Rory Miller over at the Chiron Training blog engaged me in a conversation on experience thresholds within our respective professions, and asked me what kind of experience thresholds an EMS provider might through during his professional growth and development.
The primary separation between thresholds would be the ability to make quick decisions, develop coherent plans, and execute them in challenging environments; but I also think it's important to consider emotional fortitude, attitude, and awareness of the world around them. I suspect these thresholds would be highly specific to American and Western cultures that are not routinely exposed to war and the ugliness of humanity and death. In visualizing these thresholds I see them not with clear demarcations, but as one color that gradually blends with and fades into the next color. I do not believe that a provider with no real accountability on the team progresses through these steps in the same manner as would a provider who is regularly in charge. I'm not sure I can articulate why I believe that right now, but I see it with some EMTs and nurses who are never placed in charge of a team. Also, many new providers seem to take a sort of spiritual attitude toward the profession, but for some reason providers in the fire fighter culture retain this spiritual brotherhood thing for a lot longer than other EMS providers. Because of this micro-cultural dynamic I have not made it a primary consideration in the following categories.
For this purpose I consider a critical event to be anything that might generate a CISD, such as an emotionally traumatic call, assault against the provider, or a line of duty death of a coworker.
Threshold I: Brand new.
The provider has little or no experience, and is unable to recognize serious situations or make critical decisions. Standard EMS education has prepared him poorly for real field work. At this stage, the new provider is eager, excited, idealistic, and dogmatic, and has not yet developed the psychological coping mechanisms necessary to handle emotionally difficult calls. In fire fighter culture, this person would be struggling for status within their tribe. Other aspects of EMS culture have more of a more lone wolf, produce or parish style to them, and tribal status is not often as big of an imperative for the brand new provider. In retelling the calls he's been on, the brand new provider might ham up the details a bit to sound more experienced.
Threshold II: Some experience. One or two critical events. Loss of innocence
The provider is able to function but still freezes in some new situations. He is possibly still excited and idealistic about his profession, but is beginning to realize that the job is not really about helping people, and is more often instead about your superiors getting money or political power. He is realizing that humanity is ugly. The provider has been through a couple emotionally difficult events, but perhaps still lacks the emotional self-defense skills to fully cope with what he's been through. The shitty culture of the moderately experienced providers tell him that if he can't handle it he should quit and find a different job. Being the medic in charge at this stage is terrifying. The provider is still too new to be teaching others, and should not be permitted to teach others.
Threshold III: Moderately experienced. A handful of critical events.
The provider is comfortable in most situations, but still needs help figuring things out from time to time. He has not seen everything, but has seen much of what the profession has to offer. Some anxious fear still lingers. He has no illusions regarding what this job is about. Emotional coping skills take the form of bitterness and detachment. The provider might try to teach others, but should not be teaching at this point.
Threshold IV: Experienced.
The provider is able to take command and make decisions confidently and competently in unfavorable conditions. Patient care and situation management are natural actions. There is no real anxiety or fear about the unknown any longer. The provider has seen most of what the job has to offer, and adapts to new situations readily (not to say he has seen it all, but rather he has seen enough that freezing is no longer a reaction to new situations). He would be a competent instructor or leader if so inclined and skilled in those areas. The provider possesses good emotional coping skills. He is able to explore and grow within his role.
Threshold V: The crossroads.
Providers at this stage are at a crossroads. Many appear to be bored, unchallenged, and cynical, but a few remain well respected by others in the profession. The provider can choose to be a burned out field medic, or take on leadership roles to better their surroundings. Regardless of the pathway chosen, these providers have a wealth of experience and are highly competent, even though many of them have a tendency to lean on old practices.