Everything you read here should be considered fiction. Patient rights will always be respected. Any resemblance to persons living or not is purely coincidental.

Monday, September 12, 2011

"Advice for a new Paramedic" (HappyMedic)

This is blatantly ripped off from The Happy Medic
but it bears repeating. Just as relevant to a First Responder, EMT-B, or EMT-I. My comments are in italics.

Advice for a new Paramedic
Over the years I’ve been asked by students, interns and other Paramedics for tips, tricks or advice that can either smooth things out or help the new folks adjust to this rough and tumble world we work in.
I can never stress enough the first and most important tip I have:

It’s not your emergency
No matter the incident, injury, illness or situation, you did not create it. It is not yours. There is no need to speed to the scene, run, shout, get upset or angry.
This one is difficult to follow. Adrenaline is pumping, you want to help, but the people I am learning to admire on scene are the ones who are un-ruffled, calm, and quiet. I need to work on this.  A lot.

You will never know enough
There is a Paramedic you work with who seems to know everything, and not in that smug way, but leads by example and is a confident care giver. That person will never know everything about medicine and neither will you. They read, they listen, they learn. Do the same.
Don't need any help understanding this concept. The more I read, listen, and learn, the less I feel I know...

Don’t tune your patients out
Many folks don’t know what is wrong and when they think they do, 50% are wrong. Listen to what they say but note how they walk, look at their living conditions, check the date on the milk in the fridge. Does she wince when she stands? Is the cough productive? How long? Don’t get stuck in the SAMPLE questions, but use them as a starting point.
This is another good one - I like talking with patients and am getting more comfortable asking the probing and leading questions. I try to listen to the more experienced folks, and am feeling more comfortable speaking up for myself. I need to stop interrupting people, of my big faults.

The most important person in the room is you
Scene safety is paramount. It’s not as easy as simply saying, “We’ll wait for PD” like it was in P School. On the streets, the friends come running up to the ambulance screaming for help, the parents cry for you to hurry. Keep yourself safe, then your crew, then your patient, then the rest. Dead Paramedics have a horrible cardiac save rate.
Love the last line.

Don’t leave the hospital so fast
Just like you and your partner had a little palaver about the patient at the scene, the doctors at the ER will do the same. Listen in on their conversation. Learn from it. Are they asking questions you did not? Make a note of it and ask those questions next time it’s pertinent. Wait for the 12-lead EKG and see not only what it says, but what the Doc thinks. You’d be amazed how many times I’ve seen a Doc spot something the machine misses.
This is a problem for me. I always feel like I'm in the way in the ED. Easier just to grab the cot and leave, but I need to spend more time in the room when we get there.  Hoping my EMT-B course hours at the ED will help on this.

Buy Dubin’s
Dubin’s Rapid Interpretation of EKGs is THE best resource for learning EKG rhythms. Without knowing what you have, it can be hard to formulate an action plan. Dubins will teach you the simple questions to ask yourself while staring at that 6 second print out.
Fast or slow? Regular or irregular? Does every P have a QRS? Does every QRS have a P? DONE. From those simple questions you can treat most arythmias.
Ordered it, got it, and started to read. Also bought Thaler's"The Only EKG Book You'll Ever Need" and Phalen/Aehlert "The 12-Lead ECG in Acute Coronary Syndromes."  All are so far over my head it's sickening. EKG reading is still an intriguing mystery to me, but by sheer repetition some of it may be sinking in.

Find your comfort zone and avoid it
If trauma is your strong suit, focus on cardiology. If you enjoy intubation, focus on IOs. Expand your comfort zone until everything is only slightly unfomfortable. That means grabbing for the pediatric bag feels the same as grabbing the BP cuff. That means reading, drilling and asking questions you don’t know the answer to.
Ha! I don't have a comfort zone in ANYTHING yet, so no worries. Actually, this has reared its ugly head already.  I am a fine driver.  Patient contacts - well, I still feel nervous and out of my element.  It's too easy to say, "I can drive."  So these days I try to jump in when someone gives me the option to ride in back.  Patient assessment skills are still weak - have that moment of panic when I'm first on scene and forget everything I've learned.  I need to nail myself down somehow...

Practice humility
People will thank you profusely for what they believe was a life changing moment in their lives. Accept their thanks and tell them it was your pleasure to help them. Then learn more about what ailed them so the next person doesn’t suffer as much. When you do an exceptional job, reward yourself by passing on the experience to another care provider. Not as a “war story” but as an addition to a lecture, lesson or discussion.
Again, great advice. I've been lucky so far with mostly grateful patients. The follow-up is awkward and mostly third-hand (through the medic)

Warm lunch, warm dinner, go home safe
Those are my only 3 requirements for each day. The first two are negotiable and the rest doesn’t matter.
Sounds like a good plan to me.

Thanks Happy Medic!
(btw, if you don't read his blog, you should)

Also from the Happy Medic:

My favorite term from his glossary:
Jedi Vitals – When you know the patient is fine, but still need to record something, you pass your hand in front of them just like Obi Wan Kenobi and poof! the vitals come into your mind.

1 comment:

  1. I love your for this, and i read that post on the happy medic blog?

    "It is my goal to put EMS out of business."