Kids Say The Darnedest Things

Observations and opinions of one of my pedi patients…

Junior: Do you have any kids?

P2P: Nope.

Junior: Oh. That’s too bad. You’re nice, like my mom. I think you’d be a good mom.

P2P: (totally taken aback and blushing): Oh…Thank you, that’s very kind of you.

Junior: Are you married?

P2P: Nope.

Junior: Do you want to get married?

P2P: Someday, I think I would like to.

Junior: Why don’t you want to get married now?

P2P: Just haven’t found the right person yet.

Junior: How old are you?

P2P: Twenty.

Junior: Jeez…you’re running out of time.

 

Thanks, kid.

I gave him a sticker anyway. He still won the “Coolest Patient of the Day” award.

Unprofessionalism in Education

We’re gonna play a little game today. Yep. You and me. I’m going to write a quote here that took place at school the other day, and you’re going to guess who said it. Okay? Great!

“So Elise emails me this question the other night, asking me about complications of placenta abruptio. (laughs) Seriously? How do you not know this? Like, really? How about bleeding out, Elise? That’s gonna be a pretty big problem pretty quick if you don’t see what’s so wrong with having placenta abruptio. I can’t believe she asked me that.”

You probably have a decent picture in your head. Some mouthy nursing student (similar to ones I’ve previously posted about here and here) that has nothing better to do with her time than put down the others, most likely because she’s insecure herself. But you’d be wrong.

That quote was from one of our teachers.

That really grinds my gears. I am somewhat shy, but I used to be much much worse. Speaking from experience, shy people can get incredibly uncomfortable about asking questions in a public forum (ie, a classroom.) Why? Because we’re afraid everyone’s going to think we’re stupid. At least that was my fear. So emailing a question is a nice, private way of learning while successfully avoiding judgement. Right?

Wrong, apparently. I guess now it’s okay to make a mockery of a student by name–who fully intended to speak with you privately–and flaunt it to other students. I’m proud to say that none of the students in this room so much as chuckled. No one said anything. We all just stared at her, occasionally exchanged glances with others, and waited for her to finish her rant. When she was done, there was an instantaneous understanding amongst all the students in the room. We could never feel comfortable asking her questions without fear of her making fun of it to other students. Creating an environment that discourages questions from being asked is to essentially kill off the possibility of gaining a full and comfortable understanding of subject material. Inquiries are at the heart of learning. And now, everyone is afraid to ask. Super.

I’m completely disappointed and continuously discouraged every time something like this happens. To any of you educators out there, I am begging you…please never do something like this to your students. Ever.

Are You Taught To Hate Your Field?

Why on earth is the healthcare provider education system so hell bent on burning people out before they’ve even got their license in hand?

At least that’s the way it seems. Maybe it’s just a regional thing. Maybe all the schools in my area are teaching using similar techniques, and all the teachers subscribe to a similar mindset. Or maybe I’ve officially lost my mind (I am certainly not ruling that out).

This post is going to mostly be about nursing school, because that’s what I’ve experienced. But, any new-grad paramedic I know has talked about similar problems.

For any of you that actually read my rambling, babbling, nonsensical drawl, you know that I am unhappy in nursing school. Yes, I do feel absolutely miserable. Every week, I find myself up in the wee hours of the morning on the verge of a mental meltdown. Every drive to school is filled with anxiety, and every drive home is filled with discouragement. It feels almost like a trap some days. The further into the program I get, the worse I feel, but the more obligated I feel to finish it. At my worst, I find myself panicky, physically sick, unable to sleep, and waking up with horribly graphic and disturbing nightmares. Sometimes I start wondering why I ever decided to go into nursing. In my stress, I start to look for other careers I could do. Maybe I’ll find my calling in something else. In the past, I’ve considered going to paramedic school. Currently, I have some wild aspiration to go into law enforcement…which I’m sure would be greatly discouraged by anyone who actually knows me. I have to stop and wonder if these aspirations are real, or if I’m just looking into them because it’s something other than what I’m going through right now.

I’m in an associate’s degree program, so it’s only 2 years long. Most paramedic programs are about that long as well. It’s a short amount of time in which to learn a lot of important things. It’s not like earning a typical degree…after we get out of school, our decisions could greatly impact the lives of others. The stakes are very high, and it’s incredibly important to learn as much as we can in the short time that we have. Maybe these programs are just too short to be reasonable. I find that students in these shorter healthcare degrees/certification programs are just so stressed out and inundated with schoolwork that they find themselves discouraged or disliking the career they are about to enter. It’s heartbreaking to work so hard towards something, and then to be almost directed to hate it.

Maybe I just don’t love my potential career enough. Maybe I’m not dedicated enough. And like I mentioned before, maybe it’s purely a regional thing. Regardless, something should change here. Maybe it’s just me. Or maybe it’s the healthcare system. Or perhaps something in between.

Are any of you having problems similar to this? Or did I really just plain old lose my mind.

Is EMS A Team Sport?

I don’t have a designated partner, but I do have a small group of people that I usually work with. I know how they like things set up, what things they like to do, what they don’t like to do, where their strengths are, etc. And I know how I fit in with that, and we manage to get an awful lot done without saying too much to each other. I love calls like that. They just flow so seamlessly.

The vast majority of these familiar partners have years of experience on me. Maybe I unknowingly take comfort in that. I tech my fair share of calls and actively participate. I don’t sit on my haunches and wait for direction. If I see something that needs doing, I do it. Their experience and my eagerness blends very nicely together. I like to think I’m a good partner.

One day, I had a brand spanking new partner. I don’t know if he was shy, or having an off day, or just really didn’t know what to do. I prefer to do most of my interventions in the ambulance, if I can. So after we moved the patient into the truck, my partner stood awkwardly in the truck with me for about a minute before heading up front to drive. We were ridiculously close to our destination, so I had even less time to do everything that I wanted to do. I felt completely disorganized! There was no flow to what I was doing. I scrambled around the ambulance, remembering, “Oh, I should try this!” or “Ooh, I really need to get one of these,” all while frantically peering out the window and racing against how much time I had left.

A good partner can make everything smoother, as I’m sure you know. But what about a not-so-great partner? Is EMS really a team sport? Does having a player out of the game really impact things that much? Should it? Maybe that whole incident I described speaks poorly of my skills as an EMT. Maybe I should be perfectly capable of handling everything as evenly and smoothly alone (or with an “eh” partner) as I do with partners who I’m comfortable with. Maybe I’m inadvertently relying too much on my partner…more on feeding off of their energy, so to speak, than actually relying on their skill set.

I don’t know. What do you people think?

Paramedic or RN?

Well, here we are again, internet friends. Back to the soul searching and looking for advice from my favorite anonymous third party!

Firstly, if you’ve been following my whining about nursing school, you know I’ve been dealing with several really mean individuals. I’m happy to report that most of them will not be in my class this coming semester. Yay! There’s something to be said about karma, I suppose. Well, that and hard work.

During my Christmas break from school, I picked up more hours at my department. Going back and being able to do something I love…that all by itself makes me happier. Plus, trying out my new ALS skills has been really exciting too. Anyway, with all of these additional hours, I’ve obviously been to area hospitals more often, and to the local nursing homes as well. It just seems to remind me more and more that EMS is where I belong.

That, combined with some major screw ups at my school (losing my tuition, for instance) is making me rethink the whole nursing thing. I’m planning on applying to transfer…the problem is, should I transfer into another nursing program? Stick with it? Bridge to paramedic later? Or scrap it, become a paramedic, and bridge to RN eventually? It seems like the RN-first path means I’ll have lots of years doing things I hate in order to get where I really want to be (pre-hospital medicine, although ER would be fine too). Paramedicine, however, means putting my time and energy into a field I love.

I understand the RN position would be more financially stable, and I would have the opportunity to change specialties and get out of the emergency scene if it gets to be too much for me. But the idea of being a paramedic still pulls at me. So, here we are. Paramedic? Or RN?

 

Tactical EMS

I’ve attempted to do research on my own about this, but I keep coming up short. Are any of you in TEMS, or know someone who is? What exactly do you do in your job? What’s a typical day at work for you? What’s the training like to get there? Where do you go to school for that? How long? And basically anything else you can think of to help explain or provide advice about.

Please leave something in the comments or shoot me an email! Thanks in advance!

Competence and Fear

I found this post by “Hot Lights & Cold Steel” a while back, and it’s kind of stuck with me ever since. You should go check it out for yourself, but I’ll summarize briefly for the point of this post. Basically, there are four levels of an EMS provider: unconsciously incompetent, consciously incompetent, consciously competent, and unconsciously competent. In the first, you don’t realize what you don’t know. In the second, you are aware of all that you don’t know, and almost overwhelmed by it. In the third, you can provide great patient care when you are focusing and thinking about everything you’re doing. In the fourth stage, you provide great patient care without having to think every little detail through…it just comes naturally.

Well, a piece of me wonders if this theory involves some oscillation. I do remember being in awe of how little I actually knew. I realized that my knowledge base was so small…and the things I thought I knew really only consisted of superficial knowledge. It was daunting. As time went on, I ran more calls, saw more things, and learned more from others. I began running calls with confidence. There was a fluidity to my movements, a steady process to everything. I was calm. As a EMT-B, I knew what I needed to do, and was able to do it.

Now, if all goes according to plan, I’ll be a licensed AEMT within a month. That terrifies me. Honestly, I didn’t feel that my program really adequately educated us. But, to be fair, I know that’s only part of the problem. That fear still remains, whispering poisonous thoughts, catalyzing my moments of discouragement. Although I try very hard not to show it, my methods and my thoughts all seem to be similar in nature and feel to those I had when I first started running calls: disjointed and somewhat anxiety filled.  Maybe that’s because of my broadening and deepening knowledge base. Maybe it’s because I don’t get to tech as often as I used to. Maybe it’s because I’m starting to realize the much greater responsibility I have to my patients as an ALS provider. Maybe it’s all of the above, plus so much more. Regardless, I feel that my thoughts are uncoordinated and clumsy again. Maybe not to the extent that they were when I first started EMS. But, deep down, I do worry. What will it take to earn that confidence back? Was that original confidence deserved in the first place?

Maybe these are good, healthy concerns to have. Maybe this will help me become a better provider. But for now, it’s a little scary.

The Shards Buried In Our Skin

I’m going to take a chance and throw this out there, and see what I might get back.

At times, I find myself worrying and believing the things others imply…that if you can’t handle the emotional toll of our calling, then you’re weak, and you won’t last. I hope that’s not true. I try to reassure myself, but in my hours of insecurity, those reassurances are fleeting and superficial.

I’ve been finding myself having moments where it will suddenly hit me; the awful things we have to see and deal with so regularly. We see so many life-shattering events. And then one day you realize there are little shards of these events that are buried in your own skin. There are so many things we can’t un-see, cries we can’t un-hear. In quiet hours, I sometimes ask the veteran paramedics that I trust, “How do you deal with this?” Time and time again, regardless of who it is, the answer is a resounding, “Take care of yourself. Everyone handles stress differently. Work out. Write. Make art. Listen to music. Go hunting. Fly a kite. Play with puppies. Do what works for you.”

Oddly, none of that is helpful. I don’t know what “works for me.” Other than writing, I suppose. But even then, I find myself trying to edit and make my writing more appropriate and appealing for others to read. No one wants to read some whiny kid moaning and complaining all the time. I don’t know if not knowing how to handle or react to stress is simply age-related…maybe it’ll get better as I get older and figure myself out more. But maybe it is something I should know now, something I can learn somehow.

I find myself doing what (probably) most are doing: shrugging away the memories. Not looking at the shards of lives embedded in our skin, the splatter of sorrow stained on our clothes.  Just like what we tell victims with gruesome injuries, “Don’t look at it.” Looking at it makes it worse. It makes it uncomfortable. It makes it too real. Ignoring it, leaving it to the backs of our minds, makes it a dream. Something that can be shaken from our minds like an Etch-a-Sketch, and written off with a light, “Whoa, that we weird. Anyway. Back to reality.”

But it’s not a dream, is it? It’s real. It’s all too real. It’s only a matter of time before that catches up with us, isn’t it? Maybe it’s only a matter of time for those like me. Those who aren’t sure how to handle it all; how to officially put those nightmares to bed. Can you even do that? Should you do that? Do these demons serve a purpose after all? To prove we still have empathy and emotion? That through it all, you’re still human and have a heart that beats and feels, interacts and reacts with everything? Is to silence the demons in our heads to become catatonic? Unresponsive? Cold? Without empathy or passion? Without any of those bittersweet, double-edged attributes that make us human? Should we live with the recurring pain to remind ourselves that we still care? Or should we numb it to allow us peace, but at the risk that we stop feeling anything at all?

Why Are (Or Aren’t) We A Profession?

If you have read a blog about EMS, you’ve probably read several posts about what’s wrong with EMS. If you have read a blog in EMS of any notoriety, you’ve probably read several posts proposing how we can fix EMS. One recurring theme in these posts is that EMS is not a “true profession,” which is supposed to be the driving force behind our lower salaries and perceived lack of respect as a field. So, what would make us a true profession?

“A profession has been defined as an occupation that requires extensive education or a calling that requires special knowledge, skill, and preparation. A profession is generally distinguished from other kinds of occupations by (a) its requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed; (b) an orientation of the individual toward service, either to a community or to an organization; (c) ongoing research; (d) a code of ethics; (e) autonomy; and (f) a professional organization.”

–Berman, A., & Snyder, S. J. (Eds.). (2012). The nature of nursing. In Kozier & Erb’s fundamentals of nursing concepts, process, and practice (9th ed., p. 17). Upper Saddle River, NJ: Pearson.

I encourage you to pick any of the points above and write a post about how EMS does or does not satisfy that element required to be called “a profession.” Or, maybe you have your own ideas as to what is necessary to be deemed “a profession.”

When time allows, I hope to be able to address all of these myself, but I’m very curious as to what you think. If you do write something, post the link in the comments so we can read!

Lights and Sirens?

If we are going to die at work, it’s most likely going to be in an ambulance accident. At least that’s what’s pounded into our heads at our fire department. We have trainings about driver safety. We watch YouTube videos of ambulance crashes–both out in the real world and those involving crash test dummies. (I’d post links to some, but I have dial up internet…Sorry. If you’re that curious, you’re just going to have to YouTube it yourself.)

At these trainings, we are told that a good deal of these accidents happen when the ambulance is going lights and sirens. Your adrenaline is going. You’re probably breaking traffic laws–including breaking the speed limit. It all adds up to what could be a disastrous situation. This is why we are discouraged from using lights and sirens unless we feel the benefit to the patient strongly outweighs the risk to ourselves and our fellow motorists. It’s where that whole “driving with due regard” thing comes into play.

Our 911 calls are usually dispatched at one of six levels: Omega, Alpha, Bravo, Charlie, Delta, and Echo. Omega level calls are basically for extremely stable patients, primarily for lift assists with no transport or injury. Echo level calls are for cardiac arrests, or those who are at an extremely high risk for going into cardiac arrest prior to ambulance arrival. And everything else gets assigned a letter somewhere in between. We never run lights or sirens to omega level calls. We always run lights to echo calls. Everything in between is at the discretion of those in the ambulance. We tend to run with lights and sirens while responding to calls. However, we don’t break the speed limit by more than 10 mph. Considering most of our roads are country highways and smaller roads, we don’t really navigate complex traffic patterns. Our roads don’t have all that much traffic on them either. 

 We almost never use sirens when transporting the patient to the hospital. We are strongly discouraged to use lights and sirens while transporting the patient, unless they are very very sick.

So I ask you, what is your department policy on using the lights and sirens? Do you follow it? Do you have your own rules, perhaps above and beyond the policy of your employer? What are your thoughts and feelings on the matter?