Building a strong foundation through training

This should go without saying, but the foundation of any premier service provider is a strong initial and continuing education program. Unfortunately, in emergency medical services (at least in my experience) this seems to be forgotten in lieu of getting bodies on the trucks, not wanting to pay for training hours, or giving in to the generalized demeanor that “I don’t need / want to go to training.” As a result, training budgets are slashed and makeshift programs are developed to “prove” that training is indeed occurring. If we intend to fully prove ourselves worthy of a permanent seat the public safety & health care tables, we need to redirect off this path, and soon.

Initial training & orientation

All states require successful completion of a delineated course before awarding certification as an EMS provider. But does this course offer everything one needs to know to be a competent and successful provider? I would argue no, it does not. These courses provide the bare minimum needed to advance into real-world training programs established by ambulance services.

You cannot realistically expect someone who just graduated from EMT school to understand the nuances in symptoms and treat appropriately. Even if you’re working with a relatively small differential diagnosis schematic, it takes experience in actually encountering and treating patients to accurately differentiate patients with vastly similar, yet minutely different, complaints.

Take, for example, a patient presenting with altered mental status, flaccidity, and slurred speech. Unless you get a complete patient history, or in the absence of that find clues to the patient’s daily insulin regimen, the potential for misdiagnosis is significant. Take it from one who’s done it.

Ambulance services need to review their initial training requirements to be sure the EMTs they’re bringing in exhibit core competencies, obtain real-world experience (more than a couple of patients), and are able to demonstrate clear decision making in complicated situations.

Continuing education

This is much more than the annual blood borne pathogens and HAZMAT refresher courses, which in all truthfulness should fall under recurrent education. Continuing education, when applied appropriately, provides a basic review of the topic, then expands upon that foundation to provide a growth in understanding and application in a real-world setting. In my experience, this includes didactic as well as kinesthetic components whenever possible and always when discussing updates to skill application.

The trick to continuing education is to strike a balance between what providers want to know and what they need to know. For example, many providers will chomp at the bit for juicy trauma pictures presented by a local ED physician but won’t budge when presented with an opportunity to discuss how to incorporate better documentation into their practice.

This is where the imagination of an instructor is key: how to draw in the average EMS provider who is knowledgeable and capable of performing their job, but who also could use a boost to his or her application of that knowledge and skill. An instructor needs to be able to make an enticing presentation that delivers the message while simultaneously assuring the provider that his or her time is well spent.

Conclusion

This is just a scrape of the surface when it comes to developing training programs. Future posts will provide additional detail on the successes and opportunities for improvement based upon my past experiences in this field. Stay tuned!

Terrible news

This morning, I received some terrible news: one of my colleagues, a past supervisor, was found in his home. I don't think I need to elaborate further on what that means. It hits too close to home, coming on the heels of an anniversary of another tragedy in our public safety community. I'm still stunned, as I know many feel when a tragedy of this magnitude occurs.

My public safety friends: you are not alone. You are NEVER alone, no matter how dark or desperate you may feel. We all have demons, and this job exposes us to nightmares regularly. We all have our ways of fending off those nightmares, but never, ever, should you feel like you’re the only one who feels the way you do. You may be stoic and strong with the uniform on, but underneath beats a human heart, the same as everyone else.

As your colleagues, we don’t need you to prove your toughness by shrugging off the same emotions we all feel. You prove that toughness every day when you come to work beside us. It takes a strong person to do this work, and to keep doing it in the face of what we see. What makes you even stronger is facing your own humanity and admitting that, even if only once in a while, the everyday things that make up life get to you too.

We need to remove the stigma of weakness attached to admitting you have a heart, and that it hurts sometimes. It needs to happen now, before we lose another. I’m calling a code green: http://www.codegreencampaign.org

Admit it: EMS stresses you out

A recent story in the Tampa Tribune, available here, talks about the "price" first responders pay for the stressors encountered on the job. My comment to my friend who posted it: "The reality of the job stressors in our environment is becoming more evident. I'm seeing more and more of this come out, and its about time. The public needs to understand that when you strip the uniform off, a human being remains." I caught some flak from another EMSer who read my reply and said "You need thicker skin or you'll never last." Let's see: 17 years as an EMT compared to his five..yeah, I think I'll last.

This isn't about developing "thicker skin." I'd like to think that all of us have a limit, a point where being human overcomes the "superhuman" attributes the general public likes to hang on our shoulders. We all wear different uniforms; some wear SCBA, others wear guns, we wear stethoscopes. But inside the uniform is a human being, someone who (hopefully) still retains the ability to feel raw human emotion in response to a an unnatural situation. We face it all the time, and I challenge you to stand up and say you have never, ever, been affected by at least one patient you've encountered over the course of your career. If you haven't been yet, you will be. Just wait and see.

Let's also not forget the other vital individuals in our daily lives who face similar, if not the same, stressors: our dispatchers and call takers. I have the unique opportunity to serve in both roles (field provider and dispatcher) on a regular basis, and I can attest to the genuine emotion felt when you see a job hit the terminal that you just don't want to put out: the Dad who OD'd on heroin while his kids napped. The dump truck rolled over on a car with a mother and infant inside. The child who's not breathing. I've dispatched each of those calls, each with the (somewhat) expected end results, and felt absolutely helpless as crews responded. There was nothing I could physically do to help, and hearing the emptiness in the crews' voices when they cleared the job filled me with a sadness I don't wish upon anyone.

It's part of our job, and something that we are trained to handle as responders; at least from a patient care & transport angle. What we aren't trained to do is harness our emotions, call time out, and take care of ourselves after such a traumatic experience. It's high time we, as providers and leaders of the field, take the reigns and start taking care of our own.