Operations, Patient Care, Trauma

Successful Beginnings: Sound Advice for the Entry-Level EMS Provider

As a new provider I was naive and eager. As a second-generation paramedic, I’d had more previous exposure to the profession than most. But as an entry level paramedic, I was clueless to the intricacies of being a quality provider and partner. 

When I began my orientation for my first position as a paramedic, I was paired with supervisors and senior paramedics as a primary provider on the unit. Many of my new mentors had more than 20 years on the job. They were reasonable and fair people who took great pride in their work. 

As I reflect on the experiences I’ve had as an FTO, I can appreciate the frustration that I must’ve caused them. However, I attribute a lot of my success in this profession to those that invested in me when I was the “new kid.” I’m a fond believer that your first year is crucial to the overall success of your career. 

My position is certainly a unique one. I’m experienced enough to teach and be a mentor, but still have several years ahead of me. I wrote this article with the sole purpose of giving a brand new provider the opportunity to learn from my successes and mistakes from when I was still wet behind the ears.

1. Master the Essentials

Your first gig as an EMT or paramedic can be intimidating. It’s a path we’ve all walked.

As a new EMS provider, there’s so much more to learn than what you were taught in class. I can guarantee that the rig you just hired into is set up differently than what you rode on during clinical. Learn it and know it, because soon you won’t have a choice.

Understand your protocols inside and out.

EMS agencies can operate differently depending on region. Because of this, it’s of utmost importance that you’re proficient. Study that book they give you on FTO, and know it better than most in a week or so. Chances are, you’ll have to meet with the PMD for a protocol test.

Learn the policies and procedures specific to your agency.

These can vary greatly. Learn your agencies dead on scene policy, vehicle maintenance/fueling policy, etc. Every service has a variety of additional rules above and beyond your protocols that you must know and they are just as important.

Learn to read a map.

It’s astounding to me how many of my students and new providers lack this basic, yet very important skill. I understand how wonderful technology can be. GPS and mapping software are great tools. However, they’re just that: tools.

Don’t become reliant on GPS. You’ll get burned, I promise. If you’re unfamiliar with your new territory, it might be worth your while to invest a few hours on your day off to drive around your district. You’ll likely do this as a part of your FTO program, but the more you familiarize yourself, the less stressful it will be when it counts.

Understand the culture. 

When you hire into a new company, you’re viewed by your peers as a guest. Though you’ve already committed several months, if not years, to your education, like it or not, you’re greener than grass.

Learn the culture of the service that was kind enough to offer you a position. You’re new here, and you’ll need to prove yourself as a person and as a provider to earn the respect of your colleagues. You’ll only get out of this what you’re willing to put in.

Appearance and first impressions are important. Learn how to shine your boots and press your uniforms. Greet your new colleagues with a firm handshake and a smile. Manage your time in such a way that you’re at least 15 minutes early for every shift. The off-going crew expects you to be punctual, and they’ll be grateful if you save them from the dreaded late call.

Don’t be the guy who comes on shift and plops down in a recliner. When you’re new, that’s an excellent way to burn bridges with your peers. Instead, check your truck and do your chores. If you’re snoozing at the beginning of your shift, you’ll miss out on shift change coffee and probably a few laughs. Again, another great opportunity to become acquainted with your colleagues.

2. Be a Quality Team Member

A lot of folks discount the importance of what it is to be a good partner. Whether you work 10, 12, or 24 hour shifts, you’re living with another human being. There are going to be days when you’re both overwhelmed. You’ll miss meals, bathroom breaks and sleep. I find that days like this are a great opportunity to build rapport.

Pay attention.

Every provider is different. We all accomplish the same goals, but everyone has a unique way of performing the job. Pay close attention to how your new partner does things. It’s important that you can communicate well with them, and know what your expectations are of each other. When a crew works together harmoniously on a high acuity call, it’s a beautiful thing.

Avoid gossip and complaining.

This is a quick way for your peers to lose stock in you. Most providers don’t like colleagues who complain, especially if you’re brand new. When it comes to gossip, remain indifferent and don’t participate in these conversations. This becomes even more important if the discussion is about a co-worker. After all, wouldn’t it be awkward if you had to explain to your FTO why you trash-talked him in the day room?

Take care of each other.

If you’re out and about, see if they need to grab a meal or hit the grocery store. If you’re on a long shift, consider offering up the bathroom before you go in and shower. I could continue with examples, but you get the point.

As a new provider, there are several small gestures you can offer to your partner that will show them that you care about their sanity too. Just like any relationship, it’s about give and take.

Someday, the time will come when you have the worst call of your life. You don’t know when or what that day will bring, but it is an absolute. You need to make a legitimate effort to developing a solid relationship with your peers, because they will be the ones who are willing to walk to hell and back with you.

Take care of yourself.

We’ve all read the “wellbeing of the EMT” chapter in the textbook, right? Well, it’s valuable information. If you take one thing away from my article, it’s this: You’re a human being. You have the right to feel empathy and grief for the horrors that you might see. It’s inevitable that you’ll have a front row seat to heartache, tragedy and premature death. If you ever feel that your experience has become a burden, find a healthy outlet to manage your stress. There isn’t a provider out there who doesn’t want you to feel comfortable in your own skin.

You’ll likely have an abundance of opportunities to work overtime and extra shifts. You also probably have family and friends. Don’t let the job consume you. Give your loved ones the attention they deserve. You have the rest of your life to work.

Get enough sleep before your shift. Rolling in with only four hours of rest is irresponsible and dangerous.

3. Save Your Hard-Earned Money

It’s tempting when you’re new to buy every gadget and gizmo on the market. A comfortable pair of boots, a decent stethoscope, and a quality wrist watch will do you well. If you work night shift, put a nice flashlight on your list. The disposable pen light in your jump bag performs the same function as the one you bought for $25 on the internet.

Invest in your future.

If your company offers some sort of retirement plan, take full advantage of it, especially if they match part of your contribution. Some agencies offer pay increases or performance incentives upon completion of FTO, or annually. Consider using a portion of that pay raise to increase the contribution to your nest egg. If this is your first career, it’s tempting to use your new-found income to purchase frivolous things. When you’re older, you’ll be glad that you invested in your future instead of that 80” television.

Bring your own food.

If you work out of a base, consider bringing your own food from home. If you work 10-16 shifts a month, and spend $20 a shift on fast food and gas station snacks, that is $200-$320 or more a month. I carry a “go bag” that I put in my truck at the beginning of the shift. Consider doing the same and include what you need to survive. Having snacks, a bottle of water, gum, ink pens, and other creature comforts readily available will not only save you money, but will help the shift go smoother if you’re on the road for several hours.

4. Never stop learning. 

Though you’ll likely be assigned to a primary FTO, ride with as many experienced providers as possible. Just like there’s something to be learned from every call, there’s something to be learned from every one of your peers. Pick something you like from each person you ride with and make it your own. When you identify a strength of a colleague, make it a goal to get on their level.

You need to be teachable.

Don’t get offended or take constructive criticism personally. When someone who has been on the job for years tells you that you can do better, you can do better. Actively solicit feedback on your performance during every shift. When I was a new paramedic, my documentation was poor. I heeded the advice of my more experienced peers, did research, and asked questions. A few short months later, my documentation had reached a caliber high enough for me to be included on the QA committee.

Take advantage of opportunities available to you. If your agency offers you the occasion to join a special committee, team, or program, you best jump aboard. You should be flattered that they included you. Chances are, this new prospect will offer some degree of education, experience, or perspective.

Use your down time wisely.

When I was new, it became very apparent to me that I was extremely uncomfortable with pediatric patients. I identified this as a weakness, and worked towards improvement. On my down-time, I would study my PALS book. I studied my pediatric protocols and took an NRP class. When I was finally faced with my first critical pediatric patient, I was confident in my ability as a provider. Ultimately, that confidence combined with my new-found knowledge allowed me to provide excellent patient care.

It’s never too early for research.

This one’s for the paramedics. Agree or not, we don’t do great job of preparing new providers for the inevitable critical care transfer. Without a doubt, this is certainly a specialized set of skills and knowledge that should be reserved for the most experienced of providers. However, that’s not always the case. Research the administration of vasoactive drugs, blood products and management of the ventilator-dependent patient early on in your career.

In Closing

From those who were my preceptors as a student, to my mentors as a new provider, I was molded by people that truly were the salt of the earth. These folks were experienced, compassionate and a lot of fun to be around. I’m grateful for all that this job has afforded me. 

Being a paramedic has afforded me the ability to grow and develop as a human being in more ways than most will ever know. As an educator, I’m elated to have the honor of fostering the growth and development of our professions future. Chances are, if you’re reading this, you’re going to be a part of that future.

In the coming months, you’ll experience the best and the worst that humanity has to offer. It’s important to remain humble, reasonable and coachable. When you put on that uniform, you should be honored. That patch on your shoulder represents something bigger than yourself. Do it justice and be an advocate for the people you serve, and your profession. 

If you are lucky enough to operate in a system that has a fire department or rescue squad respond with you on emergency calls, you need to go out of your way to let them know that they’re valued. Many of these people are there on their own time and aren’t being paid. Always thank them and let them know they’re instrumental to ensuring a good patient outcome.