Short FTO Period

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Handsome Robb

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A recent thread brought something up that was pretty shocking to me. I've heard of agencies doing it but I guess I thought it was isolated. I was going to ask in the other thread but decided not to gum it up.

How long is your agency's FTO period? Did you feel it was long enough? Too long? Did you feel like it adequately prepared you for working in that system?

I always hear people make the argument that a lot of EMS education is learned on the job... Ok so we refuse to add class time because we should be learning on the job but then we run ridiculously short FTO periods? How does that work? How do you do all this on the job learning when you're only with a FTO for a few shifts then set free on the world, often times with a young, inexperienced partner... To me that's not on the job learning that's trial by fire...sink or swim...

What are your thoughts on this?
 
We have a benchmark based FTO process. In short, it's broken into three parts. Observation, where candidates watch how the system works while observing the treatment and thought process of the paramedics. Mentoring, where the candidate works with a partner. The FTO provides teaching points and prompts to guide candidates through the calls. Following these first two steps, candidates move into the final evaluation phase, where they are graded pass/fail on calls and expected to fully function as a paramedic. This is the point of no return and where we see candidates wash out. There are very specific guidelines and benchmarks for each segment of this process. Following completion of the FTO process, a paramedic candidate is "released to DORs". The DOR phase is daily observational reports. This is where the new paramedic learns all of the operational aspects of the job (station duties and responsibilities and the like) and learns how to function as a single paramedic, split from his partner. The entire new hire process, from start to finish, can be anywhere from six weeks to a year.



New medics are watching pretty closely after being released, and may be remediated or replaced with an FTO to polish up rough spots.
 
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We have no FTO period. I think it is the stupidest thing the company has done. We get brand new medics and basics that never worked a day in their life. Show them how to use a vent and throw them on a truck with another medic sometimes new as well, and expect them to thrive.
 
I've worked in a couple of places like that. Fill out the paperwork, get asked what size uniform shirt I wear and then they throw me the keys. No lie, I applied for a job at 10 o'clock in the morning, By 1 o'clock in the afternoon I was running interfacility.
 
The places I worked had no real set time that you spent with an FTO. You rode as a third until your FTO signed you off. One place I was at cut me loose after three shifts, another cut me loose after 2.
 
5-6 week academy followed by about 30-50 24hour shifts on average with an FTO. Sometimes longer depending on the new hire. The "Clearing" process is broken down into 5 tiers. There is set criteria to advance from 1 tier to the next. Once at Tier 5 you are about ready to go off on your own, and are waiting for the Medical Director to come ride along and give you his blessing.
 
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DEmedic said:
I've worked in a couple of places like that. Fill out the paperwork, get asked what size uniform shirt I wear and then they throw me the keys. No lie, I applied for a job at 10 o'clock in the morning, By 1 o'clock in the afternoon I was running interfacility.
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Ahh trimed...
 
I get cutting it short for experienced medics or EMTs who are coming from another system where all they really have to learn is operations stuff but even then 2-3 shifts isn't enough to do that....

At what point could you start the willful negligence argument at these companies.

Ours is 3 weeks +2 if you need it for EMT-I and 6 wks +3 for Paramedic and that still didn't feel long enough.
 
Robb said:
I get cutting it short for experienced medics or EMTs who are coming from another system where all they really have to learn is operations stuff but even then 2-3 shifts isn't enough to do that....

At what point could you start the willful negligence argument at these companies.

Ours is 3 weeks +2 if you need it for EMT-I and 6 wks +3 for Paramedic and that still didn't feel long enough.
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I would say experienced medics usually clear "earlier" but we do not cut it short for anyone. Experience is a very good thing to have and usually it helps you along through your FTO process. But we also find that a lot of experienced Medics benefit from some re-education, unlearning of bad habits, and we must be sure that you will not resort back to protocols or operations of your old system. We want consistency and excellent medicine to be practiced, so we must see this before you are cleared.
 
For us it's 6 weeks of academy followed by an FTO period that is generally 3-4 weeks. If a new-hire is really sharp, experienced and moves fast through FTO they can make it out in 2 and a half weeks, but that's not typical. Someone brand-new to the industry, being their first EMS job take longer, for obvious reasons.. my FTO lasted the full 4 weeks. (Brand new, new to EMS, unfamiliar with city...etc. Just needed a bit more time than my classmates who knew the city, and had worked in EMS for years.)

I was very grateful for the long FTO duration. The first few days of FTO I felt like I was so behind the curve, not at all prepared to be a fully functioning member of the 'crew'. By my last day, I truly felt READY to be signed off. It's worth the extra FTO time to put out new-hires who are really prepared. Not trying to say I "know everything", of course not. No one ever will. But as far as feeling like I'm competent enough to be a functioning member of the crew, yes. I've been off FTO since 1 January, and while I still feel "new", I at least have the basics down.
 
AtlasFlyer said:
For us it's 6 weeks of academy followed by an FTO period that is generally 3-4 weeks. If a new-hire is really sharp, experienced and moves fast through FTO they can make it out in 2 and a half weeks, but that's not typical. Someone brand-new to the industry, being their first EMS job take longer, for obvious reasons.. my FTO lasted the full 4 weeks. (Brand new, new to EMS, unfamiliar with city...etc. Just needed a bit more time than my classmates who knew the city, and had worked in EMS for years.)

I was very grateful for the long FTO duration. The first few days of FTO I felt like I was so behind the curve, not at all prepared to be a fully functioning member of the 'crew'. By my last day, I truly felt READY to be signed off. It's worth the extra FTO time to put out new-hires who are really prepared. Not trying to say I "know everything", of course not. No one ever will. But as far as feeling like I'm competent enough to be a functioning member of the crew, yes. I've been off FTO since 1 January, and while I still feel "new", I at least have the basics down.
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What all is included in your academy? I guess I don't understand what these multi-week academies include for single roll EMS agencies.
 
Three days spent at the Level 1 Trauma Center that runs the rig service. Two days of orientation at the garage. Then twelve 12-hour shifts with a FTO..

Adequately prepared? Ugh, I've only met one man in my EMS life who I think is prepared for everything.
 
Robb said:
What all is included in your academy? I guess I don't understand what these multi-week academies include for single roll EMS agencies.
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Company policies and procedures, like using the toughbook's computer software. Learning the protocols. Learning the city's coordinate system. Review of all BLS skills. CPR certification (to get everyone on the same renewal cycle). Some fit responder training. Lots of scenarios...

It's a very comprehensive overview. For someone with a medic cert (we hire medics, but they start out working as EMTs until they promote to Medic, usually 6-ish months) it's a very basic review. For someone like me (brand new to EMS) it was a much NEEDED review and really defined company-specific policies and procedures. Some would say it might be overkill, but I think it's good preparation for going out into a busy, urban, 911 system.
 
our FTO periods are waaay to short. The biggest problem is we only have enough money budgeted for 3 to 4 days. Well, that and there is no consistancey among the FTOs as to the "proper way to do things"....

I would like to see 6 shifts with various tours (days, nights, & weekends) where you are working as a 3rd (with various approved FTO). than 6 weeks / 18 shifts with a steady FTO as a second, who would evaluate you based on what you know, and provide feedback to the newbie as to what they are missing. This would be for for ALs and bls people, and they couldn't pick up OT on other shifts until this period is over. Then 1-3 months for BLS and 3-6 months for ALS with a different FTO who evaluates them, and they can only pick up OT with another FTO. After they pass, they are free to work whenever they want with whomever they want.

it would allow for the newbie to be properly acclimated to how the EMS system operates, as well as the ins and outs of that particular primary and secondary response area, and would allow management to ensure that the person knows what they are doing before being cleared to work with anyone.

BTW, as a former FTO, there was nothing more frustrating than trying to train someone properly, only to have my per diem partner (who has been there for over a year) say that I was wrong, in front of the newbie, and he was never taught that way. And once I pulled out the written policy that describes in details how to do this (in this case, how to use EMS charts), only to be told "well, i have never seen this before...."

There is the right way, and the wrong way, and the way our bosses want stuff done. How do you think FTOing should be done?
 
Nursing is notoriously bad too.

I love when they drop a six inch thick binder next to you on a table and say "Here, read this then sign the paper". And that is how you learn the protocols.
 
I've come to think that regardless of how long you formally ride in training, the real key is partnering you with someone highly experienced and willing to teach (preferably, hey, an FTO). You can only learn so much over any training period; you learn the job over your first year or so.
 
Our service has a short FTO period. We don't hire new EMTs, it's a BLS service, there isn't much to know about the job besides some minor local protocol and policy and the NJ protocols. Most of the learning is familiarization with the geography and dispatch. There's no need for a lengthy FTO. some nearby agencies don't clear you to drive for a year, which is ridiculous
 
Brandon O said:
I've come to think that regardless of how long you formally ride in training, the real key is partnering you with someone highly experienced and willing to teach (preferably, hey, an FTO). You can only learn so much over any training period; you learn the job over your first year or so.
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While I agree with this it doesn't happen.

We routinely have ambulances with a brand new medic and brand new Intermediate on them. As assigned partners for a 4 month shift bid.

Everything is done on seniority so the senior employees usually bid the good shifts and with their established partners or other senior employees and the newbies are left to pick at the scraps.
 
Robb said:
We routinely have ambulances with a brand new medic and brand new Intermediate on them. As assigned partners for a 4 month shift bid.
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I've been places like that, but also places where they require one senior and one junior spot in any crew (whether ad hoc or a permanent schedule). Even that's not quite the idea though, it just avoids major disasters; a senior partner isn't the same as an FTO (actually they're sometimes sorta the opposite...)
 
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