needs, so your student
will be exposed to other paramedic preceptors. But as
a general statement, having the same preceptor for at
least 70% of their schooling and starting a consistent
rotation on the ambulance as soon as possible has
proven most effective in my experience.
Why I precept: I look at precepting as an opportunity
to impact someone’s view on this career, as my preceptors
impacted mine. I can influence (somewhat) how
my student will treat the grandma that hasn’t bathed in
two weeks and calls at 3am because she is lonely. I can
hopefully influence how my student will process his or
her first pediatric cardiac arrest. I will impact the essential
information my student passes along to the hospital
when transferring care and I will make them a provider
that always thinks one step ahead. I will teach them
THE HANDS ON APPROACH TO HANDS-OFF PRECEPTING
tips and tricks and knee jerk reactions that have saved
my patients’ lives. I will help them avoid some of the
mistakes I have made and teach them to learn from the
ones they inevitably will also make. I am hopeful that by
precepting, I can create more paramedics that go the
extra mile and maintain their education and love for the
job. I am hopeful that I can create more paramedics that
want to teach their own students to do the same. At the
end of the day, I have saved lives based on researched
algorithms and protocols and because of what my preceptors,
educators, and instructors taught me; that one
tip, that one little trick, that one little red flag to always
watch for, and that ability to distinguish between sick
and not sick. My preceptors and educators have saved
the lives of my patients through my hands, and that is a
beautiful gift and opportunity we have in this career.
Paris PM, Roth RN: EMT-Paramedic: National Standard Curriculum.
Available at http://healthandwelfare.idaho.gov/
Gregg S. Margolis, Gabriel A. Romero, Antonio R. Fernandez
& Jonathan R. Studnek (2009) Strategies of High-Performing
Paramedic Educational Programs, Prehospital Emergency
Care, 13:4, 505-511, DOI: 10.1080/10903120902993396
SPECIAL EVENTS @ SYMPOSIUM
SATURDAY - AUGUST 3 rd
6:30PM - 8:00PM
Joshua G. Salzman, David I. Page, Koren Kaye & Nicole Stetham
(2007) Paramedic Student Adherence to the National
Standard Curriculum Recommendations, Prehospital Emergency
Care, 11:4, 448-452, DOI: 10.1080/10903120701536701
James E. Pointer (2001) Experience and Mentoring Requirements
for Competence in New/Inexperienced Paramedic,
Prehospital Emergency Care, 5:4, 379-383, DOI:
Josh Salzman, Justin Dillingham, Jenny Kobersteen, Koren
Kaye & David Page (2008) Effect of Paramedic Student
Internship on Performance on the National Registry Written
Exam, Prehospital Emergency Care,12:2, 212-216, DOI:
Peter O’Meara, Helen Hickson (2015) Paramedic instructor
perspectives on the quality of clinical and field placements
for university educated paramedicine students, Nurse Education
Today, Volume 35, Issue 11, 1080-1084, DOI: 10.1016/j.
Tilton, Brian James, “The selection and preparation of paramedic
preceptors in emergency medical services” (1999).
UNLV Retrospective Theses & Dissertations. 1084.
Sean Kennedy, Amanda Kenny, Peter O’Meara (2015) Student
paramedic experience of the transition into the workforce: A
scoping review, Nurse Education Today, Volume 35, Issues 10,
1037-1043, DOI: 10.2016j.nedt.2015.04.015
7:30PM - 11:00PM
David Page, MS, NRP, Director, Prehospital Care Research Forum at UCLA, St. Paul, MN
Co-Presenter: Heather Davis, EdD, NRP, UCLA Center for Prehospital Care, Hawthorne, CA
Witness the power of the NAEMSE Trading Post LIVE! Bring at least 3 of
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New instructors can join EVEN if you don’t bring anything. Pizza and
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www.naemse.org | Educator Update | 17
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Foundations of Education: An EMS Approach, Third Edition is
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18 | Educator Update | www.naemse.org
SAVE THE DATES!
August 3 - 8, 2020
& Trade Show
July 30 - August 8, 2021
& Trade Show
August 2 - 7, 2022
& Trade Show
28th EDUCATOR SYMPOSIUM
August 14 - 19, 2023
& Trade Show
www.naemse.org | Educator Update | 19
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