Please don’t KISS me: Training to minimum standards is not enough
Fire and EMS professionals must go beyond the “how” to understand the “why” of every technique and tool in our arsenal
If you have ever participated in any military or public safety training or education, then you have probably heard someone say, “Keep it simple, stupid!” This mantra has been circulating for decades, and it seems to hold universal approval from students and instructors.
The idea behind “Keep it simple, stupid!” (KISS) is that the training and education should focus on the practical without the complications of “what if” contingencies. This educational philosophy infers that teaching the least capable member to a minimum standard is more important than exploring any subject in depth. At a minimum, KISS makes students and instructors feel good about hitting the highlights of a topic that are necessary for a particular job or task to be accomplished. But, does this philosophy extend to modern fire service and EMS topics?
Certainly, the American Heart Association and other national professional groups that are charged with training people regarding emergency medical issues have simplified their messages over the years. You need look no further than the current CPR algorithm to realize that it is far more straightforward than versions published 20 years ago. The current algorithm is circular and does not seem to include any critical decision points. So, maybe KISS can be applied to emergency medicine topics. However, a glance at the current algorithm for tachycardic dysrhythmias reveals that there are still many critical decisions to be made during a medical emergency. So, when should our teaching include complex foundational and background topics and when should we only concentrate on the highlights?
The intended audience is a key factor. When we are attempting to teach citizens how to perform CPR, then the more direct, simplified strategy seems to be appropriate. We want to teach as many people as possible the life-saving techniques of CPR without losing anyone in an attempt to explore the nuances of electrophysiology.
But should EMTs be educated with a task-oriented KISS mindset? After all, most of their job responsibilities are psychomotor in nature. Does it really matter if an EMT understands the how or the why? What about fire tactics? Isn’t it OK to teach new firefighters to spray water into a structure fire before entering to cool the environment as part of a transitional attack? What if the new firefighter doesn’t understand flow path science?
I often hear new hires at the fire station asking the veteran firefighters and officers about things that they don’t quite understand like fire flow path and the cardiac conduction system. Almost universally, the new hires are told not to worry about it. “You don’t need to know all that! Just do what we showed you,” seems to be the standard reply. This attitude is certainly a result of the KISS educational philosophy.
Our department has an EMS continuing education program that brings in physicians to teach on key CE topics. The physicians usually provide an expanded degree of foundational medical knowledge to whatever EMS topic is being discussed. I frequently hear comments during EMS continuing education classes such as, “We’re just stupid firefighters. We don’t need to know all that.”
So, is it true? Do we need to know “that”?
Recently, I was tutoring a young firefighter who is having trouble passing the NREMT cognitive exam at the EMT level. I asked him to explain to me what he knew about albuterol. He replied, “It’s breathing medicine.” I asked him if he knew how it worked. He replied, “You give it to patients that are having trouble breathing. You squirt the liquid in the little bowl of the mask and then you run the oxygen at 6 or higher.” This firefighter has been well-trained on the psychomotor aspects of administering albuterol. But, when I asked him if he knew that albuterol was a sympathomimetic that was a Beta 2 selective agonist, he looked at me like I was from another planet.
I explained that albuterol dilates the bronchioles but also increases the patient’s heart rate and the heart’s demand for oxygen. So, you should only give albuterol to patients who are wheezing. Other patients, such as those having difficulty breathing because they are having a STEMI, can be harmed by albuterol. He was astonished. He is the product of the KISS educational philosophy.
Fire and EMS leaders do a pretty good job of instilling a good work ethic in their members. This is true when it comes to physical labor at least. The problem is that our profession has become increasingly complex, and it requires physical, intellectual and emotional labor. The public expects us to be competent as firefighters and as EMS providers.
Our job is increasingly dynamic. Our service now carries over 25 emergency medications, including ketamine and TXA. We routinely use waveform capnography. We have video laryngoscopes and cardiac monitors that cost as much as a new car. Our fire suppression gear is top notch complete with 45-minute SCBA bottles and thermal imaging cameras. All of these technological advancements have increased our ability to help people and the potential for us to inadvertently harm our patients and/or ourselves.
Fire and EMS professionals must go beyond the “how” to understand the “why” of every tool and technique in our arsenal. So, maybe it’s time that we stop tolerating intellectual laziness in the same way that we don’t tolerate physical laziness. Our job is not simple, and we are not stupid. So, please don’t KISS me!
Editor’s note: How do you feel about the KISS educational philosophy in fire and EMS? Share your thoughts in the comments below.
This article, originally posted in June 2021, has been updated.