Question to 1+ year medics or EMTs

[legion1202]

i`ve been at my comapany for a few weeks now and I`m am on my clincal part of my training. I have to get 30 ALS calls before I am cleared by med control. I feel find performing skills, talking to the pt and getting plans togather but.. my preceptor says I need to work on my time mangement skills which he says will come with expirence. Can anyone tell me how to get better at this? I know my 1# problem with this is I dont ask for help. I should be asking my Preceptor to get me v/s and do simple stuff. He knows I can get a bp and a pulse... But I still tend to want to do these things on my own.. We had a Chest Pain call last night and the 2 BLS guys that backed us up had there hands in the jackets the whole entire time.. I know I should have used them more wisely but here I am only been in the EMS world for a few years mainly in school and I`m asking 10 yr vets to grab me a blood pressure. Anyone else have a problem with this when they started out?

 

[NYMedic828]

Time management 101



Spend 5 minutes taking baseline vitals assessing your patient and attaining pertainint information. (History/meds)

Realize that they do or do not need a doctor, and progress accordingly. If you can treat them do so otherwise to ambulance and do the rest during a nice slow and steady ride to the ER. Haste makes waste. If your partner is a "cowboy" and likes to race through things, take his advice with a grain of salt.


Also 30 calls, why even have an internship period? Ours is 6 months...

 

[EMSrush]

One of the most important (and sometimes challenging) parts of your job is being a team leader. Scene management includes more than just the patient and their surroundings. If you're still being evaluated, you had definitely better be able to ask anyone with you to help you out, no matter how senior they are to you to show that you are able to multitask and allocate your resources appropriately.

As long as you are polite, any veteran medic worth their salt will be glad to get you a BP or throw down some electrodes... whatever you need. Don't be shy- just ask.

 

[legion1202]

well we dod 4 weeks of watching and then 30 true als calls which can take about 6 mos.. Putting a monitor on and giving an IV is not part of those 30 calls.. We need actual treatment.. Like tubes, defibs, given meds, etc.. Then after that we are paired up with a supervisor or a lead medic for a shift bid.

 

[Christopher]

Spend 5 minutes taking baseline vitals assessing your patient and attaining pertinent information. (History/meds)

We call this the "2 minute drill" for you and your partner.

General medical flow

Lead: AVPU, ABC's (includes inexact vitals such as fast/slow pulse/breathing, lung sounds), history, OPQRST/SAMPLE.

Other: exact vitals (pulse, blood pressure, BGL as indicated, rhythm or 12-Lead as indicated).

General trauma flow

Lead: AVPU, ABC's (see above), rapid trauma exam, "How did this happen?"

Other: equipment gopher (extrication, immobilization, splinting, stretcher whatever), begins packaging once you've done your rapid trauma.

At the end of two minutes your partner will have all of the quantitative figures you need to put together with your qualitative findings. At this point you can make a Big Sick / Little Sick decision and have a treatment plan ready to roll.

This works BLS or ALS; 1, 2, or 3+ crews.

(Oh and when people just stand around on scene, tell them they can ensure forward progress is made or clear the scene.)

 

[Brandon O]

We call this the "2 minute drill" for you and your partner.

Seconded. Basically, the key is that one person is directing care and making the decisions, which generally means they're also the one communicating with the patient (since the flow of a history and flow of care are linked). They can delegate any other "skills" to whatever hands are available -- get some vitals, get a 12-lead, bandage that, etc. Exception would be if for some reason the person in charge is the only one who can do something, such as if they're the medic on a mixed crew (or the only competent person on scene...).

Just remember that anything that could be done by a trained dog doesn't need to be done by you. I realize this may be a shift from the "skill-centered" training that you just finished doing, but if you're "doing a skill" instead of running the call, then it's a leaderless ship. Farm it off instead so you can plow ahead with the difficult stuff. (Obviously, if you can do both -- talk while you start an IV -- that's fine too.)

 

[Tigger]

i`ve been at my comapany for a few weeks now and I`m am on my clincal part of my training. I have to get 30 ALS calls before I am cleared by med control. I feel find performing skills, talking to the pt and getting plans togather but.. my preceptor says I need to work on my time mangement skills which he says will come with expirence. Can anyone tell me how to get better at this? I know my 1# problem with this is I dont ask for help. I should be asking my Preceptor to get me v/s and do simple stuff. He knows I can get a bp and a pulse... But I still tend to want to do these things on my own.. We had a Chest Pain call last night and the 2 BLS guys that backed us up had there hands in the jackets the whole entire time.. I know I should have used them more wisely but here I am only been in the EMS world for a few years mainly in school and I`m asking 10 yr vets to grab me a blood pressure. Anyone else have a problem with this when they started out?

You're the medic and they're basics, delegate tasks to them. You are in charge of the scene, and if they have a problem with it too damn bad.

 

[abckidsmom]

An important thing to remember is that they're not grabbing *you* a blood pressure, they're doing something for the patient. Whenever I'm not the lead medic, I'm the one who checks the vitals. It's really standard throughout everywhere that the lead provider will keep an eye on the general scene management while everyone else goes in for the details.

 

[legion1202]

Thanks guys.. I was fine with all of this is school. At my other job we had a LT always holding on to the tough book making the calls. I have no problem telling someone to do somthing but I guess being New to the company, New to working with the local fire departments up here. I just do not want t step on any toes.. Guess I`ll just have play a leader and be nice at it =)

 

[abckidsmom]

Thanks guys.. I was fine with all of this is school. At my other job we had a LT always holding on to the tough book making the calls. I have no problem telling someone to do somthing but I guess being New to the company, New to working with the local fire departments up here. I just do not want t step on any toes.. Guess I`ll just have play a leader and be nice at it =)

It's a skill that usually is not developed in school, but in real life. Just keep swimming!

 

[Epi-do]

Ask away! No one is going to know what you want them to do, if you don't speak up and give some direction. As long as you are polite and respectful, no one should have any problems doing anything you ask of them. It's just part of the job. Not everyone can be the lead, stepping back and gathering information, all the time, and you aren't going to get any better at it if you don't get experience doing it.

You will be fine! Now that you are a medic, you basically will get to spend a large part of your first year figuring out how to be one. Over time, you will develop a rapport with the people you work with, as well as a flow to how you like to do things. Eventually, the basic framework for how you run a call will become second nature. If you act confident, people will do what you ask. As time passes, you will grow into that confidence and find that you are no longer acting confident, but that you really are confident. It all just takes time.

 

[akflightmedic]

Did you ever listen to a symphony or watch a marching band do their thing?

Both are fun to watch and amazing to listen to but they had something in common...there was either a CONDUCTOR or a Drum Major leading the group. They do not involve themselves in the little things, but overall they make sure it all sounds and looks nice.

YOU are a conductor.

As the medic on scene, you are in charge. You stand back and watch the whole scene and you delegate all the small parts to make sure the big show is running smooth.

When there are 2 or more people on scene (aside from yourself), there is very little you should actually be doing hands on. You will build rapport and speak with the patient, you will take notes, you will do the ALS interventions if needed, but in general...most everything else can be delegated and managed.

The moment you get focused on a singular task (easy to do as a newbie) you have lost scene control and scene management. Sometimes, it is hard to recover this once gone.

Delegate, delegate, delegate...which amazingly enough gives you all the time in the world to do the more important things when they arrive.

 

[Handsome Robb]

Did you ever listen to a symphony or watch a marching band do their thing?

Both are fun to watch and amazing to listen to but they had something in common...there was either a CONDUCTOR or a Drum Major leading the group. They do not involve themselves in the little things, but overall they make sure it all sounds and looks nice.

YOU are a conductor.

As the medic on scene, you are in charge. You stand back and watch the whole scene and you delegate all the small parts to make sure the big show is running smooth.

When there are 2 or more people on scene (aside from yourself), there is very little you should actually be doing hands on. You will build rapport and speak with the patient, you will take notes, you will do the ALS interventions if needed, but in general...most everything else can be delegated and managed.

The moment you get focused on a singular task (easy to do as a newbie) you have lost scene control and scene management. Sometimes, it is hard to recover this once gone.

Delegate, delegate, delegate...which amazingly enough gives you all the time in the world to do the more important things when they arrive.

This.

As for recovering from getting tunnel vision, as a new medic that had a bad habit of doing it, trust me when I say ak is spot on on this part.

Please and thank you go a long way. "Can you check a CBG for me please?" "It's 92 mg/dl" "thank you." Rather than telling people what to do. With that said sometimes when things aren't getting done and you've got a really sick patient you may have to step on some toes and anyone worth their salt will understand. Anyone who gets grumpy over it isn't worth worrying about.

It takes a while to get used to but I've found I can get a much better grasp on the "whole picture" and can provide better care while standing back and gathering information rather than jumping in and getting tied down into a single task.

 

[Brandon O]

Many newer providers also seem to glom onto "doing something" as a fallback when they aren't sure what direction to take things. It takes a bit of sack to force yourself to keep your head up and manage the patient rather than taking refuge in the psychomotor skills you know how to do.

I sometimes have to hide blood pressure cuffs from people.

 

[Handsome Robb]

Many newer providers also seem to glom onto "doing something" as a fallback when they aren't sure what direction to take things. It takes a bit of sack to force yourself to keep your head up and manage the patient rather than taking refuge in the psychomotor skills you know how to do.

I sometimes have to hide blood pressure cuffs from people.

Random and kinda off topic but it may be helpful to the OP. ***learned this trick from a coworker, I can't take credit for it.*** When I'm not sure what direction to go pin or what's going on I listen to lung sounds, even if I already have already.

1) it makes me look like I'm doing something rather just standing around looking confused.
2) stethoscopes work great as ear plugs to quiet your surroundings down so I can actually think
3) people generally won't interrupt you so you can get that 15-30 seconds you need to think
4) it assesses for changes but in all honesty if I'm doing this I'm still trying to straighten everything out in my head to get a solid idea as to what's going on.

 

[Brandon O]

Yeah, that's good. Or meditate on a radial pulse. Or peer at paperwork.

 

[Christopher]

Random and kinda off topic but it may be helpful to the OP. ***learned this trick from a coworker, I can't take credit for it.*** When I'm not sure what direction to go pin or what's going on I listen to lung sounds, even if I already have already.

1) it makes me look like I'm doing something rather just standing around looking confused.
2) stethoscopes work great as ear plugs to quiet your surroundings down so I can actually think
3) people generally won't interrupt you so you can get that 15-30 seconds you need to think
4) it assesses for changes but in all honesty if I'm doing this I'm still trying to straighten everything out in my head to get a solid idea as to what's going on.

A trick one coworker uses is they do not put on their gloves until they are at the patient's side. They claim it gives them 15-20 seconds to think things through before putting their hands on the patient. Nobody expects you to touch/do anything while you glove up either.

 

[Brandon O]

A trick one coworker uses is they do not put on their gloves until they are at the patient's side. They claim it gives them 15-20 seconds to think things through before putting their hands on the patient. Nobody expects you to touch/do anything while you glove up either.

Just some perspective from the wonderful Thom ****:

I know a great ED doc named Jim Hogan who has developed a similar strategy in his environment, and it's very applicable in the field. At the time of this writing, Dr. Hogan works night shifts. When somebody comes to his ED, he watches them come in. He stands quietly outside the patient's room, leaning against the doorjamb and watching. He listens to the medics' report to the nursing staff, and after the medics leave the room, he enters and introduces himself.

'I'm Dr. Hogan,' he says. 'I understand you're having a really bad night.'

Then he lets the patient do the talking.

Or, of course, there's the House of God more concisely:

AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.