Keeping Calm on Scene

ghost02

ghost02

CA Flight Paramedic
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Hey guys,

I am a newbie to ems, and in my first EMT job. I'm in my FTO process (third day) and we almost exclusively handle 911 calls. I have got a bit of a problem, I keep 'spinning' on scene. When I first started, I would go blank with the most non-emergent of calls, but I am starting to get the basic calls under control. I just had my first truly critical patient yesterday, and even though I knew what the problem was and what I needed to do, I froze. Instead of getting O2 on a CHF patient, I just started doing OPQRST. Thankfully, my preceptor took control and we were able to get the call handled, but if he was not there that patient would have coded because of my inaction.

How do you guys remain calm on scene? I really need to find a way to put my emotions aside. If the call was in a classroom, I could do it no problem, but when it is real I get bad spins. Help me out!

Thanks
 
Practice and experience are the only things that work for me. Most people were in your spot right now and some still are.

The more calls and patient contacts you get the more comfortable on scene you will be.
 
It all comes from experience. You'll get there.
 
Preplan on the way to the call. If you're dispatched to a difficulty breathing call, on the way there start thinking about the different possible illnesses you might see and what you'll do to treat it. If you're right, then you have already thought about your most likely treatment options. If you're completely off base on what the actual call turns out to be, at least you'll already be getting in the right mindset.

Think about your breathing. If you start feeling yourself get excited, take some slow, controlled breaths.

If you really just start getting lost and are at a loss of what to do, fall back to your ABCs and transport. Odds are the patient isn't going to die on you, but if they try, you'll at least be all over it with ABCs (hopefully you don't regress this far).

The anxiety should pass fairly soon, and you'll fall into a rhythm. The more calls you run, the easier it'll be. It'll actually start getting fairly monotonous.

Best of luck.
 
1st - your avatar pic ... is great!
2nd - as you said, you're a newbie. No one is perfect in the beginning. It'll take lots of practice. And that is why ... people get precepted.
3rd - STXmedic has great advice. I think his post is dead on.
Best of luck to you.
 
I'll just reiterate for emphasis! Just keep running the calls, keep doing your job. Keep in mind that the patient is plenty more scared then you, and that your confidence level can instantly effect their anxiety level. Be the leader in the room, and be confident in yourself that you know what you are doing, because you do. Slow is smooth, and smooth is fast.

STXmedic gave a great point on running differentials in your head and thinking of the algorithms. That is what helped me smooth out my calls.
 
The only thing that will do it is just running calls and getting the experience. Don't let the patients emergency (or in most cases non emergency) turn into YOUR emergency! If you feel yourself start to panic a little, back off mentally a little bit and start back a step or two with a clear head. Also, watch your preceptor run a few calls and learn from them. Like everyone said, it will all come with time.
 
STX was spot on, and like everyone's said just keep running calls and try to project confidence when you walk into a chaotic situation. Fake it til you make it. After a couple weeks in metro Bako you'll be beyond where 90% of EMTs in this state are, don't stress about it too much. Soak up as much as you can from your FTO and don't take it personally, it's all a learning experience.
 
The more you do it the more adept you will become. So dont sweat it, just think about the things that you missed last and improve on them. Good luck and welcome to the world!
 
oddly enough i have the opposite issue. ive gotten in trouble for being too calm on scene!
practice will make perfect. dont forget to breathe! its not your emergency! slow is smooth, smooth is fast!
those are some things i tell myself and i guess it works...
 
Take your time. I always stop look and smile, make a slight joke and move in to work. It calms everyone else down and thus it decreases your stimulation as well. Everything runs smoother when you are calm. After thirty years in the field you certainly don't get the adrenaline rush, but you can get excited periodically.
 
Thanks guys, I just need to get my head straight. I got 4 more weeks to before the end of my FTO time, so I gotta get myself under control.
 
Keeping calm is just part of the job. You see what needs to be done and you just do it. You can get all emotional and nervous and excited and puke all over the floor... after the call is done. Remember that it's not your emergency. Just because someone else is having an emergency doesn't mean you have to have one too. Have a script. Mentally rehearse what needs to be done. Do it smoothly... deliberately... thoughtfully... and with purpose. Everything you do must have a purpose. If there's no purpose to it, it doesn't need doing. And always ask people to do things. You'd be amazed what people will do. And say thank you when they're done. They'll do more for you later...
 
Experience. If you freeze up on scene, always remember your ABCs.
 
Think about the vast majority of your 911 calls this way.

The VAST majority of your patients fall into two groups

1. Those that would be totally fine with no medical care at all as long as they get transport in the near future

or

3. Those that are so critical that no matter what you do prehospital their outcome at the hospital is likely going to be very poor and pushing more drugs and hanging more drips and doing more interventions really isn't increasing their chances of making it.


Then there is group 2. The select few patients we run into where not only are they time sensitive, but our pre-hospital treatment will also make a difference in their length of stay or outcome. These patients are honestly few and far between, but they are the ones you really can see you make a difference on.





Okay so what was the point of that -

When you show up on scene, don't think about what this patients problem is specifically, don't think about treatment plans and algorithms and medications and interventions and transport decisions and etc..etc...

Think about, Is this patient time sensitive (going to crash in the next hour)? Yes, No, or possibly.

If they are time sensitive it's time for you to do one of two things. If you have a medic on the truck look at him/her and ask what he/she needs. If you are a basic truck and your calling the shots, then make the decision right there in the house that your going to do what you have to (which is really going to consist of very few things) and haul ***.


If this is not a time sensitive patient then kick back and relax, introduce yourself, ask their name, ask whats going on, ask about their kids, ask what they like to do for a hobby. Chat with them, crack a joke, express how sorry you are they are going through this and let them know your here to take care of them. If it is something you can do as far as treatment (O2, Icepack, splinting) ask if THEY want it, "sir you said your having some trouble breathing? I can put some Oxygen on you if you want, it may help". The important thing for the take home here is if they are NOT a time sensitive patient then quit worrying about OPQRST, or SAMPLE, or Trauma assessment, or anything else....relax, kick back, and talk to them as if you are having a completely normal conversation....

If you don't know if its time sensitive then put the patient in the truck, start your treatment protocol based on their complaint (always asking if THEY want the treatment) and take a nice easy ride to the hospital as if it is not time sensitive. talk to them, chat them up, ask questions, enjoy the ride...



Sorry that was a little long and unorganized.

TLDR -
There are only two types of patients
1. Time sensitive
2. NOT time sensitive.
 
Stop. Deep breath.

Make a conscious effort to look bored by everything. We cultivate this. It doesn't matter what we're feeling inside. On a typical call, an experienced medic probably actually is bored; if there's locusts and hellfire bubbling from the patient's mouth they are probably not, but either way it doesn't matter, because they're wearing their bored face for everyone else.

Part of this job is convincing everyone that you're just not impressed, because there's nothing worth freaking out about. Then people don't freak out. Which, incidentally, helps keep you calm too. Positive feedback and all that.

But either way that's the game. I assure you that not everyone who looks cool and collected is feeling that way. They just understand they have to pretend or everything's gonna come off the rails.
 
Most calls that I ran, I was either actually bored or just looked it. This young lady pretty much summed it up well:

j7tvK.jpg
 
Really good stuff above.It sort of comes down to worrying about the unicorns and zebras (i.e., not remembering every little tidbit of EMT lore).

Your training was structured to try to organize and present it in a manner everyone has a chance of absorbing and to prevent missing stuff, not teach you how to think on approach and arrival. That will come, listen to your preceptors, patients and co-workers.
If you had a good instructor your were told when the curriculum was wandering off from Horsesense Blvd into "zebra" or even "unicorn" country like a teenager texting on a narrow road.
If you have a good preceptor they will bring up the zebras and unicorns, but accent the practical. Anyone intent on drilling you on the minutiae (like many folks on EMTLIFE…haha) is intent on showing off or reasurring themselves of their superiority. KNOW the zebras, but most calls are like all successful medicine: assess, treat what you see not what you think, reassess.

Remember the patients are just as scared as you are. You have to be brave for them, too. ;)
 
So half a roofie and some Red Bull worked? ;)
 
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