# What advice would you give to a newly certified EMT?



## GreatJob (Jul 15, 2012)

Just a couple of more weeks until I'm done with my course. Couldn't be more excited.

What are some things you know now that you wish you knew when you started working as an EMT? What did they not teach you in class that you think is important to know?


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## NYMedic828 (Jul 15, 2012)

That I should of gone to PA school instead :rofl:



In all honesty, everything. 

An EMT class really doesn't teach much beyond general common sense and what someone felt the proper way to apply oversize bandaids was.

People who are actually considerable as competent medical providers as an EMT/paramedic reached that level by self improvement, experience and ambition.

Thankfully, just by being on this forum you are on the right track. This forum alone has taught me a great deal and I usually pick up atleast one new thing a day here. 

The Internet and smartphones are also an invaluable resource. When you do a job, and there was something you didn't know, whether it be a medication or a disease or something anatomy related, immediately look it up afterwards. I find this to be a great way to learn.


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## GreatJob (Jul 15, 2012)

NYMedic828 said:


> That I should of gone to PA school instead :rofl:
> 
> 
> 
> ...


I'm actually trying to get into PA school in the long run, I figured working as an EMT for a couple of years would be a good thing to add to my resume until that time comes.


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## bahnrokt (Jul 16, 2012)

Avoid "firehouse politics" at all costs and do your best to keep your head above water. I've known several good emts who were great on calls but lost their careers because they couldn't keep a professional attitude between calls. 

Don't :censored::censored::censored::censored: your partner in the rig...or in the bunk room...or anywhere. 
Learn to get along with everyone.
Only publicly judge your coworkers on their abilities as an EMT.
Don't put yourself in the position where the police are investigating you for releasing information on a pt to the media after you transport the mayor.


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## mrg86 (Jul 16, 2012)

Seek out the good apples in your organisation and learn everything you can from them, especially the mistakes they have made on calls in the past and what they learned from them. Identify the traits they exhibit that make them good at their job and try to emulate them. Get comfortable talking to patients and doing a quality patient assessment/interview. If you see a medication or medical condition on a call that you are not familiar with, look it up or ask someone who has some years under their belt. Take pride in your patient reports and the care you provide. Make sure your patients are comfortable, little things like cold/hot packs and pillows go a long way! Finally, if you are unsure or don't know, ask for help.


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## EMT91 (Jul 16, 2012)

Get a good physiology book. Ask doctors nurses emt Is medics things.


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## Dwindlin (Jul 16, 2012)

Use your ears and mouth and in the same proportion they were given to you.


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## lucky13 (Jul 23, 2012)

bahnrokt said:


> Don't :censored::censored::censored::censored: your partner in the rig...or in the bunk room...or anywhere.


:beerchug:


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## EpiEMS (Jul 23, 2012)

Ask anybody and everybody questions. More often than not, they're willing to teach.


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## medicman14 (Jul 23, 2012)

Don't get sucked into the couch.  Aka, keep learning - your patients deserve it...
One course per term, before you know it you've got some initials.

When you make a mistake, make sure the lesson is worthy of the price you paid.
In other words...some lessons are expensive, very expensive.  Don't ignore the ones on sale...

Your patient had no choice in who arrives to care for them, make sure you are the best available - especially since you are the only one who can.

Last, and most importantly, keep showing up...

Be safe,
Medicman14


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## MSDeltaFlt (Jul 24, 2012)

GreatJob said:


> Just a couple of more weeks until I'm done with my course. Couldn't be more excited.
> 
> What are some things you know now that you wish you knew when you started working as an EMT? What did they not teach you in class that you think is important to know?



You don't save lives. The ones who fix the problems are the ones who save lives (those with MD or DO behind d their names).  You do, however, begin the process.

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.


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## xrsm002 (Jul 24, 2012)

I learned that patients with bradycardic heartbeats or irregular heartbeats you have to take a BP very slow if doing a manual. I don't have a problem telling my partners I can't hear a BP.


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## NYMedic828 (Jul 24, 2012)

Considering the fact that the thuds you listen for when auscultating a BP are generated by the pressure wave sent forth with each heartbeat, that would make sense.


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## crazychick (Aug 3, 2012)

Ask questions and go over scenarios continuously! as a newb, you really dont know much, so take it all in. You will find your groove but it does take time. Listen!!!!!!! Learn where stuff is. Every company is different!


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## PVC (Aug 3, 2012)

GreatJob said:


> Just a couple of more weeks until I'm done with my course. Couldn't be more excited.
> 
> What are some things you know now that you wish you knew when you started working as an EMT? What did they not teach you in class that you think is important to know?



Everything MSDeltaFit posted

Pee every chance you get.

Patients with a heart rate above 250 often don't have a palpable pulse.

O2 is not good for everyone.

EMTs save medics.

I don't really need all that crap hanging off my belt.

There is always more to learn.

If you show up at a MVC after 0200 and there isn't a drunk in the car, keep looking, there is a patient missing.

When your patient has priaprism, he is probably not happy to see you.

Helping others does not make us heroes.

We really don't save that many people.

Some others I can't remember and 

Lesson number one; Don't get sucked into the adrenaline junkie BS. Stay away from the wackers and knuckle draggers that got into EMS "because chicks dig the uniform" "trauma is cool" or "the EMS discount Jo's BBQ". Run from those people. They will drag you down.

Stand up for yourself, just because some dude has been hanging around the station since he was 12 does not make him better than you. Odds are he knows less.


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## firetender (Aug 3, 2012)

*"Best of Advice" category*



PVC said:


> When your patient has priaprism, he is probably not happy to see you.


 
You deserve a bumper sticker from BBG.


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## Medic Tim (Aug 3, 2012)

Few people actually need O2 or spinal motion restriction
slow down.....driving.....assessments.....whatever. With time and experience you will become more comfortable and calls will become less stressful and easier to handle.  
Never stop learning. 
Eat when you can, pee when you can, and sleep when you can because you never know when you will get a call.
SSM sucks






PVC said:


> EMTs save medics.



New EMT's often say things like this and
 Paramedics save lives and
 treat the monitor not the pt.

facepalm


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## Tigger (Aug 3, 2012)

Slow down and think before you do, and make sure you have a reason for everything you do that's something more than protocol. 

Also remember the big picture. You are part of a team, from the CNA at the nursing home that you thumb your nose at to the emergency room doc that you are terrified of. All of you are playing for the same reason, to benefit the patient. Everyone plays a distinct role, some more important in the long run than the others, but nonetheless everyone contributes in a unique and needed way. No one saves anyone. Work together with everyone you meet. Try and learn from everyone you meet, and if the opportunity presents itself, educate those that you meet. Without continuing to improve our knowledge we are nothing. Don't forget it.


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## Handsome Robb (Aug 3, 2012)

Medic Tim said:


> New EMT's often say things like this and
> Paramedics save lives and
> treat the monitor not the pt.
> 
> facepalm



Took the words right out of my mouth. 

Believe it or not Paramedics were EMTs once... :unsure:


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## PVC (Aug 3, 2012)

firetender said:


> You deserve a bumper sticker from BBG.



Unless, of course. the Original Poster is Harmony Rose!


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## DrParasite (Aug 3, 2012)

GreatJob said:


> What are some things you know now that you wish you knew when you started working as an EMT? What did they not teach you in class that you think is important to know?


When all else fails, take the patient to the hospital.

when you are stumped on what is going on, ask someone who is more educated and take the patient to the hospital.

ABC's are important, as long as you have those, odds are the patient isn't going to die on you, regardless of what you do.  If the patient doesn't have those, you got to fix them or else the patient is going to die.

There are some times when you can't do anything for a patient, except take them to the hospital.

If they meet you at the curb, odds are you don't need to spend 20 minutes on scene assessing them, it can all be done enroute to the hospital.

your EMT training was the beginning of your education, not the end.  Take good CEU classes, hard classes, classes that you actually learn stuff in and have to pay attention to pass.  And don't just take them in your agency, go elsewhere to see what others do.

Network, network, network!!!  make friends in other agencies, towns and counties.  

The grass is might look greener on the other side of the fence, but it isn't always.  Sometimes change is good, but don't be surprised if once you get a new job you find it isn't as good as your old job.

Transporting with lights and sirens is usually not needed, especially with a stable patient.  Esp when you use L&S with the stable patient, and you T-bone the busload of nuns, and have to justify your actions.

do not date anyone at your agency.  it rarely ends well.

you won't save many lives, but you can make a difference, even if it just being nice to someone who needs help.

Slow down, most calls aren't worth getting yourself hurt over, especially if you are rushing to a scene.  That being said, if I'm treating the patient and I say "get me to the ER, I got a patient who is circling the drain and I can't stop it," get us there are quick as you can, but please don't kill us in the process.  And please tell the ER you are coming, so they can have a bed waiting for us when we arrive.


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## SubiEmt (Aug 6, 2012)

Take your registry asap


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## codethree (Sep 3, 2012)

There will be a time when you will freeze when you get to a patient, try to calm down and retrace you thought of mind. It happens to a lot of us.


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## Doczilla (Sep 4, 2012)

Do not install lights in your car. 

Do not make a "jump bag" for the sole reason of looking for an excuse to use it. 

Do not follow ambulances to calls, then announce your credentials to everyone; expecting to receive a standing ovation for your assistance. 

Never do anything for recognition. 

Show work ethic and discipline in even the small aspects of your job--- checklists, cleanliness, care and appearence of your uniform. Superiors rate you on Consistency, not a few stellar performances.


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## eprex (Sep 5, 2012)

Doczilla said:


> Do not install lights in your car.
> 
> Do not make a "jump bag" for the sole reason of looking for an excuse to use it.
> 
> ...



I wasn't planning on putting lights in my car but I'm curious why you mentioned that.

All pretty sound advice though I'd say


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## Handsome Robb (Sep 6, 2012)

eprex said:


> I wasn't planning on putting lights in my car but I'm curious why you mentioned that.
> 
> All pretty sound advice though I'd say



Two words, Ricky Rescue...


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## Remeber343 (Sep 6, 2012)

I'm not sure if this has been covered, mainly because I only ready page 2.  But, don't be a tool bag.  Otherwise have fun and learn all that you can!


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## NomadicMedic (Sep 6, 2012)

Only reading page two is toolbaggish. 

Jut sayin'

But yeah, don't be a tool bag was mentioned.


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## FDJohn (Sep 6, 2012)

You've heard pretty good advice already. Learn more though. Ask your partner questions. Ask the nurses questions. Also learn how to take criticism. You'll have a partner, a nurse, or a doc. who's more than willing to point out mistakes. Don't take it personally. Learn from it. When you screw up document it. DO NOT TRY TO HIDE IT. And remember, sometimes the doc, or the nurse, or the partner is having a bad day.


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## Dearing (Sep 6, 2012)

As a new cert I'm interested in how to find a job right now. I love all the advice and plan to take the lights out of my car tonight.


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## FDJohn (Sep 6, 2012)

Well, volunteering is a great way to get experience. Otherwise it's just like getting any other job. Put an application in. And, fyi you should check your local and/or state laws about having lights in your POV. Where I live volunteers are allowed to have lights in their cars but can only use them with sirens on the way to a cardiac event or structure fire.


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## Dearing (Sep 7, 2012)

I was kidding about the lights. I don't think anyone would take a medical honda seriously anyway. 

Thanks for the advice about the volunteering I'll try that while sending out resumes.


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## supermoto69 (Sep 10, 2012)

use your base hospital!! if you and your partner dont know its better to ask base for advise dont think of it as a pride thing think of it in a patient care aspect. radios are there for a reason


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## Handsome Robb (Sep 10, 2012)

supermoto69 said:


> use your base hospital!! if you and your partner dont know its better to ask base for advise dont think of it as a pride thing think of it in a patient care aspect. radios are there for a reason



Not trying to pick a fight but at the BLS level what exactly are you contacting a base physician for? I'm truly curious, we don't use BLS providers in my system at all.


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## Tigger (Sep 10, 2012)

NVRob said:


> Not trying to pick a fight but at the BLS level what exactly are you contacting a base physician for? I'm truly curious, we don't use BLS providers in my system at all.



We have a "high-risk refusal policy" that mandates that medical control be contacted for a refusal if the patient is:

Any patient under the age of 18 (where parental consent has not been obtained) or over the age of 70.
Any patient who is a type 2 diabetic (taking oral medications for control of their diabetic condition) who is having a condition that may be diabetes related.
Any patient who is under the influence of alcohol or drugs.
Any patient with a head injury or altered mental status.
Any patient who has attempted suicide or has verbalized intent to harm themselves or others.
Any patient who was administered medications or reversal agents prior to or in the presence of the EMS personnel.
Any patient whom the providers feel has a potentially serious medical condition that is in need of further medical attention yet refuses care (medical control may be able to help persuade the patient).

We are also supposed to call med control to administer repeat dosing of the patient's own NTG and if using activated charcoal.


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## supermoto69 (Sep 10, 2012)

NVRob said:


> Not trying to pick a fight but at the BLS level what exactly are you contacting a base physician for? I'm truly curious, we don't use BLS providers in my system at all.



In san diego emts cannot do a lot and my bls company has contracts with many SNFs who like to call us for emergent calls so if there is something that looks too advanced for me or there is something out of my scope that can be done to help the patient ill contact base hospital to see what they need me to do that way if something happens it helps cover me and it can potentially help the patient if I upgrade to als


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## supermoto69 (Sep 10, 2012)

NVRob said:


> Not trying to pick a fight but at the BLS level what exactly are you contacting a base physician for? I'm truly curious, we don't use BLS providers in my system at all.



I didn't mean a physician all the time either the MICNs can tell us to upgrade or drive code or we can handle it till we get to the hospital


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## NomadicMedic (Sep 10, 2012)

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.


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## leoemt (Sep 10, 2012)

NVRob said:


> Not trying to pick a fight but at the BLS level what exactly are you contacting a base physician for? I'm truly curious, we don't use BLS providers in my system at all.



At the BLS we need to contact Medical Control if we are to give NTG, ASA, or MDI's. We also need to call them if we have a high risk refusal or if we have questions concerning treatment. 

If Basics in WA have IV Therapy endorsement, then they will need to obtain MPD authorization prior to administering drugs (ALS should be enroute)


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## JPINFV (Sep 10, 2012)

n7lxi said:


> 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.



...and that's why I disagree with contacting medical control for refusals unless you think that the physician can talk the patient into going because, well... "the doctor said so."



> 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 can see the need for med control for some funky DNR situations.


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## NomadicMedic (Sep 10, 2012)

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!


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## JPINFV (Sep 10, 2012)

n7lxi said:


> 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).


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## supermoto69 (Sep 11, 2012)

n7lxi said:


> 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 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


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## Tigger (Sep 11, 2012)

supermoto69 said:


> 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.


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## Melclin (Sep 13, 2012)

*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:*




MSDeltaFlt said:


> 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.
> 
> ...


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## emt835 (Sep 14, 2012)

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


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## Porta (Sep 18, 2012)

Wash your damn hands.


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