# Students, what should we do with them?



## lightsandsirens5 (Apr 10, 2011)

Ok people, after reading the recent posts in the 100% thread, I decided to start a new thread. If you are an FTO, like I am, you have probably wondered, also like I have, how far do we let our trainees and/or students go before they are informed that EMS isn't really for them. 

Is it the first "nasty" call they can't handle? The second? Third? I know when I started, I could not handle near what I do now, there were calls I could not do much except keep my lunch down. Now, I could eat while tech-ing the same call (figuratively of course). But no one ever told me to get lost even though I used to not be able to handle burned and chewed up people.

But when do we tell out students, "Ok, that is enough, this might not be for you." Is there a time period? A certain trigger? What are you opinions?


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## Sasha (Apr 11, 2011)

I hate trachs. They make me gag. I have never thought of refusing to sit in the patient compartment with a trach patient, even on ride times. If I had, I would have expected to recieve a failing mark.

I failed the student. She refused to sit in the back with a screaming, writhing dementia patient. It's part of the job. We can't refuse to do a call because of your personal feelings. There is still a job to be done and a patient to be taken care of. 

There are tons of calls I don't want to do for some reason or another, some smell, some are combative, some are just freaking annoying. It has never even occured for me even as a student to say "No, sorry, I'll sit up front."

If it's not for them, don't you want to know before you are too invested?


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## mycrofft (Apr 11, 2011)

*Ought to formulate an interview script.*

If someone refuses to attend a patient, or consistently fails to either follow protocols or at least fail to in a reasonable manner, I think a one on one session to find out what's up is in order. If it is a misunderstanding (paradigm problem) it can be addressed and the trainee told they are going to have to exhibit some improvement. If it is an attitude problem, or the trainee is too far behind the class but still "making it by faking it", then those need to be smoked out too.
I was "eased out" of training to drive and operate fire trucks and crash trucks by the asst chief telling me that therr was a rescue school opening and they felt I was perfect for it...which was the whole point of my joining and going for the fire department, so it was a win/win.


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## usafmedic45 (Apr 11, 2011)

> how far do we let our trainees and/or students go before they are informed that EMS isn't really for them.



I did it as soon as possible.  I used to actually keep the paperwork to remove someone from the EMS programs overseen by my medical director in several places (in the clipboard behind the blank run reports, in my desk and a couple copies at home).  Most EMTs are neither mature nor intelligent enough to bow out on their own, especially the younger generation who have had it drilled into their heads that if they try hard enough and just don't give up eventually they will achieve their goals.  Case in point: that one "Chiefwhatshischops" on here recently who had failed the Registry exams multiple times.   We were instructed to weed folks like that out before they ever got to the testing stage.



> Is it the first "nasty" call they can't handle? The second? Third?



I can't recall that ever being the reason for having someone removed from the program.   Normally it was attitude issues, behavioral issues, lack of maturity, failure to progress academically, the inability to perform the technical aspects of the job, etc.  

Then again, I'm the guy who threw up and passed out after his very first trauma case ever (as a civilian first aid trained bystander).  I still get a little queasy over the sight of my own blood.


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## Sasha (Apr 11, 2011)

To echo usaf. Sometimes by being "too hard" on someone we are doing them a favor. They don't know when to quit and guess what, sometimes you have to quit.


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## Aidey (Apr 11, 2011)

I deal with students by not having them, and really I view them the same way I view children. It can be fun to deal with them for a little while, but at the end of the day I'm giving them back.

I would be the type to warn someone up front that if I don't see them making progress that EMS might not be for them. I am up front about the fact I would make a poor FTO based on what my company wants an FTO to be. I'm way to demanding, exacting and impatient. 

For me, the deciding factors in determining if someone has what it takes are 1. Do they know what they don't know, and admit they don't know it? and 2. Do they know their strengths and weaknesses. If someone can't admit their short comings they will never be able to manage them or get pas them.


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## mycrofft (Apr 11, 2011)

*We spoonfed a guy through USAF fire school.*

When he was finally failed and they made him a cook instead (ironic, no?), he reported it was a big relief.


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## mycrofft (Apr 11, 2011)

*On the other hand...*

Before I even started classes but having been accepted on the basis of my transcripts to date, I was told by the Dean of Student Affairs I wouldn't pass nursing college. I dug in, borrowed money, got a job, and forced them to treat me as they did younger female students, and I passed with good grades.

The first day I was on my relief supervisor's shift at an ER, I was told by her when I was orienting  that I wasn't going to pass probation. I asked her why, and her reply was "Oh, you just aren't", and I didn't. If that happened now, I'd see her in court.

It can go either way. Have objective measures in place beforehand, then apply them and document. If you don't like orientees, get away from them.


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## YCALR (Apr 11, 2011)

Sasha said:


> To echo usaf. Sometimes by being "too hard" on [YOUTUBE][/YOUTUBE]someon[GVIDEO][/GVIDEO]e we are doing them a favor. They don't know when to quit and guess what, sometimes you have to quit.



And sometimes they adjust to similar situations merely thru field experience. Brand new EMTs don't know what it is 'really' like during a trauma call, and to assume that their first, second or even third trauma determines their career outcome is ridiculous. As i have stated before, people in general need time to grasp the concepts and skills required during any call, hence the TRAINING period. Training is the time to explain situations and try and teach the student how to better themselves. Simply giving them a failing mark defeats the whole purpose of the training. Perhaps there was a deeper reason for not being able to handle the situation, if that was the case, then an encouraging conversation would have sufficed.


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## bigbaldguy (Apr 11, 2011)

usafmedic45 said:


> I did it as soon as possible.  I used to actually keep the paperwork to remove someone from the EMS programs overseen by my medical director in several places (in the clipboard behind the blank run reports, in my desk and a couple copies at home).



ROFLOL why am I not surprised. You crack me up.

As a newbie to EMS I have to say I was absolutely useless on my first couple of runs. Granted I don't think I would have refused to ride in the back with a patient but I do remember a specific patient with severe dementia who spit and screamed and I honestly almost didn't go back, I thought about giving it up. I really really didn't want to continue my rides after that call. I thought to myself if this is what EMS is about then I can't handle it. But I did go back even though I wasn't really sure I wanted to and I think it was the right choice for me. I very nearly said screw it and I would have never finished my basic and that means I wouldn't have started volunteering and that would have been a shame because I think I'm pretty good at this now. Sometimes I think the folks that are most affected by what they see and feel are the people best cut out for this job and that's a shame because they are the ones least likely to last long doing it.


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## mycrofft (Apr 11, 2011)

*YCALR, yes, but...*

Sometimes first impressions are revealing, because they don't know how to fake it through.

There've been a couple times I have had an orientee who was shocked out of their game, and I used the opportunity to get inside their guard for a little while and give them the "411". One dropped the tough guy act and got on with orientation, the other felt I was unfair and eventually was fired after probation for insubordination because nothing was his fault.


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## mycrofft (Apr 11, 2011)

*BigBaldGuy (can we call you "Moose"?)*

The people most shaken up by it are not the best. It's the folks who act calmly then ask questions later who are the best. If you identify with the patient you can become worthless very quickly, and will burn out.


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## bigbaldguy (Apr 11, 2011)

mycrofft said:


> The people most shaken up by it are not the best. It's the folks who act calmly then ask questions later who are the best. If you identify with the patient you can become worthless very quickly, and will burn out.



Yes you may call me moose but you better smile when you say it


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## YCALR (Apr 11, 2011)

bigbaldguy said:


> ROFLOL why am I not surprised. You crack me up.
> 
> As a newbie to EMS I have to say I was absolutely useless on my first couple of runs. Granted I don't think I would have refused to ride in the back with a patient but I do remember a specific patient with severe dementia who spit and screamed and I honestly almost didn't go back, I thought about giving it up. I really really didn't want to continue my rides after that call. I thought to myself if this is what EMS is about then I can't handle it. But I did go back even though I wasn't really sure I wanted to and I think it was the right choice for me. I very nearly said screw it and I would have never finished my basic and that means I wouldn't have started volunteering and that would have been a shame because I think I'm pretty good at this now. Sometimes I think the folks that are most affected by what they see and feel are the people best cut out for this job and that's a shame because they are the ones least likely to last long doing it.



Exactly, you made that decison, you chose to go back. What if the decision wasnt yours, what if someone failed you for one of your first calls? Only you, yourself know whats best for you. If i quit everytime someone told me I couldn't succeed in something, then i would be no where in life. When I hear "you can't do this, its not for you", guess what, that just motivates me so much more. Now I am a 21 yr old, female working with AMR finishing up my Bachelors in both Biology and Psychology. Tell me again I 'can't' succeed!!!


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## mycrofft (Apr 11, 2011)

*"YCALR, you can't earn the Nobel Prize"*

(heh heh)h34r:

Point taken.


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## YCALR (Apr 11, 2011)

mycrofft said:


> Sometimes first impressions are revealing, because they don't know how to fake it through.
> 
> There've been a couple times I have had an orientee who was shocked out of their game, and I used the opportunity to get inside their guard for a little while and give them the "411". One dropped the tough guy act and got on with orientation, the other felt I was unfair and eventually was fired after probation for insubordination because nothing was his fault.



I agree, first impressions are revealing, however your first impression may not always be true to character. Some people should be failed, but without giving the fair opportunity to have an educational conversation regarding performance, then what is the point of training?? Some EMTs need guidance not just a door shut in their face.


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## YCALR (Apr 11, 2011)

mycrofft said:


> (heh heh)h34r:
> 
> Point taken.



WATCH ME!!!! lol


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## mycrofft (Apr 11, 2011)

*YCALR, see my earlier replies*

I was a victim of stereotyping before and I suggest a pre-planned interview to evaluate the issues .
As they say in the vernacular, "go girl, get somewhere". I guess


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## Sasha (Apr 11, 2011)

YCALR said:


> And sometimes they adjust to similar situations merely thru field experience. Brand new EMTs don't know what it is 'really' like during a trauma call, and to assume that their first, second or even third trauma determines their career outcome is ridiculous. As i have stated before, people in general need time to grasp the concepts and skills required during any call, hence the TRAINING period. Training is the time to explain situations and try and teach the student how to better themselves. Simply giving them a failing mark defeats the whole purpose of the training. Perhaps there was a deeper reason for not being able to handle the situation, if that was the case, then an encouraging conversation would have sufficed.



It was not a trauma call.

It was what is actually a very routine transport. Patients scream. They scream because they're pissed, they scream because they're scared, they scream because they're hurt and they scream because they don't know any better. We don't get the option of going "Hey nope, not feeling this patient today. I'm gonna sit up front so I don't have to listen to them."

We had already had one lady with CP who let out blood curdling screams in the middle of the hallway taking her out. It is something you get used too. If you are not going to even try to get used to it, then you've got to get out.

If she had tried to sit in back and half way through go "You know what, I can't take it." Maybe I would have been easier on her, because she at least made the attempt to get acclimiated to the job. But no. She went directly to the front.

And this is NOT her first clinical.


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## Sasha (Apr 11, 2011)

> a specific patient with severe dementia who spit and screamed



We had a psych with serious bipolar disorder and schizophrenia who was combative and a spitter. It was a great opprotunity to show her sometimes it's all how you approach the patient and every patient deserves your respect. Sitter tried to manhandle the patient onto the stretcher and got swung at, my partner and I were very nice and "Would you mind sitting here on the stretcher so we can get you out of here?"

And we had zero trouble with him the entire transport.


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## Veneficus (Apr 11, 2011)

*The immortal question*

How you handle students depends mostly on what you are trying to accomplish.

If you are trying to build great providers it takes time. In addition to the basic knowledge and capabilities, time must be spent discussing motivations, goals, and obstacles. Plans for overcoming shortcomings must be developed, not simply telling people they are not perfect and bouncing them out.

If you are trying to simply give somebody an evaluation as to whether they meet expectations, as Mycrofft said, objective expectations must be defined before hand. Otherwise a student or trainee has no idea what to expect or focus on from one day or preceptor to the next.

From my own perspective, I have seen people who I thought would never make it develop into outstanding providers. I have also seen people I thought would be outstanding providers bail out within weeks of starting work.

From the perspective of refusing calls or patients, I was trained in the era where it was absolutely unacceptable to refuse any call or patient for any reason. To ask for help or recognize it was somethig that would cause an individual stress, breakdown, or other was completely unheard of. You were either "man" enough, or you simply didn't belong.

It has taken sometime and effort to see past that mentality.

I have noticed that at all levels, working with people to become great is a lot more successful then simply telling them they are not.

Nobody starts out as the best. The lessons learned from failures are especially important. The idea that if you make a mistake even once you are gone has been tried by the US military. All that it has produced is incapable leaders whoo are trying to make it as far as possible before the law of averages catches up to them.

Just like not everyone is capable of standing in front of a class and teaching, not everyone is capable of being a clinical preceptor. The point of teaching is so that students learn, not to simply weed them out.

We didn't have FTOs until the later part of my EMS field experience. Many times a senior provider was "that guy who will show you the ropes." In my time as "that guy" if I failed everyone that didn't meet my standards, maybe 1 or 2 out of 100 would have made it. 

But with some time and temperment, I realized that just like everyone cannot be a champion sports athlete, not everyone can be a pulitzer prize winning author, not everyone can be the healthcare provider who is the best of the best. 

Without that rank and file, not only would the best people never stand out, but they would never get a day off either.

Not every student will one day be world class, probably 1:10,000 won't be. But patients who don't get a world class provider would get nothing if there wasn't a base level of less than perfect.


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## Sasha (Apr 11, 2011)

I teach. I show her and tell her things ive learned that she will never see mentioned in the ems books. Doesnt make up for the fact even with coaching she refused to sit in the pt compartment.


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## Ridryder911 (Apr 11, 2011)

I am the Clinical Operations Manager, in which education is one of my duties as well as over seeing the FTO's. We have several programs in place to try to deal with such difficulties as discussed. 

I believe that one way to prevent problems is to address the potential problems and try to have some guidelines such as assigned reviews and evaluations, addressing the problems (and good points) ensuring the employee/student fully understands their weakness, that proper documentation and identification of that problem exists and attempts to remodify per education, more clinical exposure, etc has been made to relive the problem. After such attempts have been exhausted; it should be clear to both parties that it is not in the best behalf for both of them and that they should be released. Emphasis may be made that EMS (depending on the situation) may not be the right career or this employeer is not right one. 

R/r911


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## steveshurtleff (Apr 11, 2011)

As a current student, I would say that it's probably better to fail during training than after.  My AMR clinical was just 3 days ago, and while I did choke on a simple patient SAMPLE interview, I felt like I did well during a car vs. motorcycle trauma.  I was on a dual-medic unit and, within reason in all cases, they stood back and let me go to work.

Anyway, if I am a bad fit, I'd much rather know sooner than later.


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## YCALR (Apr 11, 2011)

Sasha said:


> It was not a trauma call.
> 
> It was what is actually a very routine transport. Patients scream. They scream because they're pissed, they scream because they're scared, they scream because they're hurt and they scream because they don't know any better. We don't get the option of going "Hey nope, not feeling this patient today. I'm gonna sit up front so I don't have to listen to them."
> 
> ...



Oh, I was no longer referring to just your student. I was speaking in a general tone regarding this thread. I had read previously when you mentioned it was a dementia patient, I agree on that call. Dementia?? That should've been a 'no-breather'. But in regards to the thread, I don't think a student should be failed on their first 'nasty' call without some sort of guidance. But, I understand where you are coming from, there has not been one time that I have refused to take a call. I ak the front man(so to speak), always doing as much as possible.


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## usafmedic45 (Apr 11, 2011)

> And sometimes they adjust to similar situations merely thru field experience. Brand new EMTs don't know what it is 'really' like during a trauma call, and to assume that their first, second or even third trauma determines their career outcome is ridiculous. As i have stated before, people in general need time to grasp the concepts and skills required during any call, hence the TRAINING period. Training is the time to explain situations and try and teach the student how to better themselves.



But you miss the point that the issue is generally not a person not being able to handle a situation but simply not having the right character, intelligence or even common sense to function adequately.  Very few people wash out of EMS programs because they can't come to terms with bad trauma.  Most who flunk out tend to do so because of their intellectual shortcomings or because of some manner of gross (as in, overt) flaw in their personality.



> Perhaps there was a deeper reason for not being able to handle the situation, if that was the case, then an encouraging conversation would have sufficed.


....and in the comparatively few cases where people are washing out because of bad calls, that's a great strategy.  However, that is not the primary etiology of EMT class washouts. 



> Simply giving them a failing mark defeats the whole purpose of the training.



Actually, no, it does not.  The purpose of training is two-fold:
1. to give the skills necessary to do a job
2. to determine if that person has the criteria that we want in the field.  It's a weeding out process.  Ask a Navy SEAL or Army Ranger or PJ if flunking out students who don't measure up is defeating the purpose of training.  It's an extreme example but one that does apply to this discussion.  



> Some people should be failed, but without giving the fair opportunity to have an educational conversation regarding performance, then what is the point of training??



As I said above, primarily to serve as a "gate-keeper" for the profession.  



> Now I am a 21 yr old, female working with AMR finishing up my Bachelors in both Biology and Psychology. Tell me again I 'can't' succeed!!!



Obviously you haven't taken (or had a very crappy instructor for) statistics and/or psychological research methods.  Come back to this discussion when you can adequately discuss the problems with the above statement which are not limited to the following:
1.  Anecdotal evidence ("n=1")
2.  Egocentric bias ("self-serving bias")
3.  Fundamental attribution error
4.  Confirmation bias


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## Veneficus (Apr 11, 2011)

*answering out of order.*



usafmedic45 said:


> As I said above, primarily to serve as a "gate-keeper" for the profession.



I hate to be the one to point this out, but in the US EMS is not a profession. It meets none of the criteria.

Furthermore, when you look at most of the people who are self appointed "gate keepers" in US EMS, most of them are the skills focused, "we don't need this education, can you do the job, response times matter, we are not doctors," crowd.

Like attracts like. 

In many areas whether yo can be an EMS provider isn't determined by your knowledge, ability, or dedication. It is determined by whether or not you can pass a physical test that has no realism or applicabilty to EMS or Fire Operations.  




usafmedic45 said:


> It's a weeding out process.  Ask a Navy SEAL or Army Ranger or PJ if flunking out students who don't measure up is defeating the purpose of training.  It's an extreme example but one that does apply to this discussion.



I am not surprised to see this argument raised, I am surprised to see you are the one who raised it. 

I don't think this is an accurate comparison when talking about EMS. These types of myrmidons are already part of their respected branches. They are not entry level. 

To use the comparison in medicine, medical students already have a base of knowledge to be selected to proceed to higher levels of knowledge and capability.

EMS providers are an entry level position. Similar to basic infantry or unrated sailors. The only thing required of them is to be able bodied, follow orders, and use the equipment they are issued.

While some EMS providers excel passed that level, it is not a requirement. 

Lest we forget, a majority of agencies providing EMS see it as a merit badge or a collateral part of their real job. Just ask the people who represent the emergency services in the capital of the USA.

It is called "fire based EMS" not "EMS based fire."


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## usafmedic45 (Apr 11, 2011)

> I hate to be the one to point this out, but in the US EMS is not a profession. It meets none of the criteria.


Point taken.  I misspoke.  I meant "trade".  



> I don't think this is an accurate comparison when talking about EMS. These types of myrmidons are already part of their respected branches. They are not entry level.



I used them as an example simply because the handful of _real_ Rangers, Airborne, PJs and SEALs on this forum were a lot less likely to crow about being used as an example than say using Marine Corps boot camp as an example.


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## dixie_flatline (Apr 11, 2011)

Going through fire school, we had a teacher who was Mr Negativity.  "You're going to get eaten up by that nozzle reaction," "You'll never get up that ladder in time," "You don't have what it takes to fight fire" etc.  

By and large students training under him DIDN'T do well.  The same students responded (and performed) completely differently with a more supportive instructor.  I can't stand the types who make snap-judgments based on some anecdotal evidence about who will and will not 'make it'.

Yes, I absolutely think we should be more willing to 86 someone who we wouldn't trust with our own lives, but it is certainly a fine line.  Frankly, I'd be even more scared, I think, of a student who comes out swinging 100% on his/her first really bad call.  The first patient contact I ever had was a super minor MVA on the side of the interstate - and it was even a refusal - just get some vitals, a signature, and be on our way.  My hands shook like I was about to go into a diabetic coma (and I was a theater minor in college who doesn't usually mind talking to people).


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## BandageBrigade (Apr 11, 2011)

It seems to me that two different things are being discussed here. The first is based off of being an FTO for a new employee. The second is being a preceptor for a student. My question would be what are your companies guidelines or policies for who can precept or be an FTO? Experiance? Time in with the company? Education? Instructor or evaluator specific courses?


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## mycrofft (Apr 12, 2011)

*I'm told Am Red Cross trainer's porcedures will reflect a new direction..*

Instead of a slippery "test" with questions not addressed in the mandatory video, we will be using a checklistr to see of they know how to do CPR.



Downright f'in' revolutionary.

Next revision will reinstate the test, betcha.


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## usafmedic45 (Apr 12, 2011)

> By and large students training under him DIDN'T do well. The same students responded (and performed) completely differently with a more supportive instructor. I can't stand the types who make snap-judgments based on some anecdotal evidence about who will and will not 'make it'.



Have you ever thought that the reason for the difference in "performance" were lowered standards or more of a willingness on the part of the instructor to let marginal performance slide?  I am willing to bet there is more going on than a simple correlation like you are trying to paint it.


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## dixie_flatline (Apr 12, 2011)

usafmedic45 said:


> Have you ever thought that the reason for the difference in "performance" were lowered standards or more of a willingness on the part of the instructor to let marginal performance slide?  I am willing to bet there is more going on than a simple correlation like you are trying to paint it.



Did the first (bad) teacher have higher standards for performance?  Well, yes, perhaps.  But in this case, I think the difference was mainly a bad instructor (who is no longer permitted to teach anyway).  His approach was to throw them out there, let them make mistakes, and hope they learned from them without getting discouraged.  It works for some, I'm sure, but by and large the overall effect was negative.

Example - advancing a charged hose line (class's first experience opening a nozzle near working pressure).  He just had groups get on the line, and try to control it while walking and spraying.  Too many new skills, too little preparation.  Some people took big steps, some little, and few at the same time as their squad mates.  His sole idea of constructive criticism was "You need more upper body strength to handle that line", including the 245lb collegiate wrestler.  A different instructor spent time explaining what would happen as the line opened and moved, had groups practice advancing in unison, things like that.  Those groups didn't get knocked on their keisters or send water in all directions.  They put the wet stuff where it was supposed to go, and I'd call that a success.  

Did the other groups learn from their trial by fire under the other guy? Sure, but it didn't build any kind of positive student-teacher relationship, and it actively discouraged quite a few people who started to think they didn't have what it takes, when really they just needed more planning and practice.  I guess it sounds like I'm arguing for the carrot over the stick, but I don't think the second instructor really coddled the class.  The first one just preferred to set more up for failure.


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## Shishkabob (Apr 12, 2011)

It's one thing to be grossed out by a call.  I, as well as everyone I know, wont fault someone for getting physically sick at a call.


However, there's a difference between getting sick, and refusing to do patient care.  Refusing to do patient care is a no-no, student or licensed provider.


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## usafmedic45 (Apr 12, 2011)

> Did the first (bad) teacher...



Then the issue was that he was a lousy instructor, not that he was hard on the students.  Big difference.


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## Veneficus (Apr 12, 2011)

Linuss said:


> Refusing to do patient care is a no-no, student or licensed provider.



I wish it were that simple.

But there are several assumptions that must be met.

There must be a patient provider relationship, or at the very least a duty to act. 

A provider does not always have to provide care. A great example of this is abortion.

Personal safety, abusive patients, etc, may negate the requirement to provide care.

Now EMS doesn't always fit into these categories, IFT is more likely to, but I think EMS exercises the exceptions more than they realize.

Obviously lack of safety absolves from care.

BLS providers are more than used to turfing patients they are "uncomfortable" with.

I see and hear of male EMS providers quite regularly turf female patients they feel uncomfortable caring for. A provider who does have an established relationship to care for a patient is obligated only to see the patient receives equal and appropriate care. They do not have to be the one who provides it.

LIke I said earlier, I am old school, male, female, menance to society or upstanding civic leader, I make no exceptions and personally care for all. 

I don't think providers should refuse calls. But I also realize that my personal convictions on the matter are not the law.

In the original example that spawned this thread, the provider (student who has no obligation and moreover cannot have an obligation) felt uncomfortable providing care. A higher level provider (aka paramedic) was readily available and did provide care. At no point was care compromised.

Whether or not any of us find that unacceptable is moot. She was within her rights.


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## Shishkabob (Apr 12, 2011)

I had an EMT refuse to ride with a patient once during a hospital discharge because the patient had a history of seizures... though hadn't had a witnessed one in a long time, and was being controlled by meds, but he felt "uncomfortable" 



"Not feeling comfortable" is the biggest piece of crap excuse I hear all the time and it gets on my nerves.   Right, because I have a P in my name, I'm instantly comfortable with any and every call, my short experience be damned.   I truly don't give a darn WHAT someone is comfortable with, as that shouldn't factor in to the equation to the point of outright refusing to do something based off just that.   I'm not comfortable with MUCH of what I do on a daily basis, but I do it.  The only way to get comfortable is to do it and be exposed to it.




I had a patient much like Sasha's when I did transfers.  I hated the call.  It changed my view, to an extent, on abortion / euphanasia, yet I still worked the call.




You're looking at it legally.  I'm looking at it as I don't want you as my partner if you refused to do something because it's not comfortable.  Not dangerous, just uncomfortable.


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## katgrl2003 (Apr 12, 2011)

Linuss said:


> "Not feeling comfortable" is the biggest piece of crap excuse I hear all the time and it gets on my nerves.



I hate that excuse!  I had an basic partner pull it on me, and I'm the same level. :wacko:


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## Veneficus (Apr 12, 2011)

Linuss said:


> You're looking at it legally.  I'm looking at it as I don't want you as my partner if you refused to do something because it's not comfortable.  Not dangerous, just uncomfortable.



Linuss, not trying to single you out or direct these comments towards you, but you happen to give the most thought provoking replies.

If I may?

Sometimes discretion is the better part of valor.

In some cases not only is it acceptable to defer when you are not comfortable, but actually benefits the patient.

In surgery, only the most skilled surgeons attempt to reoperate on most cases, much less the more complex ones. 

That doesn't apply to EMS do you say?

Sure it does.

What if you were riding with another medic as your permanant partner? You come upon a patient who needs intubated. Your partner assesses the airway, determines it to be a difficult intubation, relates that he hasn't intubated in a while, that he does not think he can intubate this patient and asks you to.

He is defering to you because of his lack of comfort.

Would you not do the same if the situation was reversed?

How many male providers have turfed female patients with OB/GYN issues on their female partners? 

How many of those do you think were doing for their comfort as well as or more so than that of the patient? 

Is that wrong? (incidentally I think it is. A healthcare provider should be not just capable, but proficent, of taking care of all people.)

What if the motivation is fear of litigation? Is that any less of not being comfortable?


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## Shishkabob (Apr 12, 2011)

Veneficus said:


> A healthcare provider should be not just capable, but proficent, of taking care of all people.



And how do you become capable and/or proficient if you never step up to that which you are initially uncomfortable with?



I had a patient almost give birth in my ambulance a couple of shifts back.  We called for a second unit and we had the female EMT ride in with me.


Was I uncomfortable?  You betcha.  Did I leave the patients side or refuse to do the call?  Nope.


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## VFlutter (Apr 12, 2011)

On a side note. The variation in EMS education in my area is ridiculous. About a month after my class started i volunteered as a Pt for the skills test and I was shocked by the amount of people that failed the skills. And I am talking about failed horribly, missing critical criteria and using the equipment totally wrong. I had a person put the KED on backwards  

But having said that, I think students do need some time to adjust to the emotional side of the job, it does not happen over night. And as pointed out on this forum multiple times even veteran EMTs have a hard time handling some of what we will see on the job. However, I do understand we need to weed out people instead of letting them waste a good amount of time and money on a profession then may not be fit for. I have had no problem seeing trauma and very sick patients but seeing a 17 day old baby being brought in practically dead because her meth addict mother dropped her on her head, I was not ready for that on one of my first days in the ER and I am not sure how I would have reacted if I had to respond to that call on my first day.


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## mycrofft (Apr 12, 2011)

*Wow, good points and replies.*

Chase, sounds good, but I don't know how to ease anyone into it emotionally except by cherrypicking their calls for a while (good case for starting at an interfacility transfer operation) then having supportive co-workers or mentor.

Linus, I first encountered "_uncomfortable_" in nursing college as a wiggle-word to let you express anything from "EEEEEW! Gross!" to " There are some real professional issues with this". I dislike it because it gets used when ambiguity is not profitable. If something tells me I need not to be there but I can't put my finger on it, then I need to figure that out...while initially following my "spidey sense". It's saved me a couple times.

If your employer sees that you have some unalterable limitations to the types of patients you are willing to care for, it can affect your employment, and maybe your certificate/license if it can be alleged, from a pattern of refusal to care, that you undertreated or failed to treat ("non-feased"?) because you "decided" you didn't like a class or a particular patient. (And who knows, maybe the pattern shows something you don't notice about yourself on your own?).


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## CAOX3 (Apr 13, 2011)

"No such thing as bad student, only bad teacher." -Mr Miaygi


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## Sasha (Apr 13, 2011)

CAOX3 said:


> "No such thing as bad student, only bad teacher." -Mr Miaygi



Mr.Miaygi is full of himself.


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## CAOX3 (Apr 13, 2011)

Sasha said:


> Mr.Miaygi is full of himself.



Dont be a hater.


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## usafmedic45 (Apr 13, 2011)

CAOX3 said:


> "No such thing as bad student, only bad teacher." -Mr Miaygi



Mr. Miyagi never met some of the :censored::censored::censored::censored:ing retards EMS instructors deal with.  Not to mention he had the luxury of punching his students in the face.


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## ffemt8978 (Apr 13, 2011)

usafmedic45 said:


> Not to mention he had the luxury of punching his students in the face.



Jealous of that?


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## usafmedic45 (Apr 13, 2011)

ffemt8978 said:


> Jealous of that?



Not going to lie, so yes.  At times I am jealous of that.


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## Aidey (Apr 13, 2011)

I literally lol'd at that. I can't say I've ever wanted to punch a student, but I haven't had many. I'm more apt to threaten to beat them with the appropriate text books.


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## CAOX3 (Apr 13, 2011)

usafmedic45 said:


> Mr. Miyagi never met some of the :censored::censored::censored::censored:ing retards EMS instructors deal with.  Not to mention he had the luxury of punching his students in the face.



Well in my experience, the students are far from the problem.  EMS instructors for the most part leave much to be desired.

That being said there is always exceptions to the rule.  Substandard instructors usually develop substandard providers.


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## usafmedic45 (Apr 13, 2011)

> That being said there is always exceptions to the rule. Substandard instructors usually develop substandard providers.



Given that I won awards for my teaching ability both from students and my peers and superiors, I don't think that was the issue in my case.  It's all too easy to blame the instructors and that has been the popular tactic over the past few years as the educational system has become more about not "leaving anyone behind" and less about turning out a quality productive member of society.


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## WolfmanHarris (Apr 14, 2011)

usafmedic45 said:


> Given that I won awards for my teaching ability both from students and my peers and superiors, I don't think that was the issue in my case.  It's all too easy to blame the instructors and that has been the popular tactic over the past few years as the educational system has become more about not "leaving anyone behind" and less about turning out a quality productive member of society.



I wish there was a "like" button some times on this forum. I meant to just read a bit before bed and now I've been sucked into posting. 

For a laugh try to track down "Penn and Teller's B-S-" on self-esteem.

I also enjoyed this article so much I bookmarked it in my "education" folder.
http://nymag.com/news/features/27840/

Good night.


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## Veneficus (Apr 14, 2011)

usafmedic45 said:


> Given that I won awards for my teaching ability both from students and my peers and superiors, I don't think that was the issue in my case.  It's all too easy to blame the instructors and that has been the popular tactic over the past few years as the educational system has become more about not "leaving anyone behind" and less about turning out a quality productive member of society.



I agree with what you are saying, but I also think that the majority of EMS instructors are the problem. 

Not the handful of good ones.


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## usafmedic45 (Apr 14, 2011)

> I agree with what you are saying, but I also think that the majority of EMS instructors are the problem.



I agree with you on that.  I just wanted to rebutt what I took to be a slight accusation that the reason why I have on a couple of occasions felt the desire to punch a student was due to my own shortcomings and not because they were subpar and being beligerent.


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## Sasha (Apr 14, 2011)

Eat them.


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## usafmedic45 (Apr 14, 2011)

Sasha said:


> Eat them.


That's a little harsh, don't you think?


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## JPINFV (Apr 14, 2011)

Sasha said:


> Eat them.


Sounds like a rather modest proposal...


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## Veneficus (Apr 14, 2011)

Sasha said:


> Eat them.



I thought we already did?:blush:

oops..


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## CAOX3 (Apr 14, 2011)

usafmedic45 said:


> I agree with you on that.  I just wanted to rebutt what I took to be a slight accusation that the reason why I have on a couple of occasions felt the desire to punch a student was due to my own shortcomings and not because they were subpar and being beligerent.



The comment wasn't directed towards you, it was a general statement about EMS educators as a whole. Their awful for the most part, exceptions do exist like yourself but are far from the norm.

The majority of EMS classes taught by EMS providers lack credibility and are often based on opinion and experience rather then science and evidence and at times laughable at best. 

This isn't  knock on all EMS instructors, good ones do exist but its like trying to find a needle in a haystack.  

I often walk in a class and within two minutes you know if its even worth staying. I have walked out of many in the middle because I couldn't stomach the nonsensical information and war stories that permeates most of these classes.  

I'm part of the problem, I often don't say anything I just get up and walk out. My time is too precious to get in a pissing match with some mental midget about the usefulness of HEMS activation on mechanism alone.  I have a wife a daughter and a double digit handicap that I rather spend my time with.


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## Veneficus (Apr 14, 2011)

CAOX3 said:


> I'm part of the problem, I often don't say anything I just get up and walk out. My time is too precious to get in a pissing match with some mental midget about the usefulness of HEMS activation on mechanism alone.  I have a wife a daughter and a double digit handicap that I rather spend my time with.



Then you are spending yor time wisely.

It does no good to argue with them. They are often not smart enough to even realize you are right.


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## usafmedic45 (Apr 14, 2011)

Veneficus said:


> Then you are spending yor time wisely.
> 
> It does no good to argue with them. They are often not smart enough to even realize you are right.



Is it bad that I continue to do so simply because it gives me a smug sense of  professional and intellectual superiority?


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## Veneficus (Apr 14, 2011)

usafmedic45 said:


> Is it bad that I continue to do so simply because it gives me a smug sense of  professional and intellectual superiority?



Not at all, I was going to try and enroll in a EMT-B course last summer. Perhaps I will try again next year.


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## DitchDoctorGabe (Apr 14, 2011)

I think everyone has made some pretty valid points; this field isn't for everyone and some quickly learn that. Looking from the student aspect I think that part of it falls on whatever training institution they went through. Are they an "EMT" mill and look and quantity and not quality? Is there any sort of pre-screening that can be done? Granted that won't weed out those who aren't cut out for it but it's a start. The other part is that if a student isn't cutting it and a preceptor isn't giving feedback then that person slips through the cracks. There needs to be good communication between everyone involved and sometimes it isn't until they get further along in their education that someone figures out it's not for the student.
  From the new hire standpoint, I think ASAP is the best time to let them know. count your loses and move on from there. Granted each person is different but after a few runs you figure out if they are meant to do this job. Good post you started, sorry didn't mean to be so long winded.


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## Luno (Apr 15, 2011)

*Wow, another EMS gone wrong thread... *

Well, I guess to answer the OP question, having worked as an FTO, there's only one thing that I will make me throw the towel in.  When the rookie, newbie, probie, etc... doesn't care anymore.  I can spend a ridiculous amount of time trying to get them up to speed on very simple things, but when they don't want to learn or the first time that they say :censored::censored::censored::censored: it, I wash my hands of them, and turn in appropriate paperwork.  I've worked with providers that were dumb as rocks (I know, it's a slight against rocks...), but they never gave up, we worked on simple things that they should have mastered in EMT class, they did homework, they practiced their little hearts out, and eventually they got it and became good providers.  My philosophy is that I can help guide them through a lot of things, but I can't teach them to want to do this.  EMS isn't rocket surgery, it's really just trained monkey work (as it stands now) anyone can do it, if they really want to.  This isn't saying that everyone should, but it's not that hard, and if they really want to learn, and they will make the sacrifices to do it, then the least I can do as a trainer is to help them succeed.  But I will also say that it's just for basic EMS, other specialized evironments do require personalities and/or abilities that you might have to work on just a little bit more...


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## mycrofft (May 12, 2011)

*Wake up, thread!*

After reading a few "studies" and "news" rumors getting dumped into the forum then debated fiercely, let me say that the answer to the OP question may be that "we" need to stop accepting just anyone into EMS training beyond basic first aid, medical first responder, or EMT-B.

(As for who "We" is, as of now, there is no "We" except maybe as a contentious and disorganized class of people).

How can we ever progress past "cookbook" protocols if the people entering the training for basic and advanced EMS are naive and undereducated enough in how to be informed consumers of the news and it's so-called "statistics" that, on the one hand,  they will accept whatever they are told by the mediae and run with it, but on the other hand cannot recognize or believe real data as facts and then take them into consideration?

I think the more important question isn't when to bounce orientees, it's how to *screen* them first before you go on to having to judge/guide/teach unproductive rookies who should never have gotten to their probationary period anyways.

Sample job app questions:
1. Space aliens build the Interstate Highway system.
2. Long spineboards are a definitive treatment for any fall from any height.
3. A study is scientific if it is published in any part of JEMS magazine, regardless of the size of the sample or who conducted it.

In fact, all medical directors and supervisors should be required to take this sort of test retroactively, wearing a polygraph because we all learn to mimic and lie to keep our cushy jobs.


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