Back on the streets: An old paramedic's return to patient care
It's important to brush up on protocols, equipment and other areas of EMS after taking some time away from the field
Last year I had the opportunity to return to practicing as a paramedic for a local ambulance service. I had spent the last several years working in a few different non-clinical positions, including EMS coordinator for a county system and online EMS education contributor. But, I had a little more time available now and thought it would be a good opportunity to return to the streets.
I immediately began questioning how easily I would be able to pick back up and provide direct patient care again. I had maintained my state license and National Registry certification and completed all of the required continuing education, and then some. I had also done occasional teaching of PHTLS and PEPP classes, and helped with paramedic classes at the technical college. I felt confident that my brain still housed the knowledge to be a paramedic, but would my hands be able to do what needed to be done when the time came?
My first day back went well. The crews were very welcoming and I was assigned a preceptor and a mile-long list of orientation to-do items. From there, I was able to ease back into the saddle after being away from patient care for several years. What did I do different? The people I would be working with all knew that I was an experienced medic, so I doubted they were going to give me the leeway that would be given a newcomer. I needed to become competent again, quickly.
Here are the top five ways I got back up to speed.
1. Reviewing protocol as a refresher
I started my reintegration by pouring over the service patient care protocols. I made flash cards and quizzed myself over and over, created patient scenarios and wrote out the assessment and care I would provide step-by-step. I felt like I was back in high school Spanish class flipping through the cards, but it was great reinforcement.
Once I was comfortable with the protocols, I switched to the procedures. Many of them came back quickly, but others needed a little more attention. The equipment, technology and supplies had all changed a bit over the years and some of the procedures had improved steps.
Enter YouTube. The internet is a vast resource of instructional videos. Watching some high-quality clips from other EMS agencies, training centers and websites like EMS1.com was a great way to refresh on the indications and contraindications of the procedures, see the steps being performed and hear tips and tricks from other experienced providers. There are also a number of great patient assessment videos including clips on breath sounds, heart tones and conditions you don’t regularly encounter.
2. Creating mental scenarios for practice
After getting spun up on protocols, I started running scenarios in my mind. I would think back to real patients I had cared for in the past, and sometimes I made up situations based on calls I heard other ambulances being dispatched to cover. I started by finding the scene location and how we would get there. When I was last running calls we were still using map books as our primary source of navigation. Mobile GPS units were around, but their accuracy was limited. We now all have mapping on our phones, plus my service has local GIS information uploaded into the ambulance GPS units.
Once I mentally arrived at the address, I visualized walking into the scene and consciously assessing for our safety and the resources I would need to care for the patient. I knew that the mechanics of running a call was going to be one of my bigger challenges, so I made sure to include it in all my scenarios. Which partner does what? Who shuttles equipment? Who do we call for lifting help?
Next I imagined doing the patient assessment and initial treatments. I would stop every few steps to be sure I was following our protocol. It seems silly to imagine these scenarios, but surgeons, musicians and athletes all know that mentally rehearsing procedures and performances increases skill.
3. Using spare equipment for practice and familiarity
As EMS providers we are expected to be well-versed in the use of all pieces of equipment and supplies on our rigs. Your hypoxic patient cannot afford to wait while you try to figure out how to assemble a nebulizer or CPAP mask, and we have all seen what can happen when a crew is not well-versed on the stretcher. Getting intimately familiar with a splint, monitor or other device takes an understanding of the features and how it works, as well as plenty of practice.
Back to the internet. A quick Google search will turn up the user manual for almost every piece of equipment out there, and YouTube comes to the rescue again with wonderful instructional videos, many from the manufacturers themselves.
Finally, I pulled each piece of equipment out and practiced with them over and over again. Our training cupboard has extras of many of the supplies we carry, plus extras of the non-disposable equipment, not to mention the manikins needed to practice the skills. I took the time to pull them out and get familiar with them. Again, using the power of mental rehearsal, I imagined using these pieces of equipment with exam gloves on in critical conditions, low-light scenes and in the cold.
4. Reviewing medication field guides and regulations
Feeling good about the protocols and equipment, I moved next to the drug box. It wasn’t quite as intimidating as it was that first day on my original orientation so many years ago but I knew it still deserved some special attention. One by one, I pulled the medication vials and bottles out and reviewed them carefully, using my trusty medication reference, now smartphone-based (although I also carry a field guide for back-up.)
I poured over each medication’s indications, contraindications, actions, side-effects and where it fell in our protocols. I thought through how each would be drawn up. What size syringe would I use? How fast can it be administered? Are there any incompatibility concerns? I reviewed the concentrations we carried and practiced calculating dosages and mixing or diluting the drugs as appropriate. I did this for each drug several times during my orientation shifts and still do on the occasional slow shift.
5. Initiating Q&A sessions
Finally, I turned to question and answer sessions to fill in the gaps. While I appreciated that my preceptor and fellow employees felt that I was already well-versed in the ways of EMS, I knew that I still needed a more practice, particularly in the finer points of how our service operated, how the electronic PCR worked, who we called for equipment issues and other details. The good news was that I knew I needed to know those things, I just didn’t know the answers. That’s when the Q&A sessions began.
Holding a Q&A session is not a secret tool, but it is amazing how often it is skipped. It is pretty easy to get busy doing other things, completing paperwork, checking email or simply getting lost in the smartphone. As an “experienced” orientee, I sometimes felt like I shouldn’t have to be asking and that I should already know this stuff, but I reminded myself that now was the time to ask, before I was on my own and lives were on the line.
After a couple months it was time to kick me out of the nest, again. The education coordinator put me through a handful of simulation scenarios and dutifully signed me off, sending me back out onto the streets. I felt great and was really glad I put the extra effort in. Watching the videos, pulling out manikins and equipment and the mental rehearsals all helped smooth my transition back to patient care.