Staying calm in the field

[lockstockbarrel]

So I'm a new EMS based paramedic in a fairly large urban center. One of the biggest challenges I've found is keeping myself relaxed in tough situations (critical MVC's, pediatric arrests). I know that some amount of anxiety is normal for most paramedics, seasoned or new, but I feel that between being in my FTO's crosshairs and just getting acclimated to "crisis management" that I begin to sweat the small stuff and lose sight of the things I've been trained, educated, and KNOW how to do - and so I begin to second guess myself and overthink things to the point I become scatter brained. So, any advice for the new guy? How do you remain calm/calmer on those big calls? I use to be the type of guy that was always the most laid back in the hairiest of situations, but now I'm beging to question my ability to do this job. From the moment the pager goes off, responding, the scene, to the receiving staff. Will this ever pass? The simple ALS calls seem to go great, it's the just the major trauma and potentially emotionally charged calls.

[tcripp]

You know...I'm kinda in the same boat with you. What I hear from others is, "they'd be more worried if we didn't get this way in the beginning" and "it will get better with time".

I also work a truck with me and the a basic...so, it's usually all me in the ALS part of the world. But, I have some really GREAT Basic/Intermediate partners...so I've not worried too much on that.

I've started taking deep breaths on the drive to a call and even keep my SOC book in the front with me so I can do a quick review while in transit. I work rural, so sometimes we have several minutes before getting to the patient.

Good luck to you...and stay in touch.

[WelshMedic]

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

Edited August 18, 2010 by WelshMedic

[HERBIE1]

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.

Edited August 18, 2010 by HERBIE1

[fiznat]

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!

Edited August 19, 2010 by fiznat

[Richard B the EMT]

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.

[Lone Star]

Great responses, guys and gals!

I can only hope that when (if) I can get through the medic course, that I can remember all of these tidbits of advice!

The rate things are going, algebra will be the bane of my existance!

There's not much I can add from my BLS point of view!

[Richard B the EMT]

I usually try to keep my commentary gender neutral, but ...

If

If you can keep your head when all about you

Are losing theirs and blaming it on you;

If you can trust yourself when all men doubt you,

But make allowance for their doubting too:

If you can wait and not be tired by waiting,

Or, being lied about, don't deal in lies,

Or being hated don't give way to hating,

And yet don't look too good, nor talk too wise;

If you can dream---and not make dreams your master;

If you can think---and not make thoughts your aim,

If you can meet with Triumph and Disaster

And treat those two impostors just the same:.

If you can bear to hear the truth you've spoken

Twisted by knaves to make a trap for fools,

Or watch the things you gave your life to, broken,

And stoop and build'em up with worn-out tools;

If you can make one heap of all your winnings

And risk it on one turn of pitch-and-toss,

And lose, and start again at your beginnings,

And never breathe a word about your loss:

If you can force your heart and nerve and sinew

To serve your turn long after they are gone,

And so hold on when there is nothing in you

Except the Will which says to them: "Hold on!"

If you can talk with crowds and keep your virtue,

Or walk with Kings---nor lose the common touch,

If neither foes nor loving friends can hurt you,

If all men count with you, but none too much:

If you can fill the unforgiving minute

With sixty seconds' worth of distance run,

Yours is the Earth and everything that's in it,

And---which is more---you'll be a Man, my son!

Rudyard Kipling

(Parody of same:

If you can keep your head when all about you

Are losing theirs and blaming it on you,

You obviously don't understand the situation!

So what is it going to be, friend? Which are you?

[DwayneEMTP]

Great advice from all!

Every basic partner I've had, specifically the new hires, get used to this saying...

Q: "What's the first thing we do upon arrival at every call?"

A: "Nothing!"

Silly I know, but I've seen so often that people get worked up over the dispatched report, despite it very rarely having any resemblance to the actual call. (Not bagging dispatchers as I know that this is seldom their fault.)

I do find that people new to the field, as I was not so long ago, tend to believe that thought can be replaced with motion. They often seem to feel that when they're confused that no one will notice as long as they just keep moving, whether the motion is productive or not. And trying to create so much motion when thinking, and not action, are what's called for, brings about an amazing amount of stress. At least it does for me.

Ignore your dispatch report, unless it regards something you are unfamiliar with. For example, dispatched to "18 month female, difficulty breathing, lethargic." This often won't be the same call as it would be in an adult so you might want to mentally review the ways you may assess this pediatric emergency when compared to an adult. And when you show up to find the call is actually a 34 y/o that broke his leg trying to show his son a new trick on his skateboard you haven't really lost anything, but have gained a ped review. :-) Slow down, breath, don't do anything that you haven't decided is necessary. Don't allow yourself to freak out about thing that you have no information on. Sometimes gathering information will bring a bit of anxiety, but being anxious over what "might be" is hard on your body and terminal to your thinking.

So when my partners say, "Nothing!" they don't literally mean nothing, they understand it to mean that they should stand still, take a deep breath, look around the scene to see who is where, who is doing what, and formulate a logical initial plan to approach. 'Nothing' refers only to their motion....stop the motion and you will be able to think more clearly, when you can think more clearly you will see and understand more, gather and analyze information more efficiently and you will make better plans, and once you can trust your initial plans, a great deal of the anxiety will resolve on it's own. See?

Great question man! Thanks for participating!

Dwayne

I usually try to keep my commentary gender neutral, but ...

Does that make you asexual?

[HERBIE1]

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!

Don't be afraid of mistakes. Be very afraid of repeating mistakes.

Do the same things on every call ALL of the time. Even the BS ones. Cannot stress this enough.

These 2 are gems. VERY true. The basics are vital, and vitals are basic.