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Too Much Information For a Paramedic?

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This is a coordinated post by our friends Greg Friese and Steve Whitehead.

 - Greg’s post on this topic can be found at: http://www.everydayemstips.com/?p=3628

 - Steve’s post on this topic can be found at: http://theemtspot.com/2010/08/25/too-much-information/

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“They Don’t Know What They Don’t Know”

It’s an established fact that 60% of fatalities within confined spaces are would-be rescuers. They see someone down in a confined space, enter the space, and are overcome by the conditions that took down the initial victim. The process sometimes repeats itself, with multiple would-be rescuers entering the space and falling victim themselves. It’s tragic really, but the cold, hard fact is that these people are victims of their own ignorance. They don’t know what they don’t know. They don’t know that there is a fatal set of conditions within the space, and they don’t know that whatever it is that killed the first victim, or subsequent victims, will kill them as well. It’s a well documented phenomenon that plays on the compassion of the would-be rescuers and ends up getting them killed.

They simply don’t know what they don’t know.

Hey Guys?? Guys?

So when I was approached by our friend Greg Friese from www.EveryDayEMStips.com the other day regarding a comment he received on one of his training articles, I was interested in doing a co-post with him. He also has contacted our friend Steve Whitehead from www.TheEMTspot.com and together we’re tri-posting on this issue. Their links will follow below and are just great as always.

The comment that followed this online training article was written presumably by a paramedic. It was a critique of the article that simply stated “too much information for a paramedic”. I read that, and immediately thought of confined space incidents, where ignorance can get a person killed. Lots of situations fit that scenario and it’s not always the rescuers who get killed. EMS providers who “don’t know what they don’t know” can and do kill patients. More often, they don’t provide the best possible care.

There’s this thing that we have made it our business to know how to repair. It’s called the “Human Body” and if you’re reading this article, the chances are good that you possess one. The human body is VASTLY complex. It’s the most complex machine we humans know about and we are still learning about it to this day. There are some amazingly smart people out there who have dedicated their lives to studying these meat machines that our brains pilot around and they still haven’t figured everything out yet. We can help set it back on course to heal itself in a lot of cases but we can’t construct a new one. We don’t know about all the minutia, the microscopic works inside of it that make it do all of the amazing things that it does. The levels of systems within systems that function seamlessly within still other systems are numerous and fascinating. I learn something new about it all the time, and still there are people who know vast amounts more about the inner workings of it and about the huge number of things that can affect it’s operating effectiveness than I do. The human body is remarkably complex yet elegant and perfect in its design.

C'mon... Don't be a wuss.

And we who call ourselves “medical professionals” are well advised to study every possible aspect of it. Consider it your “life’s work”. If your job is to fix and support the end users of the human body, you darn well better know everything you can about it.

“But”, you say, “There are people out there who are supposed to know much more about the human body than we are. They’re called Physicians, and they get paid a whole lot more than we do. We’re just paramedics. (or EMTs).” And you’d be right for saying that, of course. Physicians have the ultimate responsibility for knowing the human body. It’s their life’s work as well. Their patients live and die based upon their knowledge, skills, and talents they have for examining the human body and being able to figure out what’s going on. Their whole practice is based upon their knowledge, skill, and talent. The more they know when they’re working there, the better provider they are.

It’s that simple, and it’s exactly the same for us EMS people. The more we know, the better we are. Nobody is better served by dumbing us down. Nothing is gained by denying yourself knowledge. Not a single patient is better served by you not knowing everything you can know about what is going wrong with them and it’s your duty to learn as much as you can about what you’re supposed to know about.

What is the line for how much paramedics “need to know?” Is everything that we need to know covered by our initial training course? Is that everything we need to get out there in the world and start slinging IVs and Meds all willy nilly?

I look at the paramedic license as a “learner’s permit”. It’s the baseline knowledge level needed to function at that level under supervision. It’s a jumping off point from which the provider should immerse themselves in knowledge. I can certainly say that I’ve learned volumes past my initial certification and that the “extra” knowledge has saved lives. Did you know that Fentanyl can cause chest muscle tetany when administered too rapidly? Or how about that lasix, when pushed too rapidly can cause hearing loss?  Do you know that ST depression in the high V leads can signify a posterior MI? What about differentiating an acetabulum fracture from a “pulled groin”? Can you reliably predict the patients whose blood pressure is going to crash after Nitroglycerine administration by reading a 12-lead EKG? What about the clinical presentation of a non-ST elevation MI? Do you know the MEND stroke screen? What about the different neurological exams to find an intracranial bleed?

Etcetera, etcetera… The point is, there isn’t a cut off. The final exam we take for our licensures prepares us with the baseline knowledge to get out there and learn what it takes to make us truly great EMS providers. The true professional will learn this, and constantly seek the knowledge he or she needs. The average to sub-average provider will comment that they “don’t need to know” something.

Get out there, get fascinated, and learn as much as you can. It will never be enough knowledge… but your mind is a sponge for a reason.

Study Hard. Know Your Stuff. No Excuses.

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This is a coordinated post by our friends Greg Friese and Steve Whitehead. Be sure to read their posts on this

Greg’s post on this topic can be found at: http://www.everydayemstips.com/?p=3628

Steve’s post on this topic can be found at: http://theemtspot.com/2010/08/25/too-much-information/

Posted by Ckemtp on August 24, 2010 • Filed under: EMS, EMS Motivation, EMS Topics, EMS ethics, EMS practice, EMS rant, EMS training, Emergency Medical Services, Paramedic, Patient Management, Training & Development, Uncategorized, change, ems education, paramedic education, training-fire-rescue-topics

EMS: Is what you do the Best You Can Do?

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Not too long ago I was reading an article in Entrepreneur Magazine when I came across an article speaking on negotiating tactics. I wish I could find it, but unfortunately it was long enough ago that I’ve disposed of the printed issue (I subscribe) and cannot find it on the web. It was a good article and it taught me some words that I’ve since used quite a bit in my own life:

“Is that the best you can do?”

From the time our parent’s first put us out there in the world most of us have probably been told to “Do our Best” when we try to do something. No matter if we win or lose, we’ve been told that it’s ok as long as we “do the best we can” while trying. We seem to feel better at the outcome of almost anything if we feel that we’ve “Given our best shot” when we try to accomplish what we’ve set out to do. We all like to do our “best” and we hope that our “best” will be good enough.

This begs the question… is what you’re doing today in EMS “the best you can do?” Career wise, operationally, with your service’s treatments, with your own personal training and education, and with your own attitude… is this really “the best you can do?”

I would like to think that I “try my best” in my own EMS career and paramedic practice. I would also like to think that I work for an EMS organization that is trying to do the best it can for its people and its collective patients. However, there are quite a few situations where I have felt that I have not done or have been prevented from doing my best for a number of reasons. Some are reasonable and others are not. I’d think that all of us would give the answer that we always want to provide every patient with our “best” possible care. However, I’d also guess that everyone reading this can think back to any number of situations where they feel that they didn’t give it. Sometimes this reason comes down to the skill set of the individual provider. This could be a situation where the provider didn’t have the best possible information or knowledge available to them. They may have provided an ineffective or even harmful treatment modality or might have failed to act upon a missed assessment finding, such as by giving a medication for which a patient has a documented allergy because the provider didn’t know or simply forgot that the patient had the allergy. Sometimes the actions of others in the organization can prevent a provider from rendering the best possible care. This could be by failing to check, clean, or restock a needed piece of equipment or by providing inadequate care prior to a provider assuming patient care such as in the case of a first-responder crew failing to place a patient in full c-spine precautions when indicated prior to moving a patient to the transporting ambulance and the transporting EMT not having enough manpower to safely immobilize the patient. Sometimes the organization can hinder an EMS provider from doing his or her best by doing things such as providing inadequate equipment or medical protocols, or by mandating that a provider regularly work past exhaustion-level hours.

People inherently want to do well at whatever they choose to do for their careers as well as at other tasks where they feel strongly about the outcome. I may have accepted that I’ll never be as good of a basketball player as Michael Jordan, nor the same-level of cartoonist as Scott Adams, nor the best noodler in the world… but I’m certainly going to try to be the best paramedic I can be.

THIS guy, however, may be The Best Noodler In the World

Sometimes our own personal biases prevent us from doing the best we can do and for this I’m not talking about bias regarding any protected classes or topic, rather I’m talking about our own version of the status quo. A personal example of this would be my ALS Quick Response Vehicle at work. We went a solid week without having the proper forms available for the daily equipment checks and I didn’t have the computer access to print more off. During that week, I got in the habit of not using the forms and simply checked the truck based upon my knowledge of what was supposed to be in there and what was supposed to be checked. The way it played out, I ended up continuing to not use the check sheets when checking the vehicle, even though the forms had been replenished. A few weeks later, someone found that there was equipment missing in the vehicle that had gone unnoticed for some time. At that point, I realized that I had developed my own bias against using the forms for a reason that is even unbeknownst to me. I had gotten in the rhythm of not using the forms, and that caused me to miss that the infrequently-used piece of equipment was missing. I had developed a personal mental bias that prevented me from “doing my best” and thoroughly checking the truck.

Another preventer of best practices can be organizational politics, both internal and external. As a paramedic who regularly responds to other ambulance services to provide “ALS Intercepts”, I have observed that the politics between the services we work with can affect patient care for both the negative and the positive. While I am not saying that any of these arrangements result in inadequate patient care, I can say that the services with whom I interface most frequently and most pleasantly get a better provider out of me than do the services with whom my relations are less frequent or are strained due to political turmoil. When I respond to a request for an ALS intercept, I am being called to the “house” of another group of providers. While I am the highest level of care on the scene, I’m also a guest in their house. They have their own internal biases and I have mine. Sometimes the synergy in our working relationship can be strained, which results in a palpable difference in the flow of the scene and the teamwork exhibited at it. While I will ensure that I “do my best”, it’s easier to do it when I work well with the team I’m working with.

So how do we change things? We’re all human and we all have things that prevent our “best shot” from being the only thing that we “give it” in our EMS careers. This may be consciously, as in the case of internal politics; Subconsciously, as in the case of my not using the check sheet; or Involuntary, as in our service not providing us with needed equipment or our coworkers failing to replace an item in the ambulance that we did not have an opportunity to check. As in most things, the easiest thing for us to change is ourselves. Changing ourselves is a great place to start and will make serving as an example to others your main tool to use to try and get the best out of them.

Most situations can be made better and almost all of us can try harder. The secret is to attempt to do our “best” at all times and to try and ingrain our own best practices into our daily routines. This can be as simple as always trying to check the truck in the most thorough way possible or by making sure that you always check and recheck things to ensure that they’re done right. It helps to continuously seek out and recognize one’s own personal biases, (remember my check sheet?) to make sure that our own preferences and routines aren’t leading to suboptimal performance. Consistently ask yourself if what you’re doing is the “best you can do” and then ask yourself what you can do to make it your best. Mentally prepare yourself for your shifts with adequate rest when possible, manage your stress level so you can keep your thoughts focused on your care, and train hard. Ingrain your best efforts into the systematic way you do things and make your best way your normal way of doing things. We can’t change everyone around us in an instant, but our quiet positive efforts can pay large dividends in how people around us think, feel, and act. Our best may in turn get the best out of our partner, which may in turn get the best out of the next crew, and so forth. Soon enough… deciding to give our best may change your organization, our industry, or our profession.

And I assure you, doing your best will indeed make the difference in someone’s life. It’s just what we do, Folks.

“Is that the best you can do??

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For more on doing your best in EMS and in getting the best out of your EMS people read:  “The Shine Factor”

Posted by Ckemtp on August 19, 2010 • Filed under: ALS Intercept, Administration & Leadership, Ambulance cleaning, Command & Leadership, EMS, EMS Topics, EMS ethics, EMS training, Emergency Medical Services, Fire Rescue Topics, Firefighter, Management, Paramedic, Patient Management, Training & Development, Uncategorized, edemse, politics, pride, profession, professionalism, training-fire-rescue-topics

Automatic Window Roller Uppers and Other “Great” Ideas

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A few years back I had the chance to drive a 1997 Saturn 5-speed coupe for a while. It was a pretty nice car and I drove it back and forth on my tri-weekly 2 hour commute from the Quad Cities of IL to the Chicago Suburbs for my 24hr ambulance shift. It actually worked out well because the pay for paramedics was so much higher in the Chicago area than it was where I lived. I’d go up, do a 24 or a 48 hour shift, and have plenty of time to work my other jobs back home.  I didn’t really mind the drive but I’d save so much money by driving the Saturn instead of my full-size truck that I’d drive it whenever the ex-gf would let me.

One thing about driving the highways around Chicago is the incessant amount of toll-booths that one must cross while driving there. There are literally more toll-booths than I can count and every one of them requires a person to get out of traffic, stop, and pay the toll. It’s annoying in a car with an automatic transmission and even more annoying with a manual transmission. It aggravates me to say the least.

One of the features of the 97 Saturn SL 2 Coupe is an automatic window roller downer (is there a better name for that?) where the window will roll all the way down with just one click of the button. It was actually pretty handy for going through a toll-booth in a car with a manual transmission. I could click the button, then focus on downshifting for the quickest stop possible. This feature is common on cars nowadays, but back in the primitive turn-of-the-century it was my first Automatic Window Roller Downer Feature and I thought it was pretty cool… Except for one problem:

The window only went down automatically, It wouldn’t roll back up with only one click and had to be *manually* automatically rolled back up again. Yes, by this I mean I actually had to use one whole finger to hold the button. It was kind of a minor annoyance when I had to reaccelerate while shifting the manual transmission. Back then I didn’t think it was a huge annoyance, mind you… but I thought that the simple addition of an automatic roller back upper feature would have been much better. I could just imagine that the simple change would make it more useful and I was a tad angry about the shortsightedness of the engineers. I mean, why couldn’t they have thought of this when it seemed so obvious to my 20yo self? If I had thought of it had to be a good idea, right?

Well then some years later, I rented a car that actually had both an automatic roller downer feature *and* an automatic roller upper feature. I was so happy to find that! It was SO COOL! Finally the engineers had listened to my private thoughts that I never shared with anyone and put in my feature! I was happy.

Then I tried it for a while… and it sucked.

Yea, having a “one click” roller upper feature means never just cracking the window open a bit. One click may bring the window down a touch, but the auto feature keeps it rolling down all the way. In the previous design, without the automatic roller upper, this could be stopped by one quick click in the other direction. However, with the automatic roller upper feature, the window just rolls back all the way up! Getting the window open just a little bit is nearly impossible. Then I thought that if a kid or a less-than-intelligent adult chanced to stick their head through the open window and the button got depressed, the window could roll all the way up and choke them. The automatic window roller upper feature is annoying as heck and wasn’t the great idea that I thought it would be. It was an idea that I didn’t think all the way though. I thought I was smart and well, I wasn’t. It’s probably a good idea that I didn’t get all fired up and start a national letter writing campaign to lobby the car companies to put in automatic window roller upper features (Which I would have urged them to rename to “Chris’s Awesome Mega RoLL uPPahhz”) because then I would have looked like an idiot to more people than just myself. It’s the reason why I rarely orchestrate nationwide letter writing campaigns: experience. 

This got me thinking about all of the ideas that I’ve had about things in EMS and in other aspects of my career that I didn’t think wholly through. Steve Whitehead, the genius behind http://www.TheEMTspot.com wrote an article recently that spoke of the fatal flaws in the heroes of Greek Tragedy that I really liked. You can find the article here “8 Tragic EMS Behavior Flaws to Avoid” (I’ll link it at the end too, because you really should read it) but here’s what struck me so blatantly in the article:

The Critic – “This is all so stupid”

This is perhaps the easiest of all the hero flaws to slip into and the toughest to shake. The critic is convinced that the world desperately needs his or her opinions on the way things ought to be.  They figure out that offering opinions is so much more fun and rewarding than working to solve a problem and then it becomes like a drug. Soon they’re framing everything they see with the question, “How should this be done better?” and then offering their sage analysis. Usually with a poor understanding of why the thing is the way it is in the first place.

The problem with the critic is that they genuinely believe that the world wants to hear their endless assessments and when an army of engineers doesn’t show up to start doing the hard work of implementing all their great ideas, they get frustrated. The second problem is that they jump to analysis without seeking to ever understand the nature of the problem. Research and implementation are hard, but critical evaluation is fun and easy. As long as they don’t build anything real, they never have to worry about the next critic showing up, spending a few minutes looking at what they built and offering up their sage criticism.

This is the part of Steve’s article that really got me thinking. Have I been “The Critic” too often in my career? I mean, I don’t try to do this… but I find faults in a lot of aspects of contemporary EMS. I look at things and try to find ways to make them better. If you’re a regular reader, in-fact, that’s probably why you come to read what I have to say as often as you do. New ideas are great.

However, as my Automatic Window Roller Upper debacle (that yes, wholly occurred only within the boundaries of my own cranial cavity) has shown, some ideas that come to me and seem so obvious can also be bad ideas. My experience has proven to me time and time again that I need to think things through. I try, but EMS doesn’t always allow us the time to consider all options, let alone every aspect of every option. The Law of Unintended Consequences abounds and rears its ugly head quite often.

As the years have drug on, I’ve been trying to analyze my “Great” ideas more fully, but one person rarely has the ability to completely devise the correct answer to every problem. Two heads are better than one a lot of the time and systems have a way of developing themselves.

So as we go forth to change this thing we call EMS and usher in the new world of EMS 2.0, let’s remember to consider as many reasoned opinions as we can. We need your input and we need your participation. The more we grow together, the better our ideas become.

Oh, and here’s that link to Steve’s Article again: “8 Tragic EMS Behavior Flaws to Avoid”

Posted by Ckemtp on August 16, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Management, EMS Motivation, EMS Topics, Emergency Medical Services, Fire Rescue Topics, Firefighter, Paramedic, Training & Development, ckemtp, ems 2.0, grumblemedics, inside the mind of a paramedic, paramedic education, training-fire-rescue-topics

Paramedics and EMTs are Special, a salute to the Spork!

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Ah, the humble Spork. At once it is an example of utility and futility. It is well suited to nothing but bridging the gap between the usefulness of its parent utensils and the burden of having to provide a separate spoon and fork. Sporks are great for when you need to have an eating utensil that is suited to a variety of food consumption scenarios but do not have the space nor the gumption to provide separate utensils. Sporks can perform lots of tasks but they do nothing very well. While I love the concept and the fact that the name is *really* fun to say (Spork? Spork… Spork!!), eating anything with a spork is a challenge. I mean, have you ever tried to eat soup with a spork? You’ll end up wearing a percentage of it. Heaven forbid that you have to use it to hold something you have to cut with a knife like a piece of meat. It’s nearly impossible. I suppose that eating salad with a spork would be fairly manageable but not if you have a lot of non-lettucy stuff in the salad like cherry tomatoes, mushrooms, and/or pepperoni. Honestly, who wants a salad that is comprised only of rabbit food? 

Die hard Sporksters, that's who

However, I digress. What I’m trying to say is that the spork, the half-breed malformation of a spoon and a fork, has its place as a substitute for either when it is not economical to provide both. Like its lesser known brother the “knork”, it is a natural idea and a somewhat cool concept. However, there is a very clear reason that the spoon and the fork are separate utensils. There are specific purposes for the design of the spoon and the fork and good reason to have separate tools that are suited to the kind of tasks that they’re used for. The spork is the watered down version of both. It can somewhat perform the tasks of its parents, but not well. It is the “Jack of all trades, Master of none” if you will.

And that is why I’m writing about our humble friend the Spork in my usual rotation of EMS topics. A conversation I had on Twitter the other day with my tweeps @pgsilva and @rescue_monkey brought up the spectre of why exactly ambulances aren’t staffed with nurses and physicians’ assistants and are instead staffed with Paramedics and EMTs. PG and The Rescue Monkey thought that the conversation would make that vein pop out of my forehead like it does sometimes when I get enraged. They were mistaken. It doesn’t make me angry. In fact, I informed everyone that I would write a post on what exactly it makes me think about. This is that post.

The “Why don’t nurses and/or (insert title of healthcare provider here) staff ambulances debate” has a clear answer for me. Here it is:

EMS providers are sporks. We’re also not sporks. We exist in the realm of both the specific and the generalized. We are jacks of all trades and the master of the non-specific. EMS providers are generalized in nature and that generalization is specialized into the random nature of the work in which we perform.

Or women with sporks, you know. That too.

Are you confused? Well that’s understandable. Let’s look at it this way. The ultimate healthcare provider has always been the physician. Since the beginning of western medicine, the physician has always been the healer that people have turned to. Physicians are learned professionals who seek to learn and apply knowledge to the human condition in the name of healing. Physicians are “clinicians” in the fact that they make a clinical diagnosis based upon an examination of a patient and then devise a proper treatment path to treat a patient’s diagnosis. They physician assesses a patient, makes a diagnosis of the patient’s condition based upon their knowledge base and ongoing research, and then uses that same knowledge base and research in order to devise the best treatment possible for the patient. It’s the definition of a clinician.

Nurses, and their modern incarnation as the Registered Professional Nurse (RN) developed as the ultimate assistant to the physician. Their goal was to be the caregiver, the person with enough medical knowledge to continue the care plan and treatment that the physician determined with the compassion and the ability to meet the ongoing needs of the patient. While the physician devoted their efforts to learning and education, the nurse required less education and more compassion. Medical technology and knowledge has expanded greatly and has required the nurse to develop a vast array of knowledge and a myriad of specializations, but their basic function has remained the same. They care for patients in the long term during their convalescence from an illness or injury.

Physicians and nurses have worked in concert. They have developed a system where the sick and injured are brought to them so they may take care of them using the resources they gather together. Each of them performs their role with the goal of making people get better. As knowledge of medicine has increased, different types of physicians and nurses have developed into specialties. The general practitioner acts as a gatekeeper to specialties and treats the most common maladies and is assisted by nurses qualified to care for the largest population of patients. Specialists, such as Cardiologists, Oncologists, and Surgeons, have developed to allow patients the benefit of having people treat them who have sought out to become experts in exactly the illness that the patient may have. The nurses have adapted and have become specialized in their own right, with nursing specialties that complement the specialties of the physician.

However, there is a drawback to all of this specialization. When you have a malady that affects your feet, you would benefit being under the care of the podiatrist. However, you wouldn’t get the best care possible if the only physician available were a cardiologist. The same holds true for the oncologist that attempts to treat your pulmonary condition or for the proctologist who treats your sore throat. While the basic concepts are there, the specialization of focus is not. To be sure, while a person who has graduated from medical school may be able to treat pretty much any condition that you may have at a level that is basically adequate, specialists have devoted their time in the quest of knowledge in their specific area at the possible expense of their knowledge of other areas. This is a good thing, and it’s the reason that pretty much every hospital is full of people with vast arrays of knowledge in singular topics. This system wasn’t designed. Like capitalism the system designed itself. It works and works well, most of the time. However when economics dictate a limited number of available specialties, certain conditions may be left out.

Nurses have done much the same. While the basic concepts are the same pretty much across the board, a School Nurse would have trouble transitioning into the operating theatre as much as the Oncology nurse would have trouble transitioning into public health. Both of them can probably change a bedpan, start an IV, pass medication, or lend a caring smile in the same manner but the oncology nurse would be much more well versed in the management of chemotherapy drugs and chronic pain management than a would be a surgical nurse.

This brings us to Paramedics and EMTs. We are a profession born out of necessity and forged in battle. Really. We can thank Napoleon for bringing forth the first example of the “flying ambulance” which was a brigade of horse-drawn ambulances staffed by medically trained soldiers. They appeared on the battlefield during the Napoleonic wars and boasted that “No soldier lay with undressed wounds for more than a quarter of an hour”. Battlefield “Medics” have always been on the forefront of emergency acute care in the field. While some examples of ambulance care available to the civilian population exist, in the US it wasn’t until after the Vietnam War that civilian emergency ambulance service became popular and seen as a need rather than a nice thing to have. While physicians often made house calls where they travelled to the patient to provide care, in the interest of efficiency they began to confine themselves in clinics and hospitals where they could more efficiently care for larger patient volumes. With the publishing of the “EMS White Paper” entitled “Accidental Death and Disability: The Neglected Disease of Modern Society”  in 1966, the attention of the public was focused on the need for an effort to extend care out of the walls of the hospital or clinic. The white paper laid out statistics of trauma, stated the need for injury prevention and education, and stated the need for standardization of emergency medical training. The US. Dept. of Transportation took up the mantle of the new Emergency Medical Services system due to the alarming number of fatalities on the burgeoning highway system and modern EMS was born.

"Stick a Spork in me, I'm done" should be part of your daily speech patterns

The EMT and the Paramedic are the equivalent of sticking a spork in the problem and calling it done. EMTs were cheap to train, cheap to employ, and could be widely distributed out there in the field. At the time, it was the perfect solution. Train people in how to perform in the first few moments of a severe injury or acute illness and give them the ability to safely transport a patient to a hospital where the physicians could work in concert to help heal the patient. The nurses, in their role as the assistants to the physicians, stayed in the walls of the hospital or clinic and developed within their specialties. The system grew and developed as the innovators in the field saw more and more acute treatments that could be performed by these new breed of healthcare providers and as the EMTs and Paramedics proved themselves in service.

EMTs and Paramedics are clinicians in the sense that we evaluate a patient and develop a treatment plan that we follow to help them. Our specialty is in the acute, the treatment of disease in the here and now. If it’s happening to a patient and it is directly threatening their life, chances are that an EMT or Paramedic can intervene in a meaningful way. Our specialty is to stabilize and stop the progression of the acute disease process or chain-of-events in an injury that will eventually lead to death. We plug holes and we do it with a knowledge base taught to us by physicians. Our generalization is across the entire spectrum of possible patients, from field delivery of neonates, to jumping in to help stabilize patients in outpatient surgery centers, to taking care of the elderly in nursing homes. Whether a patient is crushed in an industrial machine, is trapped in a rural car accident, is having a heart attack on a baseball diamond, or whatever happens to a person wherever it happens to them, the Paramedic or EMT is the person most specialized in coming to their aid. We gain knowledge and hone experience not just in the treatment of our patients’ medical conditions, but also in the environmental circumstances in which we find them. We may be generalized sporks when it comes to treating any possible injury or acute illness across any patient population, but we’re highly specialized utensils when it comes to treating emergency conditions anywhere at any time.

"Sporks and Phasers" would be a good name for a Rock Band

No other healthcare provider fits into our role… and that seems to make us a full-fledged utensil in my opinion. We are unclassifiable into any other role yet indispensable for our own.

And we need to get out there and let everybody know just how special that role is. Nobody has developed the breadth of knowledge in our specialty that we have. We have made the spork our own.

And that, folks is my answer to why no other healthcare professional can quite full our role. While as a paramedic I am competent in the basic skills needed to say, work in a endoscopy unit, I would not function there to the level of a person experienced and knowledgeable as an endoscopy nurse. Neither would they be able to manage a traumatic airway upside down in a crushed automobile at night as well as I would. It’s my specialty to do the latter, not the former, even though the basic skills may be the same.

For more on this, g’head and read “Any Random Person” an older post of mine. Then get out there and shine up your sporks.

Posted by Ckemtp on July 6, 2010 • Filed under: ALS Intercept, EMS, EMS Topics, EMT, Emergency Medical Services, Paramedic, Training & Development, ems 2.0, ems education, humor, paramedic education, politics, potential, profession, training-fire-rescue-topics

Master Paramedics? I’m asking you a question

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Let me ask YOU a question. What do you think about this:

How do we recognize the best and brightest among us? How would we distinguish the EMTs and Paramedics who have earned the respect and admiration of their peers for being “Really Good” at what they do? I don’t mean just a little bit good, or “pretty” good. I mean masterfully good. The kind of Paramedics that Johnny and/or Roy would have wanted to be had they grown up watching them on Saturday mornings. The kind of people that have worked in the profession for as long as they can remember but that never lost the passion for the job. The kind of people who read everything they can, study everything they can get their hands on, and always seem to have the answers to the most challenging of EMS trivia, as well as the most mundane.

What would we call them?

The old trade guilds used to call their most experienced and skilled members “Master”, as in the term “Master Craftsman”. As their members worked through the years and learned the ropes of the trade, they progressed through the various levels until they reached “Master” status. Some unions still use those terms and honestly, I’m unfamiliar with what all of them are. That’s ok with me because I see Paramedicine as a profession and not as a trade, but I do respect their tradition of honoring those that have earned the title of “Master” by thoroughly mastering their craft.

So what do we EMS people do? How would we recognize a “Master Paramedic” or “Master EMT”?

I’ve been thinking about this for quite a while, honestly. As I progress in the profession and in my career path, I’ve seen the people who were my mentors keep working alongside of me. They’re my colleagues now, and although they still mentor me in some ways, they have been progressing along their own paths just as I have this whole time. Some of them have become true masters of the profession. Some of them have not. Some of them could really be called “Master Paramedics” and I would like to know how we as a profession should recognize those people. I see that these people don’t tend to be treated very well by the profession in general and I think that it’s a crying shame. Think about it, new paramedics walk in the doors to the profession and are allowed to work in the same capacity as our master medics within a relatively short time. Employers tend to not want to keep these people around when budgets get tight because these people tend to be on the upper end of the pay scale. In some agencies there’s a defined career path and upward ladder, but in a lot of (and dare I say most) agencies there is not.

So what if there were a certification, or some way to define a “Master Paramedic” and/or “Master EMT”? What would be the qualifications? What would be the benefits? How would we define those people who have earned (Yes, really EARNED) “Master” status?

This is one of the things I’m asking you to think about. If you would please, put some thought into this and write what you think would make a “Master” paramedic or “Master” EMT in the comments section. No, I don’t think that this is silly. I really want to know what you all think about this.

Here’s what I think:

-          Minimum Years in the Profession: The Master EMT or Paramedic should have more than 10 years of FULL TIME service (15 years if volunteer, depending on call volume)

-          Minimum Experience and Type of Calls:  The master EMT or Paramedic should be experienced in a broad spectrum of the different types of EMS. 911 response within diverse response strategies, Medical Transports, and In-Hospital medical care.

-          Teaching and Precepting Experience:  The Master EMT or Paramedic should have experience teaching EMS classes and in mentoring new providers.

-          Command Experience:   The Master Paramedic of EMT should have experience in being in command of different types of emergency scenes and large scale responses.

-          Knowledge:  The Master Paramedic or EMT should have to pass a complex series of tests that show not only rote memorization, but also complete conceptualization and deep background knowledge of a broad spectrum of EMS and Medical related knowledge.

-          Acknowledgement by Peers:  The Master Paramedic or EMT should have the support and admiration of his colleagues, coworkers, and peers and should be able to get them to vouch for him or her when asked.

Now, I also ask you. If you were to recognize a person that could pass the standards that I’ve set, or that you and others set in the comments below, how should we show our respect to these people for their professional achievements? How should our profession honor and acknowledge our highest achievers?

I’m very curious about this issue. Please feel free to add your thoughts.

Posted by Ckemtp on June 8, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Management, EMS Motivation, EMS Topics, EMS ethics, EMS pep talk, Emergency Medical Services, Paramedic, Training & Development, appreciation, ems 2.0, ems education, paramedic salary, pride, profession, professionalism, training-fire-rescue-topics

Mental Quickness – Do Smart Alecks Make Better EMTs?

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Alright, I admit it. Driving to work this morning was a bit of a challenge. We had two inches of fresh snow and the tires in my car are in desperate need of replacement. Yes, I drive a Subaru and usually it’s all-wheel drive does awesome in the snow… but I cheaped out on the tires, and they’re honestly a bit mismatched size-wise. Therefore driving it in conditions even remotely slick is hard as heck. I would have driven the SUV and had no problems at all but the wife had to drive the kid to school and then had to drive into the city afterwards and I wanted her to have the safe vehicle. Who cares if I go into the ditch? Work can do without me if they have to, but I need my family to be safe.

Since I think of things to write about when I drive, this morning brought my thoughts to how hard I had to concentrate on the road and the minute adjustments of the steering wheel and the accelerator needed in order to keep the car safely on track. Like everyone who knows about driving in slick conditions, I kept my eyes on the road ahead of me in order to “read” the changes in the road surface before I got to them in order to be ready to quickly make the adjustments needed to keep the car heading in the right direction. See a dark shiny patch? Foot off the gas, be ready to steer slightly away from it when the car slides in that direction. See a pile of snow with a frozen rut running through it? Minutely avoid it if possible and steer into the slide with just enough change in the gas to power through the slide. I made it to work, but I had to call in a favor to have a guy stay over for me for ten minutes. I let him know the night before that he might have to, and I did leave early… but I’m not wrecking the car just so I can save a few moments.

I consider myself a pretty good driver in the snow. In a vehicle with good tires I wouldn’t even worry about anything less than 6 inches this far into the winter season, but today was hard. I’m not patting myself on the back here, because if I would have put good tires on the car in the first place I wouldn’t have been in this position, but isn’t that most of what we do in EMS? We end up using our mental prowess to clean up other people’s messes caused by their lack of planning all the time. Today wasn’t much different. The amount of mental power and concentration needed to keep a car moving forward safely in snow-covered conditions is actually quite staggering when you think of it. You have to make quick observations of rapidly evolving conditions, surmise what you think the presentation of the road surface means to vehicle’s path of travel using your limited observations paired with your past experience and knowledge, and come up with a near simultaneous decision on how to handle the situation ahead of you. If you find yourself to be wrong, based upon the car not reacting the way you want it to, you have to instantaneously correct the situation while adjusting for the conditions ahead… or crash.

Now picture yourself managing a challenging patient presentation, one requiring a handful of pharmacological and physical interventions. You’re pretty much doing the same thing as driving in snow. Just like playing a game of chess, you have to be “thinking a few moves ahead” in order to keep up with what the patient’s physiology is going to throw at you. Do you have a fall victim with a broken hip in need of pain control? Did you think that they’re possibly going to drop their blood pressure with a dose of morphine? Well then you better be ready to give fluid to bump it back up to acceptable levels. However, what if you’re treating a CHF patient that would suffer further from the added fluid? What if they were a patient with Chronic Renal Failure? Would that affect your initial dose of morphine based upon the unknown factor of untoward hypotension? In my Northern system, I’d choose to use Fentanyl over Morphine in that case because of the lessened risk of hypotension, but in my Southern system I’d just have to start with a lower dose of Morphine and slowly titrate to an acceptable level of pain control once I gauged the patient’s response to the med.

How about a patient with a large anteriolateral MI? Their Left Ventricular function is soon to be compromised if not treated in a cath-lab. You need to increase blood flow to the Left Ventricle and decrease overall cardiac work by decreasing afterload with use of nitrates, but that’s going to decrease their cardiac output and blood pressure by decreasing their preload as well. You need to stabilize the infarct as best as possible while maintaining the patient’s hemodynamic state, and you may need to consider supporting their left ventricular function with the use of a vasopressor such as dopamine to treat possible cardiogenic shock. In this case, careful observation of the patient’s presentation and all information available to you is of paramount importance in order to make the minute treatment decisions necessary for your patient’s best possible outcome.

It all comes down to “Mental Quickness” or having the mental prowess and state needed to rapidly intake complex information, process it against your knowledge base, and then make reasonable decisions on a course of action in a very short period of time. We call people who are good at this “Quick Witted” and it applies to myriad situations in daily life. People who are good at this are usually funny, are quick to react to new situations, handle change fairly well, and make darn good EMS providers. I practice by trying to have a joke ready for any situation… so you could also call a person who’s mentally quick a “smart ass”.

You can practice your skills at being mentally quick the same way I do. Use humor and try to make good comebacks to the hooks and barbs that your coworkers and friends throw at you. When we’re sitting around busting each other’s chops… we’re actually practicing our EMS skills, right?

Think about it. Exercise your mind through reading, learning new things, and trying to come up with new ways to think of existing information. You’ll be funnier, more popular, will be able to knock your buddies down a peg better, and will improve your patient care.

Posted by Ckemtp on February 2, 2010 • Filed under: Administration & Leadership, EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMS paramedics, EMS practice, EMS training, Emergency Medical Services, Fire Rescue Topics, Paramedic, Patient Management, Training & Development, change, ems education, ems scenario based education, inside the mind of a paramedic, mental imagery, paramedic education, patient care, scenario based training, training-fire-rescue-topics

Be the Glow Worm – HazMat for EMS.

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I am not a glow worm.

Full disclosure – This is a repost from 09/2009 – It deserved a bump-up and to fix the video. Make sure to watch the vid!

Hazardous Materials, or “HazMat” as it is commonly known, is scary stuff. At least for me that is. In public safety circles, they’re mainly the concern of firefighters and I’ve never received training on them outside of the realm of the fire department. My EMS only agencies have always told me that we remain in the “cold zone” and wait for patients to be brought to us after decontamination.

And that’s just fine with me. Ckemtp is NOT a glow worm… did I mention that?

But, since I’m also a firefighter I finally broke down one weekend and gave in to the pressure I was under to get my HazMat Operations certification. 40 hours of class, lots of homework, and some very dry PowerPoint slide shows. After the first weekend of the class there’s some things that I’ve learned and figured out.

1. HazMat’s still scary.

2. Ck’s still not a glow worm.

3. EMS agencies really need to train more on HazMat.

“We know hazmat” you say. And I know that you’re saying it because that’s what I would have said before those last 20 boring hours spent learning that I knew nothing about hazmat. HazMat is something that we take for granted in that we think that it won’t happen in our jurisdiction, or that it won’t affect us on our day to day. I happen to hope that it won’t hit during my duty days.

This video is from Seward, IL. A small town in the middle of a lot of corn that found itself one day having a big problem. The video is from a surveillance camera on the side of a grade school in the middle of town. The vid starts slow, but has a definite “HOLY CRAP!” moment about halfway through. You’ll see what I mean, all hell breaks loose.


 
See? Holy hell on crutches! That’s anhydrous ammonia, a common chemical used in farming (and in methamphetamine production). A tanker truck full of the stuff sprung a leak and flooded the town with a toxic cloud. Thankfully, nobody was killed. There were a few firefighters sent to the hospital, and some very scary moments, but it all turned out to be ok. This one’s from the same school. It’s just as scary.

Remember this, a HazMat incident doesn’t have to be the once in a while overturned tanker truck full of MethylEthylBadJuJu. Any every day response can turn quickly into a hazardous materials incident.

Not too long ago, an EMS only agency that I may or may not work for received a call for an “eye injury” in one of our really rural response areas. This call generated a single ALS ambulance only response out to the farm where the injury happened.

The medic and the EMT responded out to the scene, which was about a 15minute emergent response. Arriving at the farm, they were directed to the dairy barn to find their patient.

Their patient was in a lot of pain.

Apparently, he worked for a dairy services company and was delivering product to the farm when he was injured. If you don’t know much about dairies, milk processing leaves a byproduct called “Milk Stone” which is the dissolved minerals in milk solidifying on dairy equipment. Think of hard-water stains. Dairies use products containing phosphoric acid to clean it out. It’s like Lime Away on steroids. This stuff is pretty nasty. Dairies use it in a diluted form, but the supply companies carry the concentrated stuff. This patient was filling a container with the high-powered stuff to dilute it into the customer’s container when the concentrate fell. He reflexively looked right down at the falling container and got a face full of the stuff when it splashed back up at him.

Do you remember that chemical burn stuff you were trained on? He had them. Do you remember the decontamination training you had? What about proper personal protective equipment, do you have it? Do you know when to put it on? Do you know how? What do you know about the chemical?

While treating the patient, one of the paramedics noticed that his EMS gloves was turning white. It was the acid eating through it. A lot of water was used to irrigate the patient, and the providers, before transporting the patient to the hospital.

This was an everyday incident that actually happened. Think about how you’d handle it, because tomorrow it could happen to you.

And once again, Ck is not a glow worm.

Posted by Ckemtp on January 20, 2010 • Filed under: EMS Topics, EMS safety, EMS training, Fire Rescue Topics, Firefighter Safety & Health, HazMat, Major Incidents, Special Operations, Uncategorized, Videos, accident, disaster, training-fire-rescue-topics, volunteer fire department, volunteer firefighter

The day I didn’t die – Firefighter Close Calls

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Laying prone on the quivering floor, I had been pushed down flat on my stomach by the searing heat and smoke. I was as terrified as I’d ever been as I frantically yanked and tugged on the inch-and-a-half hose line that was stretched down the basement stairs towards the engine company that had disappeared down the dark hole an eternity ago. What had started out as a small, concealed fire with light wispy smoke conditions had quickly deteriorated into this hellish, searing inferno that I was convinced was killing the three men below me.

Twenty minutes before this, my two man tanker company had been first on scene to this structure fire that had been dispatched while we were returning from a small brush fire. We were the closest unit and were first on scene. Light staffing that day caught us when this fire was reported during the height of our daytime volunteer shortage. These factors combined a two-man tanker company together with a two-man brush-truck company to make a primary search of the structure. The light smoke and little heat had lulled us into a false sense of security as we entered the single-family home. The concealed fire between the first floor and the basement caught us unaware. It spread quickly and weakened the floors we were standing on. When I found the first floor had been weakened, I sent out my partner to inform command as we were on the tanker and had no radio communications inside the structure. Unfortunately, another engine company with a hot-shot lieutenant arrived and, despite my fervent protestations to the contrary, he took his three firefighters down the stairs to the basement. I stayed to mark their exit.

Outside the air-horns sounded their three quick blasts, calling for an evacuation of the structure. I stayed, waiting for the crew to emerge from the staircase so that I could lead them to safety. They never showed. The intense heat burned me through my turnout gear as I screamed as loud as I was able through my SCBA mask into the abyss. I tugged on the hose and screamed at them to return, only taking a break to recognize the ringing of my low-air warning bell on my air tank. I had no idea how long it had been ringing, but when I noticed it, it was slow. Instead of a sharp ring, it was a slow ding that was getting slower as I was sucking as much air as I could to yell down the staircase.

This moment, this intense moment, was where I made a decision the likes of which I hope I never have to make again. I knew that if I stayed more than a few moments longer, I would suffocate and burn to death right there on that floor. I also knew that the men below me needed me to be there for them when they came out of the basement. They needed me to be there to lead them to safety.

It was a decision that made me choose between leaving my brothers to perish by saving my own life, or staying to face my own probable death. Ding… Ding… Ding… the sluggish bell ticked off my air supply, inching ever closer to the point where it would just stop, leaving me to asphyxiate.

That moment, I chose to flee and save myself. It’s why I’m sitting here typing this story.

I knew where I was in the structure. While it was pitch black from smoke and I was blind, and while every movement made my skin contact my turnout gear and burned me, I turned tail on my stomach and frantically crawled towards the doorway I knew it was only a few feet away. I knew I could make it. I knew my brothers were dead or dying. I knew…

“CRACK” went the floor as it opened up to reveal the inferno underneath my belly. I felt myself falling I saw the flames come up and envelop me. My vision turned from completely black to completely orange as I felt myself falling into the intense heat. I screamed and reached out ahead of me into the darkness. I clawed and flailed forward, grasping on to anything that I could grab to save me. God willing, my fingers found the concrete steps out the outside door to the residence. Inch by excruciating inch I pulled myself up and out into the light and the fresh air.

As soon as I was out of the house I stopped breathing as my SCBA mask sucked into my face for lack of air in the tank. I ripped it off of me and sucked in the sweet outside air. Waiting for me outside, about to try and find me, were the three firefighters who had went into the basement. They had evacuated through a basement door. Nobody knew that I was still inside waiting for them until they made a headcount in the confusing scene and found that I was not accounted for.

Looking back at this experience, I am proud of myself for finding out that I will go up to the last possible second to try and save my brother firefighters… although thinking about the decision I made to turn tail and run, I’m almost ashamed that I didn’t stay past that point of no return.

Of course, my policy is that I go home at the end of the day every day… but still.

Close calls are terrifying experiences. Thinking about losing any one of my coworkers or colleagues is unfathomable. It can happen, however, and we combat this reality with safety and organized command structures. This call was years ago in my career but it sticks in my mind at every call I’ve been to since that day.

Train hard. Keep your wits about you. Take everything seriously.

 

The Hole a firefighter fell through in a strucure fire (uninjured)

The Hole I fell through in a strucure fire (look right by the door)

Posted by Ckemtp on November 25, 2009 • Filed under: EMS Health & Safety, Fire Rescue Topics, Fire department, Firefighter, Firefighter Safety & Health, Firefighting Operations, Fires, accident, fire, training-fire-rescue-topics

Education vs Training: The “Professional Ambulance Cleaner”

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Imagine if you will this hypothetical scenario:

You and your roommate have just graduated EMT school together and go to work at competing ambulance companies in the same city. He works for HIS ambulance service, and you work for YOUR ambulance service. Both services have similar fleets, similar deployment patterns, and similar call-volumes. In fact, there’s really no way to tell them apart other than the fact that the HIS ambulance service uniforms are sickly green jumpsuits, and YOUR ambulance uniforms are Macho Blue Shirts with navy blue pants.

You both go off for your first day on the job which understandably includes several hours of training on company policies. For both of you, the whole day turns out to be a long class on how to clean the inside of ambulances.

Here’s the differences, though. At YOUR ambulance, you learn about the biological functions of bacteria and viruses. You learn their strengths, their weaknesses, how they reproduce on inanimate environmental surfaces, how they create biofilms to increase their reproductive capabilities and life span, and how pervasive they are in randomized samples from real-life ambulances. You learn how grime collects in the ambulances, how it adheres to the surfaces that you will be cleaning, and what the various types of substances are that you will most commonly find in real-world applications. The whole first day is spent on nothing but learning about dirt, grime, and germs and how they contaminate ambulance interiors. They even threw in the types of materials that the ambulance interior is made from and what the specific dirt-holding and germ-breeding properties of each material are. You see samples and scenarios pertaining to germ and dirt proliferation on ambulance interiors.

Not only that, there’s homework, reading material, and a report due the next day.

The second day that you report to YOUR ambulance service, you learn all about different types of cleaning products, tools, and disinfectants. You learn how to properly choose the detergent needed for optimum dirt-dissolving power on what type of surfaces you may have to clean; You learn the proper disinfectant to choose for each type of commonly encountered bacteria, virus, and fungi spore; and you learn the proper contact times to leave each product on for optimal disinfection and/or dirt dissolving power. Then you learn about every different type of sponge, mop, rag, fabric, and tool used to clean the ambulances. You spend a few hours in the laboratory they have testing out the material and performing experiments in the name of learning.

Oh, and after that day too, there’s a lot of homework and reading material.

Your roommate, on the other hand, went to work and found out that he too had to learn about ambulance cleaning. He learned that they also expect clean ambulances, however his choices and training are much simpler. He is told to clean the ambulance using two bottles: One marked “Cleaner” and the other marked “Germ Killer”. He is given ten rags and is told to clean the ambulance for inspection by the owner of the company using the tools given in the time allowed. He does so and is told “Good, now do it again tomorrow”. The next day, he again cleans the ambulances using the tools and training provided, and is again told “You did a good job”

In the above scenario, the first ambulance service, “YOUR Ambulance, uses a form of advanced education to teach their people how properly to clean the ambulances to their specifications. The education is rigorous and in-depth.

At “HIS Ambulance” they use training, and vocational experience to teach their employees how to properly clean the ambulances.

Here’s some questions I have:

  1. Which ambulance service do you think will have cleaner ambulances in the long run?
  2. Which employee do you think will do an overall better job in cleaning the ambulances?
  3. Which employer, “YOUR Ambulance” or “HIS Ambulance” do you think has the better philosophy?
  4. Which ambulance cleaning class will result in the better, more motivated, happier employee?

Anyone else see the relationship to EMS training/education here? Which one results in a more “Professional Ambulance Cleaner” that is better equipped to handle the job?

Posted by Ckemtp on November 12, 2009 • Filed under: Ambulance cleaning, Ambulance maintenance, EMS Management, EMS Topics, EMS training, Emergency Medical Services, Management, Paramedic, Training & Development, disinfection, ems 2.0, ems education, ems scenario, ems scenario based education, paramedic education, profession, professionalism, sanitize, scenario based training, training-fire-rescue-topics

Could it be? A Good EMT-B Student?

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What is with students these days?

I precept and mentor quite a few students these days. Maybe it’s because I’m old and my memory is going south on me, but I don’t think that I acted quite like this current crop does when I was a student. I think that I took it seriously. I think that I respected the elder members of my profession and did what they told me to, right?

I always tell students that I’m a real jerk when I’m precepting them. I’m not… but I like the whole Mr. Myagi (old reference, look it up youngins) thing. You know, “Wax on Wax off” equates to something EMS related or what not. I try to reinforce the things I think that are important for them to know to be a good provider at whatever level they’re currently working on. Everyone has to work on their assessment and patient communication skills. Everyone has to get good at MANUAL BPs, listening to Lung Sounds, Abdominal Sounds, and their patient’s stories. Everyone has to get good at not being afraid to assess the patient in a competent, professional way. I figure that once they get the assessment and the friendly, professional communication thing down, the rest can be reinforced pretty easily.

Recently I’ve been adopting the “Dr. Cox” school of mentoring students. I love the TV show Scrubs. On the show, Dr. Cox torments his young protoge’ relentlessly and calls him a different girl’s name every time he addresses him. I think that it’s funny as heck and I’ve been doing that lately. The first student I did it to left the program after a week (Not my fault! He was running with another medic a lot more than he was running with me!) and the second, well… the second student I pulled this on really surprised me.

He was an EMT-B already, but was fresh out of class and was working for a fairly slow volunteer service that one of our part-timers volunteers for. She had brought him over to get some experience on a busy service and since I was her partner for the day, he got to be subjected to my whims as a preceptor. I think his name was Stacy, Jennifer, or something.

We had two calls right off the bat. A refusal at a “Nursing Home” that called us for a patient with pink eye, and a “Elderly Man out of Control” at a farm house way out in the country where the County Sheriff ended up transporting on. This kid seemed to be good luck, considering that we weren’t having to go to any coffeeless hospitals that early in the morning. Our streak of luck ended when we caught a tranfer from an ER to a secondary admitting hospital for an elderly lady with a GI bleed.

This was perfect for the kid. It was about an hour-long ride with the patient. Plenty of time to teach the kid “friendly banter” skills with the patient and also to have him do a reassessment q 15min while I sat back, cracked jokes, and worked on the three reports. Win win. We picked up the patient at FavoriteSmall Hospital ER and got her in the truck. He was quiet at first, as all students are, but I made a deal with the patient. I asked her if she could help me get the student over his shyness. Oh boy, she did. She talked his ear off the whole way and he participated in the conversation like a champ.

Yes, I think that it’s important to connect with your patients on a human level. He did that pretty well, actually.

The only thing that I thought he needed work on was how he took blood pressures in a moving truck. Admittedly, that’s a hard skill to master. One of my cardinal sins is to make up a BP and tell me the made-up number you “think” it is. He may have done that.. but I didn’t call him on it right away. Instead I waited until after the trip because the patient was very stable.

“So Denise, how sure are you on those BPs you took? Because… I didn’t know if you could really hear them or not..” I asked him.

“Uhhh, well I was pretty sure… mostly… a little I think” he stammered.

“Stacy, just make sure that you tell me you’re not sure if you’re not sure. I’d rather use incomplete information than fictional information anytime. I’m not accusing you, just curious here.”

After we got back to quarters, the calls died. The other truck ran a DOA but we didn’t get anything for hours. Knowing me, I sat down and worked on the blog for a while and ended up putting a couple of hours into the new site design. After two hours, in walks the student and takes a BP on me. Apparently the kid had spent the last few hours taking Blood Pressure readings on every person at the base!

I think that his name was Joe. He can ride with me anytime.

Posted by Ckemtp on October 16, 2009 • Filed under: Administration & Leadership, EMS, EMS Humor, EMS Topics, EMS training, Emergency Medical Services, Paramedic, Patient Management, ems education, paramedic education, training-fire-rescue-topics • Tagged: , , ,