I'd like to say that I suspect it's a lot harder to come up in this business in these times.
Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about as much of the bureaucratic baloney. When I treat a patient, I can NOT just focus on getting my technique right, I have to focus on being very careful not to say the wrong thing, keeping track of everything that's said, not looking too clumsy or stupid but not coming off as arrogant or overconfident. I have to mince words and avoid common sense conclusions in some situations and am expected to "read between the lines" in other situations and to a degree, I'm expected to walk on the job with a certain amount of that aptitude from day one. There are now circumstances where mistakes made during clinical rotations can get you thrown out of the program.
A good portion of my training from the first day of EMT-B has been centered on NOT taking risks, NOT screwing up, NOT being okay with your mistakes. Dog forbid I forget some by-the-book detail that many of the old-timers with experience haven't bothered with for years. The old-timer will make fun of you for doing it and the school environment will "write you a chit" so-to-speak for leaving it out.
"Sometimes you have to get resourceful and use duct-tape trauma shears in creative ways," says the wise, old-dog medic.
"Never use duct tape or non-approved equipment unless you're prepared to get sued," says the book and the men in suits.
"You don't need to put a nonrebreather on this pt," says the efficient, old-dog EMT. "3L NC will be fine."
"NO! Everybody gets hi-flow O2 and treated for shock zOMG NOW!" says the book.
There's a lot of bureaucratic dissonance and confusion these days for the up-and-comer and there's a marked lack of empathy for the time it takes some of us to RELAX and figure out where we stand. It's often overwhelming.
I am NOT saying y'all didn't and don't deal with a buncha BS too...good lord knows you do and many of you handle it beautifully but not all of us are "naturals" at mastering the book knowledge AND the bedside manner AND the watch-your-step bureaucracy in an environment where we already feel like a lot is at stake if we step wrong. It's a juggling act...complete with circus clowns and a guy in a top-hat, holding a whip.
Is it appropriate to laugh when someone sounds so sincere? Today's EMT and paramedicine courses have in many respects been dumbed down to accommodate the demand for and influx of new practitioners and students. The first paramedics were taught by physicians and were often expect to have physician level knowledge. EMT courses are essentially advanced first aid, and aren't too different from what is taught in the Boy Scouts. Sure, bedside manner is often a learned skill, but saying that watching out for legal pitfalls puts an added burden on "new" practitioners is like saying that "new fangled traffic lights" makes it nearly impossible to get a drivers license.
Yes, both books and anecdotal stories warn of the dangers of making a misstep that will get you sued, but in all my years I have yet to actually go through any serious litigation.
And yes, you ARE expected to "walk on the job with a certain amount of aptitude". You should learn the basics in your course AND have the proper personality and demeanor for this job. Just like you're supposed to have a certain affect as a law enforcement officer, a banker, a salesman or a manager. You must possess a good working knowledge of the job you are expected to perform and have the aptitude to quickly learn and apply the field experience you pick up in training.
And also yes, "NOT being okay with your mistakes" is an inherent part of this work. If I mess up, I'm NOT okay with that. But I learn from it and grow. Accepting failure is not an option! Yes, there is a learning curve during the transition from school to the field, but we WANT the people who accept nothing less than perfection. We WANT people who strive to be the best they can be, and we deride those who accept mediocrity.
It can be a rough, arduous road from civilian to paramedic, but if you truly want to be successful in this job you will apply yourself and learn all you can to do it well. Saying that watching out for potential litigation poses an added hurdle to doing this job successfully is not only insulting, but also demonstrates how little you know about actually doing this job in real life.
The "old dogs" have much wisdom and advice for you "young pups", and you would do well to listen. Before 12 leads we were doing modified chest lead placement in the field, and CHF patients were often nasally intubated because CPAP wasn't an option. Things have changed, and the old dogs have changed with them. The old dogs were running calls before most EMT students were born, and they have seen more than you can probably imagine. They won't always talk about it, but they were there for some of the most wild and crazy times that EMS has seen.
So don't say that the new guys have it tough. The old dogs have proven themselves and have demonstrated that they can survive the job and adapt to all the changes that have come. You think the old dogs are immune to litigation? Think again. We're working in the field just like you, and we're just as susceptible to errant (or justified) lawsuits as you are. But the old dogs have learned the tricks of the trade and know how to talk to and treat patients in a way that not only does them the best good but also avoids any potential legal problems.
Learn from the old dogs. They may be a tad hard of hearing, but we can teach you how to survive and succeed in EMS. Your training isn't any harder or easier than ours was, and we dealt with the same struggles when we were new.
