As a volunteer EMT working rural and frontier EMS, or a suburban volunteer who picks up one shift a week in a low volume service, getting enough field experience to become a confident provider is challenging. And truthfully, paid EMTs in low volume agencies can have the same difficulty.
I have experienced this my entire career as a proverbial “white cloud.” My personal record is 11 consecutive 12-hour shifts over 3 ½ weeks without a call. Not so much as a refusal or even a standby.
Challenge of low call volume
Infrequent response gets under your skin, unless you’re one of those “earn money sleeping” types. For the rest of us, who strive to give every patient our best effort, low call volume can create angst and uncertainty. You obsess over letting your patient and your agency down, concerned that you won’t be up to the task when you encounter “the big one.”
At that point, insecurity sometimes becomes a self-fulfilling prophecy. You fear that you will look and feel incompetent, and so you will be, lost on scene giving the patient what ALS providers call the “stare of life,” too paralyzed to obtain vital signs or manage an airway.
Other EMS volunteers experience and feel the challenge of low call volume. An attendee at a recent EMS conference told me:
“Our service only runs about 50 calls a year and they tend to be pretty serious. If we can’t get a full crew, mutual aid is at least 45 minutes away, if available at all. I love giving back to my little community and having that chance to help someone in need, even though it’s rare. But I struggle with self-confidence. I worry about making mistakes. Sometimes I even wonder if I should keep doing this. I am usually the first person on scene, but I have only run 10 calls on my own since I became an EMT in 1986.”
The growing anxiety about competence is often the reason members become increasingly less available and eventually quit EMS altogether. Few people want to show their hand and admit insecurity or lack of confidence to their peers. When they leave, they take their secret with them, often giving an excuse like, “I don’t have time anymore.”
What gets measured gets managed
So how do we fix this? Here is one way to get started.
Begin with an honest assessment of all the responders in your department. Identify the strengths and weaknesses of each person, and then the organization as a whole. Establishing priorities helps direct an action plan focused on specific training goals. Although this may seem like an overwhelming task, there is a simple and effective means of getting it done.
SWOT your EMTs
A SWOT Analysis is a simple tool used to identify Strengths, Weaknesses, Opportunities and Threats. It is most often used in organizational assessments, but also lends itself well to individual assessments. The SWOT should be a dynamic process used first to establish a baseline, and then to continuously measure improvement. As items in the weakness column are crossed off or converted to strengths, confidence naturally follows.
Here is an example of how a personal SWOT self-assessment might look:
Member: Fills out strengths and weaknesses.
Threats: Determined by training officer/chief.
Opportunities: Should be discussed in a meeting for everyone and should address both individual needs and those shared by the agency overall. Based on a SWOT analysis of individuals (see EMT Suzy Sweet’s individual SWOT) and the organization this is an example of opportunities.
1. Pediatric training: Most of the group needs or wants more pediatric education. This is an in-service training opportunity.
2. One-on-one training: EMT Sweet and training officer will review blood pressure skill.
3. Increase scenario-based training: If one person admits a problem, there are probably also others who need practice. Build in hands-on use of all equipment into scenarios. During training members will use the stretcher, stair chair, Pedi-mate, suction, airway adjuncts.
SWOT is positive, non-judgmental process
Successfully using the SWOT is entirely dependent upon achieving buy-in. When self-assessments are graded or tied to pay raises or promotions people can be anything but objective.
To foster an honest individual SWOT assessment, you need to be very clear that this exercise is a positive effort designed to help each member achieve his full potential as a competent and confident provider, and for the organization to provide the best of care to the community. If your members truly believe that the purpose of the SWOT is only for personal improvement, not to be singled out for condemnation or judgement, those providers who lack confidence will feel more comfortable admitting to specific areas of concern. They then can also focus on recognizing their individual strengths. Choosing to share that you are unsure or uncomfortable with a specific skill or clinical component feels better than hearing criticism from other EMTs. And there are few things more effective at building confidence than to be reminded of what you do well.
Dunning-Kruger
In almost every organization there is ‘that guy’ who seems unjustifiably overconfident despite clear evidence of incompetence and is surprisingly lacking in self-awareness. This is known as the Dunning-Kruger effect. Typically, this is a member who is openly critical of other EMTs, comes off as a know-it-all and can be difficult to work with. This type of person contributes to creating self-doubt in other EMTs and can undermine the success of those who are working together as positive force multipliers.
Because the SWOT process encourages him to recognize his weaknesses, it demands introspection. The SWOT then gives the leadership a chance to counsel him on his role in addressing the threats and opportunities that face the entire organization, and develop him as a team player. Ultimately, however, if this strategy does not work, be prepared to ask him to leave.
Invest in EMS volunteer success
Use the combined results of your individual member and organizational SWOT analysis to prioritize upcoming training and continuing education focused on the clinical areas and skills most important to your members. Collaborate on creating training and educational opportunities that are realistic and challenging, and make them interesting and fun. When members are given the opportunity to participate in the development of an action plan, they become more engaged and invested in its success.
