# Staying Frosty



## Mad Max (Aug 18, 2012)

So just last week, I managed to land a job with a local private service that mainly deals with patient transports to and from dialysis, with a little bit of hospital discharges thrown in for good measure.  I'm new to EMS, like graduated from EMT class less than three months ago new, and I was wondering if anyone had any suggestions for keeping my trauma skills sharp, considering for the foreseeable future, all I'm going to be doing is basic assessment and vitals.  Don't get me wrong, I absolutely love finally being in the field, (seriously, I giggled a little bit when I got to ride shotgun in the rig for the first time,) but I don't want to lose what little edge my skills might have since I'll likely not have a chance to ever put them to use in my current job.


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## shiroun (Aug 19, 2012)

Mad Max said:


> So just last week, I managed to land a job with a local private service that mainly deals with patient transports to and from dialysis, with a little bit of hospital discharges thrown in for good measure.  I'm new to EMS, like graduated from EMT class less than three months ago new, and I was wondering if anyone had any suggestions for keeping my trauma skills sharp, considering for the foreseeable future, all I'm going to be doing is basic assessment and vitals.  Don't get me wrong, I absolutely love finally being in the field, (seriously, I giggled a little bit when I got to ride shotgun in the rig for the first time,) but I don't want to lose what little edge my skills might have since I'll likely not have a chance to ever put them to use in my current job.



Got a girlfriend?

Practice on her here and there. Mentally play with scenarios on your free time. That'll help a lot.


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## NYMedic828 (Aug 19, 2012)

You come across a booboo, make it stay in place or put a dressing on it...

Not to be a ****, but what is there to keep sharp realistically...


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## DesertMedic66 (Aug 19, 2012)

NYMedic828 said:


> You come across a booboo, make it stay in place or put a dressing on it...
> 
> Not to be a ****, but what is there to keep sharp realistically...



Assessment skills and backboarding skills (I've seen many EMTs who are horrible at it) just to name a few


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## Thriceknight (Aug 19, 2012)

firefite said:


> Assessment skills and backboarding skills (I've seen many EMTs who are horrible at it) just to name a few



+1 Agreed


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## NYMedic828 (Aug 19, 2012)

Odds are, those EMTs are horrible at everything...


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## Sandog (Aug 19, 2012)

NYMedic828 said:


> You come across a booboo, make it stay in place or put a dressing on it...
> 
> Not to be a ****...



That ship has sailed.


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## BeachMedic (Aug 19, 2012)

I wouldn't practice assessment skills and back boarding someone off duty.

I definitely wouldn't quiz my girlfriend either.

Getting ALS experience will be the refresher time you need. If you have questions, ask an ALS FTO when the time comes.


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## DesertMedic66 (Aug 19, 2012)

BeachMedic said:


> I wouldn't practice assessment skills and back boarding someone off duty.



Why not practice assessment skills and backboarding skills off duty? If you're able to get all the proper equipment for backboarding why not practice?


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## Tigger (Aug 19, 2012)

NYMedic828 said:


> You come across a booboo, make it stay in place or put a dressing on it...
> 
> Not to be a ****, but what is there to keep sharp realistically...



This is pretty much the truth. There is just not that much to forget at the basic level.


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## Handsome Robb (Aug 19, 2012)

Tigger said:


> This is pretty much the truth. There is just not that much to forget at the basic level.



Or even at the medic level for that matter. Add in IVs, fluids and needle decompression and that's about it.


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## NYMedic828 (Aug 19, 2012)

NVRob said:


> Or even at the medic level for that matter. Add in IVs, fluids and needle decompression and that's about it.




I can stick plastic and metal into a rubber patient 1000 times over, doesn't equate to being able to do the same on a real patient.


Beyond anatomy/physiology, patient assessment is the absolute basis of being a medical provider. You can't treat anyone if you can't properly assess them. That in mind, you can practice on your girlfriend all you want, but what is it really accomplishing? It is wasted effort for anything but a skills test. Following a cookbook approach in the field is often wrong regardless of what your "experienced" instructors tell you. The only way to practice your assessment skills, is to assess real patients. Being able to assess and treat through critical thinking, general knowledge and experience only comes from real patients.


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## Tigger (Aug 19, 2012)

NVRob said:


> Or even at the medic level for that matter. Add in IVs, fluids and needle decompression and that's about it.



Ugh. Speaking of which, I have not started an IV since December and my non-ambulance job boss expects me to do so (since he cannot). Time to find a friendly ER doctor I suppose.


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## Handsome Robb (Aug 19, 2012)

NYMedic828 said:


> I can stick plastic and metal into a rubber patient 1000 times over, doesn't equate to being able to do the same on a real patient.
> 
> 
> Beyond anatomy/physiology, patient assessment is the absolute basis of being a medical provider. You can't treat anyone if you can't properly assess them. That in mind, you can practice on your girlfriend all you what, but it is honestly a wasted effort for anything but a skills test. Following a cookbook approach in the field is often wrong regardless of what your "experienced" instructors tell you. The only way to practice your assessment skills, is to assess real patients. Being able to assess and treat through critical thinking, general knowledge and experience only comes from real patients.



Not sure if you're agreeing or disagreeing with me :lol:

I forgot about intubation too.

With that said, I wholeheartedly agree with everything you just said.


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## DesertMedic66 (Aug 19, 2012)

So let me make sure I understand this. If you don't have an opportunity to asses a real patient it is better to not practice at all. How are you supposed to get experience assessing a real patient if you don't have that opportunity? Run around and hit people and make them have allergic reactions so that you have a real patient?

A cookbook approach is better then no approach at all. 

If you want to stay up on your skills but don't use them in your normal job (don't get to use them) then why not practice according to what tests want? Should you just not practice anything at all then come into a job and say "I haven't used or thought about any of my skills for 2 years but who cares I got this."

I would 100% rather have a medic or EMT who has been practicing skills based on tests then a medic or EMT who hasn't practiced anything for a long time who thinks "Ahhhh these skills are easy. I got this".


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## Jon (Aug 19, 2012)

shiroun said:


> Got a girlfriend?
> 
> Practice on her here and there. Mentally play with scenarios on your free time. That'll help a lot.



Giggity.
But seriously, some truth to this. He or she would probably be comfortable with you practicing assessments... and we're just gonna stop there, OK? Family friendly site and all.



firefite said:


> Assessment skills and backboarding skills (I've seen many EMTs who are horrible at it) just to name a few



You can practice assessments ALL DAY doing dialysis transports. News Flash: these are some of the SICKEST people you'll see, ever.


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## Tigger (Aug 19, 2012)

firefite said:


> So let me make sure I understand this. If you don't have an opportunity to asses a real patient it is better to not practice at all. How are you supposed to get experience assessing a real patient if you don't have that opportunity? Run around and hit people and make them have allergic reactions so that you have a real patient?
> 
> A cookbook approach is better then no approach at all.
> 
> ...



No doubt it is preferable to have some sort of practice rather than none at all. However I am also no fan of the EMT that talks about how often he practices his assessment on his girlfriend but is still worthless on a call. The wrong kind of practice breeds the wrong kind of perfect, if there is in fact any sort of perfect to be had. This partner supposedly practiced his assessments all the time, but no call is textbook. Assessing a healthy person is easy, even one faking sick. He on the other hand simply could not cope with any sort of deviation, i.e. a staff member also on scene, the patient being unable to concisely answer questions, I could go on. We had a nice talk about assessments after the fact which I hope was helpful, but I really doubt it considering all he talked about was making better scenarios.

The point is that practicing only gets you so far. You need real, sick patients. If you have to go out and find them because you don't see enough at your job, do so. Volunteer, shadow ER staff, ride with fire, get creative. If you don't have those opportunities, well I am not sure what to tell you frankly. Ideas welcome.

Hell yesterday when I onsited a rollover on the interstate in my POV, I will admit I was a little frazzled. I get MVAs very rarely at work, and when I do I have a chance to mentally get into gear instead of it just appearing in front of me. Could my assessment of this patient have been more fluid? You bet. But I also haven't responded to an MVA in over a year and still managed to get a proper assessment out of the way before fire showed up, perhaps evidence that you don't forget as much as you think you do.


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## DesertMedic66 (Aug 19, 2012)

Real patients is also going to be the best but some people in don't have that opinion. For example in my area there isn't any places where you can volunteer. If you have your NREMT then you can't do ride outs at most ambulance companies. So you are left with no choice but to practice on non sick patients. 

If I wasn't employed I would be SOL. I'm to old for the fire departments explorer program. The volunteer program/reserve program is on freeze. Hospitals don't allow EMT volunteers (unless you want to make beds only and see no patient care). I have my NREMT so I can't ride out with ambulance companies.


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## Youngin (Aug 19, 2012)

firefite said:


> Real patients is also going to be the best but some people in don't have that opinion. For example in my area there isn't any places where you can volunteer. If you have your NREMT then you can't do ride outs at most ambulance companies. So you are left with no choice but to practice on non sick patients.
> 
> If I wasn't employed I would be SOL. I'm to old for the fire departments explorer program. The volunteer program/reserve program is on freeze. Hospitals don't allow EMT volunteers (unless you want to make beds only and see no patient care). I have my NREMT so I can't ride out with ambulance companies.



Just out of curiosity, why can't you do ride outs with an ambulance company if you're nationally registered?


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## DesertMedic66 (Aug 19, 2012)

Andrew said:


> Just out of curiosity, why can't you do ride outs with an ambulance company if you're nationally registered?



Not sure why. I kept getting the "liability" reason.


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## Tigger (Aug 20, 2012)

firefite said:


> Real patients is also going to be the best but some people in don't have that opinion. For example in my area there isn't any places where you can volunteer. If you have your NREMT then you can't do ride outs at most ambulance companies. So you are left with no choice but to practice on non sick patients.
> 
> If I wasn't employed I would be SOL. I'm to old for the fire departments explorer program. The volunteer program/reserve program is on freeze. Hospitals don't allow EMT volunteers (unless you want to make beds only and see no patient care). I have my NREMT so I can't ride out with ambulance companies.



Again I agree, I just think it is important to realize that practicing one's skills on healthy people is capable of breeding false confidence that can bite one during actual patient content.


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## Mad Max (Aug 20, 2012)

I appreciate the feedback, folks, and I can understand how vague a question I might have posed.  While there may not be much to basic trauma care in the grand scheme of things, I guess I'm just a little paranoid that I'm going to forget what I learned, considering the only time I ever used it was for practical nights in class.  As the saying goes, "If you don't use it, you lose it," or so said Steve Carrell.  It's hard to fight my squirrelish instincts, since I'm new and all, I just don't want to be standing there, looking like an idiot not being able to do something that I learned in EMT school, but hadn't really got to use in the field yet.  

That being said, yes, I do have a girlfriend, and I made great use of her during EMT school, Giggity x 2.


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## Sandog (Aug 20, 2012)

Tigger said:


> Again I agree, I just think it is important to realize that practicing one's skills on healthy people is capable of breeding false confidence that can bite one during actual patient content.



As opposed to doing no practice at all?


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## NYMedic828 (Aug 20, 2012)

I am not suggesting that any practice is better than no practice. I am suggesting that fake experience is just not that valuable past the skills testing level.

I can ask my patient to make up a scenario, they can tell me ok I have chest pain for 40 minutes. In that case what am I really going to learn other than "turn to page 9 in the protocol book." 

Practicing splinting and applying dressings can only go so far... There is next to nothing to it and honestly most hospitals hate when we put cling over a wound the way we practice it. No one enjoys cutting off 10 feet of dressing to see what is going on underneath.

Now if you have a dynamic training tool such as a laerdal simulator manikin, that is another story. Absolutely use that. It is as close to real as you are going to get. (I do not work for or endorse leardal)

The best thing you can do with free time is read and enhance your medical knowledge. Odds are you won't forget what to do when confronted with a standard injury, but, when someone out of the norm occurs, maybe you have read about it and at a minimum can devise some form of treatment.


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## Tigger (Aug 20, 2012)

Sandog said:


> As opposed to doing no practice at all?



Did you read my posts?


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## Jon (Aug 20, 2012)

firefite said:


> Real patients is also going to be the best but some people in don't have that opinion. For example in my area there isn't any places where you can volunteer. If you have your NREMT then you can't do ride outs at most ambulance companies. So you are left with no choice but to practice on non sick patients.



I repeat myself. First, dialysis transport patients ARE real patients.

Second of all... they are VERY sick. They need to be plugged into a machine for 4 hours a day, 3 days a week, just so that they don't DIE.


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## johnrsemt (Aug 20, 2012)

Practice with your partner in slow minutes;  verbalize what you would do on the way to a scene to pick up your dialysis patient.
     Practice actually doing it while posting in a park or somewhere similar:  at some parks I would actually ask people there if I could borrow an older child (or younger one) to practice with:  think families at parks.    Worked great, kids liked it and parents could watch and the kids wouldn't be waiting and getting in the way of the BBQ cooking.

   Sometimes we would actually get more trauma in the IFT than at the FD;  1st on scene of MVC's; and grandma fell at ECF.


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## DesertMedic66 (Aug 20, 2012)

Jon said:


> I repeat myself. First, dialysis transport patients ARE real patients.
> 
> Second of all... they are VERY sick. They need to be plugged into a machine for 4 hours a day, 3 days a week, just so that they don't DIE.



But these patients are usually not TRAUMA patients.... Which is what the OP wanted practice in.


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## firetender (Aug 20, 2012)

Volunteer in an ER.


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## zmedic (Aug 20, 2012)

firetender; said:
			
		

> Volunteer in an ER.



I disagree with this. Most volunteers are running around making beds and handing out food. Even those hired as techs aren't doing much assessment, though you get to at least see pathology. You'd be better off volunteering with a fire department, ski patrol, search and rescue, or ambulance. Something that gets you real patient contact. 

But at the end of the day, if you want to be good at treating 911 patients, you have to work 911. So you should be working on getting hired where you can work 911 if that's what you want to do.


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