“I Don’t Know”

How does a paramedic handles those three words says a lot about the kind of provider that they are.  Despite all of the training and continuing education one might seek out, there are still going to be situations where we just are not sure what to do.  We will encounter conditions we have just read about and never seen firsthand.  There will be tools in our bags that we might never pull out during our careers, and in many cases, never having to use something like a Quick-Trach or a needle crich is never a bad thing.  None the less, we need to be ready for anything.

This is where personal responsibility comes into play.  If someone does not understand something, they need to speak up when asked if they have any questions.  They need to be ready to seek out the answers if they do not understand.  For example: CPAP is still relatively new to my service.  We have had it now for just about a year, and as a supervisor, I am not getting nearly as many patient contacts as I used to.  In the course of my field time, I have had to use CPAP six times, and on three of those, I did not feel as though I had done as good as I could have.  I did not feel that the seal was tight enough, and as a result, the device was not working as well as it could.

I decided it was time to ask a respiratory therapist that I know if he had any tips for how to achieve a better seal, and he was able to give me some great advice: “if the patient is able, let them control 90% of the mask when it is being applied.  Get it tight and comfortable for them, and work on tightening the straps when they have it placed.”  On the next CPAP call that I had, I gave this a shot, and it worked really well.

I had identified a part of my patient care that I was not doing as well as I could, sought out advice, applied that advice, and was now a better provider as a result of the whole process.  It was not difficult to do, it did not take much time, and my pride was left unharmed.  I think the biggest challenge that people have is getting past their own personal pride.  It is not easy to admit that you might not be good at something.  Paramedics are great at keeping this on the inside and not talking about it.  They are afraid that they’ll be judged by everyone around them, because as prehospital providers we are under a lot of pressure.

In many cases, that teamwork setting that exists in most hospital settings is not a possibility in the field.  Quite often, it is just the paramedic and his or her partner who may or may not be trained at the same level that they are.  The pressure to make sure the correct patient care is applied often falls on the shoulders of the paramedic, and when something is not done, they are often asked “well, why didn’t it happen?”

Sometimes the reason is time.  Short transport times can be a huge asset, but at the same time they could be the answer to many questions.  A second line might not be in that trauma, or another round of epi might not have gotten on board on that code, and the simple reason for it is “I did not have time.”

Another reason might be indecisiveness.  There are two root causes of indecisiveness: not knowing, and not being sure.  If a paramedic does not know what is going on with their patient it is their responsibility to find out what it was so they know better next time.  If they were not able to narrow down their differential diagnoses enough to follow one single treatment path because it was just a complicated patient, they need to be able to show that they did they best that they could with the information they had at hand.  Their treatments might not have fixed the problem at hand, but they could have ruled it out ,making the unveiling of the true underlying cause of a patient’s condition that much easier.

It is up to each individual to decide just how good of a provider that they want to be.  I have encountered all sorts of paramedics in my career: some carry their text books with them for the first year of their career.  Others take those blank “notes” pages in the back of their flip guides and fill them with cutouts and extra information that they might need someday.  Unfortunately though, I have met even more who never open a book after they get that card in the mail.

I am sure you all know the ones I am talking about: they are the ones who bring the newspaper to refresher class, or raise their hands at the start of a continuing education class and ask “Are we going to be here the whole time?”  These people quite frankly scare me.  I am an eleven year medic, and I learn stuff every day.  I am sure there are many of people out there who have been at this for twenty, or even thirty years who will tell you the same.  You never stop learning, and there is always something to improve upon.

Putting the management aspects of this field aside, I think that is one of the things I enjoy most about EMS.  Everything is constantly evolving and changing.  I’ll admit I am not always immune to growing pains or thoughts of “that will never work” but none the less, it’s a factor of my everyday existence.  And really, the career I have chosen is not about me at all, it is about the patients.  They always have to come first when patient care is the focus.