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.
Sleep and shift work
I feel that the problems surrounding sleep and shift work are by far the hardest issue to deal with as a paramedic. Our job requires us to be operational 24/7 and depending on what your roster is you could spend 14 or more hours working in a day. It takes a bit of getting used to, especially when you’re working when you’d normally be sleeping.
We know sleep deprivation is bad for us. When we don’t sleep we become temporarily diabetic (google it!), we eat rubbish and gain weight, our mood is impaired, our decision-making abilities start to suffer and we generally hate life. I’ve been lucky enough to be a good sleeper but I tend to need more of it than the average paramedic – the good evens out with the bad. Other people I know are horrendous daytime sleepers but can get by on little naps. By now you probably know where your preferences lie. You need to work with them, not against them.
The main advice I can give here is that sleep needs to become much more of a priority than you’re probably used to. This may mean going to bed at 2130 (or earlier) in order to get eight hours down before your 0530 day shift wake up. This may mean leaving early from a family function (hooray!) or a boozeathon with your mates (boo). The late-evening TV binges are probably not going to do you any favours. Sleep is more important. By far. Expect your life to come apart if you don’t prioritise your sleep.
I also suggest that you get serious about napping. Thirty minutes lying down in the middle of the day is brilliant for taking the edge off the working week’s fatigue, even if you feel like a nanna. If you live with non-shift workers you’ll have to put some work into making them understand how important your sleep is. Use weapons and threats if necessary.
One technological adjunct which has helped me is a sleep-cycle tracker on my phone. These little bits of software use your phone’s accelerometer to measure how much you’re moving in bed which corresponds with how deep your sleep is. You set them to alarm when you’re sleeping the lightest, which hopefully means that you don’t wake up groggy and baffled. I’ve found them to be useful, even if it means that I might be woken up for a day shift at 0530 rather than 0600 sometimes.
Try to avoid using medication to help you sleep. Apart from being neurologically bad news, you need to be trying to develop a sustainable routine rather than using drugs to iron yourself out. If you can’t sleep at a normal time it may be that anxiety may be to blame – consider taking up meditation or even just developing a bedtime ritual. If you google “sleep hygiene” you’ll come across lots of ideas.
Speaking of rituals, I have a night-shift ritual which works well for me. On the day before my night shift I get up at my usual time and go about my day, but I try to keep it fairly low-key and I go easy on the coffee. Then, after lunch I go to bed at around 1300 until 1600. Even if I can’t sleep I find it helpful just to relax in a quiet room for a couple of hours. Something about turning off all the stimulus seems to reset my brain. Then at 1600 I get up, have a snack and a coffee and go to work. I have another coffee or cup of tea around 2200-2300 which seems to set me up for the next few hours. During the night I nap where I can, even if that’s in the back of the ambulance while waiting at hospital. Then when I get home I have a banana and a protein shake and go straight to bed. If I’ve only got one night shift I get up around 1300 and commence de-fogging my brain. If I’m going back for round two I try to stay in bed as long as possible and have a big feed when I get up.
I’ve found that as I get older the night shifts hit me harder physically, but I’ve got very used to doing them so that I find them less psychologically stressful. Night shifts giveth and night shifts taketh away.
If after trying a variety of techniques you can’t get your sleep organised you need to seek help ASAP. Nothing will knacker your life and health quicker than not sleeping. Talk to the people around the branch, talk to your partner, talk to your manager. If you’re still struggling, talk to the support services of your employer (Peer Support and VACU with Ambulance Victoria), or your GP or your mum. But don’t discount how important sleep is.
You’re going to need to study. Sorry.
University may be finished but you still need to keep plugging away at the books. Above all you will need to be *very* familiar with your employer’s collection of Clinical Guidelines because this is your roadmap for your clinical practice. Beyond that you’ll need to have a solid working understanding of the pathophysiology and pharmacology relevant to your new job. Your book of clinical guidelines is your protection – if you stick to it strictly you will (probably) not make a catastrophic error. Disasters happen when inexperienced people start getting creative.
The important thing to understand about the study you’ll be doing is that the basics aren’t enough. If you were a “Ps get degrees” student in university you’ll be in for a rude shock, because that kind of attitude is unacceptable when people’s lives rely on your knowledge. I demand a 95% knowledge of my book of clinical guidelines from my students, and 100% recall of doses, indications and contraindications for drugs. To my mind this degree of knowledge is an absolute given if you want to be trusted with people’s lives.
You can make it easier on yourself by getting organised. Accept that ongoing study is a necessity, then work out what you need to learn and write yourself a timetable. Your first month on the road might be spent studying cardiology and associated drugs. Month two might be respiratory conditions. Month three might be neurology and spinal care. Month four might be a review of what you’ve done before something new in month five. If you keep that up until the end of your graduate year you should be streets ahead in knowledge and confidence compared to your peers and I can guarantee that it will make your final assessments much less stressful.
Think about where your study is going to fit into your week. Yes, you can snatch a bit of study during down time at work but unless you work in a quiet rural area you can’t count on it. You need a better plan. Maybe your second day off is spent studying. Maybe you do 60 minutes at 0600 every morning before your housemates\partner get up. Maybe you do a bit every night before bed. If you have kids, use the time that they’re napping or at school. It doesn’t matter what it is, but you need a plan and you need to make study a habit.
Other things to consider:
- Laminate your drug sheets and stick them up in the shower.
- Form a study group with your friends. Highly recommended for the social aspect too.
- Flash cards. An oldie but a goodie.
- Handwrite your notes rather than just reading over things or using a computer. The process of hand-writing notes and drawing diagrams is excellent for really embedding the material in your brain.
- Every time you find something you don’t understand, write it down in a notebook and follow it up later with your colleagues or the textbooks. I still do this and senior colleagues love to be asked clinical questions.
- Try to work out the “whys” of things. If you understand “why”, “how” is usually easy.
- A lot of learning is making connections between new things and things you already know. Stop trying to bash information into your brain, get creative and try to understand how it relates to other things you know well. (an exercise for the reader is to try to work out how salbutamol and ipratropium bromide relate to adrenaline and atropine.)
While you’re studying, please don’t whine in my hearing about motivation. Motivation is for amateurs. Professionals show up every day and get the work done regardless of mood. If you need motivation to acquire the knowledge necessary to do your job, perhaps you need an easier job.
On the other hand, don’t be afraid to take a bit of time off. Memory becomes permanent after you stop studying, not during the cram session. Don’t be afraid to take some time away from the books and not feel guilty. Sleep on it. It will probably help in the long run.
“I soon realised that I WAS LEARNING whilst at work. I was able to pull back the book smarts a bit and actually enjoy my days off – instead of feeling guilty that I wasn’t smashing text books.” – Dan
One big issue is that the people who need to study the most are usually unaware of it; other people often need a tranquiliser dart to get them away from the books. You need to work out where you are on the spectrum – know thyself. Appraise yourself honestly and work out whether your learning would be best facilitated by an epic 8-hour library session or by a walk through the park and a drink with your mates.
Part 2 coming soon…