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:
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.
