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This week’s episode (with a new intro!) of EMS Office Hours, Jim Hoffman and David Aber, discuss job requirements in EMS. Toward the end of the show I joined the show.
Have A Heartbeat? You’re Hired.
What does it take to get hired in EMS?
Are the requirements for police departments relevant to EMS?
Are the requirements for fire departments relevant to EMS?
Early in the show, Jim mentions that the requirements for FDNY (Fire Department of New York) are different from the requirements for the voluntary hospitals (a NY term for hospitals that are not run by the city and provide 911 ambulances).
Are the FDNY requirements relevant to EMS?
What kind of physical fitness requirements should there be for EMS?
Greg Friese of Medical Author Chat, Everyday EMS Tips, and the EMS EduCast loves to run, but I don’t think he will tell you that it is good as a job-specific assessment of fitness. The most important part of any physical fitness routine is that we not hate doing it. We hate enjoy different things.
Does running/jogging a certain distance have anything to do with EMS job requirements?
No, but it is the only surrogate that some of us can think of, so it becomes the standard for cardiovascular fitness for that organization. What would be better, or more specific to the demands of the job?
There are several purposes of these requirements. To protect the organization from paying for lost time and for medical bills. To be able to hire people who will be productive for a longer time. To be able to do the job safely without needing to call for help frequently (being smart enough to know when to call for help is not a physical fitness skill).
Where does EMS run into fitness problems?
Ability to deal with these circumstances are what we should be looking to assess.
For example –
Performing 10 minutes of continuous chest compressions, with excellent quality, for 10 minutes (without any breaks). This is more than what would be required on scene, but testing should go beyond what is routine. This also provides an excellent opportunity to stress proper compression technique.
Carrying all of the equipment up 5 flights of stairs, running a scenario, then carrying a 110 kg patient down in a stair chair (preferably with a supervisor on the other end of the chair. After a break, carrying the same patient up a couple of flights of stairs. Maybe the lead paramedic, or whoever determines what goes in the bags/boxes, will demonstrate for candidates and have the opportunity to re-evaluate the necessity of what is in the bags/boxes.
Supervisors participating in this can help the candidates with technique (an important part of every supervisor’s job) and demonstrate that they can do the same job as everyone else. Supervisors also have to maintain fitness to be able to do this. Some of the best use of a supervisor on scene is to have them move equipment. They can switch and do the patient care, or they can carry equipment, but it is usually better for continuity of care for the supervisor to be the schlepper.
Lifting patients in different conditions. We are never supposed to lift and turn at the same time, but our patients do not present in ways that allow us to avoid lifting and turning. What kind of equipment do we use to help lift patients? A sheet may be the most useful, but most ignored piece of equipment we have. We can tuck it under patients with much less irritation than a backboard, reeves, or other devices, but how many of us are trained to use a sheet well? There are commercial devices that have handles built in, but many of these patients have been immobile for longer than their bowels have been immobile, so the ability to just throw the sheet in with the rest of the soiled linen at the hospital is a plus. Simple knots can be used to create hand holds on a sheet to make it easier to get a grip.
And what about ethics?
How many EMS organizations have any kind of ethical standards?
If they do have ethical standards, are the standards really ethical, or do they just represent an oath to always follow orders, no matter how unethical the orders are?
We should have hiring standards that go beyond a patch, a pulse, and a license to drive.
What kinds of physical exams have you seen?
What kinds of physical exams do you think would be better?
With fire fighters, we are supposed to assess for ability to return to fighting fire, but in the current heat wave, are there any requirements to assess EMS for the ability to check for physical exhaustion? Are there any requirements to provide crews with adequate fluids for working in the heat?
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It is true I love to run.
Bryan Fass is the person I would check with about pre-employment fitness testing and ongoing testing for EMS professionals.
My agency has a pre-employment physical abilities test that is job-related and has been validated by an outside resource. It was invented by the folks at MEDIC in Charlotte and they will give you the information if you ask. A pulse is a good idea.
The “patch” should indicate a certain level of clinical competence. Unfortunately, it does not. State EMS offices are typically driven more by politics (read, whining of people who oppose high standards) and are not supported by folks who want to make things better. So, while clinical requirements should be stronger and tests should be harder, don’t look to the state to make that happen. You have to do that at the agency level.
How about background checks? If you want to see how it should be done, go to the California POST (police officer standards and training) site and download the Background Investigation manual. See what every police agency in California has to do before hiring a new police officer. While in EMS we should do the same, OR MORE, most agencies would choke on investing this level of resources. Why? ‘Cause, I think, we’d rather not know.
Unfortunately, the legal standard for most of the employer negligence stuff is “KNEW OR SHOULD HAVE KNOWN.” Emphasis on SHOULD HAVE.