I find myself shaking my head over a post over at Rogue Medic, he is talking about two separate but important situations, one being bad or poorly written protocols and the second is how one deals with those protocols. I will take what he has written in a different but related direction. Does forcing the paramedic/EMT student to slavishly follow skill sheets and failing them because they didn't say "Scene Safety and BSI" before doing anything to the patient really doing anything for patient care? Does anyone actually do that in the field? EMS training needs to be much more realistic and get away from rote memorization of NREMT Skill Sheets. I have nothing against the NREMT and understand that testing standards are needed but question the way the many of the courses I have seen or observed/taken seem to spend much more time on manual skills than on thought process. I have also trained a few new EMT's and found more than one of them wide eyed in fear because "It was never like this in class!"
I also have to say a few words about the program I am in at this point, it is taught by street paramedics and their instruction shows it. They emphasize that we need to learn the protocols but love to bring in real life situations that don't fit the nice carefully laid out skill sheets and or protocols and how they dealt with it when it happened to them. This post is not meant as any kind of complaint about the program I am currently enrolled in and should not be taken as such. I am very pleased with American Professional Education Services and would recommend them to anyone without hesitation. Forgive the commercial but I felt I needed to state that to be fair to them.
It would not be fair to anyone if I simply complained and didn't offer a solution but must be truthful the idea is not totally mine, both my instructors and many of the other bloggers such as Rogue Medic have said similar things. I find that teaching people to think is much more important than teaching them what to think, many of the best EMT's/Paramedics I know are good because they are always thinking and how why they do things rather than just that they should do them because that is what they were taught to do in that situation. I realize that some discussion of medical direction and how it effects education would be appropriate here but will also admit that my current level of exprience in providing Paramedic level care would render my thoughts both unimportant and ill informed and possibly misleading. In closing I would say that there needs to be much more teaching about why something is done instead just telling people to do it because protocol says to do it. EMS providers need to be trained to think and decide what is needed rather than what the rules are in a certain situation because the more rules that have to be followed are created the less thinking allowed and that can't really be better for the patient but I bet we should be focusing on the patient and what we think they need in addition to what protocol says is needed to treat the patient
Tuesday, December 28, 2010
Wednesday, December 22, 2010
Top Fifty List
I am happy to report that the Student Paramedic blog has been named to a top fifty list by another blog. The Paramedic to RN blog has named Student Paramedic to their list. This was an unexpected Christmas gift and you can read the whole list here. I appreciate the feedback and hope to improve as a blogger in the months ahead.
MERRY CHRISTMAS AND HAPPY NEW YEAR!
MERRY CHRISTMAS AND HAPPY NEW YEAR!
Friday, December 10, 2010
Paradigm Shift
I am now at the end of the first trimester in the paramedic course for the second time around and noticed something a few days ago that deserves to be blogged about. I am now required to do a twelve hour shift each month as an observer on a paramedic level ambulance. I noticed during my last shift that rather than being scared that I would someday have to do this stuff myself I was itching for the opportunity to try and do some of this stuff myself. This is a major shift in my thinking and I have no doubt that my instructors have caused this change to occur, they have done an excellent job of giving me the information and skills needed and have given me the confidence that I can do the things they have taught me. The medic on that call was my course coordinator for the class the first time through so I am sure that was also part of the change as well. He took quite a bit of time out of the day to go over important points and pull the material out of the classroom and apply it to the calls.
Class is going well and I am benefitting from hearing the information over again and having a much greater understanding of how everything interacts in the body and its systems. It is a huge amount of information and the repetition has been a real plus for me. I am sure that having to go through the information for a second time and being much more familar with the material has also had an effect but also have to say that input from my instructors has also changed how I approach the material. This time through they seem to be taking the time to correct my mindset and not just throw the material to me. They are training me how to catch the material as well, I am sure they did the first time I just didn't notice.
Thanks.
Class is going well and I am benefitting from hearing the information over again and having a much greater understanding of how everything interacts in the body and its systems. It is a huge amount of information and the repetition has been a real plus for me. I am sure that having to go through the information for a second time and being much more familar with the material has also had an effect but also have to say that input from my instructors has also changed how I approach the material. This time through they seem to be taking the time to correct my mindset and not just throw the material to me. They are training me how to catch the material as well, I am sure they did the first time I just didn't notice.
Thanks.
Wednesday, November 10, 2010
Thoughts on giving away what you don't have.
I enjoy reading what others have written and then applying to myself and this post gave me much to think about and not just about compassion. What is the most important thing we give our patients? My abilities and my knowledge are more important than compassion, but much harder to demonstrate to the patient. You have to have both to function in this career field. A Paramedic is supposed to be a leader and manager onscene and direct others and allow cooler heads to prevail. What if he isn't normally one of the cooler/compassion people? I remember a line from the movie Chariots Of Fire "You can't put in what God left out." Can you develop compassion if you don't have it already?
I have a certain amount of compassion, and my wife, who is also an EMT, shames me frequently with the way she cares for people and has compassion for them. I know that often I let my emotions and feelings get the better of me, does that mean I shouldn't be in EMS? I hope not because I have choosen it as my career and don't want to walk away from it but often find that when reading posts like this wish that I had other attributies than the ones I was born with.
I have a certain amount of compassion, and my wife, who is also an EMT, shames me frequently with the way she cares for people and has compassion for them. I know that often I let my emotions and feelings get the better of me, does that mean I shouldn't be in EMS? I hope not because I have choosen it as my career and don't want to walk away from it but often find that when reading posts like this wish that I had other attributies than the ones I was born with.
Thursday, October 7, 2010
IAFC EMS Study
I wish I could say I was surprised by the study results, but I wasn't. I 'll bet that anybody who has ever done an EMS call could have told them that more help makes things go better, and more better trained help makes things go faster sooner. I don't know how this could be accomplished but I would love to know if it had a significant effect on patient outcome. Because is the one question that is not really dealt with except to say it wasn't dealt with at all. The bias of the IAFC is not really why I mention this, it is because in this current economic climate a study that says more help makes things work better is useless infomation. Anybody with more than a weeks experience in EMS could tell them that and wouldn't need an expensive study to know it beyond a doubt. What changes can we make that will have a significant effect on the outcomes for the patient?
Monday, October 4, 2010
Post Hoc Ergo Propter Hoc
The title of this post was taken from the comments of my previous post and I have to comment on the idea that just because something happens first means it caused the second thing to happen. When I looked up the phrase "post hoc ergo propter hoc" it was defined as a common logical fallacy. We in EMS tend to follow this fallacy in many cases. The fact a patient signed a refusal or was referred to other care and died later doesn't mean that the referring person made a mistake. The flip side of this is also true because something didn't happen first doesn't mean that it could have prevented the second thing from happening if it had been done. I personnally think that we are not at the level in EMS today that we can reliably allow many EMS providers to routinely not transport patients that they don't feel are in need of an ambulance. I say that for many reasons and want to enumerate them in order to spark discussion.
This post at Life Under The Lights talks about an EMS crew that may have made some serious mistakes in patient care because it seems they didn't take the time to do it right.. I don't think this patient could have made an reasoned decision about the situation that quickly and neither could the paramedic. I link to the post so that others can learn for themselves and to illustrate what I am talking about. We cannot grow to the level we aspire too if situations like this can happen far more often than they should. They should never happen, but perfection is impossible with human beings involved. Too often we make the expedient decsion instead of the right decision for the patient. Whether that is because we are worried about being available for the next big call or because it is the end of a very long shift and we are ready to go home doesn't really matter, neither reason is justified. Many things on this call could have or should have been different. I was not there and am speaking only on what I have read but it makes my point that if we don't take the time to do it right we do it wrong.
I live in a small city and our firefighters do a great job with the resources available. The next town over has a smaller population and has six ambulances to the cities three. Only two are manned at any one time, and the third is available only by taking another piece of apparatus out of service. I mention this because our current economic climate is causing many towns and cities to curtail services and slash budgets. I wonder how often a person signs a refusal because someone, somewhere is more worried about getting a unit available than making the best decision for the patient. Often the person making the decision is a politician far removed from the ems call or patient.
I am currently an EMT studying to be a paramedic and one of the things that amazes me is the level of training that I am recieving. I think there should be a paramedic on every ambulance, there are far too many things that an EMT can overlook simply because he doesn't know or doesn't care because he has been volunteering for twentyfive years and doesn't care as much as he used to because he doesn' have the drive or passion he used to have and nobody else is offering to help.
So to wind up what has become a long post, there are many reasons that we transport everybody and some are financial and some are just part of the culture of how we provide EMS. Alot of why has to do with the level of training and resources available to the majority of EMS organizations. I am a volunteer and do not say this to disparage volunteers but the industry is in dire need of professionals, note I did not say paid professional but I seriously doubt that most volunteers are able to rise to the level that is needed, they may be willing but not able, but that is a topic for another day.
This post at Life Under The Lights talks about an EMS crew that may have made some serious mistakes in patient care because it seems they didn't take the time to do it right.. I don't think this patient could have made an reasoned decision about the situation that quickly and neither could the paramedic. I link to the post so that others can learn for themselves and to illustrate what I am talking about. We cannot grow to the level we aspire too if situations like this can happen far more often than they should. They should never happen, but perfection is impossible with human beings involved. Too often we make the expedient decsion instead of the right decision for the patient. Whether that is because we are worried about being available for the next big call or because it is the end of a very long shift and we are ready to go home doesn't really matter, neither reason is justified. Many things on this call could have or should have been different. I was not there and am speaking only on what I have read but it makes my point that if we don't take the time to do it right we do it wrong.
I live in a small city and our firefighters do a great job with the resources available. The next town over has a smaller population and has six ambulances to the cities three. Only two are manned at any one time, and the third is available only by taking another piece of apparatus out of service. I mention this because our current economic climate is causing many towns and cities to curtail services and slash budgets. I wonder how often a person signs a refusal because someone, somewhere is more worried about getting a unit available than making the best decision for the patient. Often the person making the decision is a politician far removed from the ems call or patient.
I am currently an EMT studying to be a paramedic and one of the things that amazes me is the level of training that I am recieving. I think there should be a paramedic on every ambulance, there are far too many things that an EMT can overlook simply because he doesn't know or doesn't care because he has been volunteering for twentyfive years and doesn't care as much as he used to because he doesn' have the drive or passion he used to have and nobody else is offering to help.
So to wind up what has become a long post, there are many reasons that we transport everybody and some are financial and some are just part of the culture of how we provide EMS. Alot of why has to do with the level of training and resources available to the majority of EMS organizations. I am a volunteer and do not say this to disparage volunteers but the industry is in dire need of professionals, note I did not say paid professional but I seriously doubt that most volunteers are able to rise to the level that is needed, they may be willing but not able, but that is a topic for another day.
Sunday, September 26, 2010
You want to do what?
http://999medic.com/2010/09/26/a-medic-mortality-allowance/
The link above is a post by Mark Glencourse an English Paramedic who who has taken the patient refusal question to a whole new level. He is and he isn't advocating so much a change policy as he is advocating a change in mindset. Nobody wants to lose a patient and none of us wants a patient to die on us, (For the most part) but we all know that we are going to make mistakes and a patient may die as a result. We in EMS seem to have this mindset that we can never say no to a patient and it doesn't mater if the patient ends up being discharged before we get the paperwork done.
I am quoting Mark: "Now think what our job what look like if it was accepted that some patients may slip through the net. Not through negligence, but through a natural disease process that was not present at the time of the assessment by the paramedic."
In my opinion that kind of a change would be nothing more than an acknowledgement that sometimes we don't get it right. We can evaluate a patient and they may seem fine, but we may overlook something or there may have been no signs or symtoms of another issue that would happen a short time later. I am reminded of a patient that I transported that showed absolutely no signs or symtoms of a cardiac problem and was transported for a minor injury, they began having nausea and had a major MI while at the hospital. I could have let them sign a refusal and it would have been perfectly fine for me to have done so. That MI would have occurred in their own car or at home and who knows what the result could have been.
I guess what this really boild down to is, are we really willing to admit that we don't always get it right and we may mistakes if we say no to a patient and tell them that right now you don't need to go to the hospital by ambulance and you can be appropriately treated another way, such a an appointment with your regular doctor or transport some other way than a 911 (999) ambulance. This would be a major change for the EMS industry in the US and I am not sure it would or could be accomplished without quite a bit of grandstanding by outraged politicians who would claim racism or some other false charge to make the transition difficult. I honestly think we need to make that attitude change but it will be very difficult and there will be a few missteps along the way. By missteps I mean people getting fried by the media because some politician felt it was more important for them to get reelected than for them to tell the truth and admit that sometimes mistakes happen, and we need to realize that sometimes STUFF HAPPENS!
Isn't that why we are here? Because sometimes stuff happens and it really is nobodies fault?
The link above is a post by Mark Glencourse an English Paramedic who who has taken the patient refusal question to a whole new level. He is and he isn't advocating so much a change policy as he is advocating a change in mindset. Nobody wants to lose a patient and none of us wants a patient to die on us, (For the most part) but we all know that we are going to make mistakes and a patient may die as a result. We in EMS seem to have this mindset that we can never say no to a patient and it doesn't mater if the patient ends up being discharged before we get the paperwork done.
I am quoting Mark: "Now think what our job what look like if it was accepted that some patients may slip through the net. Not through negligence, but through a natural disease process that was not present at the time of the assessment by the paramedic."
In my opinion that kind of a change would be nothing more than an acknowledgement that sometimes we don't get it right. We can evaluate a patient and they may seem fine, but we may overlook something or there may have been no signs or symtoms of another issue that would happen a short time later. I am reminded of a patient that I transported that showed absolutely no signs or symtoms of a cardiac problem and was transported for a minor injury, they began having nausea and had a major MI while at the hospital. I could have let them sign a refusal and it would have been perfectly fine for me to have done so. That MI would have occurred in their own car or at home and who knows what the result could have been.
I guess what this really boild down to is, are we really willing to admit that we don't always get it right and we may mistakes if we say no to a patient and tell them that right now you don't need to go to the hospital by ambulance and you can be appropriately treated another way, such a an appointment with your regular doctor or transport some other way than a 911 (999) ambulance. This would be a major change for the EMS industry in the US and I am not sure it would or could be accomplished without quite a bit of grandstanding by outraged politicians who would claim racism or some other false charge to make the transition difficult. I honestly think we need to make that attitude change but it will be very difficult and there will be a few missteps along the way. By missteps I mean people getting fried by the media because some politician felt it was more important for them to get reelected than for them to tell the truth and admit that sometimes mistakes happen, and we need to realize that sometimes STUFF HAPPENS!
Isn't that why we are here? Because sometimes stuff happens and it really is nobodies fault?
Wednesday, September 8, 2010
Too Much Information For A Paramedic
I read this post and have to comment! I can't speak for anybody else but I don't think it is possible to have too little education if you work in the EMS field, and it doesn't make any sense to me for someone to say it is too much information. I will admit that I have been to training opportunities that I wasted because I didn't know enough to take full advantage of them but that was not the fault of the instructor. There are two things that I need to start doing and the first is to stop finding out what the bare minium is that I have to do to make sure I pass the course. I have gone back to class after breaking my rib and right out of the gate found myself ill prepared because I didn't allow myself enough time to prepare. I guess I am trying to say that it's not too much information, it's just that I'm not always willing to put forth the effort to learn the information I have available to me and it might force me to work on improving myself. I don't think that makes me any different than the individual that is mentioned in the post above. (I really hope you bothered to read the other post by this point!) This probably makes both of us just like alot of other people in the world, but doesn't help make us better human beings or paramedics. You have to struggle every day against the urge to be just good enough or just trained enough. You have to struggle against the idea that you aren't quite smart enough or the job is too difficult for you and you are good enough now and don't need to be any better or maybe can't be any better. I hope I can always push myself to be better; I may not always succeed, but I hope I always care enough about my patients and myself to keep trying.
Thursday, August 19, 2010
Being Laid Up
I recently broke one of my ribs because of a fall and spent two days in the hospital, although I was well taken care of hated the whole experience. I was told I broke my 11th rib but was never told exactly where the rib was broken even though I asked several times point blank for the information. The doctors came into my room several times but I couldn't help feeling like they never really listened to what I had to say.
How do you think our patients feel? I hope as time goes by I will remember how I felt and take the time to actually listen to what is being said and not just blow it off as unimportant. I hope I don't give my patients the impression I am not really listening to what they have to say or that they are unimportant.
I have also had to drop out of the paramedic program due to my injury and will have to start over again in September when the next class starts. This gives me a unique opportunity to correct mistakes I made the first time in terms of how I prepared for the class. I also have the added boost of the two biggest things about the class I was afraid of failing I have already been exposed to and know that I can do them. I am looking forward to the challenges ahead and don't have nearly as much fear, this is a good thing and I have a unique opportunity ahead, not to mention the added study time time while I am recuperating and waiting for class to start.
How do you think our patients feel? I hope as time goes by I will remember how I felt and take the time to actually listen to what is being said and not just blow it off as unimportant. I hope I don't give my patients the impression I am not really listening to what they have to say or that they are unimportant.
I have also had to drop out of the paramedic program due to my injury and will have to start over again in September when the next class starts. This gives me a unique opportunity to correct mistakes I made the first time in terms of how I prepared for the class. I also have the added boost of the two biggest things about the class I was afraid of failing I have already been exposed to and know that I can do them. I am looking forward to the challenges ahead and don't have nearly as much fear, this is a good thing and I have a unique opportunity ahead, not to mention the added study time time while I am recuperating and waiting for class to start.
Friday, August 13, 2010
Happy Medic-You make the call!
I read the post on the Happy Medic about what would you do if you saw someone drinking in uniform with a stethescope around their neck and took note of the following quote:
"I guess my point is that just like Police and Fire we in EMS need to stop eating our young and try to take care of each other a little better."
How many of us would say nothing to the person and just dimiss them as a wannabe and go no further?Therin lies the problem, we are so quick to point out when people screwup, but not nearly so quick to offer help. This person needs so much help on several levels that it isn't even funny. If they are a wannabe then somebody needs to give them a hand up and see if they can help them to be a "I am." Often someone wants to be but has no idea how. My gut instinct is that this person is a wannabe and needs some mentoring and we in the fire-ems field are way to good at "eating our young" as Happymedic put it!
I am very lucky in that I have had a couple of really good mentors in my life and they have helped me get over some real rough spots in my career. Some of them were only very short term but profound and some were much more long term but both had value to me in many ways some of which I didn't see until years later. But there have been many more people who have been quick to laugh at my mistakes and remind me of them at every opportunity. That is the biggest problem we have in EMS today, we are so busy caring for ourselves we aren't taking the time to train the new generation to take over! We need to get rid of this attitude that: "If they can't take it, they don't belong here." The modern world of EMS is too much to deal with on a day to day basis for people to just keep getting used up and then move on. We want to be taken seriously as a career field then we have to take care of how we train and equip ourselves to do our job. The ability to deal with what we see on a daily basis is not the always the same level for every person. A thick skin is neccesary to do our job but it does need to be permeable on some levels. The attitude that if you have to ask for for help you can't handle the job also needs to go by the wayside. If somebody has to go find a bar to deal with what they see our first question shouldn't be why are they drinking in uniform, but what can we do to help them so they don't feel like they have to drink in uniform?
"I guess my point is that just like Police and Fire we in EMS need to stop eating our young and try to take care of each other a little better."
How many of us would say nothing to the person and just dimiss them as a wannabe and go no further?Therin lies the problem, we are so quick to point out when people screwup, but not nearly so quick to offer help. This person needs so much help on several levels that it isn't even funny. If they are a wannabe then somebody needs to give them a hand up and see if they can help them to be a "I am." Often someone wants to be but has no idea how. My gut instinct is that this person is a wannabe and needs some mentoring and we in the fire-ems field are way to good at "eating our young" as Happymedic put it!
I am very lucky in that I have had a couple of really good mentors in my life and they have helped me get over some real rough spots in my career. Some of them were only very short term but profound and some were much more long term but both had value to me in many ways some of which I didn't see until years later. But there have been many more people who have been quick to laugh at my mistakes and remind me of them at every opportunity. That is the biggest problem we have in EMS today, we are so busy caring for ourselves we aren't taking the time to train the new generation to take over! We need to get rid of this attitude that: "If they can't take it, they don't belong here." The modern world of EMS is too much to deal with on a day to day basis for people to just keep getting used up and then move on. We want to be taken seriously as a career field then we have to take care of how we train and equip ourselves to do our job. The ability to deal with what we see on a daily basis is not the always the same level for every person. A thick skin is neccesary to do our job but it does need to be permeable on some levels. The attitude that if you have to ask for for help you can't handle the job also needs to go by the wayside. If somebody has to go find a bar to deal with what they see our first question shouldn't be why are they drinking in uniform, but what can we do to help them so they don't feel like they have to drink in uniform?
Tuesday, August 3, 2010
Good Instructors
The title of this blog being what it is you should already know that I am studying to become a Paramedic, and that is many things; interesting challenging, scary, demanding, intriguing, but not easy! I don't find this class easy and even though I sometimes wish my instructors were a little less demanding or nitpicky, I know they are not doing me any favors if they were that way. But the good ones make it alot easier to keep trying and help me to believe I can do this and become the kind of Paramedic I want to be!
THANK YOU!
THANK YOU!
Well Worth Reading!
I am posting this because I agree with it and don't think I can say it any better!
http://lifeunderthelights.com/2010/08/volunteer-fireems-taking-the-high-road-and-letting-go/
http://lifeunderthelights.com/2010/08/volunteer-fireems-taking-the-high-road-and-letting-go/
Sunday, July 4, 2010
Cardiology
I am at the point in training where we have started to study cardiology(hence the title of the post) and once again find myself surprised by how even what a simple thing like a sinus rhythm can be both more complex and tell you far more than just a simple heart rate. I am truly amazed at how intricate the functions of the body are and yet simple in other ways. I am also amazed by how complex a simple thing like a heartbeat can be! There are five different parts to the heartbeat; a P, Q,R,S and T wave and any and all of them tell you something different about the heart and how it is functioning. The human body is an amazing thing but it sure can go wrong in many different ways! Take care of your heart, it is a truly amazing organ! :)
Tuesday, June 8, 2010
Paramedic Thinking
This is one thing that caught me by surprise, in terms of how difficult it is for me to do. The idea that I have to think like a Paramedic, or at least begin to develop the ability while in class. One habit I have developed over my life is being very afraid of mastering new skills and having to use them without a good deal of backup and fail-safes. That isn't working when learning to be a paramedic. Self confidence is an important trait for a paramedic, because his patient is depending on him or her doing the right thing, right now and not just standing there trying to make up his mind. I am finding this training harder than anything I have ever done and not for what I would call ordinary reasons.
Monday, May 24, 2010
Scary Point
I am at an interesting point in my paramedic training, I know just enough to be very dangerous. I have learned just how much ignorance I actually have working as an EMT, but have not learned all I need to be a paramedic. This creates the situation where I hesitate when working as an EMT because I don't have the tools to use the information I now have. I am glad that most of the calls I am on are fairly straight forward and BLS has been enough, but am looking forward to having the tools to go with the knowledge. I think that is the best part of being a paramedic student, knowing that when it is over and done with I will have more and better tools to help people when they call. I have also grown to have much more respect for the paramedics I have worked with because now I have a much better idea of how they function.
Thursday, May 20, 2010
A Good Example
I was in class on Monday and had a fantastic instructor discussing RSI, he made it very clear that it is not something to be taken lightly, but not a skill we should be greatly afraid of performing when a patient needs RSI. He also admitted that is ok to recognize that you may be a little afraid everytime you are faced with doing RSI simply because the patient is in very serious trouble and there are great risks for both you and the patient involved. I appreciate when an instructor is that honest about himself and what I may face in a situation or have go through my mind.
I think that what made him a such a good instructor is that he has passion about being a paramedic and an instructor and he was not afraid to show it. He is a good example of the kind of Paramedic I hope to be.
I think that what made him a such a good instructor is that he has passion about being a paramedic and an instructor and he was not afraid to show it. He is a good example of the kind of Paramedic I hope to be.
Sunday, May 16, 2010
Some Beginning Thoughts
I find myself continually wondering what kind of paramedic do I want to be? What does it take to be a good paramedic? What will it take to make me a good paramedic? These thoughts run through my mind and hopefully as I progress through my training I can find some answers. I have uncovered part of the answer already, a good paramedic is one who never wants to stop learning.
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