Practicing Fearless paramedicine

[fiznat]

My favorite quote from Moby Dick:

"I will have no man in my boat," said Starbuck, "who is not afraid of the whale." By this, he seemed to mean, not only that the most reliable and useful courage was that which arises from the fair estimation of the encountered peril, but that an utterly fearless man is a far more dangerous comrade than a coward.

That said, "fearless paramedicine" means to me:

-Never be afraid to make mistakes, as long as you admit and learn from them.

-Never be afraid to report abusive behavior.

-Never be afraid to stand up for your patient when everyone else wants to cut corners. Never be afraid to do the right thing.

-Never be afraid to challenge yourself to learn more. To ask questions from the people you respect, to follow up on what you don't know. Never be afraid to go back to school.

[HERBIE1]

My favorite quote from Moby Dick:

"I will have no man in my boat," said Starbuck, "who is not afraid of the whale." By this, he seemed to mean, not only that the most reliable and useful courage was that which arises from the fair estimation of the encountered peril, but that an utterly fearless man is a far more dangerous comrade than a coward.

That said, "fearless paramedicine" means to me:

-Never be afraid to make mistakes, as long as you admit and learn from them.

-Never be afraid to report abusive behavior.

-Never be afraid to stand up for your patient when everyone else wants to cut corners. Never be afraid to do the right thing.

-Never be afraid to challenge yourself to learn more. To ask questions from the people you respect, to follow up on what you don't know. Never be afraid to go back to school.

I like these. I would also add:

-Never be afraid to stand up for yourself and defend your actions.

-Never be afraid to question authority- as long as you are on solid ground, and have a viable alternative to offer.

(Example- a lousy policy that adversely impacts the patient, you, or how you do your job)

[usalsfyre]

Fearless, nope. I practice scared $hitless paramedicine.

What that means is I understand and fear the consequences of:

Not fully assessing my patients

Doing needlessly invasive procedures

Growing complacent with certain patient populations

Not having a plan B (and C,D,E and F)

Not understanding the capabilities of local facilities, and not putting the patient's need to get to the proper one above my need to get off on time, eat, ect.

More that don't come readily to mind.

So mark me down in the yellow-bellied coward category.

[rat115]

I would say that "fearless" is more knowing your limitations and knowing when and how to work within those.

How many of us have been injured on the job and then walked back in knowing that we could be injured the same way again. Instead of being afraid and possibly causing problems for our coworkers, we deal with that fear and knowledge. Would you look at a coworker and say "now you know how it feels" because you'd been injured on the job? Would you be unwilling/unable to get take any position (driving or attending) due to something that's happened to you in the past?

As for our patients, we've got to be knowledgeable about what can happen when we use interventions. We have to understand when to use them and when not to, so that we can do what we can for the patient.

[Bieber]

Fearless paramedicine to me seems somewhat different than it seems to many of you.

Practicing fearless paramedicine to me means standing up and taking responsibility for our actions, our interventions, and our knowledge. It means "owning" our practice, expanding our education, and having the knowledge and the confidence to know what is best for our patients. It seems that today more often than not what we really practice is "cover your assology", not paramedicine. We're undereducated, and it shows. Instead of knowing without a doubt the best course to take for our patients, we "cover our asses" because we (often rightfully) doubt ourselves and defer to physician judgment. Which isn't a bad thing in and of itself, because whenever in doubt we SHOULD be deferring to a more knowledgeable provider. However, it IS very telling when we have to defer to physicians because we simply don't know as much as a competent provider ought to.

Practicing fearless paramedicine to me means increasing our knowledge base, and being able to confidently make independent decisions--tough decisions--for the sake of our patients and being willing and able to defend our actions before our peers and supervisors. Practicing fearless paramedicine is what the Kiwis are doing, what the British are doing, and what we in the U.S. sorely lack. And that is the education to need physicians less and less, and the confidence of those same physicians to trust our judgment and to know that that trust is well placed.

To me, practicing fearless paramedicine would mean I have the knowledge and the ability to no longer need a "cookbook" of protocols It would mean instead of rigid rules that I must follow, I instead have guidelines. It would mean that instead of a list of MOI's for determining trauma triage, it would merely say "per paramedic discretion"; it would mean instead of needing to use an "abdominal pain protocol" or "chest pain protocol" to give anti-emetics, my guidelines would merely list the indications, contraindications, and cautions for administering Reglan, or any medication for that matter.

It's not about being unregulated or supervised. It's about having the education and the skill to not need as much supervision, and to be able to practice without as much restriction and with much more trust in us; because we've proven ourselves competent to care for our patients without needing someone holding our hand the whole way through.

Practicing fearless paramedicine to me would mean that we've reached that point in our education and standards that we're no longer ashamed to call ourselves paramedics; that we've reached that point where we respect and recognize our profession as just that, and that we've reached that point where we no longer advise paramedic hopefuls to "just go become an RN instead".

We're not practicing fearless paramedicine where I work, and I suspect many of you aren't practicing fearless paramedicine the way I see it either. But we could be, some day.

Edited February 23, 2011 by Bieber

[Just Plain Ruff]

Although this is not really practicing fearless paramedicine I got this email today on how to make yourself more valuable to patients, co-workers and management. I thought it was interesting. I think that we could interchange EMS with nursing on this one.

I think that the message here can be applied to each and every one of us. No exceptions. It's slanted to be from management to employees but seriously, this does apply to us all.

Starts here

Skills for a New Economy: A Message to All Employees

(Part One of Two)

We are living and working in tough times. The healthcare industry is changing, budgets are shrinking, and a national emphasis on quality means our outcomes need to keep getting better and better.

Even organizations with a strong culture and talented employees can't afford to relax. There is an unprecedented need for excellence at every level, every time.

What does that mean for individuals? It means every employee needs to consistently show his or her value—to bosses, to coworkers, and to patients.

Here's the message leaders need to convey to staff members: To gain the sustainable excellence we'll need to meet the challenges that lie ahead, we all need to take ownership of our individual roles and our organization's mission.

So how can an employee show value and do his or her best possible work every time? Here are a few insights and suggestions to share with staff:

Hone Your Ability to Transfer Your Value across the Organization.

As the external environment gets more complex, an individual's ability to survive and succeed is directly related to the ability to connect the dots, show insight, and communicate well with others. It's important to show value to peers and leaders, inside and outside of your department.

Here's how:

Understand the group you support. Know your audience. It's important that we all learn to manage our time with consideration to the time of those we work with.

Have a nose for money and opportunity. Be efficient. Look for opportunities and be known as a problem solver inside the company.

Periodically attend other department meetings. It's amazing how a different perspective changes the way we view things. Not only does this help us understand how what we do affects others, a fresh pair of problem-solving eyes in the group may help resolve the problem.

Offer insight. Be an active participant and share key learnings with those not in the meeting.

Connect what you do to revenue. While it isn't possible to do with every job, most positions do connect to revenue directly or indirectly. Understanding this and being able to articulate it can help show value.

Understand the external environment and the need for a culture of always. Knowing the state of our industry, it's important to create a culture of always that constantly implements best practices—every time, on every occasion, without exception.

Step outside your comfort zone. Sometimes people are too close to a challenge to see a solution. A fresh perspective—yours—can help others in the organization "connect the dots" in a new way. Being willing to boldly offer insights from an "outsider" point of view is a great way to show individual value.

Own Your Professional Development.

When we make a conscious effort to learn new things, professional development happens organically. Seek out structured professional development and training while keeping in mind that some of the most effective growth happens in day-to-day interactions.

Here's how to make it happen:

Evaluate your personal brand. Do you like what you see? If not, it's time to make adjustments. If you do, it's time to take your personal brand to the next level. It's important for employees to be self-aware and to get their unique talents out there.

Search out best practices and use them. Studer Group has spent years inside our National Learning Lab of nearly 800 healthcare organizations researching, harvesting, and refining the best ideas for maximizing human potential. Become familiar with the theories and enable them to work.

Take constructive criticism well. Honest feedback is a critical part of professional development. Think carefully about how to respond when feedback that is less than positive comes in.

Duplicate yourself. Mentor and teach whenever possible. Not only is it good for the organization (it frees you up for other things), it is incredibly rewarding.

The tips noted here focus on an individual's personal value, brand, and development. In Skills for a New Economy, Part Two, we will focus on how each employee can take these skills to the whole company through maximizing profitability and communication.

[paramedicmike]

So you're telling us we need god in order to practice fearless medicine?

[Just Plain Ruff]

So you're telling us we need god in order to practice fearless medicine?

NO I'm not saying that. I never once said anything of the sort.

I said I thought he was practicing a form of fearless medicine NOT that you need God to practice any sort of medicine, fearless or not.

I thought in the back of my mind that someone in this group would pounce on the Christian references but I said, no, the group would see it for what it was worth, which I thought was this persons way to practice fearless medicine on his own terms but I was wrong.

Why whenever someone posts anything remotely religious on this site that it gets hammered and discounted?

I'm done and if I can delete the above I will, I don't want to offend anyone's delicate sensibilities.

Edited February 24, 2011 by Ruffems

[paramedicmike]

I'm not offended, Michael. It was a simple and honest question based on the content and presentation of the information in the post. The question was drawn more from your emphasis on the Christian content of the material in deference to how the email played into the topic of fearless paramedicine.

Quite frankly, I'm disappointed in your response to my question. I thought you had thicker skin that this. What's more, I thought you would've been more willing to stand behind your words than to immediately assume you were being criticized and/or ridiculed for your religious beliefs.

[Just Plain Ruff]

I'm not offended, Michael. It was a simple and honest question based on the content and presentation of the information in the post. The question was drawn more from your emphasis on the Christian content of the material in deference to how the email played into the topic of fearless paramedicine.

Quite frankly, I'm disappointed in your response to my question. I thought you had thicker skin that this. What's more, I thought you would've been more willing to stand behind your words than to immediately assume you were being criticized and/or ridiculed for your religious beliefs.

I was going to post my response to this out in the open but I think a better dialog will happen via pm's. So I sent my response in a PM.

The entire site doesn't need to see our replies to each other even if they are not negative. I know how much we all like watching other people's conflict, know what I mean?

But honestly, the intent of that original thread post that I deleted was not to focus on the religious aspect but more along the lines of what my friend has learned over the time that he has been in EMS and some of that learning and knowledge he attributes to God. He also I felt had some good points in how we should act towards others regardless of their circumstances.

Edited February 24, 2011 by Ruffems