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Medics must learn the difference between perfectionist and control freak

It has long been my observation that the medics who refuse to allow their EMT partners to do anything on scene are often the medics that could most use the help


“So my managers told me I need to lighten up a little, not to expect so much of my partners. I’m a perfectionist. That’s like asking me not to breathe.”

A medic sent that to me not long ago, asking for advice on how to better get along with his EMT partners. He told me that he has no steady partner, and works with a number of EMTs. Most of them have 911 experience, but a few have done little but interfacility transfers. None of them were totally green.

I reminded him that the only perfect EMS call is the one you haven’t run yet, but we kept coming back to the complaint that so many of his partners were incompetent. Then I asked him, “What is it they’re doing wrong? What do you ask them to do on scene?”

“Well, I don’t let them do anything, because they can’t do anything right!”

And that was the root of the problem.

So I asked him, “Answer one question for me honestly: Do you feel the need to micromanage your partner’s every action because you lack confidence in his abilities, or because you lack confidence in yours?”

After a very long pause, he said, “Dude, I’m scared to death. I’m always afraid I’ll miss something. I’ve been a medic three years, and I’m still trying to find my comfort zone.”

Ah, an epiphany.

EMT’s job is just as important as the medic’s job

It has long been my observation that the medics who refuse to allow their EMT partners to do anything on scene are often the medics that could most use the help. A psychologist would call it projection, one person attributing their perceived faults to others, but whatever the motive, EMS scene calls are a team effort. They run much more smoothly when both members of the team are contributing.

Medic doesn’t stand for “My Education Didn’t Include Carrying Stuff,” nor does BLS mean “Basic Lifting Service.” Expecting your EMT partner to stand silently aside and hand you stuff is a waste of an EMT’s training and education.

You often see this phenomenon in the newest medics. The ink still wet on their paramedic card, they are awed by the responsibility bestowed upon them, yet still just one successful test attempt from being the uncertain student they were just yesterday. But now that they’re IN CHARGE, they think that means they need to be IN CHARGE OF EVERYTHING.

There is no Monro-Kellie Doctrine for EMS crews. Just because you got officially cleared as medic in command, doesn’t mean your partner got stupider overnight.

Keep in mind that the vast majority of EMS calls require only BLS care. Those that do require ALS, the sickest ones generally need their ALS interventions en route to the emergency department. That means that while you’re still on scene, the EMT’s job is just as important as the medic’s. And if you’re doing ALS while still on the scene, barring cardiac arrest resuscitations and emergency airway interventions, those patients generally are not in immediate danger of losing their lives. I’m sure we could all think of exceptions, but most of the time, if you’re doing paramedic-level stuff in Grandma’s living room instead of a moving ambulance, your priorities are either skewed, or you have tacitly admitted that the patient is just not deathly ill.

If the latter is true, then mistakes made by your partner are not really all that big a deal, are they?

Empower your EMT partner

Control freaks and micromanagers often have trouble realizing that just because a task was not done in the way they prefer, does not mean the task was performed incorrectly. There are many approaches to patient care, and if you can relax and let your EMT spread his wings a little, he might just teach you a better way.

Everybody makes mistakes, even paramedics. What is often not recognized is that we usually learn more from our mistakes than our successes. It’s your job as a paramedic and mentor to make sure that the mistakes your partner makes don’t hinder patient care. Adopting a laissez faire approach to leadership will empower your EMT partners to make their mistakes in a safe, non-judgmental environment. No one can perform at their best with the ever-present fear of constant criticism and withering scorn from an unreasonably demanding medic for a partner.

Partners tend to meet the expectations you set for them. Require them to be a statue who occasionally hands you things and drives you to the hospital, and that’s what you’ll get. But expect them to be thinking clinicians who know how to provide the full spectrum of BLS care and assessment, and assist you with ALS skills as needed, and they’ll meet those expectations, too.

And often exceed them.

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