Advice..

[andyrad]

Currently I'm doing my BLS practicum. I've actually only got 2 days left. I think it has been going well. I've stumbled on a few things, gotten better over time.

My preceptor today tells me that maybe I should consider a different career as I'm too 'task oriented'. When I show up on scene I don't instantly jump to everything I have to do. It takes me some time and sometimes, takes some prompting.

The call I think that set her to saying this was a seizure. I've never seen a seizure before. I've read about it. I know about the different types of seizures. I realize that he could have been hypoglycemic. Needs O2. I didn't rush in to it right away and it took some prompting. I understand what these things are for and why they are administered/suspected.

Should I be reconsidering? I've had issues with the practicum and my school doesn't get back to me. So now I have to be told I don't understand something just because I've never seen it before and didn't act quickly enough. I thought I was supposed to learn and get better with time? I'm confused and well, I don't feel very good. This is a career I've wanted to get in to for a long time. I want to succeed and be the best that I can be.

Any advice?

 

[Sasha]

No one comes off the starting blocks knowing exactly what to do and when, it may just take you some more practice than it takes others. I was a very shy girl when I started and took major prompting but that has improved with time.

Give it some time, if it turns out EMT/Paramedic isn't right for you, shrug it off, there are plenty of other health care professions to choose from.

 

[Shishkabob]

Tell your preceptor to shove off (after she gives you a pass that is)

It's not their job to decide if it's right for you or not. Some people take time to get comfortable with their knowledge. It's natural. Once you get used to doing the calls, it will be second nature. As of right now you have the education, but not necessarily the understanding.


I'm generally a shy guy, and am still getting used to what I can do as an EMT. Now I'm a medic student and have to do more. It will take time, but you have to do it at your pace.

 

[silver]

Hey how many patients have you contacted and how many hours is the practicum?

And that should basically explain why you don't feel up to pace. It takes a long long time to get comfortable and proficient.
Just stick with it!

 

[WuLabsWuTecH]

I'm still sometimes very shy with patients. I have a tendency to keep to myself. Now volunteering in ERs since I was 15 I've seen a lot, so often times I can be too cold as I think it's not going to kill you anytime soon, so I'll keep to myself. I'm getting better though and after a year in a Children's ER doing something else (not as an EMT) i've gotten better with the social aspect of it. It takes time, you'll get there.

BLS practicum is a joke--not nearly enough to get you street experience. Give it a year or so of working and then come back and tell us if you're still having the same problems. More runs=more info for us to go on and help with, but before a year is up, you're too green for anyone to know if it's you or just the lack of experience.

 

[Melclin]

Its a common complaint here that students can shoot off a whole pile of theory but can't really apply it that well.

"You grad medics, ask you for a 1500 word essay on the causes of chest pain and its no problems, but you get all shaky and confused when you get to guy clutching his chest" - every medic over 30 y/o in Ambulance Victoria.

Plenty of those medics will turn out to be great. I reckon it just takes time and practice. It's mighty hard to turn textbook knowledge into practical ability. Of course you're going to take a moment the first time you see a particular presentation when you're still learning.

 

[Hastings]

I heard that plenty of times when I was in paramedic school. "This isn't a profession for wallflowers." "Maybe you should consider a different profession."

I told them I wasn't going to give up.

I didn't.

I'm doing fine. Confidence comes with experience.

 

[spisco85]

I find thinking about the call you are being dispatched to on the way to figure out a game plan helps to make things go smoother. Until you develop your own system it is definatly a plus.

 

[CAOX3]

Any advice?

Yeah ask him if he's a fortune teller if he say yes, find a new job.

Shrug it off, he's probably a meathead that has nothing better to do then pretend he can determine who is going to be a competent provider. Unfortunatley that attitude is rampant in EMS.

Keep your head up and get used to it. Everyone in EMS thinks there better then everyone else? Unfortunately this attitude is also rampant.

You will be fine.

Later.

 

[PapaBear434]

This guy is a moron, and likely of the "old school" guys that thinks he knows it all. I'd also venture out and say that he's a "para-god," the kind of medic that thinks the fact that he went to medic school makes him superior to anyone with less time than him. That he alone has the knowledge to stave off death and no one else has a clue. And that he is able to tell, at first glance, who has what it takes to join his perception of an elite group of folks that he considers worthy.

Just keep your head down, do what you are supposed to do, and keep learning. I was horribly procedural when I started my BLS. I wanted to dump O2 on almost everyone. I wanted to do a full physical assessment on anyone who called about a stubbed toe. After a while, you get a rhythm for it and it becomes instinct in what to do.

That isn't to say that you should get lazy. I've seen plenty of guys get lazy, and won't check the rest of the foot or leg with that stubbed toe. But you'll get a feel for it, and will stop checking for hip fractures and spine deformities and instead just ask if they fell or have any kind of pain, and decide what needs to be checked from there.

Right now I'm doing my ALS qualifications, and I'm back to being procedural oriented. I want to drop IV's on everyone. I have the urge to get fluids in them every time their BP is a little low. I feel compelled to give a breathing treatment to assist a cough, even if it's productive and low grade. It's just part of being new.

Get passed, ignore him, and keep going. Only time will tell if you'll end up a cookbook medic, not him, us, or even you.

 

[ResTech]

That preceptor sounds really counter productive... she is supposed to be helping you so next time you encounter a seizure patient, you have a better idea of what to do and are more comfortable with the situation. Every student encounters situations they may not be 100% sure of... thats why your a student! Sounds like a bad preceptor to make a comment like that.

 

[Ridryder911]

All above posts could be correct ... that saying "could be". The other side, maybe the Preceptor is being honest? I am currently going to a meeting in about 30 minutes, where I have been developing a Preceptor program.

Too many students are either riducled or passed over too easy. There is a happy medium.

I have seen students that Ihave informed that if they do not improve or show sudden change, that they should consider a change. It is much better than allowing false hope. Not everyone can work in this job as a professional. This even means that they have a 4.0 GPA.

Unfortunately, we are only hearing one side. I have only seen preceptors be that blunt when the student really is making some serious errors or when they have false or delusional ideas about the EMS profession. No matter what, something to think about. Either that it was a bad clinical or maybe.... things you need to improve and work upon or ... not going into EMS as a profession.

I wish you luck,

R/r 911

 

[PapaBear434]

All above posts could be correct ... that saying "could be". The other side, maybe the Preceptor is being honest? I am currently going to a meeting in about 30 minutes, where I have been developing a Preceptor program.

Too many students are either riducled or passed over too easy. There is a happy medium.

I have seen students that Ihave informed that if they do not improve or show sudden change, that they should consider a change. It is much better than allowing false hope. Not everyone can work in this job as a professional. This even means that they have a 4.0 GPA.

Unfortunately, we are only hearing one side. I have only seen preceptors be that blunt when the student really is making some serious errors or when they have false or delusional ideas about the EMS profession. No matter what, something to think about. Either that it was a bad clinical or maybe.... things you need to improve and work upon or ... not going into EMS as a profession.

I wish you luck,

R/r 911

While it's true that we are only hearing the one side of things, I have seen plenty of medics have this attitude that they are better, smarter, and just have an instinct about things they could not possibly know about. They also have the view of medic school as a paramilitary institution along the lines of the police academy, which thinks you need to break people down to build them up and that only the strong will and should survive.

I'm not saying you're wrong and I'm right, but I'm saying that you COULD be wrong, and so could I.

But this is a new student in an EMT-B course. I'd give them the benefit of the doubt and say that they need some time out in the field before he can make the determination that he's not made out for this.

 

[Ridryder911]

I agree. We have too many with egos and "I'll show you" attitude but also have too many students expecting to be hand fed.

Something also to think about. I am in charge of the testing, hiring of applicants. I had over 12 applicants yesterday that made it to the second phase of test (we have four phases) which is the practical examination and first interview portion (supervisors, FTO's & myself Operations Manager).

They tested each one based upon several factors, yes to be sure the minimal is covered but also who presented that they would really know what to do and work as a partner. Most of these were brand new EMT's with little to no experience and very many of them were in Paramedic school.

For those that hesititated this would appear to present a bad light, as not knowing what to do. By the time the student arrives for clinicals they should have had a grasp on how a call operates by simulations and scenarios within the class. If they have not participated in simulations upon on how to operate a call, then the program is crappy. Yes, it is understood on maybe not knowing how the medics will orchestrate the call; but not to do anything or just stand there? You should be very aware, all patients gets v.s., ask....."Want me to get their v.s.?".. do something, unbuckle the straps, etc... It's called participation. Something that my students gets evaluated for.

R/r 911

 

[gcarlisle]

I'm going through the exact same thing right now. I went through my EMT-B course back in the fall, finished at the top of my class and had my test click off the earliest my instructors had heard of. I did fine in my clinicals, too, but they weren't in depth whatsoever, I was only allowed with the patients who were perfectly stable and were going to be waiting a while because their priority was so low... and my clinicals were in the ER at a small-town hospital, not on a squad.

So, I started working with my local fire department (which is, technically, a combination paid/volunteer department, but before me it had been several years since the last volunteer retired) about three weeks ago. Now, my EMT course was in a very rural area, an hour away from the nearest trauma centers, and I'm working in the largest city in a different state now. Of course, I knew I'd be green for a while, but I feel like I keep making stupid mistakes that should have been corrected in my clinicals, or that shouldn't happen just for common sense.

On the runs, I'm the third person in the squad with an EMT and a medic (the EMT driving), but in the back with patients I just feel like all I do it hook up nasal cannulas, and wrap lifepak bp cuffs on arms. Occasionally I'll do something interesting like apply the four electrodes for the heart monitor.

How long does it take to fall into a rhythm? Is it normal to feel this helpless? Or am I doing something wrong?

Thanks for your advice.

 

[Foxbat]

On the runs, I'm the third person in the squad with an EMT and a medic (the EMT driving), but in the back with patients I just feel like all I do it hook up nasal cannulas, and wrap lifepak bp cuffs on arms. Occasionally I'll do something interesting like apply the four electrodes for the heart monitor.

I am in a very similar situation. It gets disappointing sometimes, depending what medic you work with. Some medics don't let you do much. Say, I take a full set of vitals (pupils, lung sounds, etc.) and then they tell me I'm being too textbook and pt. didn't really need all this. Or they don't want me to take manual BP and instead hook pt. to BP cuff on monitor.
Not all medics are like this, though.

 

[andyrad]

Thanks for all the advice. I've done about 30 calls. I've gained a lot of confidence over the course of this month. I still have issues leading a call from beginning to end. I find I don't have much of a problem dealing with the patient. I don't struggle with the interaction part, just seems like I get too sidetracked when it comes to doing things in a checklist so I don't forget to do anything. If that makes any sense.

I get discouraged a lot too. I'll have a call that will go really well and I'll think I did just fine on it. Then my preceptor will tell me 'you were late with the BP' and I'll be totally discouraged for the next call BUT I'll work to get the bp in faster, then it's 'that patient needed something else right away'. So it just seems like it's an ongoing spiral of dejection. Should I be going through a checklist in my head for now? Just to properly get through a call from beginning to end?

 

[Melclin]

I don't struggle with the interaction part, just seems like I get too sidetracked when it comes to doing things in a checklist so I don't forget to do anything. If that makes any sense.

I get discouraged a lot too. I'll have a call that will go really well and I'll think I did just fine on it. Then my preceptor will tell me 'you were late with the BP' and I'll be totally discouraged for the next call BUT I'll work to get the bp in faster, then it's 'that patient needed something else right away'. So it just seems like it's an ongoing spiral of dejection. Should I be going through a checklist in my head for now? Just to properly get through a call from beginning to end?

Man I know how that feels. I'm a total perfectionist and my instructors tell me I've done some minor thing wrong and bam, all of a sudden I'm wanting clamp their throats with my mcgil forceps. I'm not good at wrote learning step by step stuff, but I feel that I still know how to do things without being able to rattle off every single textbook step. But I don't want to be the kind of medic that relies on my intuition solely. I believe in being systematic even though it doesn't come naturally to me. So I just set out a flow chart of exactly how I was supposed to do things ("Are they breathing? If yes... if no got to....A, Is it adequate? if yes.... if no go to B") and just wrote learned it - and I found it actually helped me with my confidence and my ability to do things by the book. To echo everything that's been said, just keep at it, cos as you say, if you get down about it you could end up being your own worst enemy. I know I'm mine - but I reckon that'll make me a good medic one day cos I push myself. At least you care enough about it to worry.

 

[el Murpharino]

On the runs, I'm the third person in the squad with an EMT and a medic (the EMT driving), but in the back with patients I just feel like all I do it hook up nasal cannulas, and wrap lifepak bp cuffs on arms. Occasionally I'll do something interesting like apply the four electrodes for the heart monitor.

How long does it take to fall into a rhythm? Is it normal to feel this helpless? Or am I doing something wrong?

Short answer...you're not doing anything wrong - most likely.

It's unfortunate that you don't get a chance to use all of your Basic skills and assessment mnemonics, but with a medic on your crew, you can't really expect to be in charge of patient care, to include performing the assessment and interventions. If you are good with assisting the medic in setting up equipment, administering oxygen, taking vital signs, etc., your medic will most likely appreciate it. But also take the opportunity to learn things that you wouldn't have learned in class.

I felt helpless way back when I was a basic...but that was mostly because I wasn't of much help on calls. Aside from cardiac arrest pts. and non-critical trauma patients, I didn't do a whole helluva lot in the way of skills or pt. care. I'm not making this into the ALS vs. BLS argument, because that horse has been beaten, but the only way I truly felt like I was making any headway in my medical career was going to paramedic school in addition to finishing my associates degree - many paramedic programs cut corners and don't adequately educate you to take care of patients.

 

[Ridryder911]

Expectations vs. reality.

Part of the problem of the EMT program is we really teach and emphasize the wrong things. Truthfully, the majority of the material the EMT performs or does on a daily basis is not covered in the EMT curriculum. The rarity of things.. such as delivering a baby, placing a hare traction on or even simple extrication is rarely performed by the EMT.

When in truth assisting a Paramedic, emergency vehicle operations and keeping the unit ready for responses, gather information and preparing the patient for transports are the main focus for EMT's working in a 911 system. As well we do not discuss IFT and non-emergency transports while in the EMT program, even though that is where the majority of EMT's find employment.

Not to be rude, but what do you expect? Maybe instead of assuming that you will be placed to care or to treat a patient, who is the best qualified for the patient? Would entrust someone who has just a few hours of training to really assess your patient for you to administer medications to? It is not rudeness it is thoughtful thinking and being safe.

One of the major objectives of new hire employees (EMT level) that I attempt to emphasize is not so much being medical but to be a good partner. It is NOT your primary role to listen to lung sounds or perform the assessment on a true life threatening illness or injury if there is someone else capable. Yes, the EMT should be able to hone their skills with more clinical experience and the ability to care for those not requiring in-depth care. One cannot gain clinical experience, by just driving.

Closely watch how each medic operates and orchestrates a call. Each one has their own idiosyncrasy and patterns. It takes time but one can do it. We never allow people to "partner". Each person should be able to work with each other and realize the whole goal is about the best care for the patient.

R/r 911