I have been volunteering for about 5 months now and still don't feel totally confident in my abilities. The problem is that my agency doesn't really have a large call volume and rarely gets anything very life threatening or traumatic. Therefore, I don't really practice my skills daily. On the occasion we get something serious, I freeze and for some reason forget all the protocols. How long does it take to feel comfortable with everything?
When should I feel comfortable?
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May sound funny, but - it takes as long as it takes. If your system doesn't have a high volume of calls, maybe pick up a different system to volly with, or volly for 2 systems simultaneously ?
Also, what kind of skills do you have to practice daily to feel comfortable doing your job ?
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It's not as easy as finding an answer on the internet.
I never felt comfortable working with pediatric patients, because I so rarely worked with the population in private EMS.
Fake it until you make it. Have your protocols easily accessible as reference. I used to use this all the time.
Good luck!
I never felt comfortable working with pediatric patients, because I so rarely worked with the population in private EMS.
Fake it until you make it. Have your protocols easily accessible as reference. I used to use this all the time.
Good luck!
I'm talking about being comfortable with the trauma skills when those types of calls come. Medical calls I'm pretty ok with as they don't require much interventions from us. It's when we get the amputation or apneic patient or something to that degree where I would start to become flustered.
Apnea and trauma aren't synonymous. And trauma calls, as a whole, are way less complicated than you might think. If you have a patient who has difficulty breathing or not breathing at all, you follow the ABC algorithm, i.e. put the pt semi fowlers -> give O2 or put the pt supine and start CPR -> get the AED. Same goes for the amputation (seriously, how many times have you even came across a patient with missing limbs anyway ?) - if it leaks red, you plug the leak 1st, then address the ABC. That's what the direct pressure/elevation/tourniquets are for. As a Basic, there's only so much you can do for the patient and it all fits into a very simple flow chart.
ERDoc
Forum Asst. Chief
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Trauma is cookbook medicine at it's finest. If you can remember ABC you can take care of trauma pts. If it's bleeding, put pressure on it, if it's broken, splint it. There really aren't many skills, especially at the BLS level.
And even if you're in a system that lets the Basics intubate (which is a last resort anyway), the only endo available to you is King's, and there's a zero chance to miss with it...
Besides, what do you think the medics can do in these cases ? Yes, they can do some invasive stuff, push certain meds and start IVs, but in the end of the day, when it comes to trauma, it always starts with ABC.
Besides, what do you think the medics can do in these cases ? Yes, they can do some invasive stuff, push certain meds and start IVs, but in the end of the day, when it comes to trauma, it always starts with ABC.
SeeNoMore
Old and Crappy
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I think there is a huge difference between being able to function competently and being "totally confident". The fact that you care enough to post is a a good sign. I am glad you care about your practice and your patients.
I work in a busy 911 system as well as Critical Care / Flight. I manage very sick patients regularly. I can tell you I am not "totally confident" , but I am comfortable that I will be able to handle the calls. This does not mean I will be perfect or not make mistakes. But I feel that I have enough experience where I will usually act reasonably , and be able to address mistakes or complications as they occur. This comfort did not come out of the blue. It came from many years of calls and frankly from making mistakes or just sub par decisions, even if not as dramatic as say a med error or a missed tube.
I am not trying to say that it should be excusable to perform the job without a solid education and degree of skill. But no provider is flawless from the beginning. This progress is certainly hindered by low call volume and lack of acuity. This is a challenge for many providers. I would focus less on being totally confident and more on obtaining the mental discipline and clarity to act in stressful situations. When you train/practice try and focus on what is most essential and as you become more comfortable continue to work on improving.
Take care.
I work in a busy 911 system as well as Critical Care / Flight. I manage very sick patients regularly. I can tell you I am not "totally confident" , but I am comfortable that I will be able to handle the calls. This does not mean I will be perfect or not make mistakes. But I feel that I have enough experience where I will usually act reasonably , and be able to address mistakes or complications as they occur. This comfort did not come out of the blue. It came from many years of calls and frankly from making mistakes or just sub par decisions, even if not as dramatic as say a med error or a missed tube.
I am not trying to say that it should be excusable to perform the job without a solid education and degree of skill. But no provider is flawless from the beginning. This progress is certainly hindered by low call volume and lack of acuity. This is a challenge for many providers. I would focus less on being totally confident and more on obtaining the mental discipline and clarity to act in stressful situations. When you train/practice try and focus on what is most essential and as you become more comfortable continue to work on improving.
Take care.
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Chest darts come to mind as a life saving intervention we do.
We also do pericardiocentesis where I work. Both involve the ABCs.
Surgical airways as well.
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No, that was in response to the question of "besides, what do you think medics can do in these cases?"
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redundantbassist
Nefarious Dude
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Impressed? I'm terrified.
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See above.
The system I work in is dual medic.
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We do have basics that are allowed to decompress (not all, only about 40).
Why's that? If it's a traumatic arrest, how hard is it to stick a needle in someone's chest? The skill itself is quite simple, and on a traumatic arrest they aren't going to do much to the patient's detriment.
Jim37F
Forum Deputy Chief
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I was taught how to do a needle decompression by the Army during CLS class once upon a time....
Because it's terrifyingly difficult, even borderline impossible, for a lil stewpid Basic, to locate the 3/4 intercostal, stick a needle in it and hear a satisfying 'whoosh' of decompressed pneumothorax.
I am impressed to see that there are systems that aren't governed by EMSA directors who are hell bent on castrating the scope of practice.
Yeah, about that. Also, arterial clamping and other 'advanced' stuff.
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redundantbassist
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What is the required training to do a pleural decompression?
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They've all been through a cadaver lab for their numerous skills, along with classroom education and a ton of scenario-based training and stress inoculation training. I'd actually put their ability to handle a stressful trauma patient over that of many AEMTs and Paramedics.
Terrifyingly, they're still just basics though.
My point stands, though. How hard is it to find a landmark, then stab a dead person in the chest with a needle? Like Jim said, it's gone over for CLS training in the military. Those guys have no medical training except for the short little CLS class (are they even still teaching CLS?)
It used to be an integral part of TCCC. Not sure about now, it's been too long.
redundantbassist
Nefarious Dude
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I see your point. I was unaware that any program even provided that degree of training to a non ALS provider.