Educator Update - Summer 2019

naemse

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

3rd Edition

AND MUCH MORE!

EU

Update

SUMMER ‘19


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IN THIS ISSUE

National Association of EMS Educators

SUMMER 2019

250 Mount Lebanon Boulevard

Suite 209

Pittsburgh, PA 15234

Phone : 412-343-4775

Fax : 412-343-4770

www.naemse.org

What’s Inside

Page 2 New Executive Director!

Page 3 Symposium Letter

Page 4 Why Do We Need EMS Research?

Page 5

A Matter of Degrees: The Case for Degreed

Paramedics - Leaugeay Barnes

Page 8 Treasurer Spotlight

Page 9 NAEMSE Member Benefits

Page 10 Hotel Information

Page 11

Page 18

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

President

Linda Abrahamson, MA, ECRN, EMT-P, NCEE

Vice President

Dr. Lindi Holt, PhD, NRP, NCEE

Treasurer

Dr. Nerina Stepanovsky, PhD, MSN, CTRN, PM

Secretary

Rebecca Valentine, BS, NRP, NCEE, I/C

Leaugeay Barnes, MS, NRP, NCEE, FP-C

HOTEL

Dan Carlascio, NREMT-P, I/C

RATE

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

(P): 817-535-6664

Sahaj Khalsa, BS, NRP, NM, I/C

below Discount Rate

Dr. William Robertson, or PhD, visit DHSc, the NRP NAEMSE

website.

National Office Staff

Stephen Perdziola, BS

Executive Director

Erin Mihalsky, AS

Membership Coordinator

Laurie Davin, AS

Education Manager

Inspiring

Educational

Excellence

Jared Kallmann, BA

Education Coordinator

Amy Brooks, BA

Office Coordinator

Reprinting Information

Interested in reprinting one of the articles you

find in this publication?

If so, please contact Stephen Perdziola via

e-mail at stephen.perdziola@naemse.org 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,

2019.

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”

Symposium overview:

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

symposium.

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

out!

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”.

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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.

4


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

[NHTSA], 2007).

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

away.

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

the discipline.

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).

References

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/

S1049023X16001114

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.

http://dx.doi.org/10.1097/NNA.0b013e31827f2028

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.

1080/10903127.2018.1519006

Institute of Medicine. (2007). Future of emergency care:

Emergency medical services at the crossroads. Retrieved

from The National Academies Press: https://www.nap.edu/

download/11629

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/

S8755-7223(98)80063-X

Kirkwood, S. (2018, January 29). 3 ways EMS leaders make

or break paramedic training programs. EMS1. Retrieved

from https://www.ems1.com/paramedic-chief/articles/374184048-3-ways-EMS-leaders-make-or-break-paramedic-training-programs/

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-

1077.

National EMS Advisory Council. (2012). EMS system performance-based

funding and reimbursement model [Final

Advisory]. Retrieved from https://www.ems.gov/nemsac/

FinanceCommitteeAdvisoryPerformance-BasedReimbursement-May2012.pdf

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

from https://www.ems.gov/education/EMSScope.pdf

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/

art00006

United States Department of Labor. (2018). https://www.bls.

gov/

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www.naemse.org | Educator Update | 7


TREASURER SPOTLIGHT

Lindi Holt

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

Board member).

Personal Hobbies - gardening & canning; rescuing special needs animals; running lights and sound for local

rock bands.

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


WHY YOU

SHOULD JOIN

You

Belong

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

prehospital environment.

Valuable

Networking

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.

Special

Discounts

A NAEMSE membership means

that you will be able to utilize the

many discounts that are available,

which include: SuperShuttle/ExecuCar,

Hertz Rent-A-Car,

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

much more!

Full Name

Annual

$95 / YR

Institutional

Starting at

$85.50 / YR

Credit Card Information

Card Type:

Discover

Visa

MasterCard

American Express

Address

City, State, Zip

Phone Fax Email

Card Number

Signature

Exp. Date /

CVV

View Membership Info at www.naemse.org/membership OR by emailing membership@naemse.org

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.

9


HOTEL INFORMATION

Hotel

Information

Omni Fort Worth

Special Rates Starting From $151 Per Night

As breathtaking as any West Texas sunset, the Omni Fort

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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

Discount Rate

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:

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Phone: 817-535-6664

RATE

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July 30 to Aug 6, 2019.

To book your room,

please visit the link to

below Discount Rate

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Select Guest Rewards

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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

Gloves-Off Precepting

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

care providers.

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

Precepting

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

blood pressure.

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

position.

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,

pertinent negatives.

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

skills.

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

members.

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

providers.

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.

PHASE FIVE:

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

care.

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.

References

Paris PM, Roth RN: EMT-Paramedic: National Standard Curriculum.

Available at http://healthandwelfare.idaho.gov/

portals/0/Medical/MoreInformation/Paramedic%201998%20

National%20Standard%20Curriculum.pdf

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

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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:

10.1080/10903120190939544

Josh Salzman, Justin Dillingham, Jenny Kobersteen, Koren

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Tilton, Brian James, “The selection and preparation of paramedic

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UNLV Retrospective Theses & Dissertations. 1084.

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Sean Kennedy, Amanda Kenny, Peter O’Meara (2015) Student

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