Hands-On Training in an Internet World

by Joseph Cahill

Because so many educational programs are now being offered online, today’s busy professionals have the opportunity not only to learn at their own paces but also at the times and locations that are most personally convenient for them. Many state, regional, and/or local oversight agencies – as well as many employers and the National Registry of Emergency Medical Technicians (NREMT) – require a minimum number of continuing education (CE) hours periodically (usually every two to three years) in order to maintain certification. To ensure that the CE hours will be accepted by the agencies requiring them, the students should be fully aware of the requirements and pre-approval processes of those organizations and agencies.

The principal goal of professional development training, in contrast, is almost always to gain additional knowledge or skills, usually without certification and/or CE credit requirements involved. In other words, although courses designed for certification and/or CE credit must meet the standards set by certifying or oversight agencies, there is no such requirement for professional development programs – and, as a result, the content and quality of those courses can and do vary widely. However, to ensure that a professional development program is produced by a reputable organization, one strategy used by some agencies and individual trainees is to enroll in CE programs even if additional CE credits are not needed.

The added convenience of taking CE and professional development training online certainly has advantages. However, when considering enrolling in courses for base training purposes, there are some notable disadvantages as well – primarily involving skills training and testing – that also should be considered.

The Basics of Base Training In the United States, the EMS (emergency medical services) professions – emergency medical technicians (EMTs) or paramedics, for example – require that candidates acquire specific certifications. The principal goal of base training is to provide the training and skills needed by previously untrained persons to achieve a specific certification and/or to prepare them for employment. However, a main hurdle that an online program must overcome is in skills training, which typically involves the following four-step process: (1) Learn the skill by practicing in simulation; (2) Test the skill in simulation; (3) Perform the skill during practicum on real people; and (4) Test the skill during a certifying test.

Because pre-hospital medicine is a hands-on task, sufficient provision for skills practice must be made not only to meet the requirements postulated for state certification but also to prepare the student for using his or her newly acquired skills in the real world. By their very nature, however, many EMS skills cannot be completely simulated within the two-dimensional world of the computer screen. Of course, some students may be able to master certain components of a skill online, but exercising that skill on a living (or dying) person provides a completely different experience.

A more viable strategy, therefore, is for program organizers to partner with local agencies in developing the skill training and practicum aspects of the program. However, as with traditional es, the student must be at a set location during a set time. Because many states have specific practicum requirements, a potential student should check with his or her state certifying agency to see that the program offered does in fact fully meet the certifying requirements mandated.

Reasonable Goals: Two Key Questions Before spending the time or money needed for an online EMT or paramedic program, the individual student should ask himself (or herself) at least two questions: (a) “Is there a compelling reason to take the program online rather than in person?” (b) “Does the online training meet my goals?” The first question is one that only the student can answer. To answer the second question, though, each student must first formulate his or her own coherent goals. Following are a few additional details for consideration in relation to both questions:

1. Is there a compelling reason to take the program online rather than in person? There are certain training advantages (as well as a few “prestige” bonus points) in enrolling in traditional room programs. Some states, of course, may allow the practicum for out-of-state online courses to be supervised locally, but the provisions made for skills practice may not prepare students sufficiently for the skills testing required within a student’s state. Moreover, although each skill itself does not change from state to state, the steps that are critical to pass the skill station sometimes do. For example, the intravenous (IV) skill station in New York City requires that candidates clean the site in three specific steps, whereas Pennsylvania protocols simply state that candidates must clean the site. A traditional – i.e., local room – program will better provide such details and train students accordingly.

As an added bonus, there are certain EMT and paramedic programs that, in ways similar to the possession of a Harvard or Yale degree, are so highly regarded that certification by those programs has a much higher value in the job market. After a person is certified and has accumulated some valuable working experience, of course, EMS managers may not care how or where that person started his/her training. Nonetheless, when applying for that first job, online training may not hold the same status as a more traditional and better known “on site” program – particularly one that is highly respected within the EMS community.

2. Does the online training meet my goals? Even when the practicum for an online program can be carried out locally, the school’s own requirements may be satisfied – but that in itself does not guarantee that the state’s requirements for certification also will be met. By contacting the state licensing agency – and, perhaps, a few potential employers – a prospective student can determine if an online will meet the minimum requirements mandated by the state. If those requirements are not met, the agency or employer may review the application either as an out-of-state reciprocity request – or simply as unacceptable for other reasons. When this happens, the students may end up either having to pay additional money to complete requirements that the online es did not meet – and/or, worse, having to start over from scratch.

An additional factor worth considering is that there frequently are local tests, over and above the minimum licensing required for approval to practice in a specific community or locality. Most agencies accept state certification as proof of the training needed to take such tests, but candidates also must be able to demonstrate their skills. The added advantage provided by traditional es is that, by their nature, they are local and will better prepare students for local tests as well as for the state certifying tests.

Without an absolutely compelling reason to obtain training online, therefore, it seems clear that base training and skill sets are often best learned within a room setting. Online es serve as a strong tool for achieving many EMS training goals and those set for other first responders, but students also must be aware of their own personal goals and the potential limitations of the training routes available to achieve those goals.


For additional information on: The National Registry of EMTs CE requirements, visit

FEMA’s professional development training, visit

________________________ Joseph Cahill is a medicolegal investigator for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Prior to that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s Paramedic Program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.