BEATING MYSELF UP, MY FIRST EMERGENCY

[Dustdevil]

I agree, that from the limited information we have here, it doesn't sound like your assessment was off-track at all. If a patient is conscious, breathing, and vocalising, your ABCs are done. No need to go through any pointless steps to satisfy any checklist in order to determine that. Assuming that immobilisation was actually warranted (which it sounds like it was), then you were absolutely on the right track to go straight to it.

Not sure why the other tech felt like s/he needed to take over. Did you ask him/her? It's possible that s/he simply sensed your discomfort and stepped in. But it also sounds possible that s/he may just be a cookbook monkey who does things differently from you, but not necessarily any better. Not everyone with more experience than you is going to be better than you, so while it is always wise to critique yourself, don't do so at the cost of your own self confidence.

Get off the energy drinks and get more sleep. Relax. And don't run your sirens any more than absolutely necessary. They don't get you there any faster, and they put everyone's life in jeopardy. I know it takes time to get over the initial excitement, but it is the most important step you could possibly take right now. This job isn't about sirens. It's about people. And if you don't arrive calm and confident enough to care for them properly, then you'd just as well not show up at all.

Good luck, and welcome!

P.S. It says "New Users - READ This First", not POST here first, lol. Chose your post locations carefully.

Edited June 1, 2011 by Dustdevil

[ERDoc]

As usual, Dust brings up a few good points. Just because someone is not doing something the same way you do does not mean it is wrong. Always be cautious with the advice from senior people in EMS. Unfortunetly this is a field where, "This is the way we've always done it," is pretty common. Medicine is constantly evolving and EMS is not keen on keeping up due to this attitude. Sometimes it's best to smile and say OK, but look it up yourself. Take everything you hear from those in the field with a grain of salt. Want an example? Look up the history of MAST.

[tniuqs]

As usual, Dust brings up a few good points. Just because someone is not doing something the same way you do does not mean it is wrong. Always be cautious with the advice from senior people in EMS. Unfortunetly this is a field where, "This is the way we've always done it," is pretty common. Medicine is constantly evolving and EMS is not keen on keeping up due to this attitude. <snip>

Agreed, can't add too much except STAND away from THE POWER-DRINKS (working, typing or doing documentation) and don't beat yourself, a chief complaint focused evaluation is not wrong.

[Lone Star]

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

With all the great responses, I don’t know if there’s anything of substance I can add; but let’s give it a shot anyway….

First step: Put down the energy/power drinks and back away slowly!

Second step: Put down the strap and stop beating yourself over this…

Ok, now that we’re calming down, let’s look at what you had and what you did:

90 year old female slip and fall…

First things you should be considering is:

1. Possible hip fracture/dislocation

2. Did she hit anything on the way down?

3. How long has she been down?

4. Any secondary injuries from the fall (sprained/broken wrist, dislocated shoulder, ulnar/radial fractures)?

What was your MOI? Did she slip on one of those crocheted/hand braided rugs that grannies are notorious for, or did she take a nose-dive off the ladder where she was painting the ceiling?

Since she was screaming in pain, she obviously had a patent airway; so there’s no real need to sweat that at the moment. That’s one checked off the list.

Did you notice any major bleeding when you made patient contact? Check another off the list….

Were peripheral pulses present? Capillary refill < 2 seconds? Check that off the list as well..

Now that we’ve covered the ABC’s, it’s time to look at the ‘D’ … what was her disability? Was she complaining of any other pain besides her neck? Did she strike anything (like the table, counter or coffee table) on her express ride to the floor?

Since she WAS complaining of neck pain, the C-collar would be a wise choice, since you don’t have x-ray vision and can’t tell if anything is subluxed or fractured. Since you’re immobilizing the cervical spine, then a LSB is in order.

Your initial patient survey usually runs from ‘nose to navel’, and your secondary is ‘nose to toes’. Complete each stage before moving on to the next, that way it becomes a systematic and complete process. This WILL take time!

As far as report writing, this too will take time to master, and develop your own style of reporting. The main thing to remember is that you should be able to pick up a PCR and by the time you’re done reading it, be ‘caught up’ with the situation at hand.

Critiquing your call is one thing, but using it as ammunition to beat yourself up is a horse of a different color all together! Look at it objectively and ask “What could I have done better?”, not “Oh look how I completely screwed EVERYTHING up!”.

You’ve had your first EMERGENCY! call, now it’s time to stop with the rookie nerves and start thinking about the possible injuries based on your dispatch information on the way to the call…this will help you ditch the ‘tunnel vision’ and start looking for zebras when you hear hoof beats…

Like the others, I can’t really see where you ‘screwed up’ anything. I see someone who let their nerves take control, not controlling your nerves.

We were all ‘green’ at one time or another (and for some of us, we’re ‘green’ on several levels in our careers). We DO understand the reactions to that first ‘hot call’, and we’re here to lend whatever assistance we can to help you through it. This ain’t the end of the world, and you WILL get through it and get better at what you’re doing as you get more experience/exposure…

Ultimately, the best time to panic is when it's all over with; until then, just keep your head in the game and you'll do fine!

[Cookie]

You have gotten some very good responses from some very experienced people. We all have had the jitters on our first call, and most of us can remember exactly the call and how it went down. There are also many who criticized themselves over the entire scenario, that is a horse you can beat to death. Every level I have had, and every class I have taken, first and foremost is ABC's. If you don't determine that first, you may not have a patient.

[tcripp]

Rookie, I thought about your post while working my 48-hour shift which just ended this morning. Essentially, I got a new partner who is both young and a fairly new Basic. On our first call together, it was a cluster. Not that either one of us didn't know what to do but rather in the fact that we simply had not gotten our rhythm. By our last call, it was getting much better. We have the month together before we switch partners again...but I wager that by then, we'll be cooking with gas.

Moral of my story...maybe part of your "issue" also lied in the fact that you and your partner are still getting used to each other as well. Communication is key. When you feel like something isn't right, ask about it. And, then take everything with a grain of salt and decide for yourself if it has merit. Some times it does...and some times it doesn't. But, at least you both will know where the other stands.

Gee...I hope this makes sense. Long shift...so off to bed now.

G'night, Gracie.

[uglyEMT]

Rookie, I thought about your post while working my 48-hour shift which just ended this morning. Essentially, I got a new partner who is both young and a fairly new Basic. On our first call together, it was a cluster. Not that either one of us didn't know what to do but rather in the fact that we simply had not gotten our rhythm. By our last call, it was getting much better. We have the month together before we switch partners again...but I wager that by then, we'll be cooking with gas.

Moral of my story...maybe part of your "issue" also lied in the fact that you and your partner are still getting used to each other as well. Communication is key. When you feel like something isn't right, ask about it. And, then take everything with a grain of salt and decide for yourself if it has merit. Some times it does...and some times it doesn't. But, at least you both will know where the other stands.

Gee...I hope this makes sense. Long shift...so off to bed now.

G'night, Gracie.

Awsome post. I totally missed on the partner dynamic. That is one of the biggest influences we have to go through. Once the "unit" gells then its like watching a masterpiece.

[HERBIE1]

All sage advice, but I will piggy back on the issue of interpersonal dynamics. Dealing with different partners is not easy- especially when you are new, and still getting your feet wet. Sometimes you aren't even able to discuss simple things like who will carry the O2 and who will grab the quick response bag before you are pressed into service. It takes time, but it does become easier to adapt to different styles of providers. Some are more aggressive Type A folks, while other partners may seem comatose by comparison. Never forget that it's all about the patient, and any squabbles or differences you have with a fellow crew member need to be shelved until AFTER the call. Be upfront about your issues but do not be confrontational. Support your point of view, and ALWAYS base your discussions on what is best for your patient. Any interpersonal issues are secondary.

It sounds like you did fine, but I like the fact that you are not satisfied with your performance. A hallmark of a quality provider is that they are always looking to do better, always questioning if there is a better or more efficient way to provide care. Complacency kills patients and careers. THAT is how you earn respect from your peers and hospital staff, gain confidence and become a true professional.

Welcome to the city, and as you can see, folks around here take their profession seriously. Here's a little tip- Using texting shorthand is frowned upon here, and although you could be the best provider in the world, nobody will take you seriously. Can you imagine a doctor responding to the impending cardiac arrest of a patient by saying "OMG!" Not professional.

[island emt]

If you can't come to work without the 5 hour energy drinks, stay home.

The last thing we need is someone amped up on caffeine & sugar trying to act calmly and responsibly.

Step back and take a deeeeeeep breath before leaping into action, it's not your emergency!

[HERBIE1]

If you can't come to work without the 5 hour energy drinks, stay home.

The last thing we need is someone amped up on caffeine & sugar trying to act calmly and responsibly.

Step back and take a deeeeeeep breath before leaping into action, it's not your emergency!

Sorry, but I disagree about the caffeine. I'm asystolic in the AM if I don't have my coffee. It's also what allows me to get over the hump throughout the day. Thankfully I don't do energy drinks or those quick energy ginseng/B-complex drinks though.