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I really like working with most of the younger people in our service, though most of them could be considered younger when compared to me. Age is really unimportant to me. I love to watch people learn, like to watch their confidence grow. We have a kid that's a full time fireman working with us as a part time basic. We ran a call to Detox, an intoxicated pt well known to me. He was working fire and asked if he could get the IV. I said sure, "Get me a 14 or 16." I wanted to make him uncomfortable, as he's not had much experience starting IVs. He was, but he jumped in, grabbed a 14 and proceeded to miss his stick. I told him to go again, he did, again with a 14 (I really liked the fact that he didn't default to a smaller catheter when he got nervous) and got his stick. He simply trusted that I knew what I was doing, jumped in and did something that made him nervous, and asked later why I did what I'd done. After the call I explained to him that the Detox crowd isn't popular with our local ER and that most often they will simply be cleared and returned, where often we'll run on them again in the next few hours. Much of their discomfort comes from being dehydrated by the alcohol and that I can run a full bag of fluid through a 14-16 in the time I have them and mitigate some of their suffering plus possibly the need to run them again in the next few hours. (People sometimes believe I use these sizes to punish our frequent fliers, but the opposite is actually true. I want to see that they get treatment, and in this group of pts, that takes a larger IV I believe.) Anyway, my very long winded reply is meant to show that it's spirit that I cherish in a partner, the desire to show up on scene and actually use the tools available when we can, to be smarter tomorrow than we are today. Ask questions, mention my mistakes, debate everything you feel educated enough to disagree with, volunteer to do things that scare you, be pt focused and I'll love you forever, regardless of your age. Dwayne

The route of education I suggested is not uncommon and is used threw out the world. The problem as I understand it is not a lack of skills but a lack of confidence. This is not a impossible problem to overcome, but requires the instructor to teach outside the box. When the student gives a review of the material in front of his/her piers there will be some anxiety but far less then in the field and the intent is to build the students confidence. Their are many people who have the ability to rise above there station but merely lack the nerve. By taking a few minutes to give a student a opportunity to build confidence in the classroom is worthwhile endeavor when you consider that this person could easily pass the course because of their intelligence and yet fail in the field because his/her nerve failed under pressure. We would cheerfully weed out the student that does not comprehend the material but we do not have a mechanism to fail a student that is competent but nervous. Don't forget that Einstein was a crappy student too.

I will agree that there are a lot of issues with EMS education, one of those being the time frame of education. I don't see where Joe said that if a student has problems with that material, they should go back and review it in class. He said "Only step in if they bomb and then only to refocus them." Again, let's go back to the OP. The student in question KNOWS the material, and HAS the skills. That is not the problem here. The problems is self confidence. If you review literature on building self confidence in students, one of the most common methods is for that person to take a leadership role in something, usually in presenting a topic in class. So, since it doesn't appear that you like that approach, what approach would you use to build self confidence in that student who already knows the material and already has mastered the skills?

A question directed toward "older" and more experienced EMS personnel: How do you feel about working with a partner that's significantly younger than you (i.e. in the 19-21 range)? Assuming that they are competent and professional while on the job, does the age dif make a difference in your work relationship? Personal relationship? If you had the choice would you instead choose an older partner with more years on the job? I myself am a younger EMT and have been extremely priviledged to work with a group of awesome EMS professionals that have been on my side and rooting for me all along. Even the senior ones have chosen to treat me with respect and seem extremely genuine in their desire to be not only my teacher, but my friend. They've made a large effort to make me part of the group, despite a significant age difference. I cannot say what this has meant to me! They've truly helped me to grow into myself and develop confidence. Young people need mentors like this. I'd like to know how other EMS agencies function in this regard. Is this common? I pick up off this site (from some) a certain level of cynicism and belittling toward anyone "below" them, as in level of training, ect. Am I mistaken in that assumption? (I do realize that a LOT is to be said for training and experience and that it deserves respect - I'm not downing on that.) Everyone starts small. What if all the more senior EMS professionals were to, instead of belittling and degrading the less experienced, become encouragers, inspiring their younger EMS brother's and sister's on and challenging them to better their work ethic and all other aspects of their job? Leave a legacy, so to speak. Thank you to those of you who already do this. You're the horoes.

So I guess whoever gave me the negitive comment didn't get my attempt at humor. If you have any doubt run an EKG, but be a health care provider not a drone.

Depends on the state and service, municiple vs commercial/private (union/non-union). On average in our state EMT's start around $15 max out at about $21 Paramedics start around $18 and max out at about $28 (non-supervisor) Most municiple medics start at about $25.13 based on the State workers pay tier. Most start on tier 13 max out on tier 20 Dispatchers start about $17 and max out about $23 Then you need to see if you get s stipend for CME's / Conferences / Do they offor a 401K, what are the costs for your health insurance. Plus depending on the service you get an increase if your an FTO or have your EMS-Instructor, PALS and ACLS-Instructor. EMS is not gonna make your wallet fat but if you manage yourself correctly you can get a nice house, car etc... On average in RN's in our area make $40 to $55/hr and as a traveling nurse we have seen close to $80. Research the area you go to before you decide if you want this as a career, I did 20yrs ago and have done just fine, yet I have seen others struggle. Good Luck

Thanks for the input, Dwayne. That's the exact same spirit so many of my coworkers have had and it never ceases to amaze me. I only hope that someday I can be the same for someone else. DustDevil, thank-you too for the input and advise. I did want to clarify several things though. For some people EMT-B is a stepping stone, not what they are settling for. I do plan to begin medic school shortly. As you've basically already said, in an ideal world we would all be medics, but, unfortunately, this is not an ideal world.:/ I also wanted to say that I've never personally had a problem with a medic and I certainly don't have a chip on my shoulder toward any. Personally, I enjoy a good challenge and I also enjoy working with people who present a good challenge. I would not want to work under anybody who would accept anything less than my absolute best. We had an instructor in our EMT class who was like that. She may not have been forthcoming with praise, she picked (and I mean picked) at the nitty-gritty details, and if you messed up you knew that a lecture was coming (loudly and in public!), but I knew that she was hard on me because she wanted to see me pass and she wanted me to be the best that I could be and I loved it because I knew that if she didn't comment on my work I had done it well. I may like the tough bosses, but, that being said, I've watched it crush others. Some of my classmates couldn't stand it and, for their sake, I wished, not that she would have lowered the standard, but that she could have come across a little more gently with them and could have been more affirmative when they did do it right. I believe that is the mark of a true teacher: to be in tune with their students and, while not lowering the standard, able to meet them on their level. We don't need preachers. We need teachers. (I just realized how that might come across. I don't know you and I am in no way inferring as to what kind of teacher you might be, simply what I believe is ideal.) And I'll use spell check in the future. (This is not spell checked though, as spell check is not downloaded on this pc.) Bear with me please.

This is an awesome approach to this student, and as mentioned by Annie, won't take a significant amount of time. In behavioral science it's called 'Proofing.' You teach a behavior until you can predict an 80% success rate or so when repeated and then you put it under pressure to teach it to work in the real world. If they fail regularly at the new level of pressure then you've moved them to fast. This is awesome for creating and then shaping new behaviors. This chick will have a stroke at the thought of being made to stand in front of the class, but if she truly knows the material will find that it's not as bad as she's imagined. She'll also find that making mistakes is not terminal. Sorry man, but if you keep posting ideas like this then I'm just going to continue to screw up your negative rating with positive votes. :-) (I hate the spelling but love the creative, 'I'm responsible for this students education' spirit.) Dwayne

So, what is your suggestion to the OP in helping the student in question? In a previous post, you focussed on poor instruction, and the instructor being the problem. Joe's suggestion is viable if an instructor is willing to structure a class accordingly and manage time frames. A 3 minute review is not going to kill a class schedule. I don't think his intent was for this review to take a significant amount of time, especially with no prep time allowed. This method does force the student to take on a lead role, which can assist a student with self confidence issues an opportunity to build confidence by putting them in a situation to stretch their skills. This would be fairly easy to implement in a classroom without screwing the schedule.

Neb, thank you for your clarification on this particular student. Again, I think it is important to stress to this student that a lack of self confidence will kill any career aspirations she may have. EMS is not a place for someone lacking in self-confidence. Push her, and your class, into leadership positions – have them present topics to the rest of the class; have them be team lead in a group project – this can be as simple as breaking them into groups for discussion, and having each group write down their ideas on a big sheet of paper, then having one person from that group present it to the rest of the class – each person must take a turn being the presenter. This will force this student into taking a leadership role, without singling her out. Be careful not to avoid constructive criticism; every student has weaknesses, and they need to know what they are, so they can work on correcting them. This student’s weakness is not knowledge or skills – it is the self confidence, and it needs to be addressed, just as a knowledge or skills issue has to be addressed. You may need to pull this student aside after class to discuss it with her, and give her the tools to improve – things like taking the leadership in class and doing presentations will help with the shyness or whatever reason she has. What are her reasons for taking this course? Where does she want to go with it? Maybe in understanding that, you can convince her to focus more on building self-confidence to attain those goals. You have 21 students – obviously you can’t focus all your attention on one student. If isn’t fair to you, or the other students for you to do that. You and the other instructors have to decide how much extra time and effort to put into this student. If, after you have discussed her weakness, discussed how she can improve it, and given her time to work on it, and you don’t see effort or improvement, you may be forced to let her fail, not academically, but by letting her find out the hard way that her lack of self confidence will get her nowhere in EMS.

Have them review a section they already know for the class no warning, spontaneous. Only step in if they bomb and then only to refocus them. Often you learn as much by teaching as learning.

Making class fun and enjoyable helps quite a bit. Don't just stand there and read from a slide show or from the book. Get the students involved. Positive reinforcement. Do not discourage. Gain their respect! Don't speak monotone.. that's boring and some will lose interest. A lot of the material can be dry. Try to keep it exciting, but remember they aren't "kids". Also remember.. the brain is directly proportional to what the butt can handle.

One thing I often worry about when I see this type of student would be "how much is this an act?" Really, I've seen a lot of students, and I hate to say this, but a lot more female students feign this no confidence "I'm never going to get this" attitude because they are seeking attention. The more time you devote to telling them how good they are and that they can do this job, the more a person that needs attention is going to crave what you're feeding them. As a result, you'll be spending all your attention focused on one student and making sure they know how good they are then on your group of students, many of whom will probably end up going on a lot further in the long run. First things first, make sure this person isn't playing the "show me attention or I'm going to cry" game. If they truly have no self confidence, I'm not sure it's something that can be taught. They have to be comfortable. Unfortunately, if they never get to that point, they won't go far as we are driven by confidence and have to master it before we can really function by ourselves. People will see though a weak person and consequently, they'll walk all over them on a scene. Once again, another fantastic post by Dwayne. People don't need smoke blown up their butts, the need quality educators that understand the learning process and are able to teach effectively. I am all forward a daisy chain learning approach. Master one small skill and move on to another small skill. Eventually all the small skills will equal one gigantic mastered technique.

Well I guess the whole idea of a good story really got lost yet again. Please dont post crap about volly or paid that isnt what this was suppose to be about.

Very good points Dwayne - it is not an instructor's job to coddle students. It is our job to make sure that they are competent. A criteria I use is "is this student good enough to work on my family member?" If the answer is no, they aren't good enough, and I tell my students that. I ask them directly "Do you think you are good enough to work on your best friend's family member?" That usually gets them to think again about how good they think they are. I also agree with your "you did OK" thoughts. The OP said that this student does know the material and the skills, but seems to lack confidence in front of others. I suspect in this situation, it isn't a lack of confidence in knowledge or skills, but an overall self-confidence issue that needs to be aqddressed. EMS is not for the faint of heart, and students need to realize that early in their EMT-B. The student really needs to take a good look at themselves and figure out if they can break out of that personal bubble of lack of confidence, and learn to project confidence even if inside they are thinking "holy sh*t." If they can't do that, they will never be successful.

We have the same EMD issues over here. The 80 y/o male who's dizzy while sitting is low priority "BLS" while the 32 y/o female with a H/A is a higher priority "ALS". ( as an aside, I understand Kiwi's position on the antiquated concept of BLS and ALS; it's still our current system, however) Our dispatchers are not required to have any EMS training. Blindly following the EMS protocol cookbook makes for poor pt care, and blindly following the EMD cookbook makes for equally poor dispatching. Each day an agency uses SSM, Jesus kills a kitten.

I think we often train a lack of confidence into students. The whole, 'You're ok! You did your best!" is SO destructive to the educational process as it simply tells me that you, as my instructor and temporary leader, not only believe that I am too weak to accept criticism, but to dumb to learn from my mistakes. Telling me that I did 'ok', or 'my best' or 'that was fine, you'll do better with experience' makes the instructor feel like a kind person, but it carries no information. If I can't trust you to teach me when I'm scared and defeated then I can't really trust you at all. What I need to feel confident is the knowledge to fix the problems I have today and the trust that my instructor will take me and my education seriously enough to help me do so. Also, I see too many skills taught as a single 'thing.' "Ok, this is how you cspine. Now lets everyone practice." At which point everyone starts to flounder around and bump into each other. (exaggerated, I hope, to make the point.) This is not one skill. Manual cspine should be practiced until they are comfortable with it, and then collaring should be practiced, SEPARATELY, until they are proficient, and then positioning the pt, separately, log rolling, separately, etc, etc. It's called Daisy Chaining behaviors. People fail at most skills because one part of the skill falls apart trashing the whole. Each part of a skill needs to be practiced and mastered separately before attempting to be put together as a whole. That's all I've got for now...Don't treat your timid students as if they're breakable, and daisy chain behaviors and I think you'll see a dramatic difference in their behavior as a whole. Dwayne

As long as you are sure that you're coping, and not simply pretending to cope, then you have nothing to worry about. I have known very few people in this field that would be disturbed by the things you've mentioned, though I'm guessing most of us have had 'moments.' Once ran a call for a woman violently raped. Face pounded, multiple stab wounds, including her vagina and rectum. I left that call shaking with anger, just wanting to beat the shit out of someone simply because of the brutality of the act. Once the adrenalin washed out of my system I was fine, went back to work, and got to run on the guys that did this after they 'resisted arrest.' Made me feel much better. :-) Watch for the signs that you're bullshitting yourself about being ok. Neuralgic hypersensitivity to noises or movements, disturbance of your sleep, a revisiting of the call or images of it in your head uncalled for, changes in your personality. If you feel fine, you almost certainly are fine, though EMS is full of 'do gooders' that will want to try and convince you otherwise. They are a much bigger threat to your emotional well being than nasty calls. Good question man... Dwayne

Good thread, Neb.... I hope there will be a lot of posts on this one. How old is this student? Are they the youngest student in the class? Are there more male students than female students? Do they only show the insecurities when in front of the class, or in a group? Or do they also show the lack of confidence when they are doing a skill or scenario by themselves, with just you watching? I am curious about the class dynamics. I am an instructor, and I am also currently a student, so I get the benefit of being on both sides of the fence at the same time. Have you spoken to this student one on one, with no other students around, and with no other students knowing you are talking to this student, to tell them that they are doing well, and that the only thing lacking is their self-confidence? Are they really nervous in front of the rest of the class? How long has this class been going on? If they are quite far into the course, and are still showing signs of poor self-confidence, you definately have a challenge on your hands. Whatever you do, don't single that person out in the class. Be careful of praising them more than other students, so they don't feel more conspicuous. Have you done a lecture as part of your class on what it takes to work in this field? It might be worth covering that in your class, to emphasize that self-confidence is key. Ask the class "If you don't have confidence, how can you expect your patient to have confidence in you?" Or, have the students prepare an assignment on the topic, and things that can be done to help self-confidence in themselves and others. Maybe make it a presentation day, where each one brings an idea.... Or, just have each student prepare a short presentation on something (I have my students each prepare a short 5 - 10 minute lecture on a drug in their protocols, and they have to explain it, the mechanism of action, the dose, and when it would be used) to get them in front of the class. I know I have types a lot of "have you"s in this post, and you probably have done most or all of them. Although as instructors, we never want to see a student of ours be unsuccessful, there is always the one that can't make it in the long run. Despite your best efforts, and then some, this student may have walls that are too hard for you to climb over. I will try to dig through some of the reference material I have, and if I find anything I think will be helpful, I will pm it to you. As good as this person may be at skills, she will never succeed if she can't get past that lack of self-confidence.

Not at all. I'm saying without volunteer's the EMS system we enjoy would be even farther behind than you seem to think it is.

Couldn't have said it better myself To Happiness: Glad to hear your son got turned around and also his friends too. Its nice to hear when an organization can do that for folks and especially when they are the next generation. Hopefully he and his friends fulfill all their asperations and go on and have long fruitfull happy lives.

Volunteer Departments are the backbone of EMS in America. The problem with Volunteer's is that they're volunteers. They're not required to participate in all of the training that a typical career EMS provider goes through. They also don't run the call volume that paid services do. EMS is not typically their passion or career choice, but they do it because if they didn't, who else would? As a state regulator, I see many different kinds of agencies. I see good and bad volunteer agencies and I see good and bad paid agencies. Volunteer's most generally do the best they can with the resources they have. Sometimes they knock it out of the park and other times they do just enough to get by. I can say that of some paid agencies. Do the best you can to thank them for their valuable service and encourage them to improve in areas of weakness. Without volunteers EMS would not be the success it is in America today.

'We, in Ireland, can't figure out why you are even bothering to hold an election; in the United States. On one side, you have a witch who is a lawyer, married to a lawyer, running against a lawyer who is married to a witch who is a lawyer. On the other side, you have a war hero married to a good looking rich woman who owns a beer distributorship. What are you lads thinking over there?'

Why did you do an ekg on a rotting corpse?

Never understood volunteers, or why a community would not shell out cash to pay for medical professionals. It's quite sad really. I don't hear much about volunteer RNs and MD's...or volunteer hospitals for that matter. In my city volunteer fire/ems is unheard of.....This is a pro career, and we earn the money to prove it.