Medic Student guide to Field Rotations

[NomadicMedic]

When you’re a paramedic intern, your field rotation is a tremendous experience. You’re playing in the big leagues now, brother. It’s no longer imaginary patient scenarios; it’s the real deal. You’re standing in the middle of someone’s living room at 2:40 in the morning and you’ve got a sick person sitting on the couch in front of you, and you’re expected to treat him or her appropriately. Oh, and did I mention that all eyes in the room will be watching your every move?

In talking to my preceptors, I’ve found that most paramedic interns don’t have much trouble with the actual medicine. However, they do have trouble with the other 22 hours of the day. The time they spend in the firehouse with the crew. So, to help those medic students who may be venturing out on their first field rotations, I’ve compiled a list of handy tips to help you make the most of your field time and to keep you from ruining it for future students. Most of this is common sense… and remember, this is from my preceptors, at my ride site. Your mileage may vary.

First, remember that you are a guest in somebody else’s home. Respect for the house and the crew is your number one priority. Simple things mean a lot. Wipe your feet. Knock before you just barge in. It sounds pretty easy, but you need to remember that the crew in the firehouse is a family, and you’re an interloper that can easily disrupt the delicate dynamic that exists. Oh yeah, bring a gift. To be more precise, bring food. Cookies, muffins, something. Here in the PNW, it’s expected that the medic student bring Ice Cream on the first day of rotation. Snacks are always appreciated. Don’t make a big deal about it, just put the cookies or muffins on the counter in the kitchen. It’ll vanish before you know it.

Arrive at least 30 minutes before shift change. Introduce yourself to everyone. Look them in the eye, shake their hand and say, ‘Hi, I’, ______ a medic student riding here today.” Be proactive in letting people know who you are and that you’re part of the crew today.

Learn what’s expected of you as soon as you walk in. On your first day you should be asking where you ride on the engine and what spot you take on the medic unit. Which bed is mine? What bag or box you’ll carry into the house. Where is the mop and broom? Figure out where to find your traffic vest for MVAs. Ask if you need a helmet and gear for calls. Anything you need to know should come out as soon as you get there. Ask your preceptor or the senior firefighter, “Hey guys, this is my first shift here. What do I need to know?” And don’t wait for them to volunteer that info, get it!

Expect to work. Don’t fall into the trap of letting the crew treat you like a probie where you’re expected to scrub toilets and kitchen tile grout for your whole shift, but pitch in with the station chores. Don’t wait to be told. Grab a broom or a mop and get to it. The crew may not say anything to you, but they’ll notice that you’re helping and they appreciate it. Usually station chores can be done pretty quickly and then you can move on to the real business at hand.

 

[NomadicMedic]

part II

Learn the location of everything on the medic unit. Everything. Spend as much time as you need in that truck to be able to put your hand on anything your preceptor may ask for or you may need in the course of doing your job. If the same equipment or medication is in multiple locations on the truck, know them all. It should be your mission to do a full rig check every time you walk into that station. Physically inspect every drug vial. Touch them all so you make the connection with the location in the drug box. You want to be able to open the box and know exactly where the Adenosine or Solu-Medrol is. Touch every piece of equipment in the truck. Do you know how to turn their brand of monitor on? Where’s the capnography plug in? How many sets of combi-pads are in the rig? Is every laryngoscope blade bulb tight, white and bright? Can you put your hand on the bougie without having to root for it in the airway bag?

Spend some good quality time with your preceptor and get to know what he or she expects from you. Conversely, let your preceptor know where you think need help and guidance. Expect to be grilled on your medicine and treatment plans by not only your preceptor, but also other medics in the station, the shift captain, the MSO and anyone else who happens by. Don’t think you can skate through this. You need to know your stuff. You need to know drug dosages. You need to know WHY you give certain drugs. You need to be able to grab gear off the truck without fumbling. Your preceptor is watching to see how much you know, how you handle stress and where your weaknesses are. When you roll out together, some preceptors may want you to just observe how they run calls for the first shift. Others may tell you to run it all while they stand back and observe. It’ll be up to you and your preceptor to find that comfortable groove where you can get great patient care experience and he can guide you in shaping your practice. And if he or she knows you need help with certain skills, they can be right there to help you out with tips and tricks to get it done.

Have some presence. My instructor calls it “Medic Swagger”. You’ve simply got to be decisive in your treatment and interaction. After all, you’re going to be the guy that everyone on scene looks at for answers. There’s nothing worse than being unsure. When your preceptor says, “This guy’s rate is 42, what are you gonna do?” Don’t scratch your head and say, “Uhhh…maybe some Atropne?” That is the wrong answer my friend. If you know it, say it. If don’t know, ask your preceptor. Don’t guess. If you do guess, expect to get grilled on treatment for that situation when you get back to the firehouse. This isn’t something you’ve got to have nailed on your first shift, but soon after you start riding, you’ve got to be able to step up to the plate and be the medic.

After the call, you clean and restock the rig. No questions. Just do it.

Study. There’s going to be downtime at the station. You better have your books with you. Use that downtime to feed your head and prepare for the next class. If your preceptor is a newer medic, chances are he’ll quiz you on some esoteric stuff that you’ll be expected to look up and report back on. No, he’s not picking on you. Well, okay he IS picking on you, but he’s also helping you to learn. And just think, in a few years when you’re precepting a medic student, you can do the same.

Dinner. On some shifts the evening meal is a big deal where the cooking starts just after breakfast. For other shifts, it’s pizza or Thai food ordered in. You’ll need to talk to your preceptor about what’s expected. At the station where I ride the rule is, Medic Students are not expected to cook and are never asked to buy in. The guys there remember what it was like to be a student and how having no money is the norm. I appreciate that, but I always offer. (And yes, I did cook for the crew a couple of nights ago. My roasted chicken with wild rice was received with rave reviews.) If you don’t cook or pay in, you’re still expected to help. Did you hear that? Offer to help! When dinner is done, clean the table and the kitchen and do the dishes. Don’t say anything, just do it.

Coffee. Make sure there is always coffee on. If you’re studying in the kitchen, it’s easy to do. I always throw a couple of bucks into the coffee fund when I’m there. One of my preceptors doesn’t drink coffee, so she always loudly announces to the crew that I can drink her share. The captain on that shift has a constantly full mug, so I make sure there is always a fresh pot on. Remember, it’s a respect thing.

Fitness. Most crews have a period of time during the day set aside for PT. If you’re comfortable working out with the crew, ask if they mind. Most don’t. Some spend their PT time “discussing” department politics, and they may not want you around for that. Don’t be offended. However, you should tale an hour out of your day to work out. My firehouse has a great workout room and I spend at least an hour in there every shift.

There’s an old joke in the fire service, ‘If I wanted your opinion, I would have told you what it was.” While you’re not expected to be silent, it is prudent to keep your yap shut. If you’re studying in the kitchen and two firefighters come in talking about something, don’t insinuate yourself into that conversation. If they want to talk to you, they’ll include you. Most times they will. If a discussion becomes heated or turn into a rumor mill discussion, it may be better to quietly pick up your books and head to your bedroom or the bay.

At my station, evenings are pretty mellow. They cross staff a medic unit and engine so we have a small crew, usually three and me, sometimes a crew of five plus me. Around 1900 or so most of the guys settle into their recliners for some TV. Medic Students are never allowed to sit in a recliner unless they are invited. Don’t ever break this rule. You are not there to watch TV. You’re there to study and learn. Now, most preceptors will give you the wave and say, “Hey, put those books away and come over here and sit down.” When I’m invited to watch TV, I do so for a short period and then excuse myself to study more or hit the rack. Be polite, but don’t expect to just hang out and watch the tube. It’s not cool.

Sleeping at the firehouse is tough for some. One guy I know can’t sleep unless he’s almost totally naked. That’s got to be rough. If you’re that guy, don’t make them wait for you. The fireguys have bunker gear to put on, so they can be ready pretty quickly. I usually just sleep in my uniform pants and a t-shirt and throw on a quarter zip with my Student ID for that middle of the night call. I also keep a box of Altoids in my jacket. Mints are always appreciated in the middle of the night. Also, make sure your bed is made neatly and you keep everything orderly in your room.

Your field rotations can be a great learning experience and you can have a lot of fun. Just remember to respect the crews you’re working with, say please and thank you and pitch in on the work. “I’ll do it” is a great attitude to have. I’m sure you’ll do fine. If you have additional tips, I'd love to hear 'em!

 

[boingo]

If you have time to sleep during clinicals you're doing it in the wrong place.

 

[daedalus]

delete. If I have nothing nice to say, might as well not say it.

 

[NomadicMedic]

delete. If I have nothing nice to say, might as well not say it.

I'd LOVE to hear what you have to say...

 

[JPINFV]

You aren't expected to chip in for food (real food), but expected to bring cookies and other junk food? You're expected to study, but also clean? No TV? You're a paramedic student, but responding on a fire engine?

Now, to be fair on that last point, I'm not saying to be a couch potateo, how ever there is a point where I just have to put down the book and decompress. Similarly, I completely agree with the sentiment above that, given the short clinical time, that overnight clinicals aren't appropriate.

 

[NomadicMedic]

Allow me to clarify... ALL of our clinical time is with Fire. There is no separate ALS only service. All of our rides are 24s. We spend the entire shift with the crew, and many of the students pull 48s on the weekend to meet the criteria for number of required ALS calls. Juggling the field time with Hospital rotations and classes can be difficult. Unlike some Medic programs, we don't do "ALS Sleepovers." All of our patients are transported by Fire Medic Unit, even the BLS calls, and the medic student has patient contact with every single one of them.

Many of the departments cross staff both an Engine and a Medic Unit. The engine has a full compliment of ALS gear on board but it's not a primary ALS response unit. However, if the engine rolls on a fire call, the medic student is expected to be on board. If the engine responds to a call that tuns out to be medical, the medic student and preceptor will manage that call to the hospital on a separate medic unit which will be called to the scene to transport.

And yes, you're there to learn and work as a member of the crew. Not to sit around and watch TV during the downtime. Students that simply hang around and don't contribute are asked to leave and the clinical director is told not to send that particular student back. There's nothing wrong with helping with the station chores and chipping in with the daily work. You're there for 24 hours. Give up 45 minutes to grab a broom and help your crew. Remember, being at a clinical site is a privilege, not some right that's bestowed upon you simply because you're a medic student. Showing up, jumping right in and putting your best foot forward not only shows that you're on the team, it's just the right thing to do.

And as I said, your mileage may vary. Many evenings, I'll be fried from studying all day and I'll be invited to watch a movie, but that's never expected. The expectation is you're there to learn.

And yeah... don't be a mooch. Bring some damn cookies.

You aren't expected to chip in for food (real food), but expected to bring cookies and other junk food? You're expected to study, but also clean? No TV? You're a paramedic student, but responding on a fire engine?

Now, to be fair on that last point, I'm not saying to be a couch potateo, how ever there is a point where I just have to put down the book and decompress. Similarly, I completely agree with the sentiment above that, given the short clinical time, that overnight clinicals aren't appropriate.

 

[redcrossemt]

When you’re a paramedic intern, your field rotation is a tremendous experience.

I like your idea of creating a "guide" to clinicals, if I don't agree with everything as you say it. It may also not apply to everyone, as many will third ride with private or third service agencies; but I think the thought and many key concepts are there.

Do you mind if I use some of your ideas and words and rewrite some of it to apply to a larger audience? Then maybe we can publish/sticky it here on EMTlife?

 

[NomadicMedic]

I like your idea of creating a "guide" to clinicals, if I don't agree with everything as you say it. It may also not apply to everyone, as many will third ride with private or third service agencies; but I think the thought and many key concepts are there.

Do you mind if I use some of your ideas and words and rewrite some of it to apply to a larger audience? Then maybe we can publish/sticky it here on EMTlife?

Sure. It's all about making sure everyone gets the most from their field rotations.

 

[redcrossemt]

I'm going to look at past posts, but if anyone has anything to add or change, please feel free to post. I will compile it all together into what I hope is a great resource for students doing clinical internships in EMS...

 

[medicdan]

You're a blogger' eh?

 

[redcrossemt]

LOL I guess I hope to be??