8 ways FTOs can make EMS field training better

Be the person you needed when you were new and set a positive example on every shift

We were all new to EMS once – we all had a first day. We all sat in front of our first EMS station, not knowing what was waiting for us when we jumped on that ambulance for the first time.

Most people have stories about their first field training officer (FTO): some good, some bad and some that may leave them scratching their heads. Being a field training officer is one of the most rewarding jobs in EMS, as you can positively impact the career life of the new trainee in so many ways. It is also, at times, one of the most stressful, frustrating and mentally taxing jobs as well.

Here are some tips I have learned along the way to ease some of the stress and frustration from both the FTO's and the trainee's perspectives.

Your first day together is like a very long first date. Openly talk about pet peeves, expectations, learning styles, how your trainee likes to receive feedback and any quirks you may have. The first thing I typically warn my folks about is that if I look mad, it is probably just my face – I’m not really mad!

We also talk about my expectations for keeping the ambulance clean and for focusing on safety, such as seatbelt use and proper equipment storage. We discuss that we treat people and not just patients, and that we do things for people, not to people. Remind them that you are there to support them and want them to succeed. I tell new trainees not to focus on what they may think I want them to do, but to treat the patient as they see fit, and to let their training tell them what to do.

If you don't have these conversations early in the process to lay out the fundamental expectations, the experience can quickly turn into frustration that will only get worse over time.

Just because it's not done your way, doesn't mean it's wrong. There are just as many personalities in your department as there are people, and not everyone is a robot who does everything the same way – but that's OK.

You can share ways to do things more efficiently, but as long as the end result is right, it is usually best to just "let it ride" and discuss it after the call. Much like in parenting, it is best to pick your battles and focus on the big picture. Nitpicking and micromanaging lead to insecurity and unnecessary stress, plus you, as the FTO, will be exhausted.

Some of the biggest challenges I see between FTOs and their trainees is when the FTO cannot stand back and let the trainee function in their role. This is often due to insecurity on the FTO's part, or simply our Type A, take-charge personalities. To be an effective FTO, you need to be able to truly step back and trust in your judgment that it will be OK.

The caveat is, if the trainee is not providing the proper care or is about to do something unsafe or that might harm the patient, of course the FTO will need to intervene. If the patient looks like a STEMI patient, you will probably want to go ahead and apply that 12-lead EKG; if the patient needs CPAP walking through the door, start setting it up and see if your trainee quickly recognizes the need.

Sure, the trainee needs to know the medicine and treatment protocols, but you are teaching them so much more, whether you know it or not. You are showing them the culture of your department in how you act, how you talk to them and how you treat those around you.

Setting a poor example not only negatively reflects on you, but your agency as well, and will most certainly set them up for failure in the future. Be the person you needed when you were new and set a positive example on every shift.

We all know the old saying, "if it isn't documented, it didn't happen." The point is that documentation is an essential part of patient care. Some trainees may be good clinicians but not so great at documentation. Those who struggle may need to pay even more attention to the clinical documentation, and the FTO may need to spend more time on documentation with these trainees.

From the standpoint of FTO documentation, you should document:

Always keep supervisors in the loop when things are beginning to go poorly, and let supervisors also know when a trainee is doing very well.

If a trainee asks you something you don't know, don't make up something that you think makes you sound smart. They will see right through you and your credibility will be shot. Be willing to learn, be willing to admit your weaknesses and faults, and grow with each of your trainees. A little humility goes a long way. Never stop learning and never stop growing as a person.

Telling people that they are not performing well is hard. My rule is "no surprises." We will have open and honest conversations on ways for the trainee to do better, and for the trainee to tell me what I can be doing better for them.

Negative feedback should always be given with respect and include a plan on how the trainee could have done better. "You really blew that call" is not constructive. "This is how I would have handled that differently" allows for a conversation, and the opportunity for learning and growth.

Our jobs are inherently stressful. You as an FTO should not be creating undue stress in the way you deliver feedback. There should be no false illusions about a trainee's status, and never just push it off onto the trainee's next FTO.

At the end of a work cycle, I typically have a conversation that summarizes that block of time. We discuss how they feel they performed and how I think they performed.

I ask my trainee if there is anything I can be doing differently or better for them. Am I providing enough (or too much) feedback in a way that works for them? In these conversations I like to focus on the positives more than the negatives, so they have a chance to enjoy their break and come back to work refreshed and ready to face the next shift.

I like to make sure that they are doing something not-EMS related on their days off – they need to take a break and recoup.

As a field training officer, you can be someone a new provider strives to be like one day, or as a cautionary tale, an example of someone who they don't want to turn into. Remember that good communication is often the key to easing frustration, and that taking care of yourself is just as important as taking care of your trainee.

We were all new once, we all have had a first day, so strive to be the person you needed when you were new to the profession.

How many field training officers should an EMS agency have?

It's better to decide how many current employees would make great FTOs instead of letting the number of new hires determine the number of FTOs needed

John Sammons is a paramedic/field training officer with Wake County EMS in Raleigh, NC. He has been in EMS since 1999, when he started as an EMT in Cape May County, NJ. Over the past 10 years with Wake County, he has served as a field training officer, a lead paramedic instructor, relief district chief and relief advanced practice paramedic.