Question for instructors - need advice

[MikeEMT]

Need some advice here from some instructors / senior people. I was recently given a new EMT fresh out of FTO. Apparently they didn't comprehend everything in FTO and was assigned to me to help them out.

My partner can't seem to comprehend driving and navigation. Even using a GPS they constantly miss turns, don't know the names of major vital roads and don't know how to get from point A to point B.

When driving, they constantly drive under the speedlimit - even during priority driving. They stop at green lights to read the street signs, even though it is displayed on GPS. I got concerned enough that I asked how their night vision was (wears glasses at all times) and their reply was it was bad, even though their glasses are new. I work graves so this is can be bad.

To top it off they have difficulty lifting a stretcher with a patient into the ambulance. In fact I have never seen them successfully do it. We are currently using a spare which has a manual stretcher. Our normal rig has a power cot which is considerably heavier. If they can't lift a manual stretcher how can I expect them to lift a power cot with a patient on it? During FTO they would have used a power cot and a two person lift (which I don't do normally) but that isn't an option on a manual cot as someone as to lift the wheels. We do a pre employment physical fitness that includes dead lifting 142lbs and carrying it up some steps. They told me they barely passed the test.

I have FTO experience and I get that they are a rookie. I get that learning a large area like the Seattle Metro / King County area can be difficult. I get that driving an ambulance, especially in a large metro area at night, can be a scary and intimidating endeavor. I have lots of patience with rookies and enjoy seeing the improvements they make and their confidence grow. I had good trainers and I want to pass that on to the new rookies that are coming on.

I have tried explaining mapping and routing to them for the last 5 shifts. I have tried using other units' calls as tests to see if they could get there. I have tried to educate them on safe driving and the importance of maintaining speed limits, scanning ahead, etc. I have told them the importance of strength and that they have to be able to lift patients safely - I can't be expected to do it all. I just don't think they are getting it. It has been 5 shifts and I have seen minimal, if any, improvement. In fact, I think they might be regressing in some areas.

For those of you who are FTO's or Instructors, what would you do? I am at my wits end. It has gotten to the point that I can't trust them to drive to the hospital with me in back. What happens if I have a critical patient and I can't be looking ahead to see if they are going the right way? I am considering going to my supervisor with my concerns but I am worried that if I do they will be fired. I can see it in them that they will make an excellent EMT once they overcome this. I know its mostly confidence related. On the other hand, these are pretty serious shortcomings that could effect patient care. Maybe EMS isn't for them.

I don't want to give up on them, I really want to see them succeed. Does anyone have any advice or tips on what I can do to help them? Going back through FTO isn't an option, I think I am a last resort.

[scubanurse]

Sounds like a rough situation, I'm really sorry you're in it. My only suggestion would be to talk to their FTO who cleared them for the field. They aren't ready to be out there on their own it sounds like and I would want to know if this is new anxiety/fears or if the FTO didn't make them do night driving/mapping. Was their FTO shifts dayside? I would maybe start there. Good luck, I really hope you get it figured out.

[chbare]

Do you routinely perform learning style assessments and have resources for learning disabilities? This is not an uncommon issue I run into as instructor, and if we can identify learning issues we may be able to intervene and help people through the learning process.

[island emt]

The real problem is your employer has two main criteria for hiring A PULSE & A PATCH

not everyone who manages to get the patch is cut out to be employed in EMS.

If your noob can't cut it after FTO and a weeks worth of shifts as a driver. then it's time to have a come to jesus meeting with them away from the job. Ask them to stop & have a coffee after you get off shift. Explain to them your concerns and ask if there is something else you could do to help them improve.

Tell it like it is, they are headed in the wrong direction for continued employment with the empire.

[Arctickat]

I don't understand, is this just one EMT or multiple? Your first sentence states you were assigned a new EMT, then you go on to say "they" or "their"

[paramedicmike]

My initial thought regarding this individual was to cut him/her loose. If this person still can't cut it after FTO training time plus additional one on one attention then it's time for the employer to cut its losses and move on.

Then I read Island's response and I like the idea of meeting after work for a last ditch effort at getting this person to clean up his/her act.

[island emt]

I think Mike is being politically correct in not using him/her.

I always try a little personal one on one ,come to jesus meeting as a last ditch attempt to get a noob to explain whats going on and maybe they just need that one little extra step to be a quality partner.

Then again as I said above, some folks just aren't cut out for this profession.

[MikeEMT]

Sounds like a rough situation, I'm really sorry you're in it. My only suggestion would be to talk to their FTO who cleared them for the field. They aren't ready to be out there on their own it sounds like and I would want to know if this is new anxiety/fears or if the FTO didn't make them do night driving/mapping. Was their FTO shifts dayside? I would maybe start there. Good luck, I really hope you get it figured out.

Thats the problem, all FTO's are dayshift. I am trying to get my car to be a night time training car but unknown if that will happen. Every newhire will rotate through at least 3 FTO's before being cleared, but I can't go to them for help because it is confidential. They won't even officially confirm if they had this new hire.

Do you routinely perform learning style assessments and have resources for learning disabilities? This is not an uncommon issue I run into as instructor, and if we can identify learning issues we may be able to intervene and help people through the learning process.

I don't know if I am qualified to make that type of assessment. No we don't have resources for people with learning disabilities other than trying to find a FTO that will fit their needs. This particular individual seems pretty smart IMHO. I just think they have a difficulty translating the book world to the real world. During our new hire academy we go over mapping and they spend a lot of time on it, like several days. In fact it is one of just three tests that a new hire will take during the academy and it is the highest point value. Apparently this particular individual did excellent on the test.

The real problem is your employer has two main criteria for hiring A PULSE & A PATCH

not everyone who manages to get the patch is cut out to be employed in EMS.

If your noob can't cut it after FTO and a weeks worth of shifts as a driver. then it's time to have a come to jesus meeting with them away from the job. Ask them to stop & have a coffee after you get off shift. Explain to them your concerns and ask if there is something else you could do to help them improve.

Tell it like it is, they are headed in the wrong direction for continued employment with the empire.

Actually I would argue that we have a pulse and a patch requirement. We have a pretty difficult process to get hired here that starts with the application. We then do a pretty tough (I found it tougher than the NREMT test) pre employment exam. An interview and then pee test and physical fitness. Pass all that and you still may not be offered a job. Then you have to pass the new hire academy and FTO. For every opening we get hundreds of apps. Only 10 - 15 will make it to the academy. Is it as tough as a fire department? No, probably not. However, as far as private companies go I would say its a pretty stringent process.

I like your idea of a coming to jesus talk. I think I am going to have to resort to that.

I don't understand, is this just one EMT or multiple? Your first sentence states you were assigned a new EMT, then you go on to say "they" or "their"

This is one EMT. I am using "they" and "their" to protect their identity. I don't want to humiliate or embarass them if they are a member here or a lurker. I truly want this EMT to succeed and am trying to do everything in my power to make that happen, including seeking advice from this forum. Sorry about the confussion.

[croaker260]

I am both an instructor and an FTO..a formally trained FTO even .

Anyway, there are several issues here. First is the FTEP (Field Training and Evaluation Program....though your terminology may differ) has issues. Is it a Training and Evaluation program, or simply a training /orientation program? From both a professional and a legal point of view, if there isnt some sort of evaluation (daily, end of phase, what ever) prior to being "released"... then the program is setting everyone..the trainee, the FTO, and the agency ...up for failure.

In this case, either the trainee was evaluated for his /her ability to perform the job...and legititamately passed..and now has a previously unknown issue...or there was no or poor evaluation and the trainee was simply "passed" for simplicity. .

I cant speak to how your FTEP is set up, but here, if that trainee is having consistantnt issues...were these issues documented during FTO? If so... then a "performance inprovement plan" (PIP)is held. This is a Formal "Come to Jesus" talk and process that is both legally defensible and practical.

Without cutting and pasting the entire process, here is it in a nutshell:

1- The FTO(s) and supervisors identify the problems in clear terms, and make sure that the problems are documented previously. They also make sure that the "problems" are true issues and not personality issues. We have some specific criteria for what warrents this.

2- A "PIP" meeting is held with the trainee. This is a scripted, agenda led meeting. The reason for this is it keeps all parties on task. It also avoids any "Ambiguity" about the seriousness of the situation. This has been a probelm with previous, less formal meetings with problem trainees.

The Performance Improvment Plan Agenga:

• The Trainee will be informed of the substandard performance.
• Specific details will be given to clearly illustrate what is unacceptable.
• The Trainee will be informed of performance expectations (what is acceptable)
• Specific details will be given to clearly illustrate the expected performance.
• A specific date of completion will be identified.
• Specific consequences of failure will be communicated.
• The Trainee is given an opportunity to respond and discuss the PIP.

The FTO/Training coordinator or designee evaluated progress. Typically up to 90 days may be given by policy, but most problems we are looking for improvement with in 30 days. if improvement is not seen and it is clearly documented, then we look at why, and termination is a real option at that point.

Now, from the trainee pont of view, this may seem harsh, but really this is best for everyone. it keeps a trainee from being caught in "limbo" for ever, it clearly spells out the issue without any sugar coating. Some people simply need to know what specifically they are doing wrong, and given step by step plan for improvement. And if the trainee succeeds, then EVERYONE gets to "move on"...including the trainee..into the rest of his/her career.

[MikeEMT]

I am both an instructor and an FTO..a formally trained FTO even .

Anyway, there are several issues here. First is the FTEP (Field Training and Evaluation Program....though your terminology may differ) has issues. Is it a Training and Evaluation program, or simply a training /orientation program? From both a professional and a legal point of view, if there isnt some sort of evaluation (daily, end of phase, what ever) prior to being "released"... then the program is setting everyone..the trainee, the FTO, and the agency ...up for failure.

In this case, either the trainee was evaluated for his /her ability to perform the job...and legititamately passed..and now has a previously unknown issue...or there was no or poor evaluation and the trainee was simply "passed" for simplicity. .

I cant speak to how your FTEP is set up, but here, if that trainee is having consistantnt issues...were these issues documented during FTO? If so... then a "performance inprovement plan" (PIP)is held. This is a Formal "Come to Jesus" talk and process that is both legally defensible and practical.

Without cutting and pasting the entire process, here is it in a nutshell:

1- The FTO(s) and supervisors identify the problems in clear terms, and make sure that the problems are documented previously. They also make sure that the "problems" are true issues and not personality issues. We have some specific criteria for what warrents this.

2- A "PIP" meeting is held with the trainee. This is a scripted, agenda led meeting. The reason for this is it keeps all parties on task. It also avoids any "Ambiguity" about the seriousness of the situation. This has been a probelm with previous, less formal meetings with problem trainees.

The FTO/Training coordinator or designee evaluated progress. Typically up to 90 days may be given by policy, but most problems we are looking for improvement with in 30 days. if improvement is not seen and it is clearly documented, then we look at why, and termination is a real option at that point.

Now, from the trainee pont of view, this may seem harsh, but really this is best for everyone. it keeps a trainee from being caught in "limbo" for ever, it clearly spells out the issue without any sugar coating. Some people simply need to know what specifically they are doing wrong, and given step by step plan for improvement. And if the trainee succeeds, then EVERYONE gets to "move on"...including the trainee..into the rest of his/her career.

Your right and we use FTEP as well. Our FTO program is designed to instruct and evaluate. It is not intended to be an Orientation - we have a two week "academy" for that. The FTO's do a pretty good job and they are constantly giving feedback to the trainee. The problem lies in the short time an FTO will spend with a trainee and the set up of the program. The trainee will get a minimum of 10 shifts on FTO, however they will rotate through at least 3 FTO's. In addition the FTO is a "working" FTO so the trainee will be a 3rd EMT on board an ambulance responding to calls.

I kind of have a problem with this kind of set up because it doesn't allow problem solving. I feel they should not be assigned to a working ambulance for their first FTO rotation. That FTO should work on driving, navigating, hospitals, etc. I would rate our FTO program as very good usually. They do a good job of getting trainees brought up to speed. However, we only have about 12 FTO's and we have been in a hiring blitz for almost a year and are continuing to hire. The FTO's have to be getting burnt out. In addition to new hires, they have to do our quarterly CBT's.

This trainee was given to me on a temporary basis (3 weeks) as my regular partner is on special assignment. While I have no formal say so, it is my impression that I was given this trainee to help bring them up to speed and try to fix what the FTO's couldn't. My trainee IS aware of their shortcomings and is making an active effort to correct them, there is just no improvement.

I have come to the conclusion that I will have a heart to heart on friday when I return to work. My gut is telling me that this is a confidence issue and that they are using the senior EMT as a "crutch". I have a plan in my head that I have come up with that I think I will implement and should be fair to them. If it doesn't work then I will be forced to contact our training coordinator with my concerns and see what they have to say.

As I mentioned, I have no intention to embarrass this trainee which is why I am kind of being vague. I know deep down they will be a good EMT. I am going to do everything I can and am allowed to do to make that happen.