Sunday, January 18

Advice for a new Paramedic

Over the years I've been asked by students, interns and other Paramedics for tips, tricks or advice that can either smooth things out or help the new folks adjust to this rough and tumble world we work in.
I can never stress enough the first and most important tip I have:

It's not your emergency

No matter the incident, injury, illness or situation, you did not create it. It is not yours. There is no need to speed to the scene, run, shout, get upset or angry.

You will never know enough

There is a Paramedic you work with who seems to know everything, and not in that smug way, but leads by example and is a confident care giver. That person will never know everything about medicine and neither will you. They read, they listen, they learn. Do the same.

Don't tune your patients out

Many folks don't know what is wrong and when they think they do, 50% are wrong. Listen to what they say but note how they walk, look at their living conditions, check the date on the milk in the fridge. Does she wince when she stands? Is the cough productive? How long? Don't get stuck in the SAMPLE questions, but use them as a starting point.

The most important person in the room is you

Scene safety is paramount. It's not as easy as simply saying, "We'll wait for PD" like it was in P School. On the streets, the friends come running up to the ambulance screaming for help, the parents cry for you to hurry. Keep yourself safe, then your crew, then your patient, then the rest. Dead Paramedics have a horrible cardiac save rate.

Don't leave the hospital so fast

Just like you and your partner had a little palaver about the patient at the scene, the doctors at the ER will do the same. Listen in on their conversation. Learn from it. Are they asking questions you did not? Make a note of it and ask those questions next time it's pertinent. Wait for the 12-lead EKG and see not only what it says, but what the Doc thinks. You'd be amazed how many times I've seen a Doc spot something the machine misses.

Buy Dubin's

Dubin's Rapid Interpretation of EKGs is THE best resource for learning EKG rhythms. Without knowing what you have, it can be hard to formulate an action plan. Dubins will teach you the simple questions to ask yourself while staring at that 6 second print out.
Fast or slow? Regular or irregular? Does every P have a QRS? Does every QRS have a P? DONE. From those simple questions you can treat most arythmias.

Find your comfort zone and avoid it

If trauma is your strong suit, focus on cardiology. If you enjoy intubation, focus on IOs. Expand your comfort zone until everything is only slightly unfomfortable. That means grabbing for the pediatric bag feels the same as grabbing the BP cuff. That means reading, drilling and asking questions you don't know the answer to.

Practice humility

People will thank you profusely for what they believe was a life changing moment in their lives. Accept their thanks and tell them it was your pleasure to help them. Then learn more about what ailed them so the next person doesn't suffer as much. When you do an exceptional job, reward yourself by passing on the experience to another care provider. Not as a "war story" but as an addition to a lecture, lesson or discussion.

Warm lunch, warm dinner, go home safe

Those are my only 3 requirements for each day. The first two are negotiable and the rest doesn't matter.


Anonymous said...

Nice advice, but I would say that its not only for "new paramedics". I know plenty that can learn form your post.
I too am a firm believer in listening to the docs and asking questions. Find a good one, and keep going back. If I had an interesting ECG and he wasnt on shift I would keep it till the next time he was on then quiz him about it. Serves two purposes, firstly it increases my knowledge and understanding which I can then pass on to others. Secondly, the docs in the A&E (ER) begin to recognise you as someone who is keen to learn and you get a whole new level of respect and relationship from them.

Mike "FossilMedic" Ward said...

Great list. As a brand-new EMT on my first observational ride-along the lead EMT was studying from the first edition of Dubin.

It is a must-have book!
Nice web site as well:


Smooth Operator said...

A lot of that can be applied to all emergency services. About your requirements. What if you want ice cream for lunch or dinner ?

Gertrude said...

Great post! Makes so much sense. Now if we can just get the kids to listen.....