BEATING MYSELF UP, MY FIRST EMERGENCY

[callmetherook]

So to start I'm a new EMT (got my ticket in april). So yesterday was my second day teching and not being a third rider. I did 40+ hours 3rd riding and the only emergency we had was a man in his 40's who was hyperglycemic no biggie. My first day teching on an 8 hr shift was one dialysis T/P (i work for a private company and this is the majority of the calls we get). yesterday my partner (senior EMT) was giving me a scenario abt a toddler slip and fall and adding a couple curves in the mix in and asking what my interventions would b. 2 minutes later we get a call for a SLIP AND FALL altho it was a 90 yo F. the sirens blaring the lights and the 5 hour energy drink i drank a couple seconds before had me wired as hell. But i was confident still plus one of our chair car drivers were on scene (who is currently in EMS school) so we had assistance. we arrived on scene and i suddenly got tunnel vision. this lady was supine on the floor in excrutiating pain. and upon assessing her LOC she told me her neck was in pain and instead of goin thru with the assessment the way i shudve i jumped right for the c-collar to get it on her and my partner looked at me like i was nuts lol. he ended up taking over the show. Idk i felt like i crapped out on my initial assessment....totally disregraded the ABC's and focused in on the c-spine almost didnt even palpate her neck jus was ready to throw that sucker right on it. I felt like as the tech I didnt perform efficiently yes i know we have partners but from what i was taught the tech is who pretty much goes the the initial and secondary assessment. and the paperwork at the ER was even more of a catastrophe. wrote 3 drafts before my partener wrote it out cuz we were already an hour over our shift and needed to clear the call. As a team WE GOT THE JOB DONE. but got damn as one i felt so inadequate. ANY ADVICE IS HELPFUL. JUST DONT BE IGNORANT PLEASE

[Kiwiology]

A confident, dexterious Ambulance Officer requires a solid grounding of praxis to solidify theoretical concepts, it sounds like you have neither nor the opportunity to obtain the former. I suggest more experience.

Correct spelling and grandma, woops, grammar would go a long way too mate.

The primary survey always comes first, consider immobilising the cervical spine if exclusion criteria are not met but always perform the primary survey first. It is inappropriate to immobilise the cervical spine or perform a secondary survey if the primary survey is incomplete or has major abnormality.

[callmetherook]

A confident, dexterious Ambulance Officer requires a solid grounding of praxis to solidify theoretical concepts, it sounds like you have neither nor the opportunity to obtain the former. I suggest more experience.

Correct spelling and grandma, woops, grammar would go a long way too mate.

The primary survey always comes first, consider immobilising the cervical spine if exclusion criteria are not met but always perform the primary survey first. It is inappropriate to immobilise the cervical spine or perform a secondary survey if the primary survey is incomplete or has major abnormality.

Yes thanks for the spell check. I was in a rush. But getting advice was the intentions of this post. I understand what I did wrong now after the fact. I guess I should be more specific. What is a good way to prep myself for a call as such when one has that adrenaline rushing and tunnel vision kicks in. I'm an EMT but i'm a regular person too so straight up advice is what I want. I don't need senior EMT's to get on the post and be pompous pricks just some pertinent criticism and advice to calm that rush and stay level headed. I know exactly what I did wrong your explaining everything in my textbooks. i know it. I just failed to apply it as I shouldve...

[ERDoc]

Whoa! Second post and your calling someone a pompous prick. That is not a good way to start or a good way to get advice. I'm willing to overlook the indescretion and give you the benefit of the doubt. As for my advice, here it goes. First, remember it is their emergency, not yours. Do not let the situation interfere with what you have to do. DO NOT let the lights/sirens/fast driving get you excited, it will get real old real quick. As for your assessment, it sounds like you did fine to me. You are in the real world now and not a classroom so you do not have to verbalize everything you are doing. I don't see how you disregarded the ABCs. You said she was screaming in pain and complaining of neck pain. From this alone you have assessed the ABCs. She has an airway, is breathing enough to be able to talk and obviously has a pulse. After the ABCs comes D for disability, which includes immobilzation on the appropriate patients (refer to ATLS). You did that. There is no way you are going to clincially clear the cspine in this pt who is elderly, has neck pain and is in excrutiating pain. I'd be more worried if you DIDN'T immobilize. Don't get tunnel vision to the posibilities of other injuries. This is where your secondary survey comes in. Palpate head to toe, in elderly people who fall, ALWAYS think hip fractures.

Trauma is pretty much cookbook medicine, even in the ER. Just follow the recipe and you will do fine. Don't forget to turn the page though. Hope this helps.

[uglyEMT]

A few quick things.

First: IT IS THEIR EMERGENCY NOT YOURS! Take a deep breath before going through the door and just try and calm yourself.

Second: It is rookie nerves. We have all gone down that road. It will get easier with time and experience.

Third: Dont see what you did wrong? ABCs patient was screaming and in pain check, check, and check. Neck pain - c-spine precautions. Tunnel vision would have been if you put on the collar but missed a pelvic fracture.

I will make a word of advise to you though and please take it as constructive critisim and nothing more. Calling the senior guys that may come down on you (especially here we don't coddle) pompus pricks will not score you any points. What may seem to you as pompus could be them just telling you like it really is. Sometimes reality needs to bitch slap you (again not you personally you as in generality)

LOL doc beat me to it LOL I'll leave it up anyways as it is good advice

Edited June 1, 2011 by UGLyEMT

[callmetherook]

A confident, dexterious Ambulance Officer requires a solid grounding of praxis to solidify theoretical concepts, it sounds like you have neither nor the opportunity to obtain the former. I suggest more experience.

Correct spelling and grandma, woops, grammar would go a long way too mate.

The primary survey always comes first, consider immobilising the cervical spine if exclusion criteria are not met but always perform the primary survey first. It is inappropriate to immobilise the cervical spine or perform a secondary survey if the primary survey is incomplete or has major abnormality.

JUST TO CLARIFY I WASNT IMPLYING THAT YOU WERE BEING A PRICK I'M SORRY IF THAT SEEMED LIKE I DIRECTED THAT COMMENT TOWARDS YOU SIR. I DID FEEL YOU WERE PRETTY MUCH TELLING ME WHAT I KNEW I JUST GOT THE JITTERS A LITTLE AND WANTED A WAY TO OVERCOME THAT. BUT THANK YOU FOR TAKING THE TIME TO READ AND RESPOND TO MY POST. AGGRAVATION MIGHT'VE SHOWN ITSELF IN MY LAST POST BUT I AM GRATEFUL FOR ALL THE ADVICE> THANKS GUYS!

Whoa! Second post and your calling someone a pompous prick. That is not a good way to start or a good way to get advice. I'm willing to overlook the indescretion and give you the benefit of the doubt. As for my advice, here it goes. First, remember it is their emergency, not yours. Do not let the situation interfere with what you have to do. DO NOT let the lights/sirens/fast driving get you excited, it will get real old real quick. As for your assessment, it sounds like you did fine to me. You are in the real world now and not a classroom so you do not have to verbalize everything you are doing. I don't see how you disregarded the ABCs. You said she was screaming in pain and complaining of neck pain. From this alone you have assessed the ABCs. She has an airway, is breathing enough to be able to talk and obviously has a pulse. After the ABCs comes D for disability, which includes immobilzation on the appropriate patients (refer to ATLS). You did that. There is no way you are going to clincially clear the cspine in this pt who is elderly, has neck pain and is in excrutiating pain. I'd be more worried if you DIDN'T immobilize. Don't get tunnel vision to the posibilities of other injuries. This is where your secondary survey comes in. Palpate head to toe, in elderly people who fall, ALWAYS think hip fractures.

Trauma is pretty much cookbook medicine, even in the ER. Just follow the recipe and you will do fine. Don't forget to turn the page though. Hope this helps.

thank you sir. I apologized to that gentlemen I wasnt implying that he was being a prick I've just seen some seniors be pricks in the little time I've worked and I'm still a little agitated but I am grateful for this advice. I really appreciate it

[ERDoc]

JUST TO CLARIFY I WASNT IMPLYING THAT YOU WERE BEING A PRICK I'M SORRY IF THAT SEEMED LIKE I DIRECTED THAT COMMENT TOWARDS YOU SIR. I DID FEEL YOU WERE PRETTY MUCH TELLING ME WHAT I KNEW I JUST GOT THE JITTERS A LITTLE AND WANTED A WAY TO OVERCOME THAT. BUT THANK YOU FOR TAKING THE TIME TO READ AND RESPOND TO MY POST. AGGRAVATION MIGHT'VE SHOWN ITSELF IN MY LAST POST BUT I AM GRATEFUL FOR ALL THE ADVICE> THANKS GUYS!

This is not meant to put you down in any way, but it is something that comes up a lot on this forum. People here are very aggressive with making EMS more professional and getting it the respect it deserves. One way to do that is to be able to properly express yourself in spoken and written communications. This may just be an internet forum to some but it is a representation of the profession to the public so people are very adamant about proper writting (spelling, grammar, punctutation, caps, etc). As a newbie, you will take your ribbing for it but trust me, the people here are phenomenal and have as much knowledge as you could want. Take your newbie hazing with a smile, fix the presentation of your posts and you will be welcome. The fact that you apologized and accepted responsibility for the miscommunication in your post speaks volumes and will gain you respect. Welcome to the city.

EDIT: Wow, I just made this place sound like a serious cult. Lamb sacrifice at noon.

Edited June 1, 2011 by ERDoc

[callmetherook]

This is not meant to put you down in any way, but it is something that comes up a lot on this forum. People here are very aggressive with making EMS more professional and getting it the respect it deserves. One way to do that is to be able to properly express yourself in spoken and written communications. This may just be an internet forum to some but it is a representation of the profession to the public so people are very adamant about proper writting (spelling, grammar, punctutation, caps, etc). As a newbie, you will take your ribbing for it but trust me, the people here are phenomenal and have as much knowledge as you could want. Take your newbie hazing with a smile, fix the presentation of your posts and you will be welcome. The fact that you apologized and accepted responsibility for the miscommunication in your post speaks volumes and will gain you respect. Welcome to the city.

EDIT: Wow, I just made this place sound like a serious cult. Lamb sacrifice at noon.

Yea man I guess I was being a sourpuss you know. But I do have to understand that I am a rookie and take ALL criticism. But all the advice from you guys really did help and gave me a lot of reassurance and confidence to be the best damn EMT I can be. thanks a lot I really do appreciate it

[uglyEMT]

Yea man I guess I was being a sourpuss you know. But I do have to understand that I am a rookie and take ALL criticism. But all the advice from you guys really did help and gave me a lot of reassurance and confidence to be the best damn EMT I can be. thanks a lot I really do appreciate it

Thats a great attitude to take and have. Especially in the profession we call EMS.

As I stated earlier we here at The City do not coddle. If you messed up you will get called on it. Happened to me enough BUT it did make me a better provider. I made me push to "get it right" each time. Mistakes will be made but learn from them. Some of my best friends on this board started out as folks I thought were coming down on me hard. But it made me go back and look what I had done wrong and what could be done differently.

There is a vast amount of knowlege here, use it wisely.

[tcripp]

...the sirens blaring the lights and the 5 hour energy drink i drank a couple seconds before had me wired as hell.

I don't think that I can add much more to what has already been said. I agree that, without knowing it, you did take care of the ABCs and were on your way to spinal immobilization. You may just have been going faster than your partner comprehended. That is when communication is paramount. As you yourself has stated...you are a rookie. It will take time.

I do, however, have a question for you. This being your first emergency call, why the 5-hour energy drink? I believe you said this was an 8-hour shift? Was this a last call in the middle of the night and you were just dragging? Did you consume the drink before the tones dropped or was this something you decided on as you were heading out the door?

My two cents. Save the energy drinks for long transfers when adrenaline won't be on board which should be enough for your 911 calls. Then, work on a healthy diet and exercise as you start your new career else you will find yourself dependent on caffeine (or other) to get you through your shift. You don't want to increase the speed of potential/probable burn out.