A needs assessment in the region of Tuscany showed that skills training amongst non-physician pre-hospital workers (“rescuers”) was not standardized. In order to improve rescuer preparedness and, ultimately, pre-hospital patient care in the region, a joint collaboration between our Department of Emergency Medicine and the University of Florence, Italy, was formed, and named the Tuscan Emergency Medical Services Initiative (TEMSI).


HMFP worked with the regional health system, through the University of Florence, to plan and implement the following critical actions:

  • Define the mission of TEMSI as the delivery of safe high-quality, patient-centered care in the pre-hospital environment through standardized training of pre-hospital care providers.
  • Create content and curriculum for a 160-hour pre-hospital skills course which combined clinical lectures, practical workshops, high and low fidelity simulation and debriefing exercises, and pre-hospital provider research and community building initiatives.
  • Conduct a 6-day training course for course instructors and leaders.
  • Provide regular skills workshops with skilled paramedics from some of the best ambulance providers and educators in the US, introducing new methods and techniques.
  • Provide regular support for course leaders and instructors as they worked through this transformative change in pre-hospital education.
  • Design and oversee practical and written exams that adhere to the new TEMSI standard.
  • Successful completion of the first 160-hour TEMSI course in 2012
  • Successful completion of the second 160-hour TEMSI course in 2013
  • Creation of a standardized TEMSI practical and written exam process
  • The graduation of over 100 professional rescuers from the TEMSI program