Advice for New EMS Providers

Advice for New EMS Providers

This is advice I've compiled with the help of some peers to offer to those new to the field of EMS, and as a refresher to all of us who have been in the field for a while.

Entering the field as a new Medic and/or EMT can be daunting. The reality of what you are responsible for isn't as pronounced while you are doing clinicals as it is when you are on your own and not being precepted. Beyond that, there are operational aspects to the job that you didn't have to consider when you were solely focused on the Medical aspects as a student. The following is some encouragement on how to hit the ground running and set yourself up for success within this field and within your service. Please know I speak only from the context of experience and my own goals and in no way consider myself to be the Alpha and Omega or the benchmark of EMS. I have my own personal preferences and standards for professionalism, and they are only that- my own. Some may have differing opinions. That's ok. I'm posting this publicly and welcome other viewpoints. With that being said:

-Decide where you want to work and get that job. Don't ever look at a service or role and think, "Well, that's probably the best I can do" and then settle. Look for exceptional organizations with exceptional people and let them elevate you to extraordinary places.

-"What do I wear to an EMS field ops interview" is a common question. You wear nice clothes. Shirt and tie at the very least. A full suit if you own one. No jeans. No sneakers. I defer to a female with similar standards as to the appropriate attire in that regard.

-When you get on with a service, find the people who love their job and don't complain. Surround yourself with them. Allowing yourself to be influenced by the toxic personalities will be your undoing. It is tough to get turned around if you allow yourself to be influenced by negativity early in your career.

-You really have to listen to your conscience early on. If you’re being told something that challenges you on an ethical or moral level, you can’t afford to disregard that internal check. Doing so cools the very fire that burns behind our desire to do what we do.

-Conversely, you can’t fight every battle. You have to choose what hill you want to die on. The simple resolve to be better than what you are seeing is often the best response.

-Advocate for yourself. Ask for what you want. If you’re an EMT, you are one-half of the crew, nothing less. Insist on being involved. Ask questions. Learn how to perform interventions. Don’t allow yourself to be marginalized to driver-only status.

-Conversely, learn diplomacy. Don’t argue with your partner or call him/her out in front of others. Ask questions without making accusations. Protect the pride of your partner even when you disagree with them…even if you don’t respect them! Avoid “right/wrong” mindsets and focus more on how to resolve a disagreement. Always remember you cannot force someone to see things your way. You can only insist on being heard. Also, remember to choose your spots. Life and limb aside, disagreements are settled after the call.

-"Because I'm the Medic and you're the EMT" is neither an acceptable response or an acceptable answer, depending on which role is yours.

-Don't fall into the trap of talking yourself out of doing the right thing. If you wonder or ask, "Should I…," then yes, you should. Yes, you should take the bag and the monitor in. Yes, you should acquire the 12-lead. That's not a guide for clinical decision making. Just as a matter of operations and ethics. You'll always work harder, avoiding good habits than you will create them.

-DO. NOT. COMPLAIN. I repeat- do not complain. Avoid the complainers. Do not step in it, do not get any on you, do not inhale it. Complaining is different from feedback. Feedback is the acknowledgment of a problem (and a possible solution) without demanding attention or consolation.

-Do not ever…ever…EVER…protest anything over the radio.

-Assume that anything you say to one person will eventually become public knowledge.

-Don't fall in love with your interventions. You want to stabilize your patient and do what is best for them. Getting task-oriented can result in delays in definitive care, and can result in performing interventions that may not only be unnecessary, but even harmful. To put it bluntly, there are two types of providers- clinicians, and skills monkeys. It's ok to want to "do stuff," but you have to be willing to leave it all on the table for the sake of excellent patient care.

-On the subject of patient care, EMS today is as much about customer service as it is patient care. I'd dare say it is entirely about customer service as patient care falls directly within that purview. Gone are the days of EMS being called only for life-and-limb-related issues. The paradigm has changed considerably, and it is unlikely to move back in that direction. The mindset of one's services not being utilized appropriately can't stay afloat. Some people do need to worry about things like that, but not those of us in the field. Smile and be gracious to all your patients. Take them to the hospital of their choice. It's easier to do this than to deal with the repercussions of not doing it.

-Driving with lights and sirens is simply the act of safely requesting the right-of-way. Not a death-defying race to the finish line. There are so few proven instances of outcomes improving because of speed. Also, remember to keep cool. We're the ones driving unpredictably. Not everyone else. It's usually our sudden presence that causes someone to do something we didn't expect. There's no payoff to getting upset at other drivers.

-Talk to doctors. Annoy them. Be a bee buzzing in their heads until they realize you're not going away, and they accept you as a seeker of knowledge.

-Learn your receiving facilities. Remember how they do things. Learn what you can do, make a positive impression with the receiving staff. The smallest investments in that relationship has some of the most significant payoffs. Something as simple as keeping a gown on the stretcher and gowning your patient before arrival at the facility. We (mostly) have one patient at a time. The nurses almost always have multiple patients. It's very easy for us to get a patient packaged to allow for a smooth check-in for the receiving RN, and it's excellent ambassadorship.

-Don't deprive yourself of your first impression. We'll often get a lot of information before making patient contact. It has a higher chance of poisoning our differential than it does of forming an accurate one. Make note of the information you receive. Be gracious to those providing it to you, but start from square one with your patient and build your own diagnosis. Don't allow others to answer for the patient unless the patient is not able to answer for themselves or is not a reliable historian.

-Consider the non-operations personnel who work within our field. They don't report to work undressed or half-dressed. They don't begin undressing at clock-out time and make their way around the property, parking lot, and whatever stops they have on the way home that way. Not only should we be matching that professionalism in the field, but we should also be exceeding it. We wear the patch on our shirt for the company, the profession, and your State or country. Being half-dressed in public view in that regard simply isn't acceptable. People may only obtain brief glimpses of us in an undone uniform, but in some cases, it may be the only glimpse of us they get. Every opportunity you get to be seen in uniform is an opportunity to provide an impression.

-There is very little radio traffic that can’t be expressed in 5 words or less.

-Your call-in to the hospital is not a patient turnover or a narrative. It should be considerably more condensed than either, particularly considering there can be numerous services and units waiting behind you who may have a far more critical patient. The call-taker is concerned with the complaint, the acuity, the vitals, and the interventions. Spend 20 minutes watching the person on the other end of the line repeating a *head-desk during a long-winded call-in. Look at the written summarization of your call in ("CP ASA NTG"). It will help considerably in crafting a more concise call-in with only the essentials.

-Don’t come into the field with the mindset that there are calls not worth your time. That ship has already sailed. There was a time when people wouldn’t call for emergency services even if their life actually did depend on it. That is not the current paradigm. These are the days of liability, medical clearance, lack of transportation, no personal physician, no other options, and no money for a copay. That isn't a battle we fight in the field. It's up to the bean counters and policymakers to determine how things change, or how we accommodate change.

-Along those lines: We are not the arbiters of social justice within the field of medicine. Every single person that we interface with has equal standing. Either the patient, a loved one, a law enforcement official or a bystander determined the patient had a need that required our services. Our job is to render that service with as much compassion as possible and to preserve the dignity of the patient to the degree that we are able. Sometimes kind words and comfort measures are the best medicine, and they are always the best practice. Also, keep in mind that when a patient is rude, mean, or hostile, it rarely, if ever, is actually a personal attack on you. It's a symptom of their condition. Do not meet it with an equal response.

-Be mindful of the fact that we have no authority over a patient. The minute we begin barking orders, making commands, meeting hostility with hostility, and assuming an authoritative position, we have surrendered any leverage we had to work with an uncooperative patient as we can't back up any words or threats with any meaningful consequence. Even in the case where your personal safety is at risk, escalation does not help.

-It's prevalent to come into contact with immigrants from less industrialized and indigenous regions that have no concept of medicine. They understand that they are sick, but they don't understand sickness. They know medicine helps sickness, but they don't understand medicine. It may seem elementary and intuitive to us. It may seem that way to the average American lay-person. It isn't that way in areas where there is no industrialized and modern medicine. It's essential to be patient in these situations and not get frustrated when these individuals take inappropriate medications or demonstrate extreme distrust of our actions and intents.

-Don't ever cave to scene-time anxiety. Our first priority (outside of our own personal safety) is to stabilize our patients. There are some steps involved with that goal that can not be skipped. If you ever catch yourself saying to yourself or to those around you, "man, we just need to get out of here," stop that train of thought and get back on track. In the case of cardiac arrest, it's been proven that it's the efforts on the scene that contribute to a successful resuscitation, not the expediency in which one got off the scene. In the case of trauma, the "golden hour," and the "platinum ten minutes"- it's been proven that generally, only hemorrhagic shock benefits from that expediency. Does this mean you have the luxury to prolong your scene time to indulge yourself or other responders? Absolutely not. It just means that you don't skip vital steps. A patient who is intubated needs a c-collar and head blocks placed. This step is skipped more times than not because responders are getting anxious about the amount of time they have spent on scene. But a dislodged tube isn't an acceptable trade-off.

-Conversely, know what interventions actually benefit the patient and be ok with not playing with all of your toys (“Don’t fall in love with your interventions”). You don’t HAVE to intubate a patient (in the case of cardiac arrest). There isn’t any overwhelming evidence that intubation improves outcomes. An airway can be managed perfectly fine without it, and you will save a considerable amount of time if you don’t. This is NOT to advocate abandoning the practice of intubating patients in cardiac arrest. It’s just some perspective.

-Protocols. Understanding them, abiding by them, and learning how to apply them is nuanced. It's a dance. You are always relearning. Balance is the key. You simply can not allow yourself to adopt a mindset that lies on the far side of one spectrum. One spectrum disregards them entirely. It's a dangerous mindset that opens up a lot of exposure for you and your company to liability. It's an assumption that the width and breadth of your ability are exhaustive and unlimited rather than limited and defined. The other spectrum sees the protocols as a series of recipes in which all ingredients must be used. That's cookbook medicine. It fails to see that the protocols are a guide of what you can do, and not what you should do. If you've ever backed up an intervention with "well, the protocol says we can do it," then you need to evaluate whether you're willing to remain open and porous to correction and new information.

-Remain open and porous to correction and new information. Be willing to be wrong. In fact, don't ever look at new or different information as something that you are "right" or "wrong about. That mindset sets us up to defend OURSELVES and leaves us closed off to correction. Think of our knowledge base as a body of water. Far too often, we (and please note I am using the word "we") keep a knowledge base that resembles the Dead Sea. The Dead Sea is a body of water in Israel that has no outflow, and thereby can not cleanse itself. There is no life in it. Any new inflow to it mixes with the stagnant, salty brine and becomes stagnant and salty itself. Our knowledgebase needs to be a body of water than has an inflow and outflow. We allow anything outdated and stagnant to flow out, and we gladly accept new information. It's about doing the best thing for the patient. Not hanging on to the old ways because we are unwilling to change.

-Having a healthy, non-work related outlet is paramount. The average burn-out time for an EMT or Medic is 7 years. There are numerous reasons, some mental, some physical. One reason is that when we enter the field, it tends to be very, VERY stimulating. In that regard, we become ALL EMS, ALL THE TIME. We eat, sleep, and drink EMS our every waking moment. Be deliberate about interrupting this enthusiasm with a non-EMS related pursuit.

-Never get in the habit of putting off your reports. You’re getting paid to do them during your work hours. You’re not getting paid to compile them until after. After you’ve been doing them for a few years, you’ll develop an efficiency that will reduce the time needed to finish significantly. It’s ok to prolong your hospital time a bit to make a dent in it right now. Just make sure you or your partner are aware of your service levels and have the radio on.

-In regards to reports concerning MVC's and calls where there may have been violence and criminal activity, be mindful that your PCR is the only documentation of your medical care. Don't include a single detail that makes you an after-the-fact witness to a crime. We document what we see. The details of the accident are details that are of concern to law enforcement and insurance companies. What concerns us is the damage we see- whether seat belts were utilized, whether airbags deployed, whether the windshield was intact. We can't confirm or verify their speed. But we can see whether there was an intrusion into the passenger compartment. We can't verify or confirm that someone ran a red light, but we can see that two cars impacted each other. We weren't around to see that someone was assaulted and battered while they were walking alone. But we can see they've received a blow to the face. We document our physical findings, patient's physical complaints, and our medical care. We do not compile a crime report. If statements are made to us that we find concerning or admissions of a crime, we submit them as separate submissions outside of the PCR.

-Have an exit strategy before you need it. You start burning out long before you realize it. And injury is a genuine and imposing obstacle to a long-term EMS career. Above that, you may love being in the field, but loathe the thought of being in an office. Don't procrastinate in charting several courses to fulfillment and provision before you're left without options.

-We’ve all said something to a patient, family member, receiving RN, Physician, Firefighter, etc., that we immediately wished we could take back. Our natural response is to go into internal damage control mode and plan for a defense against the eventual blowback. This is entirely unnecessary. The best way to recover is simply to apologize immediately and offer the individual your supervisor's name and the number to your organization. It will almost ALWAYS de-escalate the situation. Don't spend a minute protecting your own ego. Don't worry about being right or wrong. An apology isn't always the act of conceding a point you feel strongly about. Quite often, it is merely an act of diplomacy that attempts to fix broken communication. It is not always easy to offer it. But doing so is a life-skill you can't live without.

-Keep people in the loop when things go wrong. Let your supervisor know a complaint may be coming as soon as you become aware of it. If you mess up, don’t hold your breath and hope it will blow over. Management will always appreciate you recognizing your own failures and being proactive about it. A planned response to trouble is ALWAYS better than damage control.

-This is one of the most challenging concepts to embrace in any field or social setting. Never deliver or receive a negative report about a co-worker or your company. Exhaust your options in resolving conflict before taking it to the chain of command. Talk to your co-worker if your quarrel is between the two of you. But don't spread the dirty laundry, and put down an effort to bring you in the loop when you meet it. Don't disparage your company, and don't patronize others doing so.

"If you work for a man, in heaven's name, work for him. If he pays you wages which supply you bread and butter, work for him; speak well of him; stand by him, and stand by the institution he represents. If put to a pinch, an ounce of loyalty is worth a pound of cleverness. If you must vilify, condemn, and eternally disparage, resign your position, and when you are outside, damn to your heart's content, but as long as you are part of the institution, do not condemn it. If you do that, you are loosening the tendrils that are holding you to the institution, and at the first high wind that comes along, you will be uprooted and blown away, and will probably never know the reason why." -Elbert Hubbard

By: Jimmy Apple

We just want to thank Jimmy for again contributing to our humble site. His insight is not only well stated but beneficial to all who read it. Thanks RedBull