Hire Slow, Fire Fast

I'm not sure where I first read or heard the words, "Hire slow, fire fast." I like the concept. It translates quite well to the students and fellow instructors we associated with in the EMS classroom. Allow me to elaborate.

Students

Of course we don't actually hire students. They hire us. But choosing students for your classes in rural communities involves a pseudo-hiring process. Most rural volunteer EMS personnel are recruited to fill seats in EMS education classrooms for free. Maybe you have even taught some of these students. It is not uncommon to start at class of 10 students and end up with less than half that amount completing the training. Here's some free advice for you and your EMS team if you are considering training a few local people for your volunteer ambulance service, rescue squad or fire department.

1. Charge something. People don't value things that are free or percieved to be free. Freebies are easy to throw away (think of the bottle opener, pen, stylus, lobster-bib combo with the star of life logo on it that you got for free at the last EMS conference you attended).

2. Recruit motivated people. If you had to beg them to take the class, they won't finish. A large number of people who successfully complete the course never take the NREMT test. What does your squad gain if they don't test? The answer: Nothing.

3. Make sure they can read before they start. This sounds like a no-brainer. But if you can, have them write a paragraph about why they wish to become an EMS provider. If they turn nothing in to you, they are either illiterate or unmotivated (see #2 above).

4. If all else fails, fire them. Kick out those people who are not performing. Hold them accountable. Once the dead-weight is gone, you can focus on the people who truly want to learn. Think about this: Is it better to have everyone finish the class "successfully" only to have 20% of them pass the NREMT testing process, or would you rather have a few top performers break away from the pack? Personally, I'd rather end up with three superstars than ten duds.

Instructors

EMS Educators are a dime a dozen in North Dakota, South Dakota and Minnesota. In fact, I recently learned that Minnesota has more EMS Instructors than any other state and South Dakota is not far behind per capita. Why? Because they only have two rules about being an instructor. First, instructors must be trained to the level that they will be teaching (or above); and second, they must completed the outdated DOT instructor course. After they have met both of these criteria, they're "good-to-go" forever. No refreshers, no aptitude test, no pulse check to see if they're even among the living. Ladies and gentlemen, the pool is large....but extremely shallow.

Again, applying the "Hire Slow, Fire Fast" doctrine to EMS instructors, here's my recommendations / opinions:

1. Don't teach what you don't know. Instructors should start out slow. Try BLS before jumping to ALS. I can't tell you how many first year paramedics I turn away from our ACLS and PALS instructor courses. They are not ready. And what do they do when I turn them away, they find someone who will rubber-stamp them an instructor card in whatever discipline they desire. Greed is alive and well and the most novice EMT or paramedic can find someone who'll bless them with instructor certifications for a price. Is this good for patient care or is it just a budget move (we can teach it ourselves for less money and don't have to hire experience)?

2. Fire bad instructors. If you oversee EMS instructors you need to observe them teaching, look at class evaluations, audit their pass rates and educate them. If all fails, get rid of them before they hurt your organization.

3. Never make someone become an instructor. Many instructors teach because no one else on their squad will do it. Does it seem like a good idea to force someone to teach others just because they have the time to do it or they can be pressured into doing it? If you have a choice between buying a new squad jacket or paying for training from an expert; go with the training. It may save you money in the long run. Being competent in the EMS skills is a way to avoid litigation headaches.

4. Experience does not always lead to good instruction. Just because someone has been an EMT for 29 years doesn't mean they will be good teachers. Some people are just not cut out to be teachers. Unfortunately, they permeate our society. Did you ever have a teacher in high school that was really bad? Think about the classes where you've learned the most. Now think about the instructor. Was there a correllation between what the instructor did and how you performed? Good or bad, there usually is.

One final note: We will never improve EMS instruction until we hold EMS educators accountable. Recent rules changes in ND and MN have raised the bar a bit by addressing pass rates. This is only a first step, however, and more needs to be done to elevate the profession. Check out the national trends towards this effort at the National Association of EMS Educators website at naemse.org.


Those who can, do. Those who can do more, teach.

--Sherm