DwayneEMTP Posted January 20, 2008 Posted January 20, 2008 I was visiting with Dust via PM a few days back and was explaining that... Sometimes when we run a hairy call...the knowledge is like...man, I don't know...like rain. I just hits me from all directions and I can feel it soaking in.... He replied in part: I love that visualisation! And I know exactly what you are talking about too. It is palpable. It's almost like a drug taking effect in your body. You can feel the energising power as it takes hold throughout your entire being. It's wonderful! If you ever stop feeling that, you're getting lazy or complacent, so remember that feeling and pursue it relentlessly! This was in response to my first EMS witnessed arrest, but applies to much "smaller" things as well... And it got me to thinking. I could write a book on the things I've been taught during this preceptorship (no one would want to read it, but still). There have been some moments though that just stick out in my head. And I wondered what those moments were for others? For example, (I'm going to look like a bigger idiot than usual here, but am going to go with it anyway.) MVC, a larger Buick t-boned, intrusion into the driver compartment, driver side, to the point where there is approx. 8-12 inches of the drivers seat showing. Fire has been on scene ten minutes or so and are taking a refusal from a 24 y/o unrestrained driver that looks perfectly fine! He's laughing, talking about how lucky he was, remembers the entire accident, has no intention of going to the hospital. No ETOH/drugs, etc. I tell my medic that fire is getting a refusal, thinking he'll be happy to be back in service. He pushes to the middle of the crowd, pushes the clipboard with the paperwork asside, and explains to the young man exactly why anyone that has anyone that loves them, is completely insane (my words, not his) to risk the injuries he may have to avoid going to the hospital. He decides to go. As he's explaining things to this kid, I realize that he had already built a working differential from simply looking at the car. He didn't need a patient, didn't require any blood, and had no intention of taking the easy way out instead of doing his job completely. I know, I know! First week of basic class! But it's almost surreal (to me) to see a patient without a scratch on him (trust me, after looking like an idiot up front, I made SURE I wasn't missing anything in the ambulance) come out of that car. My first thought? "Wow, he was lucky!" I could certainly have built a like differential had the patient been obviously damaged...but my brain took a complete holiday when he was "fine". I know to most of you this is going to seem completely dorky...but it kicked me square in the teeth and changed the way I'll look at patients for the rest of my life... Anyway, I have a bunch of these little "lightbulbs", but would like to hear about yours as well if you want to share. If I can share this story, you should be able to share anything!! :oops: I look forward to your replies... Dwayne
ERDoc Posted January 20, 2008 Posted January 20, 2008 Dwayne, you will have many lightbulbs in your life. I still get them from time to time. You will learn that you can tell a lot just be looking at the pt before you even examine them. One thing that I think you should take from that call is to never, ever, EVER let anyone else RMA a pt, especially the firemonkeys.
DwayneEMTP Posted January 20, 2008 Author Posted January 20, 2008 You can count on if Doc... My thinking at the time was "Fire controls the patient until they release them to the private, so it's their decision, their ass." But it turned out that "control" didn't really matter to a "good" medic. He advocated for the patient regardless of the rules...I'll not soon forget that. You know, some of the simplest things, like the above example, seem to escape me at times, while the things I was nervous about...my first cardiac arrest, or my first pulmonary edema with audible rales from the porch, the answers just lined up in my head and it seemed like someone was whispering instructions in my ear...I was that confident. It's almost completely opposite of what I expected. When I have all day to think, I can turn "my wrist hurts" into a stroke/cardiac arrest/UTI combo, but when time is short (knocking on my head for luck) it seems that I get calmer, and more confident...I don't get it really.... It's not until after the calls when my decisions were most important that I go "Holly shite! It all seemed so clear at the time, but what if I'd been wrong!?" Another great lesson from my current preceptors; "What if I would have been wrong?" is great post call thinking for every run. "Holly shite!" Is energy consuming, panicky, poisonous thinking that can make me mentally impotent and has to go. And so it will. Thanks for your thoughts Doc... Dwayne
ERDoc Posted January 20, 2008 Posted January 20, 2008 I think I would ask a different question after each call. Don't ask what you did wrong, but what could you have done differently. You might not have done anything wrong but there may have been a better, safer or quicker way to do something.
AZCEP Posted January 20, 2008 Posted January 20, 2008 I think I would ask a different question after each call. Don't ask what you did wrong, but what could you have done differently. This is the single best thing a provider with less experience can do. Often you will find that when you start building your differential, you end up with 80% of your textbook running through your head. As you build experience you find out that you can eliminate most of those possibilities with a couple key questions. Sounds like you are well on your way. As an aside, if you do write your book, every student would be mildly interested.
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