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Your First Day

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It’s your first day here. You might be a new volunteer, a paramedic student, or a fresh hire. This may be your first time in an ambulance or maybe you worked ten years for a service in another state. You might be nervous or you could have so much confidence you had trouble fitting your head through the doorway. No matter who you are, this is my advice:

Show up early for your shift. By early, I don’t mean ring the bell at five AM for a six AM shift. Be here fifteen minutes early.

Come to work in clean clothes. I don’t care if your boots are spit-shined or not – mine aren’t — just don’t have your shirt untucked, your shoe laces untied, or dirt under your fingernails. First impressions can be wrong, but they can be hard to overcome and they rarely turn out to be wrong.

Tell me your name and look me in the eye when you shake my hand the first time. Like I said first impressions count.

Years ago when I was an intern in Washington, D.C. working for a United States Senator, one of my first jobs was to do a massive collation project – the copiers back then didn’t always do it for you so you had to do it by hand, spreading the copies out on tables. I introduced myself to the lady in charge of the project and she said don’t even bother to tell me your name. I have seen so many interns come and go, I don’t even bother to learn their names anymore. That was so rude of her, but the point is true for many jobs – new people come and go, and for people who have been one place a long time, they may not pay a lot of attention to you unless you catch their eye in a good way or a bad way, and they may not learn your name until you have been around awhile. I outlasted her by over a decade, and yes, I remember her name.

Unless someone asks, don’t tell or elaborate on your experience. If they do ask, stick to the facts. If they don’t, show them your experience through your actions. We had a guy come through here a number of years back who boasted of how when he worked in Maryland, they did a shooting every morning before breakfast. If there was a shooting every morning, it was likely his coworkers firing shots at his car to keep him away as he quickly proved to be worthless. You may have some good stories and you may be able to back them up, but my experience has always been the more someone talks, the less they have behind it.

If you work with me, I will ask you about your experience. I don’t care if this is your first time in an ambulance or if you have been doing it longer than I have. What you tell me won’t make me like you more or less. I just want to know your comfort level and what to expect once we walk on a scene.

I tend to believe people, so when their brash talking doesn’t bear out, it’s worse than if they had never spoken.

Strong and silent works well in EMS when you are new. It works well if you’ve been around twenty years, too.

Now keep this in mind. The seasoned person they put you with may be a jerk. Or they could just be a nice person having a bad day. EMSers are often sleep deprived and many are under stress. You are not the center of their world. You want to get yourself off on the right foot, you need to study who you are assigned to as well as you would study a patient with psychiatric illness. Is it safe to ask this person questions? Am I talking too much? Do they just want to be left alone? You need some interpersonal skills to figure this stuff out.

When I was going through my ride time, I rode with some awesome paramedics and I rode with some real losers, some certified head cases. I rode with a female EMT-I who was a supervisor partnered with a new and very timid paramedic. The EMT-I , not only wouldn’t let me touch the patient, she wouldn’t let the medic touch the patient, and did the medic’s job, including giving medications while the medic sat next to her on the bench. When she wasn’t telling the medic what to do, she was bitching to her about her husband. I still feel sorry for that man. I was scheduled to work two more shifts with this pair. I said nothing to either of them, but made certain to take myself off those shifts.

I worked with another medic when I was a student who was wound way too tight. We had been called for a seizure, the medic seeing the patient, shouted “Not you again!” and started swearing at him and basically told him to take-off in expletives. “You’r e not getting another F–ing ride from me!”

I had one chance at an IV that day – I missed it. The madman then knocked me out of the way. He proceeded to sink the IV, then removing the needle from the catheter, stabbed the needle into the bench seat, and then went about taping the line. I was offered no further attempts. Later in the shift the medic got in a shouting match with a supervisor because a doctor had complained he hadn’t c-spined a near-drowning we did. Maybe my trying to hand him a collar on that call had accentuated his reaction because after that he had nothing to say to me. At the end of the shift, I didn’t even bother to give him my evaluation form. I figured I needed at least an additional 12 hours of run time to unlearn what I had seen in those 12 hours.

Don’t let a poisonous person, poison you. Keep your mouth shut, don’t get in their way (unless they are about to kill someone), and see if you can’t tactfully find a way to ride with someone else the next time.

If you are asked to do skills on your first day under someone’s watch, be truthful. Don’t make up a blood pressure. Don’t do something you don’t know how to do or are uncomfortable doing. Don’t be afraid to step aside.

Keep your eyes open, think before you speak. The rule no question is a bad question only applies if you judge the person you are asking the question of to be a balanced and open individual. Never ask a stupid person any question unless you already know the right answer.

And the number one rule for you to follow is: Trash No One.

You might fit in quicker by talking smack along with everyone else, but just because you and another EMT are talking smack about someone else, doesn’t mean the EMT you think is your friend now won’t be talking smack about you as soon as you walk out of the room. Putting someone else down is no way to hold yourself up.

Be above the fray. Act professionally. And you will outlast lessor people.

.

Posted by on September 28, 2010 • Filed under: ems-topics • Tagged:

Why I Haven’t Been Blogging II

6 comments

I started blogging back in 2004-2005 as a way to get myself back into writing about what I most love about EMS – the patients and the calls. I had more time to write then than I do now and I was working in the field more then. Time to write is key when writing about scene calls because often it is for me the very act of writing about the call that reveals the key moments of an interaction that I might not have realized had I not written about it. While I still work 40 hours a week in the field, I don’t work in the city anymore and the suburban town where I work has less variety and often less colorful calls.

Also, when I worked in the city (a term that refers not to just to working in Hartford, but working in multiple suburban towns as well), I was better able to disguise my calls. In the days of HIPPA and HIPPA fear, it is a sad truth that the smaller your known response area, the harder it is to write about what your day is really like. There are some calls I would like to write about that I just can’t despite my multi-tiered method of disguising calls. And some calls I have written about despite their disguise can still cause me and/or the service I work for problems if someone wanted to make trouble. I do not want trouble in my life, and I certainly don’t want any trouble to come to the service I ride with, which has been good to me and has to this point allowed me to blog.

With these increasing limits on my ability to write about the fresh calls that were the heart of my being an EMS writer, I have been searching to a new direction in my blogging. I have some germinating ideas, and once I decide on a new path I hope to be more prolific in the future (as well as being better about responding to comments and emails). For the time being, however, I am ceasing writing about recent scene calls – at least in a direct way. I am reserving the right to write about calls in the distant past that may be useful to illustrate points I may wish to make. Anyone concerned can be assured that these calls which could take place anywhere and anytime in the twenty plus years I have worked in EMS will in no way be violations of anyone’s HIPPA rights or be traceable to any patient or service. I will also continue my longstanding policy of not writing anything about the individual people I work with or the services I work with that would cast them in an unkind light.

I appreciate people checking my site for new posts, and sorry that so often lately the same last one has been there.

I wish everyone safety in their jobs, health and happiness in their lives. And hope to see you more regularly in the future.

Peter

Posted by on September 20, 2010 • Filed under: ems-topics • Tagged: ,

Astray

14 comments

I read a recent article in the New York Times that disturbed me.

A Crash. A Call for Help. Then, a Bill tells the story of a 70-year old man in Chicago who was in a minor motor vehicle accident, not his fault, who was nevertheless forced to pay the local fire department $200 for their response. The article goes on to tell the larger story of the trend of first responder agencies billing victims for their services to help solve their departments’ budget woes.

I can understand rescue agencies billing people who do foolish or unlawful things such as hiking in dangerous restricted areas leading to massive search and rescue efforts, but sending a bill to a 71-year-old victim – a bill his insurance does not cover — is wrong.

What I initially loved about being in EMS (particularly coming from a recent background in government/politics) is that in EMS, we are the clear cut good guys, or at least we are supposed to be. People are in need, they call us for help, and we do the best we can for them. But as the years have past, I am coming to fear that we are not always doing the best for the public, and that in many cases, we are showing them our less munificent side.

I am not just talking about inappropriate billing. I see this with inappropriate use of helicopters (and sometimes ground transport for that matter), unnecessary RSI and other procedures because we can and not because we should, and in unrealistically portraying our abilities to try to increase our budgets.

Sure we are lifesavers and we sometimes actually do save lives. But to go in front of federal, state, city and town councils and swear upon the the every second counts, lights and sirens to the rescue, how dare anyone hold us accountable attitude is embarrassing.

We need to tell the truth about what we do and about why we are important.

The beauty and simplicity of EMS is that – whether we save lives or not — above all we about being there in the time of need. We are about community. No, the outcomes for cardiac arrests are dismal, but you can’t put a price on helping a family whose father’s heart has stopped. You also can’t really put a price on someone being there to give an elderly woman some narcotic analgesia instead of just picking her up on a board and jostling her all the way to the hospital. We are about doing right for the people.

What I am afraid of is in our desire to expand or justify our existing budgets we may be losing our way and becoming something that we were not.

We spend unjustified sums on the latest unproven medical technology. We respond to calls that we never went to before because it makes our numbers look better at budget time. (I’ve been on minor calls that have had five agencies responding). We change our staffing patterns to fit reimbursement rates. We shine artificial lights on our lifesaving myth and too few of us talk openly about our darker side. (For a truth-teller, read Rogue Medic’s Experts Debate Paramedic Intubation – JEMS.Com commentary in which he, without hyperbole, uses the term “serial killer” to describe a not unfamiliar type of paramedic.)

While these actions may seem to benefit us, the effect on the community is not always the same. Instead of being truth-tellers and true community advocates, we, in EMS, have become politicians, salesmen and marketers.

I don’t mean to be naïve. And I do not hold myself out as innocent in these issues (I acknowledge guilt of my own). I do understand that in these difficult economic times, to compete for diminishing dollars, we feel pressure to act more and more like every other interest group, business or political party. Perhaps it is inevitable. Hospitals went this route long ago. Why not us? Still it makes me uneasy.

Things aren’t so black and white in EMS land anymore.

And here is clear evidence of it:

A 71-year old man who didn’t need us in the first place and who did nothing wrong gets a bill for $200, and he ends up writing out a check because he is a stand-up citizen who has always paid his bills (and is perhaps afraid of what will happen to him if he doesn’t pay even though he knows he’s getting scammed).

Have we not gone astray?

(More on this in future blog posts).

Posted by on September 7, 2010 • Filed under: ems-topics