Failure to Train is Training to Fail

Do you work in an atmosphere that demands high performance? Do you train enough to be at the top of your profession? No? Well….it’s probably not your fault. 

I remember the feeling of being a young EMT. It was exciting. Every call was a new adventure. Each time I applied a new skill or utilized a bit of acquired knowledge, I was motivate to go out and learn more. As I progressed from the ranks of BLS to ALS provider, that desire to learn only got stronger. With new training came new skills and new interventions. With those new bits of knowledge came continued passion for development. I sought out opportunities to train based on an internal desire to be better.

Well, that motivation only lasted so long. This industry can be tough. And eventually the mundane aspects of the job weighed me down. The long shifts added up. The abuse of the 911 system had a negative impact on my morale. On top of that, my employer didn’t support my growth. If I wanted to take an advanced class, outside of the typical ABC certs, I had to pay for it…and I had to take time off to attend. They didn’t support it at all. They provided me with no incentive to further my desire to be better. Eventually I stopped seeking out new opportunities to learn. I rested on the training I had. But since I wasn’t actively challenging myself, even those skills atrophied. I should have been progressing but instead I found myself regressing into mediocrity.

Crisis was adverted in my story, simply because I changed jobs. My new job required me to train. I found myself, daily, required be involved in some type of training activity, either computer, classroom, or practical based. That mandatory training also restored a passion that I had as a young medic. Once again, I seek out additional educational opportunities. I read EMS publications again. I attend advanced classes (supported by my employer!). I’m constantly searching the internet for some bit of wisdom that will make me a better provider. I want to be the best again.

All because I have an employer that expects me to be a competent provider…

Now, I’m not totally absolving myself from responsibility here. I let myself drift. I allowed myself to lose my motivation and my performance suffered. And instead of seeking out an environment that would support my growth, for years I stalled. Oh, I still had some skills. But I stopped pushing myself to be the better. So I own part of that blame.

But who owns most of that blame? Who is responsible for employee development? Who’s job is it to provide you an appropriate environment, full of challenges and training, to maintain your passion for excellence? I say loudly…it’s your employer’s responsibility! (I even underlined it, so it must be important…) An EMS agency, undoubtedly and without question, has the responsible to provide an atmosphere that will support continued professional development throughout an employee’s career. Your employer should hold you to a high standard and provide you with the tools to maintain that level of competency. And we as an industry are absolutely negligent at doing that.

If you play professional baseball, is it your own responsibility to go out and find someone to throw some batting practice for you, or will your team provide you that training frequently? If you work as a computer programmer at a big tech company, is it your personal responsibility to seek out advanced programming training on your own, or is it in your company’s interest to provide you with that? If you’re a solider in the army, do you arrange for your own training? Or maybe Uncle Sam has a vested interest in your ability to perform the job, so he finds plenty of opportunity for you to train.

We don’t even have to look that far outside of our world to find a good comparison. Look at the fire industry. Nationally, FDs are prime examples of providing their people with high-level continuing education. I, personally, have multiple fire friends, around the country, who are going to advanced classes multiple times a year on the company dime. But how and why? Aren’t municipalities strapped for cash? Sure, some of these training dollars come from grants or other funding, but at the end of that day it’s costing these agencies money to send their people through training. So why do they do it? They have established the culture. They train because the need to be ready to respond to a wide spectrum of emergencies. Kind of like…..EMS….

Is every EMS agency broken in this country? No. There are beacons in the dark. Examples of how agencies should operate. They have high standards and hold their employees accountable. The also provide those employees the training to succeed. But these examples are the exception, not the rule. They are anomalous. There are many more systems out there broken and suffering because of poor employee development.

Well our system is definitely broken and it’s broken in so many different places, I’m not sure where to start. We don’t value education in EMS. We don’t have a national standard for EMS care and competency. We pay our people pennies to perform a demanding job. We have a failed model for billing and revenue streams. We have too many ALS providers for the industry, over-saturating the market. Our shift structure supports burnout and mental health problems. (This list can go on for awhile…) We all know the problems this industry faces. We live in it. And to pretend they don’t exist is ignorance. So how do we fix them?… I have no idea! Are you kidding?! I’m no miracle worker. You’re talking about industry wide problems. Macro issues. That ain’t me brother.

But I’ve got some strong opinions on how to positively influence the lack of a proactive training culture at the organizational level. That’s a great word…culture. We have to improve the culture. We have to establish an internal culture of competency. We have to expect our employees to be professionals, and provide them with the environment to achieve that expectation. Here are some of my thoughts on contributing to that culture.

How to prevent a failure to train:


 Employee Responsibilities:

  • You are an EMS provider, not an ambulance driver, act like it. Adopt that attitude now. Take off the stupid EMS t-shirt and be a professional. How many doctors do you see walking around in shirts that say “Off Duty…Save Yourself?” Nobody cares that you’re a paramedic. You have passion, you’re proud…cool. Me too. But it’s a career. Treat it like one. Once you begin to take this career seriously, you’ll hopefully understand you have a responsibility to be good at it. Now… go train.
  • Understand medicine. Educate yourself. Understand medical terminology. Use it when you interact with other medical professionals. Sound like you had to go to school to be in this career. When you document a call, treat it like a legal document that might be read in court, not a text message to your girlfriend. If you can’t do these things, I hear Walmart is hiring.
  • Participate in continuing education. If it is offered to you…attend. Every time.
  • Bring opportunities for professional development to your employer’s attention. They’re busy paying you, help them out with this issue.
  • Hold your coworkers to the same standard you hold yourself. Peer pressure is legit. I don’t want to work with knuckleheads, neither should you.

Employer Responsibilities:

  • Don’t hire idiots.
  • Seriously. Stop hiring idiots.
  • Have a hiring process that will assist you in following the first and second rules.
  • When you have openings and need to put people in the ambulance seats, resist the urge to break the first rule. Accept some overtime for awhile. I know…you’re a business. But having competent, skilled providers will make you more money and COST you less money in the long run than putting a bunch of Ricky Rescue’s on your staff. Your employee’s morale will skyrocket with this simple strategy.
  • Make your high clinical standards well known to your employees. Implement QA/QI systems. Involve your people. Most importantly, utilize the info that comes from this process. If your agency’s intubation success rate sucks…you know what next month’s con ed topic is going to be. If people are struggling on peds calls, bring in a peds nurse or doc to expand their knowledge. If you hold you employees to a high standard…really hold them accountable…they will live up to your expectations. And those that don’t….well, once again…Walmart.
  • Form a training committee, comprised of all walks of life at your agency, to guide training and professional development.  Value and support this committee.
  • Provide an incentive for your employees to seek out and obtain advance training. I know, money is tight. Waahh! Find it somewhere. Switch to single ply toilet paper…whatever. But establish an environment that rewards employees that want to be better than their peers. Don’t make them take time off work, finding their own shift coverage or trades, to attend training that will benefit your agency (Do you realize how ridiculous that is?). Pay for the training, pay them, cover their shifts, and thank them for being awesome. You need more of them.
  • Involve your medical director in your agency’s efforts to improve training. These docs SHOULD have a vested interest in the competency of the personnel operating under their license. But not all of them are motivated enough to participate. Motivate them. I currently have the good fortune to operate in an EMS system with a medical director that is highly active in his system. It keeps us all focused on providing high quality care. He teaches, he evaluates, he listens. I can call or email him anytime with a question or concern, and he addresses it. You need this in your system. It’s a game changer.
  • Holy hell Batman…train your employees to document. We aren’t ICD-10 coders here. Let us know what is going to help you make money and what is going to cost you money and we’ll assist. We want this agency to be successful too. Over the past year I have sat in on two classes regarding documentation. They both taught me things I should have learned in my initial education. How to document an accurate account of the clinical aspects of the call, while ensuring the company will be compensated for your efforts. Why would you not provide this training for your employees?
  • Every day expect your employees to train. Make training available and a priority and it will pay you dividends in the long run. Your agency will be the one good providers want to work at. Your reputation will skyrocket. Downstream benefits come from upstream sacrifices.
  • Any excuse you offer as to why any of this can’t happen, here is my response: “….make it happen.” You put fuel in your rigs everyday. This is no less important. Do it.


So that’s what I think about the issue. It’s something I’m passionate about. I’ve seen both sides. I’ve been at the bottom, working for companies that couldn’t care less about clinical competency. Only paid it lip service. They would rather employees be involved in landscaping duties than train to perform their jobs. Guess what? Overall the quality of care was much lower than it should have been. Employee morale suffered as a result.

And I’ve had the good fortune to work in environments that not only support professional development, they compel it. Because of this I want to succeed. Not only to keep my job, but to be one of the best. If the standards are high, and if everyone around is held to those standards, employees will perform. If your agency doesn’t support this type of culture, work to change it. Whether you find yourself at the top of the food chain, or the bottom, you can have a positive impact. Employers, demand this culture of your people. Employees, demand your bosses support this culture. We can’t do anything to change most of the macro problems with the industry. This is one area, however, that we can impact today.

This is an opinion piece. You now have a piece of my opinion. I’d like to hear yours. Please comment below. I’d like to hear what others have to say. As always, thanks for visiting.


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