What advice would you give to a newly certified EMT?

[NomadicMedic]

I agree, contacting medical control for refusals is ludicrous. If the guy needs to go to the hospital, I'm going to figure out what I need to do to get him there. If the guy doesn't want to go, and I don't think he needs to go… I don't need a doc to agree or disagree with me. Especially a doc on the other end of the phone or the radio.

As far as wacky DNR scenarios, the only thing I can think of where I would need to contact medical control would be if the family told me they had a DNR but couldn't find it. If that's the case, I usually just contact medical control, explain the situation and the doc lets me call it.

As far as med control in Washington for MDI, ASA and NTG… If you're assisting the patient with any of those things, you better have a paramedic on the way.

I'm really most interested in the guy who said he contacts medical control to find out what "out of his scope" procedures he can perform to help the patient… tell me, tell me!

 

[JPINFV]

As far as wacky DNR scenarios, the only thing I can think of where I would need to contact medical control would be if the family told me they had a DNR but couldn't find it. If that's the case, I usually just contact medical control, explain the situation and the doc lets me call it.

That's pretty much the situation I'm thinking of. It's also useful for honoring home hospital requests in patients who are on home hospice without a valid DNR present (granted, the situation I was in I didn't think the patient was acutely unstable, but I digress).

 

[supermoto69]

Wait a second… You can contact the base hospital to see if there is "something out of your scope" that you can do to help the patient? Are you serious?

I would think the best thing you could do to help the patient would be to get a paramedic en route. And the best thing you could do to help yourself would be, not perform any skills outside your scope.

I understand contacting medical control for high-risk refusals. We have to do it too, simply as a CYA move. I've always been curious as to what's going to happen when the refusal doesn't go as planned. The guy who's had two or three drinks, sitting at home, doesn't want to go to the hospital… I call medical control and the doc says, "no way, bring him in." Yeah okay Doc. He doesn't want to go, he's at his house, he's not hurting anybody… I know you don't want to let them refuse but, sorry.

Anyway… I can see a paramedic calling for medical control when there is some question of performing something that might be off the page… But for BLS? If it's a BLS call, put them 'em the ambulance and drive 'em to the hospital. If it's not a BLS call, call a paramedic.

i made this way to complicated sorry. my whole point is dont be afraid to to use base hospital if you think you need to upgrade your call to als. sorry for the confusion i stirred

 

[Tigger]

i made this way to complicated sorry. my whole point is dont be afraid to to use base hospital if you think you need to upgrade your call to als. sorry for the confusion i stirred

If you think you need to upgrade to ALS then do it. You should not have to call the hospital to do this, if your system makes you do this then well that just sucks.

If you're BLS and have a patient that you cannot manage yourself you need to figure out two things; how far away is the hospital and how far away is ALS? Pick the closer one and go there forthwith.

 

[Melclin]

So I got writing and I didn't stop...

A person who has been in the job for 20yrs and never learned, questioned or engaged in self QA/QI doesn't really have 20yrs of experience; they have 1 year repeated 20 times. Know the difference and don't be the guy closed off to learning and development.

That said, there is often value in the status quo; things are often done in a particular way for a particular reason, even if that reason is not clear to you a newbie. It is rude and naive to walk into a system and start challenging everything and everyone. Lots of students do this. There is a difference between asking why out of a desire to learn, and asking why rhetorically suggesting that there is something wrong with the idea in question. Making sure you are received as someone who does a lot of the first and not too much of the second is important to both being a good student/newbie and being seen to be a good student/newbie.

Ask lots of questions of anyone you can. Doctors, nurses, paramedics, your mum...anyone. Give consideration to every point of view offered by all manner of provider but question everything you're told (no matter who tells you, dr or otherwise) and then try and answer those questions with other opinions and more importantly, decent medical evidence. Experience without the book learning is just as useless as the book learning without experience. Once you've settled on a conclusion, realise that you may be, and very probably are, wrong or that what is considered to be right may change with changing evidence. There are very few absolutes or ideas that are set in stone in medicine. Get used to that.

Understand the problems you're dealing with. We organised a lecture on ECG interpretation from one of our senior clinical managers the other day. He started with basic atomic theory. Real basic high school chemistry. Everything in uni started with the basic science behind it. Without it, you can't really understand the rest. Pick up a good anatomy & physiology book, then good text books with far more information than you think you need to be an EMT. EMT books are full of fallacious absolutes and ideas simplified to the point of being wrong. PM me if you want some eBooks or advice on various internet and physical resources. The more you read, the more you will realise how little you know.

Figure out what kind of learner you are and how best to maintain your skills and knowledge. I'll give you an example of my own strategy. I'm good with concepts and not with wrote learning. I use this to my advantage in that I target books and articles that give sweeping, detailed conceptual descriptions. I accept that I'll spend hours reading entire books that may be irrelevant or only vaguely related, sometimes involving unnecessary levels detail, but I do it in order to understand the concepts because I know that this is the best way for me to remember ideas. At the same time, I recognise that some things NEED to be wrote learned and so I allocate extra effort/time for any given topic because I know I'm rubbish at it and that I need a bit more than others in order to retain the info.

I like solving problems rather than reading aimlessly, so I usually base my learning around case studies or around some specific question I have. I also drill myself in low frequency/high stress roles regularly. I do a cardiac arrest scenario every second morning or so. I run through scenarios where I decompress a chest, insert an LMA and manage an MVA around about every week or so. Just by myself, with a few bits of gear. Its takes a few minutes at the start of a shift and I think its invaluable. I also keep a list of what guidelines or concepts of reviewed and when (nothing fancy, just a few notes in folder) which is great at pointing out what topics I haven't looked at in a while.

Try and find a way to enjoy the continued learning process. The job and medicine in general will not stop changing and you will have to keep up or get out of the way. Best to try and find some enjoyment in that. It makes things a whole lot easier. My way involves podcasts, blogs and case studies with problems to solve, and little projects based around questions I want answered. I usually type up notes and create learning resources based on the above, which gives me a sense of achievement and also a study resource written specifically for me.

Keep a rough record of your own jobs, usually omitting the more mundane of routine jobs for the sake of brevity, and engage in active self analysis and constructive criticism. I've reviewed some of my old case sheets 10 times, but with more experience and knowledge I can shed new light and learn new lessons each time. Involve others in this process for a fresh set of eyes and new opinions/advice.

Recognise that you are not perfect and no matter how much you learn or how well your last case went, you are not bullet proof, no case goes perfectly and you will make many mistakes. Firstly, identifying and acknowledging mistakes is the first step to fixing them. If you think a job went perfectly, you just aren't looking hard enough. Once you've realised how many mistakes you're making, don't feel too bad about it. Everybody f**ks up whether they know it or not, the trick is to learn from it. Secondly, the job has a remarkable ability to kick you in the arse when you get a little to big for your boots. So do yourself and your pts a favour and keep your ego in check. Also, recognising that you know very little in the great scheme of things is a great motivator to keep learning.

Communicate clearly and calmly. Just about any job will go reasonably well if everyone remains calm, polite and communicates well. When you are too nervous to do the above, literally take a deep breath. It really does help.

ALL of this:

Breathe. Flying off half cocked doesn't do anyone any good.

Slow down. The ambulance is not a Porche'. If your medic is hanging on the oh sh#t bar like a spider monkey, then he's not taking care of the pt. Drive it like you're driving on ice.

Slow down going to the call. Lights and sirens only ask others to merge right and only ask permission to cross on red. You're not going to save any time. The speed limit is fine even with lights.

Lift correctly. That means proper lifting techniques and lifting AS ONE UNIT. Technique is everything.

If you can't hear the blood pressure, say you can't. Don't lie.

Don't get an attitude. Leave your cape with your ego... at home.

You haven't "arrived" until your peers AND your superiors tell you that you Have arrived.

Heroes receive memorials... posthumously. Don't be one.

 

[emt835]

learn anything and everything you can, and never say the q word around any of your senior staff

 

[Porta]

Wash your damn hands.