The clinical concepts that no-one teaches you about at university
You’ve spent the last three years or so getting to know the intricacies of morphine metabolism and the cardiac cycle. Those things are all important as background, but in your operational life it is at least as important to have a collection of rules of thumb to fall back on until you’ve got a bit of experience. Rules of thumb are formally known as heuristics, intellectual shortcuts which mostly work, most of the time – they’re not perfect but they can get you out of a lot of scrapes. Here are some which I’ve found useful, both clinically and in learning to live the paramedic life.
When I first started the job, members of my family were convinced that I was going to be a gibbering wreck within the first week. It wasn’t the case but I understand their concern. The public perception is that paramedics routinely deal with horrific and gruesome incidents – it doesn’t happen as often as people think but if you stay around a while you’ll get your fair share. More important than that though is the chronic stressors of other people’s emotions, the pressures of shift work, problems at home *plus* graphic jobs. I personally knew two paramedics who have killed themselves in the past two years – I don’t know why they did it but it’s incumbent on all of us to look after ourselves and our mates to try to prevent that sort of thing in future.
Food, exercise and other stuff
You know what’s sensible, you don’t need me to tell you that the 3am burger is probably a bad idea. Ambulance shifts are long and you can’t survive on biscuits and chewing gum. Eat real food, preferably food you made yourself. If you’re having trouble getting organised, set aside one evening a week to make a big batch of something that reheats well, then freeze five or six servings. Bang, that’s next week’s meals. I do this every week – it’s not exciting but it means that I never have to try to work out what eating. I just grab something out of the freezer and find out what it is when lunchtime rolls around. Also, buy a slow cooker. They can cure cancer.
Workplace relationships and expectations
For many people entering paramedicine as a career the workplace environment will be quite different from what you are used to. Here are some important things to know. Bear in mind that these are things that I think are important – you may disagree or think I’m wrong and that’s fine too.
Part 1: Sleep and Study
You’ve put on your shiny new uniform and you’ve turned up at work for your first day at your new job – Junior Paramedic. Congratulations! All those years of study and hard work have paid off, you’ve made it. From here on in it’s plain sailing, right? Living the dream?
Not yet, unfortunately. What many new paramedic recruits don’t understand is that your intern year is likely to be one of the toughest years of your life. Not only are you taking on a new job which, let’s be honest, you’re probably underprepared for, but the ambulance lifestyle is about to usher in huge and far-reaching changes to the way you spend your time that you’re probably only dimly aware of at the moment. It’s a pretty awesome way to spend your life and one I highly recommend but you need to come into it with a bit of preparation.
Luckily, I’m here to help. I spend most of my professional life training recent graduates to work as independent operational paramedics and I’ve seen a lot of issues arise in that first year. But the good news is that others have trodden the same path before and a lot of good solutions have been accumulated.
So here then is my guide to surviving your first year on the road as a paramedic. Not all of these issues may arise for you, with any luck none of them will. But it never hurts to be prepared and even if you escape unscathed you may be in a position to help someone else who is struggling.
Earlier this week I was honoured to be able to chat to the designer of the fantastic ECG Quiz that took the #FOAMed world by storm, Christopher Watford.
So a few weeks ago I was called to attend a car crash. A male had been seen driving at high speed in a high end sports car, before apparently suffering from an acute loss of talent. This resulted in him losing control, spinning out, bouncing off several curbs (which left his wheels pointing in 4 different directions – sub-optimal in terms of cornering performance I believe) before coming to rest in a fence. Witnesses then watched as he climbed out of the window, ran across the road, climbed a 2 meter high chain link fence and legged it through industrial inner west Melbourne (no idea why, I’m sure he was the lawful owner of said car…) Whilst admiring the athletic ability of the now absent “patient” I felt no need to remain at scene and instead raced off to
palliate resuscitate a 97 year old nursing home resident who had abruptly and unexpectedly succumbed to one of the 8 different listed terminal medical issues she had (sadly I was not successful: my necromancy clearly needs some work)
I have a bit of a love/hate relationship with ECGs. I find them very interesting, but I despair of how poorly I learned how to read them in my early career (pattern recognition anyone?) I therefore spend a lot of time being terrified that I am missing important, but subtle findings.
Fortunately a US paramedic Christopher, from Wilmington, North Carolina is on hand to remind me of just how hopeless I am! Christopher is a computer programmer by day, paramedic by night, and is a bona fide ECG guru. He blogs at Paramedicine101 and My Variables Only Have 6 Letters and is very active at EMS12Lead.