Continuing Development in EMS

Emergency medical services (EMS) is a fast paced and continually evolving field, and those professionals working within it must often make split second decisions that have the potential to impact people's lives. Incidents vary in nature and the work environment constantly changes from one call to the next.

The education and training of EMTs and paramedics is designed to provide them with the entry level skills and knowledge to provide a certain level of prehospital emergency care. While the initial education provides basic building blocks, it is the learning that takes place after the EMT or paramedic curriculum is over that is probably the most important.

In many allied healthcare professions, experience in the field is a critical component to an individual developing proficiency at clinical skills and decision making. This is perhaps no more true or important than in EMS. Certainly an individual can possess a wealth of knowledge that has been gained through reading and studying material from a textbook, or listening to an instructor lecture week after week, and in many cases that textbook knowledge will serve the person well. Make no mistake though, textbook knowledge and a professional credential do not automatically translate into the ability to function and make decisions in the field.

These things also do not automatically mean that a person is a true professional. There are no doubt more than a few EMS providers out there who simply hold a card, show up to cover their shift, and never do anything to grow into a true professional. The purpose of this article is to provide EMS personnel with suggestions on ways to avoid simply being a "card holder" and instead grow and develop professionally.

If one were to ask a random sampling of people what it meant to be called a professional there would no doubt be a wide variety of responses. Certainly these responses would provide a representation of what different people think it means to be a professional. Even the dictionary definitions of the word professional provide an array of descriptions. The word professional can appear in a few different contexts; however, two excerpts from dictionary definitions of "professional" as it is used to describe a person perhaps provide the best description of what it means. Webster's online dictionary defines a professional as, "one that is professional; especially: one that engages in a pursuit or activity professionally." A second definition from Dictionary.com further defines the term as, "A person who is an expert at his or her work."

These definitions fit the world of EMS perfectly, as it is certainly necessary for EMS providers to actively pursue a level of knowledge and experience in order to grow professionally with the ultimate goal of being considered an expert at their work.

Three key ways in which providers can work to grow and develop professionally include:

• Gaining experience in-the-field
• Taking the initiative to continue learning new things, and
• Professional interaction.

Gaining Experience in the Field

Gaining experience in the field is the simplest way EMS providers can improve their knowledge base and sharpen their skills. In order to gain that experience it is necessary to run calls. For those who make EMS a career, running enough calls to gain experience is typically not an issue. However, for those EMS providers who serve in a volunteer capacity this could be more difficult at times. If one were to ask any seasoned EMS provider what it feels like to be away from running calls for any length of time, they will likely tell you that they get a little "rusty." Repetitive practice of EMS skills in a classroom or non-emergent setting is good, but it is no substitute for gaining experience in real emergencies.

Growing from Each Challenge

The second part of gaining field experience is how the individual EMS provider uses that experience. Every day provides different calls, every call provides different challenges, and with every challenge comes an opportunity for EMS providers to learn and grow. Classroom learning in EMS provides a set of guidelines for dealing with patients suffering different types of emergencies. Every patient though does not present exactly like the textbook case, and certainly every call will not go as smoothly as the textbook makes it sound like it should.

This fact has the potential to leave providers, especially new ones, frustrated and feeling like they did not provide very good emergency care throughout the call. It can become very easy for EMS providers to focus on that frustration, and thus miss the training benefit that can come out of these types of situations. Debriefing with other crew members, especially those with more experience, following a call provides an opportunity to talk about what went right, what went wrong, and how everyone can improve the next time a similar call occurs.

Going hand in hand with gaining field experience is the individual EMS provider taking the initiative to continue learning beyond their initial training as an EMT or paramedic. EMS is no different from the other healthcare disciplines in that things change constantly. New ideas are always evolving, and new research is always being done to test them. Even within the last five years significant changes can be seen within the world of EMS, and if providers never learn after their initial training they will not be able to stay up-to-date.

Looking things up in textbooks, reading professional journals, taking classes (Figure 1), asking questions, and interacting with other healthcare providers are just some of the ways to stay current. Staying just a little bit longer at the emergency department or following up later on a patient's condition can also be very beneficial to improving one's knowledge base in emergency care. When dealing specifically with clinical skills, EMS providers should strive to stretch their comfort zone. One example of this is for basic life support providers is to learn what advanced providers do, when they do it, and how to best assist them.

Professional Interaction

The third way in which EMS providers can grow and develop professionally is through professional interaction. Certainly, every time an EMS provider runs a call they are interacting professionally with their partner at a minimum, but they may also be interacting with others in public safety, additional EMS providers, nurses, physicians, and a host of other allied healthcare professionals (Figure 2) either at the hospital or on scene of the call. These interactions provide the opportunity to learn what other healthcare providers do, and to pick up "tips from the field" from these healthcare providers who may add to the knowledge base and skill set of the EMS provider.

Gaining an understanding of what other healthcare providers do, and their role within the healthcare system, provides those in EMS a greater understanding of the overall healthcare system. In addition to the interaction with others that occurs on a daily basis, EMS providers should also make an effort to periodically attend professional conferences and meetings. These types of events will not only expose the individual provider to a wealth of cutting edge information on a variety of EMS related topics, but also provide for interaction and networking with numerous other EMS providers. This interaction can serve to update the provider on current trends in EMS and allow the provider to gain knowledge based on others' experiences in the field. In addition, networking with other professionals keeps providers up-to-date on the job market and what opportunities are available for those in EMS.

EMS is an exciting field that continues to evolve. New ideas continue to be tested by research, and procedures and protocols are constantly changing based on that research. It is important that EMS providers stay current on trends within the field while continually striving to expand their knowledge and keep their skills sharp. Those EMS providers who are simply "card holders" will build very little upon their initial training, and will never grow and develop into true professionals within the field. Gaining experience in the field, learning from experiences in the field, taking the initiative to continue learning, and interacting with others professionally are all ways EMS providers can grow and develop so that they can provide the absolute highest level of care to patients on a daily basis.

Brian Potter, MS, ATC, EMT-B is a member of the Upshur County Emergency Squad and a West Virginia Emergency Medical Services Instructor, and serves as Adjunct Instructor West Virginia Wesleyan College.