Monday, December 6, 2010

Stating the Not So Obvious Because Common Sense is Clearly Uncommon

At some point in each and every EMT’s career, they get asked what motivated them to become an EMS provider in the first place. As time passes, a lot of providers lose focus of their initial motivation and become complacent, jaded, sloppy, difficult to work with, etc. 

The list is endless. 

Some may think I am stating the obvious, but nonetheless, the vicious cycle continues. Clearly, what some believe is obvious really is not!  Recently I have had a revolving door of, to put it as nicely as possible, partners who are poor providers and antisocial human beings; clear illustrations of what I strive not to become as an EMS provider or for that matter a human being… ever.

I am completely aware that we all have things going on in our lives.  I certainly can attest to life never being perfect. I have my own share of current obstacles that perhaps I will write about in due time. That stated, if you walk into shift with a horrible attitude it just sets the tone for the rest of the shift. 

Additionally, if you are working with a partner you are unfamiliar with, and you walk into shift with said bad attitude, I can guarantee that you will not win favor with your new partner. 

If they’re anything like I am, one who believes that if providers got their shit together and really made the attempt to improve themselves that EMS would be the better for it, you will most certainly not gain favor with them.

And you just might end up with an Sister Mary Freakin’ Sunshine, trying to draw you out of your funk and out of your shell.

I observe my regular partners on scene. I see what their method of obtaining the patient’s pertinent history is, how they assess and provide patient care, and I try to learn from them and improve.  I also observe my partner interacting with other crews, because a lot can be learned about a person watching them in everyday interactions. 

I learn how they take their coffee. I learn what they like at the local Taco Shack and Rib Joint, the one that gives the 50% EMS discounts. I try to find out about their families and interests. 

When I am in station, I allow them to pick what we watch on TV.  Some may think, “Well damn, isn’t she just a pushover!” but doing so allows me to get to know my partner. If I know – really know – my partner,  it enables that unspoken communication that allows me to gauge whether they are comfortable on scene, or if they’re having an off day. If I see that, I’ll willingly pick up the slack because strong partnerships composed of solid EMS providers create solid patient care.

Just don’t come to expect it, because I’m not always going to be Sister Mary Freakin’ Sunshine. Sometimes, it’s your turn to pick up the slack.

I know that people only want to admit to what they are good at.  That stated, it is important to talk about what you are not comfortable doing.  Don’t lie about being able to hear when auscultating blood pressure or lung sounds.  If you legitimately don’t think you can lift a patient, speak up. 

Know your limitations as well as your strengths.  Work on improving your limitations.  I refuse to call them weaknesses because they truly are not.  They are what I like to refer to as improvement points. 

I began my career with a Sprague stethoscope and, for the life of me, could not auscultate a BP. I found myself palpating a lot of blood pressures.  In one of our local Emergency Departments one night, the paramedic on the call with me told me, “Hey, I notice you try to auscultate the patient’s BP initially, but every time you seem to give up and palpate one, and that first time, we were in a quiet room in the patient’s home.”

 He suggested investing in a decent stethoscope, and had me I try my partner’s schweeeet Littman. So, I took his advice, and Ho. Lee. Shit… what a world of difference! Suddenly I could hear lung sounds easily, and my blood pressures were very accurate. 

I may have done a Snoopy Dance right there in the ED, but I categorically deny  the rumors that I ran right outside and randomly accosted passers-by, offering free blood pressure checks.

But I was pretty stoked.

Not only did my confidence in myself as a provider improve, but so did my patient care. I mean, finally I could accurately assess my patient! I know plenty of providers who jokingly admit to using the third method of blood pressure determination – oscillation - or they fudge numbers, or just use the auto cuff on the Lifepak or whatever.

So. Very. Wrong. 

Not only are you short changing your patient, which is the paramount issue,  you are also short changing yourself.  By relying on needle bounce or fudging numbers, you are NOT being the best you can be. 

People constantly settle and slack off.  I am guilty of both at certain points in my life, and I’ve missed opportunities or been passed over for advancement as a result.

Do not settle. 

Do not slack. 
Do not allow opportunities to pass you by.  Do not set yourself up for less than your best.  That’s one mantra I have followed in both my professional and personal lives.  When I find myself slacking and settling in the field, I challenge myself. 

I set goals for myself, such as going an entire calendar month without leaving a patient care report undone before I head home. I make myself take two sets of vitals on stable patients despite having a short transport. I strive to never have a PCR flagged for quality improvement. To this day, I have yet to have one returned to me because I document adequately and correctly to begin with.

Why? Because the little things count, that’s why. Show me a provider who takes pride in doing even the little things well, and I’ll bet that provider rocks the big stuff, too. 

One thing I’m always doing is suggesting to partners that we go into the bay and practice skills and use equipment that we don’t use that often.  Maybe a quarter of the time they take me up on the offer. Who cares if it’s not a scheduled training or you seem like a loser suggesting it. 

I love having students on board or in station for this exact reason.  I can use the student as an excuse to practice.  I know that is somewhat off, but for some reason having a student in station or on the rig (if you post) helps because “seasoned” EMS providers are more willing to practice their skills in the name of educating future providers. 

I also regularly bring JEMS and EMS World to work.  Sometimes when someone sees what I am reading, after ribbing me for being a whacker, they ask what I am reading and conversation ensues regarding the topics in the publications.  Sure, sometimes the topics are old news by the time they appear in print, having already been discussed and debated in social media long before, but I am okay with that, if it provides the means to open dialogue among EMS providers. 

I’ll be blunt: I really, really, REALLY dig it when a student asks me for help with the didactic portion of EMT class. The book work was always my forte.  Skills took some work for me, but the reading, writing, and paper testing where my thing.  I excelled, and honestly did not have to read most modules more than once. I studied rarely, if ever. I am blessed in that way. 

Some are not, and I recognize that. I am willing to help anybody who asks in any way I can, and if I have no clue I tell them so.

Then I’ll go research the answer and get back to them. That’s how students make me better.   

What it comes down to, in my humble opinion, is that once the ink dries on a lot of provider’s cards and they get clearance, they begin to fly just under the radar.

They get complacent. They get jaded.
It’s only human nature, but it has no place in EMS. Complacency is dangerous to yourself as a provider and human being, your partners, your employer and most importantly the patient.   We can all improve, and during down time at work you have an ambulance full of equipment to practice and hone your skills with. You have a partner who has gone through the same schooling, so practice and discuss! Only then will you be able to develop that sixth sense that tells you exactly what your partner is thinking, and what their next move will be.

That is priceless knowledge.

 EMS is not a place for ego.  I am well aware that there are many egomaniacs out on ambulances providing patient care, but this should never be the case.  You check your ego at the door. 

The job is bigger than you, or me.

Patients care about getting quality, professionally delivered care, and if you are fudging vitals, coming to work in a dirty and un-ironed uniform, not introducing yourself to patients, doing inadequate pre-shift truck checks, throwing things back into your jump bag, etc., you’re not giving it to them.

Even worse, you’re cheating yourself.

Sure, everybody has off days and things happen.  Nobody is perfect, although Ambulance Driver comes close. But don’t tell him I said that, because his ego is already freakin’ huge.  

Perfection is unattainable, but we should always strive for it nevertheless. That’s how we become our best.

The whole point of this post is that improving EMS and improving pre-hospital patient care begins with you as the provider.  You are the first healthcare contact the public has in an emergent (or not so emergent) situation.  Make sure you represent yourself in the best way possible and in doing so you will provide the best representation of your service possible! 

It’s a very simple concept: stop accepting the excuses we make for ourselves and our fellow providers, and improved public opinion will follow. More importantly, we’ll deserve their high regard.

As far our relationship and reputation with other healthcare providers, be a consummate EMS professional, introduce yourself, smile, and give a solid report that proves that you are educated and competent.  Improving how we are perceived by other healthcare professionals begins with us. 

Seriously, I shake my head in shame when I see other EMS providers walk into  a hospital wearing disheveled uniforms, no smile, mumbling some gibberish masquerading as a handoff report to the charge nurse. Is it any wonder, then, that the nurse disrespects them?

Yet, they get righteously indignant about being disrespected, as if they deserved better. It would be funny if it weren’t so sad, and so common. I wouldn’t respect that person as a healthcare provider either, and seeing so many others like them, I’d have a pretty dim view of the profession as a whole.

To be honest, I don’t respect those EMS providers. They do nothing to improve our profession, and make it nearly impossible for those of us who are.  

Clearly, common sense is uncommon, and many EMS providers are a perfect example of that truism. It’s time for us to get together and fix things before it’s too late!  We need to strive to be our best.  We need to challenge ourselves and the public’s perception of us. 

The time is now.  Don’t hesitate or it may be too late. 


  1. Thank you AD! I am thrilled to join the ranks of you, UKMedic999, theHappyMedic, Ms. Paramedic, and the rest of the EMS bloggers out ther! Please continue reading and commenting!

  2. wow, this is a great post. Helps to remind me to put things in perspective when it comes to the job. Like you, I like doing CMEs at refreshing my brain on equipment we haven't used for a while at work... unfortunately not many of my coworkers feel the same way. Great tips on ways to get to know your partner, so you can tell if something is bothering them, and help out.

  3. Thank you Faking Patience! I love your name! I think we all fake patience at times. I really LOVE continuing education because without CME both professional and personal progress can not happen. I agree that there are way too many complacent EMS providers in the EMS world who do not feel the way we do. I think a lot of it has to do with, "Oh we don't get paid enough" or "A trauma is a trauma" and things to that effect.

    Regarding your compliment as to methods to getting to know ones partner I used the same methods in my former non EMS job and it worked there as well. There is no I in team and nobody is the best. Sure you can be your personal best but overall there is no best. We each have our strengths and improvement points and we need to learn from each other.

  4. Great Post! When I was going through EMT-I clinicals. I had some visits with ER Nurses. I asked one why sometimes my service was not greeted warmly some of the time. To put it mildly. She told me some of our crew came in looking like hillbillys. Which is sadly true. I now come in starched. In whites.

  5. Thank you Richard! I apologize for the delay it's been in insane week + for me.

    In any given event kudos to you for inquiring as to why your crew members are not respected. Sometimes simply asking the right questions the right way gets us the answers we desire! :o)