Are You Training Like You Fight?

By Daniel Batsie, EMS Conference and Seminar Presenter

As EMS professionals, most of us recognize that continuing education is a part of ordinary life. We all go through the motions of logging hours and fulfilling those nagging requirements, but how do we know if that training is really preparing us for those worst-case moments? Are we preparing for a classroom reality or for the real challenges our occupation poses?

The value of training really depends on the manner in which it is held. Far too often, we rely upon the simple regurgitation of facts or rote repetition of mindless skills. We “refresh” by listening to the same Powerpoint lecture we heard in EMT class and practice the same memorized set of steps to complete a skill station that doesn’t even really reflect “real world” practice. Unfortunately, going through the motions just doesn’t cut it.

Repetition by itself is not necessarily terrible. Reviewing concepts and skills in an ongoing manner is important to keeping our capabilities ready. This is especially true considering low-use/high-risk skills like airway management or neonate resuscitation. However, to truly be ready, we need to challenge ourselves by adding context and feedback to our practice sessions. How can we expect active engagement when everything is on the line if we have only ever practiced passively?

What if continuing education really expanded our learning? Shouldn’t refresher classes actually teach us something new? As fast as modern emergency care evolves, it’s hard to believe there wouldn’t be at least a few topics that might change our everyday way of doing things.

We all want to focus on protocols, but educating ourselves as to what’s new in the world of medicine helps us prepare for new things to come. It also helps us engage those who define our scopes of practice and challenge them to keep our standard of care in line with contemporary medicine. Reviewing key concepts is fine, but instructors should consider adding real world context. Pre-hospital medicine isn’t performed in a bubble and providing excellent care to our patients means more than reciting facts.

We have to use what we have learned as part of a larger, overall plan and as a result, we should be talking about that larger plan in training. Excellent education challenges students to not only recall facts, but to use that knowledge to formulate best practice.

Rather than skill stations, we should consider using realistic scenarios and challenge ourselves with complex problems that require high-level thinking. Remembering how to apply a traction splint is nice, but why couldn’t we improve the context of that experience by using the splint outside or in cramped quarters like we would in a real-life setting.

It is important to remember the steps of a primary assessment, but what if we added some high fidelity elements that required the student to actually assess scene safety or to actually manage an airway as part of a larger, more complicated situation? Wouldn’t that offer the student better tools to prepare for life as an EMT?

When we train like we fight, we add emotion to learning. Fear, anxiety and frustration become part of the learning process and students are taught not only the memorized steps, but how to overcome the never-ending challenges the world of pre-hospital care poses. Adding difficulty and real world context to learning produces students who have the grit to try, fail and try again. It produces EMS providers who recognize that if plan A fails, they must be ready with plan B, C and even D, for that matter.

More importantly, students need feedback on their performance. Feedback is not just for pass/fail purposes, but rather should be viewed as a list of ways that we can improve. Tell a mediocre EMT the things he did wrong and he gets mad; show an excellent EMT the areas he fell short and he thanks you.

Successful training requires performance evaluation and reflection on the steps toward improvement. Fundamentally, that is the only way to actually get better.

In the real world, no one is perfect and there is always room for improvement. Excellent teams are constantly evaluating one another and looking for better ways of conducting themselves. Shouldn’t these habits start in our training?

No one said it would be easy. Continuing education in this manner is a challenge for instructors as well.

Gone are the days of reading from someone else’s slides and simply rehashing that old lecture. As much as we educators love to hear our own voice, it turns out that the student’s voice is just as valuable. High-quality continuing education means turning around the podium and “doing” as opposed to just “saying.” It’s active, not passive.

Unfortunately, everyone doesn’t get a trophy in public safety. We try, we fail and we struggle to do our best sometimes under less-than-reasonable circumstances. Those with experience understand just how unfair life as an EMS provider can be. The best of us have accepted that challenge and recognized the need to constantly improve and be ready for the crazy problem waiting for us around the next corner.

Let’s take that experience and turn it into an opportunity. Let’s use past failures to predict challenges to come and train with an eye on the real world.

As we collectively plan our next refresher program, let’s measure success by how engaged we can be. We can talk a little, but let’s make sure we are challenging one another to think at the next level.

If you were hoping this could happen in the Lazy-Boy, take a moment to reflect on that really challenging call and think about how recliner training helped you (or failed you). Let’s all accept that performing at 100 percent requires training at 100 percent. We have the time, let’s make the best of it.

Daniel Batsie has been involved in EMS for over 25 years and has been an EMS educator since 1994. After 15 years as a paramedic program director in Maine, Batsie recently moved on to become the EMS Chief for the state of Vermont. He is also the author of two EMS textbooks, a contributing author to several other texts and has published numerous journal articles.