Monday, June 25, 2007

First Shift...

Just got home from my first full 24-hour shift as a Paramedic. Not a lot to tell, only ran 2 calls. One was a difficulty breathing and a couple of nebs fixed her right up. The other was a near-syncope. At first I was thinking cardiac because she had a stint put in about 2 weeks ago. Her vitals, blood sugar and 12 lead were all normal, so no easy fix there. I slipped an 18 in her hand and we headed down the road.

I happen to look up at the monitor and saw a big ole PVC go marching across the screen, then another and another. She was in trigiminy for a minute or so and then nothing. I stopped dead in my tracks wondering what the hell do I do now? Then I got ahold of myself and remembered there was a person attached to those wires. "Treat the patient not the monitor". I turned to her and asked her how she was feeling and she said OK, no problems. She looked OK and felt OK. So maybe the PVC's were normal for her, I kept one eye on the screen for the rest of the transport anyway. She went in and out of it the whole time, but never so much as raised an eyebrow in discomfort. Oh well, nothing to be done for it I guess...

Saturday, June 23, 2007

Must read....


I just finished "People Care, Career-Friendly Practices for Professional Caregivers". I think it is an absolute must read for anyone who works in or around EMS and the health-care industry. I especially think it should be included in the EMT and Paramedic program as required reading. Some of the things that are talked about are common sense, at least to me. But it opened my eyes to a lot of other things. I have to admit my face probably flushed with shame a few times while reading, remembering times that I treated a patient or family member a certain way that I shouldn't have. I know that I will try to do better now. I just wish that I was observant and kind enough to notice these things before hand. I can't do anything about the people that I have already faced, but I can do better with the next one. (I'm not up on the whole copyright thing, but I hope that the authors of this incredible book won't have a problem with me endorsing it on my little page.)

On a side note: I passed my oral boards with our MD. I was sweating bullets, let me tell you... After it was over I realized that I had made it a lot worse than it actually was. But isn't that the way it always goes? The anticipation of the thing is usually worse that the actual thing?

Anyways, I am now a fully-functioning Paramedic, I can finally do all the things I have been training for. It's been one hell of a long road. I have to admit I am scared shitless and eager all in the same heartbeat. Scared because when that next call comes I wonder what will I do, will I freeze up with a major brain-fart? or run screaming from the back doors? Eager because I want to prove to myself that I deserve to wear that patch, that I belong in that truck and that I can be a good medic and all that entails.

As an old instructor of mine once said, now that your out of school your real education begins, so "Go forth and do no harm". He's not on the street anymore, but I hope that with my actions, I can make his memory proud....

Tuesday, June 19, 2007

Perfection.....

My sister-in-law visited us this past weekend. It went OK, me her and the wife sat around after the kids had gone to sleep and drank coffee and talked. We talked about all the grown-up things that, well, grown-ups talk about like religion, politics, raising kids, marriage and relationships and of course EMS. Me and the wife are recent Paramedic graduates and the sister-in-law is just starting her education in EMS. She tried to get into nursing school but for one reason or another didn't make it, so she decided to go into EMS.

Not sure how we got onto the subject, but we started talking about grades and how well a person did on mega-codes and the like. The sis-in-law made a comment about me getting pissed if I didn't make 100% on every test. Apparently the wife and her had talked about this before. I then tried to explain myself and why I felt that way.

Yes, it is true that I expected nothing less than 100% on all tests. Is that wrong of me? As one of my first instructors told me, "This is people's lives that we're dealing with, it's not basket-weaving." For that reason, EMS students are held to a higher standard than other educational disciplines. We were required to make at least an 80 on all tests, unlike other classes that only require 70. I'm not sure if that is the way it is in other places, but that is the way the Paramedic course is around here.

I suppose I took that instructors words to heart. Maybe a little more than I should have, but it pushed me to learn more and be better, I think. Think about it statistically, if you make average of 80%, then that means you only know 80% of the information. What if late one night in a ditch somewhere someones life depends on that other 20% that you weren't paying attention to? Or didn't care to learn because an 80 was passing? I for one don't want to take that chance. I want to be the best I can be both for myself and more importantly for that patient that I haven't met yet. Which is always the very next one.

A few of my friends and classmates would get irritated when I would only make a 95 on a test, they would say, "You did better than I did". What they didn't understand was it wasn't a competition with any of them, it was between me and myself. I didn't really care what anyone else made. I wanted everyone to pass, but other than that it was always an inner competition. For some reason no one understood this, even the wife who was in the same class I was in. It was almost like they took it as a personal affront to themselves if I was hard on myself. I never understood this and still don't. Is it wrong of me to push myself to be the best I can be?

Perfection is something that no one can achieve, I know that. I also know that the scope of medicine and the human body is way too much for any one person to grasp and know everything about. But what is the hurt in trying to achieve that? Even knowing that it will never happen? Some people say I am just setting myself up for a fall, but thats not it. I know that I will never know everything nor ever be perfect. I know that no matter how good you are, there is always someone out there that is better. You will never be the "best". I know that I will make mistakes during my career. Hell, I've made plenty already, but I want to be able to learn from them and try not to make the same ones again. I strive everyday to be the a good caregiver, the best I know how to be. Everyday I strive for perfection. What is the harm in that?

Wednesday, June 13, 2007

Precepting....

Last night on MedicCast, Peter Canning and several other great bloggers talked about precepting and being a preceptee. I guess I thought I'd like to add my two cents in...

During the last year I have been working as an Intermediate and going to Medic school. So pretty much the entire time I have been what we call a Paramedic Intern. That means that as long as there is a Medic in the back of the truck with me, I can perform as a Medic. This has been excellent in terms of experience for me.

My partner at that time wasn't that great of a formal teacher. He never really said, "Do it this way or try this." He wasn't that great at teaching me 12-leads, or the A&P of the job. He was a stickler for the rules. He once told me that he did things by the book when asked if there was anything that he did that he knew was different from others. This is not to say that he wasn't a good Medic, he was a great one, just not a good formal educator in my opinion.

The one thing we was good at, and I am grateful for, is that he would let me do about anything I wanted to do. Just about every call he would step back and let me do all the talking and interviewing and most of the treating of the patient. He would help out and put them on the monitor or start an IV if I wanted one, but that was about it. In other words, he treated me like a Paramedic. I will be eternally grateful for that experience and freedom that he allowed me and I think it has made me better for when I am cut-loose and on my own.

He quit and went on to bigger and better about 3-4 months ago. Since then I have been in the round-robin of Medic partners. I never know who I will be working with from one shift to the next or even from one hour to the next on some days. In a way I like this as well. I am getting to see how other people do things and that helps me to form my own way. Some of the people I have worked with allow me to do anything I want. They see me as a Paramedic, even though I just finished class. Others still see me as a wet-behind-the-ears, dumbass Intermediate and they don't think of me as anything but an IV tech and a driver. Those are the days that I don't really enjoy, but it does show me what I don't want to be and how not to act. A select few Medics that I have worked with see me as I am, a brand new Medic with a several years experience as a Basic and Intermediate. They allow me to run the call, but add little hints and helpful tricks of the trade that make our job a lot easier, or subtly remind me of something that I have missed. These are the days that I love and I take away a lot of information and experience when the shift is over.

I read a lot of other blogs that are written by people in much the same situation that I am in like Baby Medic, I Heart EMS, and Medic March. It seems all of the different companies have different approaches to precepting and clinicals. Now that I have finished class and passed my test, I am waiting on all the official paperwork to finish and I will do my oral boards with our Medical Director. Then I will be able to function as Paramedic. I will still be working with an experienced Medic for at least a couple of months before I am completely cut loose. After that I will be free to work with anyone, an Intermediate or Basic partner. (In the past it has been 6 months to a year, but with the current Medic shortage, it won't be that long.) Meaning that I will be a stand-alone Medic, as we call it.

I guess we are very informal around here because we don't have any paperwork or check-list that we have to complete before we are cut-loose. In some ways I would like for that to be implemented, a list of objectives that I would have to meet so I would kind-of know where I stand. As it is, it's just a certain amount of time, it's not even based on patient contact hours. I don't think the current system is a very good idea. Everyone learns at a different pace, everyone has different strengths and weaknesses. What might take one person a year may take another only a few months to learn and get comfortable with. I think the focus should be on the individual rather than a set amount of time for everyone. Then again, I work in a rural setting. If your waiting on a code or a good trauma you might have to wait a long time. Once I ran two codes in one day and then nothing for a few months, its feast or famine around these parts.

Friday, June 8, 2007

Saturday, June 2, 2007

It's over....

Done, finished. Now just got to wait for the results to come back. Hopefully I will know something in the next week or so. I'll be walking on eggshells 'till then..