The Ambulance Chaser

Lately, a lot of the EMS social media pages have been giving advice to new medics and students. Some of the advice is good. Some of that advice is not good, which is a charitable understatement, to say the least. So, today, when a medic student asked me for advice, here’s what I told them — and also just added onto.

Here are things you’re not going to learn (or learn enough) about in a paramedic program.

1. Prescription medications. If you know and understand the medications that your patient is taking, half of your assessment is already done.
2. Understanding physician specialties, the roles of other healthcare professions, types of healthcare facilities, and hospital capabilities. This makes sure you get the right patient to the right facility. As a point of personal privilege, if your EMT partner can run the call without ALS intervention, that’s the only time you should even consider transporting to a hospital without ICU beds. (Yes, little old Mrs. So-And-So with the UTI is sicker than you think and she’s quite likely gotten herself an ICU admit.)
3. The ability to talk to a patient. A SAMPLE history and OPQRST aren’t enough. Period. Those start the questions.
4. For every patient you see, think of 5 possible differential diagnoses for them. Use pertinent positives and pertinent negatives to narrow down your diagnosis. (A special thank you and tip of the ol’ Resistol to the dearly departed Gene Gandy for that advice.)

Here are things to remember right now.

1. You’re not expected to have this down while you’re in school or while you’re the “new kid.” That’s why you’re in school or a new hire.
2. If you think you have it down, go Google the Dunning-Kruger effect.
3. Pay very little attention to the self-proclaimed EMS experts online, especially the EKG nerds. Many of those nerds speak with a great deal of certainty about subtle EKG findings that neither impact prehospital care nor are they absolute. Cardiologists will quibble about these findings.
4. There is nothing in any law book that limits the scope of your education. Have at least one physician level text on emergency medicine, or better yet, internal medicine. So much of what EMS does is what I call unscheduled internal medicine.
5. You become a good medic by seeing lots of patients. Emergency medicine, whether prehospital or in the ED, is based upon pattern recognition.
6. Go to a busy EMS service to get experience, whether it’s for your clinicals or your first few years of work. See above about pattern recognition.
7. It’s ok to be eager. It’s ok to be nice. Being “salty” isn’t a badge of honor. Nor is self-diagnosing yourself with a mental health condition because you’re in EMS.
8. Have a life outside of EMS. (Unless you’re a lawyer. Then EMS is your life outside of law.)
9. Humor at the patient’s expense isn’t funny. But it is a good way to learn about unemployment.
10. The call may not be important to you, but it’s the most important thing to happen to that patient today.
11. Be nice. Nice medics don’t get to meet lawyers.
12. Always remember that if something goes wrong, your patient care will be judged by twelve people who couldn’t get out of jury duty.
13. Lucky #13. Remember in ACLS where it says “Seek Expert Consultation?” That’s not the paramedic. It’s not even an emergency medicine physician. It’s a cardiologist or perhaps even an electrophysiologist.

And speaking of EMS social media, here are some things to remember about some of these “influencers” or pages.

1. A good chunk of them are wrong.
2. A good chunk of them are warning signs. (Fun little tidbit. Some EMS medical directors and chiefs have sock puppet accounts from where they can observe Social Media Assisted Career Suicide.)
3. A significant portion of them are self promoters.
4. Some of these people serve as a living, breathing example of why EMS doesn’t get to sit at the big kids’ table of medicine.
5. Many of these people aren’t nearly as experienced as they claim to be. Their Google Fu is much stronger than their actual experience caring for a patient.

After a little over twenty years of doing this in between reviewing contracts and nasty letters, I wish someone had told me more of these things. And on that final note, that first impression counts for something, whether it’s for a clinical, a job, or that first patient contact. Tuck the shirt in and shine your boots occasionally. (Dear God, that makes me sound old. But then again, I am….)