“I need to be running ALS calls! I’m in paramedic school — I should be learning how to be a paramedic, not doing routine transfers!”
I’ve heard this many times over my career, typically from EMTs recently enrolled in paramedic school, but those of us who have been in the field a day or two, who have made the transition from EMT to paramedic, know this isn’t necessarily true. Just because you’re watching a paramedic work doesn’t mean you yourself are becoming a better clinician. Traumas and codes may be more exciting, but these high-stress situations are not conducive to mastering the basics. Learning occurs best when a student is able to fully integrate the material.
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It can be very difficult for a paramedic to explain the why behind their actions while actively providing patient care, and many of us find it equally challenging to accurately explain our thought processes after the fact. Throw in distractors like blood or angulated limbs and the student could completely miss critical learning points. Also, since different clinicians might treat the same patient very differently, sometimes in very inefficient or non-evidence-based ways, you may need to sift through mountains of useless information to get to a few good tidbits.
The clinical internship phase of paramedic school is where you get to actively provide ALS care. If you’re working as an EMT, you can’t participate in performing that level of care, so you receive much less benefit. To those working EMTs, I’d like to offer an alternative learning style that can help you develop while on the job.
Make the Most of Truck Checks
Check the ambulance every day and put the equipment to use. When you’re checking the airway kit, put the intubation blades and handles together. Or practice using the vacuum splints while running through that kit. When you put equipment together repetitively and with intention, you build muscle memory for that task, and this is the first step toward building efficiency in how you operate.
Visualization is also a helpful technique, which can be used to work through a skill, like drug administration, in depth. Close your eyes if you find that helpful, visualize grabbing the drug pouch from the bag and removing the correct vial. Select a syringe and blunt fill, then draw the medication up to the correct dose. Then run through the medication rights before you administer the medication.
It might seem silly, but visualization is an easy way to inoculate yourself to stressful situations. Don’t know what to do on scene of an extrication accident? Visualize yourself working it. Give a sample size-up as you arrive on scene, then appropriately park your ambulance. Get out of the passenger side of the cab and put your reflective vest on. Perform a 360-degree walk around and check for any hazards, and so on, until you’ve treated and transported any patients. As you become more skilled, you can add additional sensory details to add to the realism.
Linking equipment rehearsal with visualization leads to deliberate practice, which yields exponential returns on time invested. There’s a reason why high-performing teams practice both of these techniques, over and over—they really work. And no matter how badly you screw up, the mistakes you make in your mind or in practice don’t kill patients.
Learn How to Perform Assessments
Don’t get lazy with patients. Learn to perform a full assessment, to take manual vitals, and to listen to lung sounds. If you have the luxury to work a basic life support (BLS) unit, make the most of it. Just because it’s a BLS truck doesn’t mean you can’t ask advanced life support (ALS) questions or think ALS thoughts. Write your thoughts down and take them to a seasoned clinician to get the answers, or, better yet, look them up yourself.
Commit to getting a good bedside report from the discharging facility during interfacility transfers, and review the patient packet in depth. Flip through the past medical history and medication list, and then look up what you don’t know. Not only will this give you a head start on pharmacology, you’ll actually build a more complete picture of your patient’s condition.
Finally, performing a detailed assessment will teach you how to communicate with patients. I can’t stress enough how important it is to learn how to talk to people. If your patient mentions a grandchild during transport, ask for some details. Remember to be sincere, because people can tell when you don’t actually care. As long as the patient isn’t actively dying, this will build an immediate rapport.
The best clinicians I know can take a patient that is hurting and scared, reassure them they are here to help, perform the correct treatments, and get them chatting the whole way to the hospital, like they’ve known each other for years. Health care is a customer service business at its core, and that is how you deliver a truly great health care experience.
Spend Your Time at Work Wisely
If you’re not running calls, finishing charting or practicing skills, you should be talking shop and resisting the lure of the couch and TV. Yes, it is very important to find downtime and decompress between calls, but if the majority of your work shifts are spent sleeping or watching movies, this might be a helpful wake-up call to renew your priorities.
Take time to discuss patient-care-related topics with your shift partner or other coworkers in the crew room, at the fire station kitchen table, or while posting in the ambulance. Done in a positive way, informal debriefs will help you process what happened so that you can get the full benefit from the experience. It also helps build a learning culture in your organization and gives your peers cues that you take EMS seriously and value improvement.
Professionals spend their work time honing skills and gaining knowledge, while amateurs spend their work time on inconsequential activities that lead to little or no improvement. If you work for an EMS agency that doesn’t routinely talk medicine while on the job, this can be a cultural red flag. Instead, find a place where you can be with people that have a growth mindset and enjoy perfecting their craft.
I wasted a lot of time on the road to getting my paramedic license, so if you are planning on making the jump to the next license level, learn from my mistakes. Remember that everything is a learning opportunity when approached with intention—even something as routine as a shift-start rig check. Build a deep understanding of the basics, and always ask questions. And finally, dedicate your shift time to investing in your development — professionalism is a mindset, not a paycheck. Follow these truisms and you are guaranteed to not only ace paramedic school but also be better prepared for life.