When do you know what you are doing?

DrParasite

DrParasite

The fire extinguisher is not just for show
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Kind of a simple question, but one with a VERY subjective answer.

As an EMT who has been in this field for over 10 years, I feel like I have a grasp on my field. I know how to handle myself in almost all calls, know what my underlying job is (to take people to the hospital), know when there is nothing else I can do in the field, and what the patient needs is not a prehospital provider, but rather a rapid transport to the hospital for definitive care. but that's just me.

So with everyone having different opinions on the matter, when do you know what you are doing? is it a paramedic patch? a paramedic degree? a bachelor's degree? a master's degree? completion of medical school? something else?

Maybe experience is the deciding factor? 1 year? 5 years? 10 years? 15 years?

how about where the experience is, maybe that matters the most? IFT, Critical Care (CCRN or CCEMTP) IFT, rural 911, suburban 911, urban 911, aeromedical? is there a difference? Can someone whose entire career be IFT based (but paramedic level IFT) be considered someone who "knows what they are doing"?

how about being an educator? does the fact that you are an educator for a level of EMS mean you know what you are doing?

we have a couple med students on here who were EMTs or Paramedics beforehand, who say that their previous certifications don't know enough to do their jobs properly (paraphrasing, of course), as well as a couple of former and current paramedics that say people in EMS don't know enough to do their job.

So I ask the question, what does a person need to accomplish before they "know what they are doing?"
 
When you are able to give a reason beyond "protocol" or "that's how I was taught" for the things that you do.

I don't care if you've been a medic 25 years, if you answer "because it's protocol" to a question regarding patient care, you've just dropped your stock in my eyes.
 
When you figure out EMS has almost nothing to do with life and death and can do something to help people who are not about to die.
 
I so often ask myself this question & I never seem to come up with the answer. Being an EMT for ten years now, people keep telling me im more than capable of getting my paramedic ticket.

I look at it as I would rather be a good EMT than a poor paramedic, maybe when I’ve finished my fire-fighter probation I will give it a go.

A good question thow, When do you know what you are doing !!
 
K13 said:
A good question thow, When do you know what you are doing !!
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I almost always know what I am doing, the big question is: am I doing what will help?
 
usalsfyre said:
When you are able to give a reason beyond "protocol" or "that's how I was taught" for the things that you do.

I don't care if you've been a medic 25 years, if you answer "because it's protocol" to a question regarding patient care, you've just dropped your stock in my eyes.
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Off Topic: Unfortunately, the way EMS is set up, it doesn't matter what you know to do, or why. If it's not in the protocols, and you do it, you're in trouble.


Back On Topic: I don't care how long you've been in this field...or any...there will be times when you don't know what you're doing.;)
 
Medic2409 said:
Off Topic: Unfortunately, the way EMS is set up, it doesn't matter what you know to do, or why. If it's not in the protocols, and you do it, you're in trouble.
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Depends on the agency, QA setup and medical director. I've had at least two jobs that allowed me the autonomy to reasonably perform or omit interventions as I saw fit based on my assessment as long as:
1)I could back it up with evidence
2)It followed accepted standards of medical (not necessarily EMS) care.
3)I had been formally educated by the OMD or his designee if it was a procedure.

These were also both CCT jobs, so that may play a role. I don't take that kind of trust lightly though.


Medic2409 said:
Back On Topic: I don't care how long you've been in this field...or any...there will be times when you don't know what you're doing.;)
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Very true words.
 
usalsfyre said:
When you are able to give a reason beyond "protocol" or "that's how I was taught" for the things that you do.

I don't care if you've been a medic 25 years, if you answer "because it's protocol" to a question regarding patient care, you've just dropped your stock in my eyes.
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I might be able to give a reason why I would want to do something... but that doesn't mean that I'm automatically authorized to do it that way or for that reason. Some EMS systems are designed such that if you feel you must stray from protocol, you must call-in and get an order to do it, and if your request is denied and you still stray from protocol, even for the right reason and you did the right thing, you get your backside handed to you...

So, doing something because "it's protocol" doesn't drop your stock in my eyes if you're essentially forced to do something a particular way.

So, while I might answer "I have to do ... by protocol. I'd want to do ... if I could because ..." is something more like what I'd do.
 
usalsfyre said:
Depends on the agency, QA setup and medical director. I've had at least two jobs that allowed me the autonomy to reasonably perform or omit interventions as I saw fit based on my assessment as long as:
1)I could back it up with evidence
2)It followed accepted standards of medical (not necessarily EMS) care.
3)I had been formally educated by the OMD or his designee if it was a procedure.

These were also both CCT jobs, so that may play a role. I don't take that kind of trust lightly though.



Very true words.
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That would play a HUGE role in allowing you the autonomy to do what you did.
 
I think other people will recognize that you generally know what you're doing long before YOU do. You might have an after-the-fact "A-ha!" moment after you've had a chance to digest a fairly complex call, everything was done as it should be, and you suddenly realize "Holy Carp! I did that??"
 
Akulahawk said:
So, while I might answer "I have to do ... by protocol. I'd want to do ... if I could because ..." is something more like what I'd do.
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Entirely acceptable. That comment wasn't aimed at providers in systems that are the EMS equivilent of "1984", rather the cookbook medic that can't think for themselves.

Very sorry for not making the distinction.
 
usalsfyre said:
Entirely acceptable. That comment wasn't aimed at providers in systems that are the EMS equivalent of "1984", rather the cookbook medic that can't think for themselves.

Very sorry for not making the distinction.
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You and I have a very similar aversion to that particular kind of beast. I used to work for one... it was horrible.
 
Not that simple

If you see a lot of "Disease X" then you will know more about that. An excellent Swiss internist is unlikely to be good at treating Dengue Fever.
But if you see an awful lot of DIsease X, then you may start seeing Disease X when it really isn't.

I think you "know what you're doing" when you have learned the appropriate skills for your area, you have learned to approach each patient/case individually, and when you learn the common mistakes and how to avoid them. ("What you are doing" is professionally being whatever your shoulder patch says as well as you can and keeping up on training and learning; encyclopedia knowledge of disease and trauma is not as good as knowing how to see S/S and what to do/when to do it.)
 
DrParasite said:
Kind of a simple question, but one with a VERY subjective answer.



So I ask the question, what does a person need to accomplish before they "know what they are doing?"
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They need to stop becoming paramedics so they can join the fire dept. I'm sorry but the combination of fire/ems has done nothing but destroyed something that has the potential to be the best in the world.
 
In EMS, you know you know what you're doing when you stop agonizing over what you've done.
 
DrParasite said:
So with everyone having different opinions on the matter, when do you know what you are doing? is it a paramedic patch? a paramedic degree? a bachelor's degree? a master's degree? completion of medical school? something else?
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So does that make it that only someone with the paramedic patch knows what they are doing? EMT's know what they are doing as well
 
Martyn said:
So does that make it that only someone with the paramedic patch knows what they are doing? EMT's know what they are doing as well
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depends.

I happen to agree with you, that an experienced EMT is often as capable of handling a scene as a paramedic (translation: an EMT knows what they are doing).

but some disagree. some people say a paramedic doesn't know enough to "know what they are doing" and in some cases, i agree. But in a cardiac or respiratory emergency, I think they know enough. In other cases, anyone in EMS can just monitor and transport the patient to the hospital for definitive care.

That isn't to say that a paramedic should be able to do more; an ER doc has a much greater supply of resources (longer time to examine and monitor patient, lab, xray, more drugs and tools in the ER) to stablize the patient even more, before they will release the patient and TELL THEM TO FOLLOW UP WITH A PMD. even an ER doc isn't the end of the line, they always say to follow up with a PMD.

a couple years of experience in a system that is a high patient contact sytem typically gives you a decent handle on knowing what you are doing. seeing sick people and not sick people helps you differentiate between the two.
 
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