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What you are describing is extremely common. Almost universal, I would venture to say. Applicable rule from The House of God (essential reading, by the way): 3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE. I dismissed that as a joke when I first read it (before I was a paramedic). Now I see the genius, and I honestly remind myself of that phrase whenever I feel things starting to get out of control. I would advise you to always remember: -Our job is simple, and often becomes more so as the "crazyness" of a call increases. -Do the same things on every call ALL of the time. Even the BS ones. Cannot stress this enough. -Reassess mental status, check lung sounds and vital signs often. -IV, monitor, O2. If you find yourself "stuck" on a call, give yourself time to regroup by reassessing or doing one of those tasks. -For the VAST, VAST majority of the time (read: pretty much all of the time), seconds do not count. Take your time to do things right and relax. You'll get things done quicker than if you had tried to rush. This is why we walk onto the scene and do not run. Carry that mindset with you for the rest of the call as well. -Embrace the phrase "it is not my emergency," not out of callousness, but out out of respect for a job well done. On a scene where everyone is freaking out, it is your responsibility to calm things down-- even if only by example. -Don't be afraid of mistakes. Be very afraid of repeating mistakes. -Always remember that we are here to provide comfort and reduce suffering, and are placed in a position of trust that enables us to do so. Some of that may be helpful and some not. Just some lessons I've learned along the way and would like to pass on... Things will get much better with time and experience, but don't expect it to happen overnight. Good luck!

It may sound crass, but one of the most valuable piece of advice I received as a new guy was that YOU are not the one having the issues. You have the training, you have the knowledge, and eventually you will also have the experience. As was said above, you need to be confident and competent. People called YOU because they cannot handle whatever their problem happens to be. Trust yourself, trust your training, and always review to stay sharp- especially with issues you may not see very often. Focus on the basics- regardless of how messy a trauma is, or how complicated a very sick patient;s condition may be, you always start with your ABC's. You need to look beyond the blood and gore on a trauma, and beyond the fact that a person may be a diabetic, COPD, extensive cardiac history, and a dialysis patient. Airway, breathing, circulation, disability- establish the basic parameters, treat as appropriate, and move on from there. One step at a time keeps you focused and ensures you do not get tunnel vision and miss something. You will never completely lose that anxiety- and honestly, you never really want to. That twinge of anxiety keeps you focused, and the adrenaline rush is one of the best things about the job. Even after 30+ years, I occasionally see something "new" and have a momentary "Uh oh", moment. Most often, these moments happen when you get complacent- you assume a call will be routine and something strange happens, or a 20 year old with abdominal pain turns out to be multiple stab wounds with a sucking chest wound(actually happened to me.) You get over the momentary shock, and simply do your job. For most, the best part of the profession is you never know what to expect- most of us do not want to fly a desk in a routine 9-5 job.

I am a little more seasoned than you guys and have more than 12 years EMS experience at ALS level. Here's some good news: it does get better! You learn from each and every call you do, even the seemingly insignificant ones. That experince then translates itself into a calm. professional attitude. A few points to remember: If you feel things aren't going the way you'd like. Stop, take a deep breath and reappraise the situation. This may cost a little time but your pt will benefit from it. You are going to someone who having the worst day of their life. You can't afford to panic, because that will make them panic and the buck stops with you. If you don't know something, don't be afraid to ask someone who does. Following that, never be afraid to call for back-up if you feel uncomfortable in a situation. I'll let you into a secret: the people who do that in our profession aren't the wusses but the consumate professionals. Whenever entering an incident, take the time to register your first instinct, have a plan ready and don't be afraid to fall back on your ABC's if you're not sure what's going on. Try not to get distracted by external factors such as distressed family members. And perhaps the most important: when in between calls, don't watch Home Makeover or play on the Nintendo, but learn your protocols. A sound knowledge base removes a great deal of stress. Take Care, WM

In regards a few pages back about St. Nicholas and the separate issue that there's a mosque already 4 blocks from Ground Zero, can the following comment be made? There's already several Christian churches in the vicinity around Ground Zero. Why do they need another Christian Church so close? Can't they put it elsewhere?

Perhaps there is more to it than the bad joke of: It's not MY emergency. As already stated here, it's their worst day. They are looking to you to help. Anger and confusion feed on themselves. Don't join it.

Hello, ALS is requested by a BLS crew that is on scene. You arrive to a nice suburban home and proceed inside. You are greeted by one of the responding PCP. She briefs you about the situation. Walter, a 72 year-old male had his wife call for an ambulance for worsening SOB and fatigue. Walter has a history COPD, NIDDM, CHF, AMI (8 years ago), numerous episodes of VT and had a ICD and Pacemaker inserted as well. He has just came back from the hospital were he had a colonoscopy done as an investigation for a low Hgb. No active bleeding was found during the scope. He has been NPO since yesterday. He also hasn't taken any of his medications since yesterday as advised by the endoscopy clinic. Walter is sitting in his living room. He appears frail. He is working hard at breathing and has a wet cough. His skin is diaphoretic and pale. VS as per the BLS crew: GCS 15/15 BP 120/60 HR 120 Rate 38 SpOs 88% on 15 lpm Cheers...

I'm not an EMT yet (my state practical is next Saturday) but I'd like to take a crack at this one if that's ok. Do we know what medications he is on and what, if anything he had been given for the colonoscopy?

Your state should have very specific guidelines on what is required in a licensed ambulance. I would suggest contacting your local department of health to get the details.