Freezing Up

[Vao]

So I'm a relatively new EMT, only about a month of actually work experience, and I had my first 'freeze' the other night. Seemingly basic call, nothing to even be concerned about (a respiratory with no shortness, speaking in full sentences, blah blah) and for some reason I just sorta...locked up. I had the O2 tank in hand, and i just sorta didnt know what to do next.

Now, Im not an idiot, I did rather well in all my classes, I guess i just had a bit of a gap while realizing that this isnt a dummy, and this isnt a classroom. And to be honest, it kinda messed me up.

Now my supervisor talked to me about it, told me its nothing to be concerned about, and that everyone new does it at some point. But is he right? Or am I an invalid :sad: . Anyway. Id love to hear the forums input/stories! Thanks all- Vao

 

[Amycus]

Honestly, it happens to me all the time still. Well, not ALL the time, but plenty of instances where someone else is thinking 1-2 steps ahead of me and naming the next step before I get to it...haha. I generally find when I'm on scene and I hit the "freeze" point- that's when I should start thinking about packaging and transport. Some PTs, that takes awhile to get to, others it'd happen very soon. Like in your scenario- I can't imagine I'd have a long scene time, ask what happened, check lung sounds/vitals, get PMH/meds, O2 and transport.

 

[TacoMEDIC]

It happens. If you hit a wall and all else fails, IV, O2, Monitor, Transport. While taking care of these basics, take a mental step back and figure out what your next step is. Don't beat yourself up. It's more common than you think.

 

[JPINFV]

...and while staning on the stool of life*, the Fat Man continue to exclaim, "...and the Second Rule of the House of God shall be, 'At a cardiac arrest, the first procedure is to check your own pulse."

One thing that's helpful is to remember what HAS to happen. For example, if you're lost, what's the next thing that HAS to happen? Is the patient on the gurney? Well, they're evetually going to HAVE to be on the gurney, so do that while collecting your thoughts. Is the patient in the ambulance? If not, then the patient will eventually HAVE to be in the ambulance, so do that.

*One of the uses for those small foot stools commonly seen in the emergency department is to give a provider extra height while performing chest compressions. Hence, my calling it the Stool of Life (tm). Also note, only the actual rule is cannon from House of God.

 

[Amycus]

One thing that's helpful is to remember what HAS to happen. For example, if you're lost, what's the next thing that HAS to happen? Is the patient on the gurney? Well, they're evetually going to HAVE to be on the gurney, so do that while collecting your thoughts. Is the patient in the ambulance? If not, then the patient will eventually HAVE to be in the ambulance, so do that.

This poster and the one above echo my sentiments perfectly. Ultimately, our job is to get the person from the scene to the hospital in as stable condition as possible- when in doubt, do your basics and prep for transport. Ask questions while you are strapping em in, loading em, etc.

 

[JPINFV]

...and while standing on the stool of life*,

ftfm

 

[CAOX3]

I agree, its very common. I remember my first time I just kind of wandered around aimlessly trying to digest the fact that I was supposed to care for this person.

Its like a lightulb, it will eventually go on and you will be fine.

 

[emtchick171]

There is nothing wrong, I believe every new EMT/Medic has their "freeze" moment. This is just your way of getting used to things, once you get the hang of everything, it will become second nature to you. Just remember, it is your job to stay calm & take care of yourself, THEN take care of your patient. Hang in there you will do just fine!

 

[mgr22]

When you're not sure what to do, go back to the ABCs -- sorry, the CABs. Or is it the CBAs?

 

[firetender]

At first you have all this dead space in your head because you really DON'T know what to expect on-scene and you don't have enough experience to know what you don't know.

It's called the stage of "Conscious Incompetence"

(I didn't say Incontinence!)

You're just hyper aware, for a little while, of just how much you don't know.

 

[clibb]

It happens to everyone. Hopefully, your partner will be there to save the day!

You can only learn so much from a text book. Experience will help you. I learn something new everyday and if I didn't I would be pissed.

 

[FrostbiteMedic]

We all have that "puc ker" factor moment.....as it was said before, if you get stuck, go to the next logical basic step....i.e.-get em on the cot, in the truck, on the road. You'll get the hang of it...we all have faith in you.

 

[Pittma]

I finally got a job with a local ambulance company, and I feel like I am worrying ahead of time about the same thing. I usually overthink but once I am getting down to it and doing something, I start to get into a rhythm, but does anyone have any advice for knowing just what it is to do, regardless of what the situation is? Whether it's cardiac, medical, trauma, MVA, anything in the world, what kind of processes do you all go through to ground yourself and say "okay, I need to do A, B, and C."

 

[Amycus]

I finally got a job with a local ambulance company, and I feel like I am worrying ahead of time about the same thing. I usually overthink but once I am getting down to it and doing something, I start to get into a rhythm, but does anyone have any advice for knowing just what it is to do, regardless of what the situation is? Whether it's cardiac, medical, trauma, MVA, anything in the world, what kind of processes do you all go through to ground yourself and say "okay, I need to do A, B, and C."

This isn't really the greatest advice in the world, because I'm still nervous going into most calls...but I usually start off almost every call, assuming the PT is conscious, with the same thing...

"Hello/good morning/evening, my name is Joe, can you tell me your name?"
then always follow it up with "So, tell me a little bit about what is going on today"

and just go from there. After that I tend to just ask what comes natural. Someone says they are sick, the obvious questions come to mind (like the OPQRST stuff)...when did it start? what were you doing when it started? has this happened before? describe the pain/discomfort, etc

 

[CAOX3]

It was described to me this way when I was starting out. Ever notice a child going up the stairs at first he puts his hands and feet on every stair as he grows, then he only needs his feet, soon he is flying up them, he doesnt need to hit every step anymore he knows them like the back of his hand, he recognises them but he doesnt need every step to get where he is going.

The kid will fall as he learns and so will you, soon you will be whizzing up those stairs, only hitting the steps you need too.

 

[JPINFV]

Just get into a standard rhtyhm. I like the introduction. Follow that up with OPQRST (aka history of present illness), then knock out the rest of your subjective (history, allergies, medications, surgical history, social history (as appropriate), then work your way into your physical exam and review of systems, initiating treatment as indicated. So if the patient has obvious shortness of breath or difficulty breathing, feel free to start supplemental oxygen sooner than later. Different interventions can be started at different points in your assessment or after the assessment is completed.

 

[EMTMama]

At first you have all this dead space in your head because you really DON'T know what to expect on-scene and you don't have enough experience to know what you don't know.

It's called the stage of "Conscious Incompetence"

(I didn't say Incontinence!)

You're just hyper aware, for a little while, of just how much you don't know.

This is where I am right now. In fact it hit me in the face like a brick wall the other day. I've been working as a basic for 2.5 months now while I finish up my clinicals for my EMT-I. My company mainly does IFT, but we actually got called to a scene response. After we got the patient to our truck, I was watching my parnter (an EMT-I working and in medic school) working on the patient - starting a line, putting him on O2, checking his BGL, putting him on the cardiac monitor. As I was watching him, I was trying to think of what I would do if I was back there as an intermediate (not to second-guess my partner, but to test myself), and I thought - "holy crap - I don't think I'd know to do all that stuff!!" and I panicked. How the heck am I supposed to advance up to an intermediate if something that basic spooked me? I felt like I've spent all this time in school, and for what? It seems like all that knowledge is GONE.

It really isn't gone - I just froze up too, and have done it while working with my basic patients too. It happens. It sucks. But it'll get better with time. I used to do it a lot and I've already noticed it's happening less often. Like a previous poster said - when all else fails - just remember the ABC's.

 

[Shishkabob]

My advice holds true when stuck... and whilst it's easiest to follow as a medic, you can still somewhat do it as an Intermediate, and maybe even as an EMT to a lesser extent:





It's easy to BS your way through a call, even if you have no clue what's going on.


I mean, we can do IVs, hook up the monitor, interpret the strip with extreme prejudice, stare at the drugs in the drug box, and sit pondering while you have other responders get vitals for the 5th time

That should buy you enough time to start on a ddx... or your crew will have the patient on the cot in the ambulance. Either / or works.

 

[NomadicMedic]

When you need a minute to collect your thoughts, listen to lung sounds.

 

[ttoude]

I do my best work when I'm absolutely exhausted. I've known this my whole life and it works for me. I didn't apply this knowledge twice and had a similar experience as you did on scene. Now I stay awake most of my shifts, I think being "tired" only lets my brain focus on the task at hand.

The morel of the story is get to know your body and the way you work best as well.