Education. How little or how much can depend on many things. Time, finances, need or goals.
No matter how you define it is most definitely a part of your EMS life. How much or how little may define your career or opportunities. ACLS, PALS, Recertification, A.A.S or B.S and beyond.
Educational requirements like your basic alphabet soup type classes and recertification’s can take up a lot of time and achieving continuing education along the way is also part of the education jigsaw puzzle.
Here’s the thing. While varying levels are required and more advanced levels the goal for many EMS providers. Each plays a role in your success as a provider and potentially the opportunities available to you.
So, education and success wind up being tied together and depending on your goals, how much or how little will affect your being able to seek opportunities and take advantage of them.
Now education is a big piece of the puzzle to reach your goals and succeed. But how big will depend on far away the goal is or what level of success you desire. Is it passing an upcoming exam or a complete paramedic program? Maybe it’s your passion for teaching or love of the administrative end of EMS.
No matter what your goals, short term, long term or even a combination of each. You must decide on how big a piece education will be in order for you to succeed. Attaining advanced level education or even training can help you reach long term goals. Short term success like passing NREMT or your local protocol exam can offer success on a more basic level, but still one that is necessary as an EMS provider.
My tips:
Success – achieve success by combining education with experience and deciding where it fits into your professional development cycle. Treat every milestone no matter how small in relation to the bigger picture as a successful step in your career.
Education – always be increasing your knowledge base for both patient care and professional development. Focusing on short term success, keeping higher goals at the heart of everything you do, can help reaching these goals much more realistic and keep you motivated.
Opportunity – be prepared for opportunities by defining your educational goals and capitalizing on ALL your success milestones. Whether the opportunity is promotional in nature or even patient care related, the success milestones and educational achievements will all have a place when opportunity presents itself. Will you be ready?
As part of The EMS Professionals commitment to these three key points, you will continue to see changes on the sites. These are all designed to focus on each point and help you with success, education or opportunity. Together or apart, each will play a role in your EMS career. Understanding how and why will make you the EMS provider you want to be.
In this installment I wanted to take a moment and reflect on an even greater overlooked aspect of EMS.
The First Responder.
Now when I mention that phrase many different interpretations can be assumed. Is it the EMT squad? The Paramedic in the Fly car ? Or…
To me when I say first responder it can certainly be any trained EMS professional. But I want to focus on the providers who may not be as highly trained. Meaning the local Volunteer First Aid squad, Police Officer or Firefighter.
When I refer to being highly trained I mean those EMS professionals who have a certification of EMT or above and who perform those duties in the field as their primary vocation.
Most times the First Responder is trained as a major incident action taker. Such as performing CPR, using the AED and stopping major bleeding. They are more often than not the first person(s) on the scene and await the arrival of more advanced care resources. So, what happens to them when not everything is done for the patient or perhaps a blood pressure is misread? They are berated by the advanced care providers when they arrive. They become looked upon as more of a hindrance than a help.
However, we as the more highly trained and experienced providers must remember that the basic First Responder is not at our level of care. Nor do they have the day to day experiences that we as a full time EMS providers may have.
Most of them wanted to be a police officer or firefighter not an EMS provider and the volunteer squad is just that “volunteer”. They are awakened from sleep, interrupted from their job or family and then they respond. They respond willingly and without hesitation and expect to perform the life and death actions they have been trained for. Not the nuances of the everyday EMS provider, i.e. abdominal pains, fevers and other exciting parts of the EMS professional.
My goal and yours should be this. Be thankful for the First Responder. While they may not be trained like you or have the desire to perform EMS duties, they are on scene. They have given oxygen to the chest pain or respiratory distress patient and helped them survive until you arrived with nitroglycerin or albuterol.
They started CPR and maintained the hope of the family for their loved one until you could intubate and gain IV access for more advanced medications to be given. They where first on scene of the choking child and cleared the child’s airway within the first few minutes of the 911 call. Leaving you to transport a crying child rather than an intubated unresponsive one.
Let’s face it, most arrival times from the initial 911 call by advanced EMS care resources are between 8-10 minutes – sometimes much longer. That’s a long time for someone to see their family or friend suffering. The First Responder lessens that time and helps us as the advanced team to do our job better in the end.
Show your appreciation next time you encounter them. Even if they just get the demographics for your patient or help move them to the ambulance, it helps you focus more on what you are trained for, patient care. A simple “thanks for coming out” or “good compressions” can go a long way. Just think how you feel when a patient or family member says “thank you” after a call. Sometimes that’s all you need to make your day rewarding.
In this installment I wanted to cover a wider range of topics. Read on to see how these well covered topics are sometimes overlooked. Continue reading
Ok, just so you won’t panic, this article is not going to be a big clinical lecture. There are professionals out there who can cover these topics at length and with much greater accuracy than I can.
I do however want to discuss these two topics and how they affect us as EMS professionals in the field. Continue reading
Being an EMS provider requires you to retain a lot of information. Patient assessment, treatments, transports, policies, protocols and the list can go on. We use things like pocket guides or mobile devices to help us with recalling information and preparing for the next call.
One thing I try and do is to play out potential scenarios when responding to a call based on the dispatch information. So this way I can get proper protocols for certain call types in my mind and note the hospital locations and which may or may not be appropriate for the patients I am responding to.
I try and think of what I might find upon arrival and what may be the best course of action to begin my assessment. Now in the world of EMS many dispatch details are way off. I often find the chest pain patient to be having an anxiety attack or the roll over motor vehicle accident to have the patient walking around with no apparent injuries or complaints. So all my mental treating and transporting I did on the way to the call was for nothing. Or was it…
As EMS professionals we must be prepared. Carrying field guides, getting a mental image of what you may do based on dispatch info or even checking out your vehicle are wall ways that we keep ahead of the curve. If we become complacent and don’t even “think” about what might be awaiting us on a scene, we open ourselves up to potential negative issues. Delaying or improper patient care, not knowing the most appropriate hospital or transport route,
and even put ourselves in danger by not recognizing apparent scene hazards.
So, while we may be disappointed when the big trauma call is just a simple abrasion. By preparing and playing out these scenarios in our minds we can get better at acting when the real thing does happen.
I think the important thing to note is not to get tunnel vision when you play out a scenario in your mind based purely on dispatch information.
Remember, until you get there it is a cardiac event, trauma or respiratory patient. In your mental scenario, everything will go right. It may be very different when you arrive. Preparation will help you deal with not only the expected but the unexpected. Don’t let incorrect dispatch information disappoint you. Make each response or patient contact an opportunity for a better one next time.
More and more EMS industry websites are providing online webcasts or “webinars” (seminars on the web). Some are free, some are offered with a fee and some are just a 30-60 minute advertisement for a product that the webinar is built around.
Do you take time to attend these webinars? I know with busy schedules that include not only family and home chores, but many EMS providers work two or more jobs and find it hard to squeeze that time in for a webinar.
It’s important to note I think that as EMS professionals we have to keep up with our knowledge base. Always trying to improve it or refresh our memory on content or skills we may forget if not used often in the field.
Webinars are a great tool for this and offer that flexibility that busy schedules need. Many webinars offer the recordings of the live event so that if you are busy and can’t make it you can still get access to the recordings.
I am sure you know about EMS Boot Camp and my involvement with that project. If you don’t, in a nutshell it is free live online webinars each month that I conduct with Greg Friese from EverydayEMSTips.com and frequent guest speakers. The live webinars are free and there is a small fee for the recording access but you also get a bunch of other goodies along with that.
The one thing that many people say about whether they attend a webinar or not is the continuing education credits or lack of them with many online education offerings. I can’t speak for other websites that offer these webinars, but at EMS Boot Camp we offer the handout and a completion certificate that many ALS Coordinators and EMS medical directors will accept as local CE.
Still, your goal as an EMS provider should not always be about “what’s in it for me” as far as CE is concerned. Even those webinars out there with zero possibility of accredited CE, still offer you the opportunity to advance and retain your knowledge. When you do attend these types of webinars try and think of the increased understanding of the topic and “what’s in it for the patient”.
This time I chose a couple of topics that while do not relate to each other they do relate to your everyday duties.
1 – Cap Refill – How often do you really check for it? This is one of the most basic yet overlooked assessment techniques I see used (or not) all the time.
This simple test can tell you about a patients cardiovascular status. If a refill time is greater than 2 seconds, this may indicate poor circulation and inadequate cardiovascular function. While other factors such as patients’ age, gender and environmental factors should be taken into consideration with the Capillary Refill test. It is a good start for a baseline cardiovascular function and can lead you to other more evident or possible overlooked signs and/or symptoms.
So, take that two seconds and check your patients “cap refill”. You will probably document it, so you might as well do it.
Speaking about documentation, leads us to the next topic – “Capitals”
2 – It is important to document appropriately when filling out your ambulance call report, we all know it is a legal document and a permanent record of your patient care. So, by CAPITALIZING when needed, it makes it easier for other healthcare providers to understand your assessment and treatment. It also assists YOU should the report be called into question at a later date.
As a suggestion, capitalize things like mnemonics like AVPU, DNR etc. and named symptoms or diseases such as Kussmaul’s respiration or Wenckebach. Don’t forget EKG findings QT, P-R or QRS. Using proper capitalization not only helps your documentation it also makes it easier to scan the report for “key” items.
I think you are getting the idea. While for the most part using lowercase will not hurt your patient, it may cause confusion down the line.
Lastly – Do you know what a “capitulum” is? … and no they did not use it in medieval times 
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Capitulum – is the lateral aspect of the humerous. It articulates with the head of the radius.
Use that next time in your call report and dazzle your quality assurance officer.
Remember, performing the basics and documenting appropriately will always help you perform better patient care and prevent you from missing important clinical signs, not seen on an EKG or while administering medications.
Last week I watched the Grammy Awards and yes this is a bit of a guilty pleasure where I do enjoy watching many of these award presentations.
During the show I became aware of all the lifetime achievement awards and more importantly I noticed the way that many of the new artists recognized all the older ones with respect and an understanding of what they did to advance the music industry and the how doors where opened for other music types and media to become main stream.
That got me to thinking on how EMS is very similar and I started wondering how many of us really acknowledge and understand how past EMS professionals have helped advance the industry and make people more aware of what we do as paramedics and EMT’s.
Now of course we have a long way to go but thinking about EMS professionals like Bryan Bledsoe, Bob Page, Peter Canning and Mike McEvoy who have been plugging away at advancing the EMS profession either by education, advocacy or both over the years, makes me wonder how much new providers understand the effect that these industry experts have had on the profession.
Many Grammy winners will acknowledge the efforts or show great respect when artists of years gone by are recognized for all they have done. Now while some may agree or disagree with certain staples of the EMS crowd. You just can’t help but acknowledge their efforts so far and I am sure that they still have a lot left in them to give and show guidance to upcoming providers.
Just like Ray Charles is recognized for all his work and how he broke barriers and made advances in the music industry. Beyonce also must be acknowledge for her achievements and what she is now bringing to the music industry as well.
EMS is now getting an even stronger voice with Web 2.0 and social media. Many up and coming EMS professionals who are attracting more and more attention with their dedication to EMS and it’s future are taking the reins from the Bledsoes and Cannings. People like Justin Schorr, Thaddeus Setla, Steve Whitehead and Greg Friese are all in my opinion just a few of the new stars in the EMS world.
There are many more with blogs like this, podcasts and videos who are all trying to have their voices heard and bring EMS to the next level. The best part is with technology continually advancing, the next levels may come faster with more voices being heard. We should be ready for the next level when it comes and be aware that there where many people that made it happen.
We may not publicly thank those that made it happen like Taylor Swift or Mary J. would do for their mentors. But we should think about all the effort that goes into each article, blog post, video and podcast. While there isn’t any big televised award show for EMS, I think we can appreciate the past and continuing efforts of the EMS professionals that work so hard for the EMS industry online and off.
I encourage you to comment on posts and articles. Take part in live podcasts and let your voice be heard as well. Let the people who have a bigger voice help yours get louder. Get into the picture. Together we can all look good on the “red carpet”.
1- Back to basics. We often forget the basics of patient care, especially when you have been doing this job for any length of time. Anyone can just put someone on a stretcher and take them to the hospital. But as a true EMS professional, you must remember that basic patient care is the key to your overall treatment and patient outcome.
Taking proper vital signs. Blood pressure – systolic and diastolic is important. I see too many “experienced” EMS professionals palpating a blood pressure on an elderly patient just out of shear laziness. Palpating a systolic pressure only is good for trauma or in an effort to get a baseline on a critical patient. Even then, a complete set of vitals is needed to determine your patient care and whether your treatment is working or not.
The same goes for a pulse and respiratory rate. Obtaining a good pulse rate and noting its quality is a very important aspect of patient care. Listening to lung sounds and noting the rate and quality of your patients’ respiratory rate is also a key element in your patient care decision making.
The point I am trying to make is to step back and take a proper set of vitals before, during and after your treatment. A simple thing like a blood pressure may direct you towards what is truly ailing your patient, rather than an EKG or IV access.
2- Back ups – Yes calling for assistance for the critical, overweight or otherwise problematic patient is an easy request to make. But when your back up arrives, treat them as that. A back up. They did not come to do all the dirty work. Explain to them the situation, why they are needed and what you need them to help you with. Don’t just point to the patient or your equipment and grunt a command. Remember, they are EMS professionals just like you and may even have more experience and a better way of handling the situation.
Listen to their input and make a joint decision. As long as patient care isn’t delayed, a few moments of putting your heads together may just be what the doctor ordered for you, your back up and your patient.
3 – Your back – Yes the real thing, usually your lumbar area that can take a beating with any number of twisting, turning or bending acts throughout your day. Even though your back is relied upon each day to perform any number of tasks, we rarely take the time to ensure its safety and utilize proper lifting techniques.
You know the usual lift with your legs, not your back, bend at the hips etc. How about a short warm up each day prior to the start of your tour. Simple bending exercises and stretching techniques can also aid you in keeping your back strong and ready for the day. Even overhead stretches while sitting in the ambulance can keep you somewhat limber and help avoid injury.
The key is to know your limitations and lift only what you know you can. Otherwise see part 2 above and get the help you need.
Keep these simple basics in the front of your mind on each call. You will help your patient and keep yourself safe for another not so basic day.
Emergency Medical Services. Note the words “services” and “medical”. As EMS providers we are out in the field to provide medical care to anyone who may call 911 for “medical” help.
Now there are some variations to that, where rescue may be involved or being on assignment on a fire scene or big public event. But in the end we are still there to give emergency medical care in the field.
We are not there to pull over speeding cars or try and assert some perceived authority to families or say on a drunk driver from a motor vehicle accident. We are not there to wrestle patients to our will or chase them down the street.
Yet I many times have seen providers and have had partners who feel this need to try and be more than what they are there for at a scene. Our goal is to maintain our own safety and to try and keep the patient safe. There are also times when we get into what may be an unavoidable situation and wind up in a pile of bodies trying to restrain a violent patient.
These situations though should be the very rare exception and not the normal day to day activities we do in the field. If you do find yourself in this type of a situation on a regular basis, you should look at why this is and try to figure out how you keep getting into this situation and what you can do to avoid it.
EMS has it’s role in 911 just as law enforcement does. Sometimes they work hand in hand and other times we have to know our job and do our job. Trying to act as a pseudo cop because we may know what a police officer may do, only exposes us to injury, legal ramifications and looking like we want to be something other than emergency medical care providers.
So, if you want to be a police officer, go and take the tests needed to do that and do it well. If you want to be an EMT or paramedic, take the tests to get certified, keep your continuing education up and always keep learning the many facets of being a EMS professional.
I think by focusing on this you will find very little time to think about what police officers do and have a firm understanding of your role in the 911 family.