My First Day
Nearly fifteen years ago, it was my first shift “out on my own” as a paramedic. My lead field training officer had, a mere day before, waved his hand over my head and declared me “ready.” I was too young to buy a six pack of beer after my shift, but I carefully checked the seal on the box of several dozen medication vials before my shift knowing that I was now responsible for enough morphine to pleasantly sedate a horse, enough epinephrine to give the expired hamburger in the fridge a pulse, and enough aspirin to cure the headache I’d have by the time I was done. I was young, and I had everything to prove.
Long story short, in that one short shift, I managed to take a basic transfer and make it ALS with some pain medication because, well, I was a paramedic, and I could. I agitated a group of first responders on a volunteer department by arguing a point completely irrelevant to the call (those volunteers have day jobs. If one has had an advanced degree and a medical license, tread lightly). I treated the subtle wheezes of congestive heart failure as those common to asthma in the era before we had CPAP in our toolbox. The patient required intubation which, were it not for my arrogance and a preventable diagnostic blunder, may not have been necessary.
Against Our Natural Instincts
That was hard to say to a class of soon-to-be EMTs. I’d rather tell any story but that one—any story at all. I’d rather talk about the posterior STEMI I found because I ran a 15-lead ECG. I’d be happier describing the elderly woman I saved while her granddaughter looked at me like I was Superman. I want to tell the world about the giant fish I caught rather than the time I went to cast my line and threw my pole into the water.
Changing the Culture
Patricia De Saracho, a “teacher of teachers” for the University of San Diego wrote, “But in the classroom, it can be challenging to overcome the built-in stigma associated with mistakes or with being ‘wrong.’”
De Saracho makes a valid point, but how do we apply that noble principle in an industry where we all learned by listening to a battle-hardened, world-weary veteran paramedic tell stories of his glory days? How do we talk about our mistakes without being seen as the weakest link and laughed at by the attractive ER nurse on our next transfer?
De Saracho continues, “To do so requires deliberately cultivating a safe and caring atmosphere in which mistakes are welcomed as a normal, natural — and ultimately very important — part of the learning process.”1
More from the Author
We need to normalize making mistakes and feel safe sharing them, and not just with each other, but with our students too. To allow our students the chance to learn from our mistakes is to give them a chance not to make the same ones and, hopefully, spark progress in the world of EMS that is reflective of a growing profession.
Another idol of mine since my days as a student, Kelly Grayson, compared twenty years of experience to one year of experience repeated twenty times. And therein lies the value of passing on our participation ribbons that represent our most humiliating defeats alongside the trophies that symbolize our most magnificent victories.2
Starting with Ourselves
The first step in solving a problem is admitting we have one, and that is truly between you and yourself. A study conducted revealed that nine percent of 352 paramedics surveyed admitted to committing a medication error within the previous year. More telling is that four percent of those errors were never reported in the CQI process.3
We must be willing to admit to ourselves that we are human and, thus, capable of error. This becomes challenging for professionals in which a study showed that 30-40 percent of providers display significant insecurity and anxiety.4
The solution, much like undertaking a fitness routine, is just that: routine. Begin by asking yourself after every call, “What went well?” and “What could I have done better?” Start the ball in motion to allow yourself the freedom to admit, if only to yourself, that there are things you can work on and what you must do to improve.
Our Coworkers
Years ago, I stood outside between calls with another on-duty crew. A senior paramedic, gesticulating wildly with his hands, told an epic tale of his most recent endotracheal intubation. The story went on to highlight the many ways in which this provider was clearly above-average and the newer employees standing in the circle stood there, slack-jawed and full of wonder, taking it all in. Other experienced providers, myself included, took their turns with their stories of emergency medical conquest. Looking back now, I know that we did no favors for the wide-eyed young providers in that circle. If they believed even half of the war stories they heard that day, I can only assume that they got the impression that all providers truly do perform that well, and thus set the bar high enough that they believed that a “normal” paramedic makes no mistakes.
My challenge to all of you reading this is to strike a balance between celebrating your success with each other and trusting each other to hold onto your lesser moments as well. I challenge you not to be afraid to walk up to that circle unashamed and say, “You know, I really frustrated myself on this last call.” The trick, though, is that as it becomes more normal, others will start doing the same and you won’t feel like the odd one left out in the cold. In time, we can only hope that the support system among our brothers and sisters which we have needed for decades will begin to emerge as providers feel free to help each other and accept the same help themselves.
Our Students
Lastly, I bring you to our students: the newest, most idealistic, most excited, and—yes—most impressionable lambs on the funny farm. They soak up our words and emulate the traits and values they see in us. Ask yourselves what you’re letting them see, because once those traits solidify, they become difficult to change. Are they seeing the gung-ho, big-and-bad, larger-than-life EMT? Are they seeing the person who can handle the toughest of calls without flinching?
If so, it’s time to become part of the solution. Students working alongside us or sitting in our classroom don’t just look to us for the trick to getting the tough IV start or your time-tested method of wrapping a bougie around your hand before an intubation. They are looking to us to see how an EMT or paramedic is supposed to act and how they are supposed to function.
I challenge you all to rethink the image you present to students. Talk to them after that tough suicide call and as you talk them through it, give them the privilege of doing the same for you. Explain to them how you, personally, cope with the tough parts of the job rather than reinforcing the stereotype that rescuing the worm from a tequila bottle will save us from the perils in our hearts. Have the nerve to say, “That call must have been rough on you. I know that because, after fifteen years, it was still tough on me too.”
Conclusion
That story I led off with at the beginning? I told that story to a new provider for the first time last year. It was the first time I had talked about that call since it happened. As I felt the first tear roll down my cheek, I felt peace and at the same time felt that I’d given this provider a bit of wisdom that doesn’t come around often in our industry. Since then, I’ve repeated it to classes at all levels, coworkers, and even a conference across the country, and it’s grown easier each time.
Some who heard it became chameleons just like so many others in our profession. They learned to change colors and blend in—to tell the fish stories (it was THIS big, I swear), never speak of their mistakes, and constantly display the version of themselves they believe their peers should see. Others, however, started coming to me with stories of their own because they felt safe. I started getting phone calls in the middle of the night because they made a mistake and didn’t know who else to tell because “I know the others would judge me.”
If you’re ready to see change in our profession, now is the time to show it, ironically, by saying “I’ve been there too!” This is the time to abandon the notion that we must pretend to be superheroes to succeed in emergency services and, instead, allow others around us to grow from both our successes and our failures. Only then will the culture around us change and allow us to work in a less toxic environment.
“Where do I start,” you might ask? It’s simple. Look at your partner, your student, your boss, or just your face in the mirror and say, “Let me tell you about this tough call I had a while back.”
References
- De Saracho, P. (2019, July 23). Turning student mistakes into teachable moments. Teaching Channel. Retrieved February 1, 2022, from https://www.teachingchannel.com/blog/turning-student-mistakes-into-teachable-moments
- Grayson, S. (2016, August 25). This is your profession. make of it what you will. EMS1. Retrieved February 1, 2022, from https://www.ems1.com/ems-products/education/articles/this-is-your-profession-make-of-it-what-you-will-FrrtF5O3RhYxtAv6/
- Vilke, G. M., Tornabene, S. V., Stepanski, B., Shipp, H. E., Ray, L. U., Metz, M. A., Vroman, D., Anderson, M., Murrin, P. A., Davis, D. P., & Harley, J. (2006). Paramedic self-reported medication errors. Prehospital emergency care: official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 10(4), 457–462. https://doi.org/10.1080/10903120600885100
- Pajonk, Frank-Gerald & Andresen, Burghard & Schneider-Axmann, Thomas & Teichmann, Alexander & Gärtner, Ulf & Lubda, Jürgen & Moecke, Heinzpeter & Von Knobelsdorff, Georg. (2011). Personality traits of emergency physicians and paramedics. Emergency medicine journal : EMJ. 28. 141-6. 10.1136/emj.2009.083311.
