Sunday, October 31, 2010

Common Paramedic Student Mistakes

As a fairly seasoned Paramedic in my service, I get the opportunity to teach new Paramedics and Paramedic graduates on a regular basis. I really enjoy helping the future heroes of our profession and every now and then, I get to make fun of them a little bit. This is about one of those times.

Before I get to the story, understand that I did like any good instructor or educator would. I complimented them, told them everything they did right and then verbally kicked them in the nuts. After making them see what they did wrong and how 'WE' were going to fix it, I complimented them again and away we went. This particular person went on to become a great Paramedic with our service and I'm proud to have a little part in their education.

However, I see ALOT of Paramedic graduates and even fairly new Paramedics make this same mistake. If you're reading this and fall into this category, read carefully and understand the story I'm about to tell. It'll help. Scouts honor.

We were dispatched to a 'shortness of breath' on a 74 year old female. Upon arrival, the patient is in very mild respiratory distress. She is cool and diaphoretic and says 'I just can't get a good, deep breath!'. My newb jumped in, placed her on oxygen, obtained baseline vitals and placed her on the EKG monitor.

"INFERIOR MI", he exclaimed.

"Ok, you want to explain that to everyone who didn't hear you in a 5 block radius who doesn't know what you just said? I would suggest speaking a little softer while doing that."

"Sorry." he murmured before rattling off what he had said meant to the patient, who looked like she had shat herself after his outburst.

We loaded her up onto the cot, moved her to the med unit and whisked her away to the closest STEMI center. On the way, I could tell he was fairly nervous. It was his first anginal equivalent MI and you could see he was scared. His hands were shaking and looked like someone had filled his gloves with water before he put them on from the sweat. He had given asprin in the house, got a BP and was working on an IV. She was a tad hypotensive so, luckily, he didn't go slamming NTG at her face immediately.

But the IV, he couldn't get it. Once.... missed. Twice....missed. After the third miss, I offered my services and quickly secured an 18g in her right forearm. He looked crushed. He looked as if I had kicked his little paramedical puppy. His face turned red and he started slamming things around as he was cleaning up his mess. Luckily, we weren't far from the hospital and quickly rushed the patient into the ED bed, gave our report and went back outside of a tobacco conference.

"So... How do you think you did?" I asked.

"Fucked up. I'm a moron. I never should have said that on scene and should have gotten that IV!".

"Listen, stop right there. Come down off the cross and stop pouting. You adapt, you overcome. So what you couldn't get an IV? It happens. Some of the best Paramedics in the world miss IV's. This one isn't your first miss and it won't even be close to your last. All you can do is learn from every run you make and better yourself in every way possible."

See... I can be diplomatic :)

He kept on with the pouting and the 'I fuckin' suck' comments for about the next hour until we secured for shift. Afterward, we sat around the table and had a man to man talk. I packed a dip and gave him the best advice I had ever gotten.

"Brother, let me tell you this. 20% of Paramedicine is getting to do Paramedical cool stuff. The tubes, the IVs, the drugs....all of that is a fifth of what it takes to be a Paramedic. The rest of the job is using your brain, knowing when to do what, and making the best possible decision for your patient. Using your brain is much more important than hitting every IV."

He nodded his head in agreement.

"But, she needed an IV. I was so nervous, I couldn't get it. What if you weren't there?" he came back.

"You would have done the best you could with what you had. That falls into the 'other 80%' too, hoss. Adapt and overcome. Don't let something like that frustrate you to the point that you can't function. Then, you're no good to anyone."

He smiled and shook his head.

"Speaking of being nervous, have I ever told you my 'Duck On a Pond' analogy?" I asked.

"No... But I'm sure I'm going to hear it after that, eh?"

"Damn right. It's applicable here. Let's say you're at a pond and you spot a duck chilling on the water. As you watch it, it's looks as if nothing could phase it. It's just floating along without a care in the world beyond 'I wonder if this fat kid is going to give me some bread'. But that's on the surface....."

"What in the Sam Hell are you getting at, dude? I'm like a duck?"

"No." I said. "On the surface, the duck looks cool, collected and relaxed. It's just floating around the pond. But, under the surface, that damn thing is kicking it's legs 200mph to get to where it's going. It's all over the place and it's moving a mile a minute. THAT is how you need to be! When you're in front of a patient, you should be calm and cool. Like Fonzie, if you will. At the same time, your mind needs to be going at light-speed. You have to think 10 steps ahead of yourself. You have to take in alot of information quickly, assimilate it and interpret what it means for your patient. Your brains needs to be working like the ducks legs....under the surface."

His face went from anger and frustration to the look of someone who'd just had an epiphany. "I see what you're saying. Honestly, it would probably make everything a little be easier too, eh? If I don't freak the patient out, I'd be able to develop a better rapport, they'd have more faith in my decisions and the whole run will go smoother."

"Nailed it." I was stoked. Now if he could actually pull it off, I'd hang my hat on the analogy.

The moral of the story is, to all of you young Paramedics and aspiring hero graduates, chill out. You're not going to be perfect. All you can do is use every mistake or negative situation as a learning experience. Missing an IV here and there doesn't make you a horrible Paramedic. Missing a vital piece of the assessment puzzle that results in a poor patient outcome does.

Be a duck on a pond.

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