The New EMT - Training - @ JEMS.com


The New EMT

A fresh perspective can make a big difference

 

 
 
 

Bryan Bledsoe, DO, FACEP, FAAEM, EMT-P | | Monday, November 2, 2009


It's 6:15 a.m. on a warm autumn morning, and Michael Wills pulls his 2000 Ford F-150 pickup into the ambulance station parking lot. His shift doesn't start until 7 a.m., but he wants to make sure he's there on time. He spends the next 30 minutes reviewing EMS system protocols and reading selected passages from his well-worn EMT textbook. He doesn't want to screw up.

At 6:45 a.m. he awkwardly enters the day room and introduces himself to the departing crew as well as the crew he'll be working with for the next 24 hours. They all look at him with a healthy dose of skepticism. His blue shirt is clean and starched and his new EMT patch is carefully sewn on his right sleeve. His dark blue pants are new and recently pressed. His black boots have a shine so bright you can see your face in them.

The shift supervisor calls him into the office and explains what his responsibilities will be. As he finishes the orientation, the supervisor reaches into a drawer and retrieves a new gold badge with Michael s name and the words "Emergency Medical Technician" engraved on it. Michael carefully places the badge onto his uniform and walks back to the day room. As he enters the room, there's a distinct sparkle in his eyes. He is so proud you can feel it across the room.

At 7:15 a.m., Michael goes with Sylvia, his partner for the day, and begins to clean and restock the ambulance. He starts making notes on his pocket pad about where important supplies are located in the ambulance. He listens intently as Sylvia explains the operations of the ambulance. Sylvia hands him a street guide, and he immediately begins to flip through it. She smiles and says, "Don t worry about that now. I'll help you for the first few days." Michael nervously looks at the ground and says, "OK, thanks."

By 9 a.m. the ambulance is washed and restocked, the station cleaned, and the crew begins to attend to their various responsibilities. Again, Michael sits down and reviews the system protocols. When he comes to something he doesn't understand, he runs out to his old Ford pick-up and grabs his worn EMT book and brings it back into the station for review. He paces nervously and goes into the bay and looks into the back of the ambulance. He knows he's ready for his first call but isn't totally convinced he'll do the right things.

At 10:49 a.m. the tones sound. Michael's ambulance is being dispatched to 104 South Henry. The crew members of the other ambulance start to laugh and tease Michael. One paramedic says, "Poor Michael. You're starting your career with a B.S. call. You'll quickly learn to hate 104 South Henry." Michael looks at him nervously -- really not understanding the perceived levity of the situation. Michael and Sylvia exit the day room as jeers and laughter continue from the other crew.

Sylvia drives. Michael sits in the passenger seat tapping his foot rapidly on the floor. He looks at the intersections and tells Sylvia when the street is clear, which he remembers from EMT school. They pull up in front of a ramshackle house at 104 South Henry. Michael takes a deep breath and opens the ambulance doors with Sylvia. She says, "This case is yours Michael. You're in charge."

Michael and Sylvia enter the old house. Better houses have been used for firefighter live burn training. The house has a stale odor, and numerous empty 44-ounce beer bottles are strewn about. Michael has never seen such squalor. In the lone back bedroom is an old man -- Mr. Roland Washington. He's in an old sunken bed and smells of urine and feces. The sheets look like they haven't been changed since long before Thom Dick made his first ambulance call.

Michael stands there taking in the whole situation, wondering what in the hell made him go to EMT school. Sylvia winks at him and says, "Remember, this is your case." Michael nervously smiles. Then the training kicks in. Michael looks at Mr. Washington and says, "Hello, Mr. Washington. I'm Michael Wills, an EMT with Sussex County EMS. What seems to be the problem?" Mr. Washington opens his eyes and says, "Thanks for coming. I'm so tired. I can't get out of this damn old bed."

Meanwhile, Sylvia picks up an empty beer bottle and gives Michael a knowing look, but Michael continues his orderly assessment just like he learned from his worn EMT book. After his assessment, Sylvia asks Michael about his findings. He says, "It appears to be altered mental status. He's a diabetic, so I guess it could be hypoglycemia. It could also be a stroke or a head injury."

Sylvia answers, "I see you've been reading your book and that's great, but there's a difference between what's in those books and the real world. I've carried Mr. Washington probably 30 times. Trust me. He's drunk."

Michael looks perplexed. He says, "In the chapter on AMS, my book says to never assume a patient is just drunk until you've excluded other causes."

"That's true, but you learn to recognize the difference real soon. What do you want to do with Mr. Washington?"

Michael thinks about this and says, "Well, the protocol says to check his blood sugar, give him 2 L of oxygen and transport. So, I guess we'd better check his sugar."

Sylvia says, "Go ahead and check it. He's a good patient for you to practice on. But it'll be normal. It always is."

Michael prepares the supplies for a finger stick glucose reading. He wipes the finger with an alcohol prep and pricks the aged finger of Mr. Washington. Placing a drop of blood on the strip, he puts the strip into the glucometer. Michael did it perfectly. Wilford Brimley would be proud! After a few seconds, the glucometer reads 28 mg/dL. Sylvia looks down and says, "You did something wrong." She thinks for a minute and says, "Let me check it." She repeats the test in the opposite hand and gets a reading of 30 mg/dL. A look of surprise and humility comes to Sylvia s face. She says to Michael, "Get me the IV bag." Sylvia starts an IV of normal saline and gives Mr. Washington 25g of 50% dextrose. His mental status improves almost immediately. He's transported to the hospital without incident.

Back at the station the entire crew is somewhat subdued. Michael doesn't have a clue as to why. He's afraid he has done something wrong, when in fact he's done everything right. Little did he know that after one call, he had gained the respect of his fellow crew members. Sylvia meets with him in the back of the ambulance and praises his work, thanking him for being objective with Mr. Washington.

His actions kept Sylvia from missing an overt case of hypoglycemia. As he returns to the day room, again there's the distinct sparkle in his eyes. And again his pride fills the room. He still doesn't know what he did. He just did what he was taught in his old, worn EMT book.




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Related Topics: Training, Bryan Bledsoe

 
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Bryan Bledsoe, DO, FACEP, FAAEM, EMT-PDr. Bledsoe is an emergency physician and Professor of Emergency Medicine and Director of the EMS fellowship at the University of Nevada School of Medicine in Las Vegas. He is the author of numerous EMS textbooks and articles.

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