
There is a lot to learn when a new EMT, AEMT, or paramedic is just starting out in EMS. EMS education, like many disciplines, takes the firehose to the face approach when it comes to information overload. You have completed all your competencies and here is your shiny new certification card.
I know you are nervous, but don’t worry, the public, as they should, only expects you to be rocket scientist brain surgeons who can fix anything and have all the answers and just make it better. The good news is, 99.9% of the time, we do all of that. That 0.1%? Those we call for help, and drive quickly, but safely to the hospital.
An instructor once said you have an empty Rolodex when starting out. Each new experience you have and each new piece of wisdom you learn from someone else is another card in that Rolodex that you can pull from when you need it.
Below are 50 cards out of my Rolodex that I have picked up along the way.
Helpful Tips
- EMS is a service industry, it’s right there in the name. Mindset matters, and this job isn’t about us, it is about those that we serve. Realizing that early and often is important for your mental health. Late calls happen, we get hungry, cold, and tired. People call us in their times of need, even if it seems trivial to us. We serve people, humans with a story we know nothing about, so while you are with them see if you can learn some of their story.
- EMS is a team sport. Type A personalities persist, and egos are a thing, but we all need to be on the same page and be willing to work together for our patients.
- Document, document, document. Don’t just document so your chart passes the QA/QI process, but document so you can remember the call when it gets subpoenaed in 3 years. If it is written well, sometimes the DA might just subpoena the chart and not you.
- When in doubt, work the code.
- Quality chest compressions and early defibrillation are what saves lives in cardiac arrest.
- The definition of a stroke is any new onset of loss of neurologic function. Even if they’re 25 years old, don’t waste time trying to talk yourself out of it. Kids have strokes, too. Take them to the appropriate stroke center and treat them accordingly.
- Twelve leads are noninvasive and take five minutes, when in doubt, do it.
- Don’t just tug on the EKG wires to pull them off.
- Just because someone is drunk and is on the sidewalk, it doesn’t mean they weren’t drunk in the street and placed on the sidewalk by a passing motorist. Do a full assessment. Don’t ever assume someone is “just drunk” just because someone tells you they are. Always check a blood sugar.
- Even in a relatively simple assault, look for other wounds. In the heat of the moment, they may not have realized they were stabbed. Check under shirts and pants; axilla and pits. It’s a bad day then the blood on the shirt is coming from the multiple stab wounds, not the bloody nose and you don’t recognize it.
- Hypovolemic shock isn’t always from blood loss.
- Cardiac tamponade is not always from trauma.
- Chest pain + stroke symptoms = aortic dissection until proven otherwise.
- IM epinephrine is the most important medication in moderate and severe allergic reaction.
- Most adverse effects from Fentanyl or Morphine administration are because it was given too fast.
- Correct hypoxia with a BVM prior to giving naloxone. Give naloxone slow and give it time to work.
- Goal of treatment in CHF or pulmonary edema is reduced systemic vascular resistance.
- CHF: nitro and CPAP, early and often.
- Not all swelling is from pulmonary edema or CHF, it can be extravascular fluid such as in the setting of liver failure. These patients have edema but may be hypovolemic. Give cautious fluid boluses to replace volume.
- Pulse oximetry can be finicky. Make sure hands are warm and have good circulation before being too concerned about a low reading in an otherwise healthy patient. Make sure the blood pressure cuff isn’t inflating on the same arm as the pulse ox probe.
- Some COPD patients have a “normal” SpO2 of 90-93%. Ask them.
- “A couple steps out to the stretcher” might be too much for some people. Sliding from the EMS bed to the hospital bed takes work, too.
- Call for help before you need it, you can always turn people away.
- When managing a scene, establish a staging area; if you don’t tell people where you want them to go, they will figure it out on their own and it is never convenient
- Never park in front of a fire hydrant, always leave room for the ladder.
- Most conflict can be resolved with a conversation.
- Take care of your ambulance and equipment. It’s a matter of pride.
- Check off your equipment, every day.
- Bring all your equipment to the patient’s side, on every call.
- Don’t be lazy, or complacent. Learn something new on every shift.
- Be humble, recognize you don’t know everything.
- Treat new providers or new to the system folks the way you wanted to be treated when you were new; remember we all had a first day.
- BVM ventilation is a team sport, use adjuncts and proper technique for success
- All STEMI patients should have defibrillator pads placed on their chest, preferably anterior/posterior.
- A patent 22ga IV is better than a blown 18ga or 20ga IV.
- Sometimes the best thing to do is sit on your hands and do nothing at all. We don’t do things TO patients; we do things FOR patients.
- Think about what you are going to say before you key up the radio or give bedside report.
- If you don’t know, say you don’t know, don’t make it up.
- Trust your gut, it is usually right.
- Manage pain; it is far easier to articulate doing it than not, and it is the right thing to do.
- Wear your seatbelt; secure your gear. The primary objective of every shift is to go back home to our families.
- Remember, you are probably being recorded. Act accordingly.
- Don’t give calcium and sodium bicarbonate on the same line.
- Scene safety starts from the time of dispatch and ends when you are back in your station.
- Find your people. Those that you can talk to after a bad call, or bad string of calls. Taking care of your mental health is just as, if not more, important than taking care of your physical health.
- Driving lights and sirens does not necessarily driving faster.
- Patients don’t read the textbook, or the protocol, they don’t know how they’re supposed to act, or what is supposed to come next. Have a broad index of suspicion and be curious, ask questions.
- Patient advocacy and patient education are well in our wheelhouse, and our responsibility.
- Keep families in the loop, if the patient allows. Ensure someone is caring for the family during cardiac arrests, if personnel are available to do so.
- EMS is in a unique position, somewhere between public safety and public health, primary care and emergency medicine, social services, and social safety net. We see society in a way no one else does and are invited into people’s homes to take care of them in their time of need. It is a huge responsibility and privilege which should not be taken lightly. Never stop learning.