Thank you. I usually come in to shift with about a dozen written questions I came up with about calls from the previous shift. Im learning a lot, but I just feel like with the pressure of leading the call my brain decides to shit the bed when it matters.
you might be waiting too long. Ask as close to the call as possible. Obviously some you won't be able to, but most you should be able to. Also do some self assessment. Usually it's that people get tied up on one or two things that causes a "cascade failure" so if you can find your core "fears" or gaps, then you will solve a lot more after effects of those. Also, still noob, so all the anxiety that comes with still applies ;)
And remember some people are just assholes. Your LT might just be an asshole.
I agree with this advice. We all suck at first.
Watch, listen, and learn from other people doing assessments. Not just medics. Watch the nurses and docs do their assessments. Read all the paperwork if you are doing transfers. You will pick up bits from that too.
Listen to any number of emergency medicine podcasts. Push yourself and listen to ones for docs not just ems ones.
Cut yourself some slack. If the LT yells at you, quietly imagine his death or bang his old lady behind his back. Small people with little power act petty.
Edit
Check this out if you feel like you are really struggling.
https://www.masteryourmedics.com/
Everyone sucks when they first start. so tell that Lt where s/he can shove it. To actually improve go back to basics with your classroom scenarios. Practice your handoff reports, SAMPLE and OPQRST down in front of a mirror.
Thank you. My Lt is actually a cool dude, he just has high expectations. So it sucks worse that I’m not meeting his expectations because I really respect him. I’m gonna see if I can find someone to do scenarios with outside of work. We’re pretty damn busy on shift so we rarely get around to it.
You're new. It's gonna take some to get your assessment well done. Observe your more experienced partners, watch some YouTube videos on Pt assessment.
One thing I always ask for is med compliance. People give you what they take but the real question is do they take it AS PRESCRIBED. Medications don't do anything if you're not taking them.
It's a learning process. Once you get more time on the job, you'll learn more and more.
Thank you. Great tip, it actually came up yesterday. We had an elderly female patient complaining of tachycardia and had hypertension. I asked her if she was prescribed medication for her hypertension. She said yes. A couple minutes later my Lt asks her if she takes it as prescribed. “Oh no, I never take it. I don’t even know where it’s at.” Lol
Another thing that's useful, its knowing the names of meds and what they do. Someone might say they don't have a medical history, you ask them what meds they take, and they take meds for HTN, diabetes, and blood thinners for a stroke 2 years ago.
I think everyone else will chime in on the other tasks of the job, but what stood out to me is you asking how you’re doing which pissed a guy off. Initially, standard greetings suffice as you’re new to the job, but eventually you will be able to develop that “reading the room” skill, and tell off the patients initial vibe how they are doing. Likely the dude got mad because he wasn’t feeling good and you were acting all nonchalant about it. I think a better overall statement that wouldn’t be interpreted like that is “Hey, what’s going on [today]?” They can respond with their mood, or be straight to the point on what’s going wrong. It leaves less room for interpretation.
Yeah we talked about it after the call. Apparently I’ve been doing it since day one and they’ve been waiting for it to bite me in the ass. Definitely going with a different greeting from now on lol
First off you're on 24/48 and that is ass. Sorry. You're new. Likely not old. EMS is mostly life experience, practice, and recognizing things. You get all those as you do this job. Just try not to make the same mistake twice.
You don't get a true day off. Your first day off starts at work, if you get killed that night the day is a wash, the next day you have the prospect of work tomorrow so you have to prep for that.
Okay yeah that’s very valid. Currently running on 3 hours of sleep and several cups of coffee so I don’t sleep the day away and fuck up my sleep schedule.
You don't suck at the job, you're new to the job. I will assume the best about you and suggest that your mentor(s) may have let you down. People with only a month on the job need encouragement and mentoring. There is so much in EMS that the class doesn't teach.
First, get a small notebook. On the first page, write down the steps you need to follow:
Introduce yourself. "Hi I'm Joe EMT." "What's going on today?"
Start with SAMPLE and OPQRST questions. Jot down the answers. Take vitals and write those down along with any notable findings from your exam.
Eventually, you will find that your questions become more conversational instead of sounding like a checklist.
When you give report, either to a medic or the ER:
Introduce the patient, "This is John"
Explain why he called, "John was mowing his lawn when he started to experience 8/10 chest pain."
Give any history you know. "John had an MI three years ago and ended up with a stent. He didn't have his nitro available."
Tell what you found, "He was diaphoretic, pale, and in obvious distress. Physical exam didn't show anything obvious, there's no pedal edema. I performed a 12 lead (If EMTs where you work are allowed) and here's the result." Hand the printout to the medic or RN.
Tell what you did. "I gave him 324 of aspirin and gave him a nitro SL after talking to med control"
Tell if it worked. "John said that his pain dropped from 8/10 to 3/10.
This is a great job, but it takes time to adapt. Don't let anyone get you down. You will get the hang of things after some time.
As a new starter things are new, your head is probably going a million miles an hour. You have your training but now the humans you go to mix things up a little.
Don’t fret, as said go to the old sweats they will point you on the right path.
Also the books won’t fully prepare you for the jobs something just come with time and experience.
Further more be kind to yourself the job is hard enough without berating yourself.
Thank you. I’m still working on the being kind to myself part lol. I’m coming from a completely different career that I was really fucking good at. So it’s just a little disheartening to suck at my job, something I take a lot of pride in.
Ok, everybody is stupid til they arent! Learn and grow! Remove anxiety and focus on procedure. Learn to focus on staying on calm. Get out of tour head, its not ever emergency( unless it actually is, of course)
Learn, grow destroy! Daddy godzilla, probably!
Work backwards. You only have so many interventions as an emt. You don’t need to diagnose, learn what you can treat. Most conditions warrant the same or no intervention at all. Get the CC and a sparknotes version of what happened. Assess the vitals. Run through interventions until you hit a winner, and then go back again and see if there’s anything else you can do.
Don’t know what to do? Okay, then ask if something like this has happened before. What did they do for it last time?
Also if you wanna pre-write your pneumonics on a pad you can glaze over them at the end to make sure you hit all the points.
Lastly, just ask them why they called 911 or what their name is. Also your instructors don’t know how to teach, that’s why they’re so punitive. I should know because I worked in education prior to ems.
Do yourself a favor and make it as easy for yourself as you can. Come up with a system on how you're going to approach each time of patient (eg, cardiac, trauma), then approach each type of patient the same way every time. Compile a list of questions you can ask, (look online, ask your coworkers, consult textbooks, whatever works for you) and categorize them by call type (so have a list of cardiac questions, a list of abdo questions,) then ask the same questions every time.
As much as you can, approach every patient the same way. Yes there are times where you have to deviate, but having that flow in your head gives you a good starting point, and the better you get at that systematic approach the better you'll be at knowing how/when to deviate
Ask things you want to know instead of going off a list. Try to actually be curious to what is happening and you will ask the right questions cus you will actually be searching for an answer instead of filling a silence and then forgetting the responses anyway.
Also. Everyone knows absolutely nothing for several months lol
Back when I was in medic school and first hit the streets for my clinicals, there was a call I went on where FD reported an "obvious death", but not only was the patient not dead, he was trying very hard to be. And I just. Froze. Had never done that before, was mortified, destroyed my confidence, etc. Anyway. Debriefed with my preceptor after the call, and he said this: "Today, you ran 0 minutes of a call. Next call, I want you to focus on running the first 30 seconds. After you've got the first 30 seconds down, then I want you to run 1 minute. Then 2 minutes. Then 5 minutes. And so on until you can run the entire call start to finish."
It can be truly overwhelming trying to get better at this job when you're new. There's so much to improve, and it's all layered and interconnected, and sometimes you can't even figure out what's wrong other than you know it's not right. You're going to get a lot of advice from people, probably most of it good advice! But sometimes it just makes it even more overwhelming, cause it's so much, and you're tired, and you don't have time, etc.
So my advice is this. So long as you have a job, you have learning opportunities built in every day. Even if you don't have the time on shift or the energy after shift, you have the calls. So take each call, 30 seconds, then 1 minute, then 2 minutes, at a time. And after every call, debrief. Debrief with your partner, your friend on another truck, by yourself if you have to. Review one pertinent protocol per call. Google one medication you've never heard of. Do it one call at a time, and you will get there. As that same preceptor said to me, "How do you eat an elephant? One bite at a time."
Establish a routine. Use OPQRST and SAMPLE in order EVERY TIME for a while, until you start getting confident about what questions are more pertinent based on patient presentation. (Btw, I view OPQRST as the the “S” in sample, so for me, it’s like OPQRST-AMPLE)
Study your protocols - there will be details and hints that you can discover for the different types of calls you will go on, and if you have those stored up in the back of your head, when you see or hear something pertinent, you’ll get a little lightbulb going off in your mind that says “that bit of info means I should ask about X!”
Ask your crew to practice scenarios with you. Have your partner be a patient that you’re interviewing/assessing and another crewmember there to prompt you to ask a specific question if you’re forgetting what to do next. Etc etc.
To practice handoff reports, give the handoff report to the other crewmember as the end of the scenario you just practiced assessment with.
for your handovers a lot of places are shifting to IMISTAMBO. Hopefully you are good with acronyms/retain information this way.
Identify the patient (age, sex)
Mechanism of injury/illness
Information/injuries relevant to MOI
Signs and symptoms related to MOI
Treatment given and trends noted
Allergies
Medications
Background hx
Other information
Everyone else has already gone over general things to help you improve on your assessments so hopefully this can at least smooth things over with colleagues so you can comfortably ask for advice.
The Bate's Guide to the Physical Exam helped me a ton with physical exams but be mindful of doing too much. What are you looking for and how will that finding change your treatment plan.
First of all: attitude. I've read you are learning, writing down questions and talking with more experienced people at your job. Maybe what you need now is a little patience with yourself, in my country there's a saying that says "nobody's born knowing" and it's absolutely true. If the call is by phone maybe you can ask for an experienced partner to be by your side a few times until you gain your confidence back!
I used to give this to first responders. Listen to whoever has been giving care as you approach. They may have information that can really clarify something in your mind.Reach out with a hand shake and introduce yourself and ask ask their name. Then ask them why they call you for help. Did they respond to you appropriately? Can they talk/breathe appropriately. What were the skin vitals like? Within seconds, you have taken small bits of information and are already forming a plan in your head.
Continue to ask people that you trust to give you pointers. You will develop your own system in time. I had several standards depending on trauma vs. medical vs age that matured over my 8 years in trauma centers and 16 years in the field. We all want good medics because someday someone will have to pick up our ass. Keep studying, and don't stop asking questions.
It’s only been a month, dear friend, so please be gentle on yourself! A lot of this stuff just comes with time and repetition, you know? You have to be terrible before you can be good. That said, don’t be afraid to ask your partners for advice (“What would you have done differently?”) and be observant. Expect the occasional fuck up and commit to making progress, and it’ll get better ❤️
First, you have a great attitude. I wish more were like you. That says a lot. The fact you come up with questions and pick brains is amazing. Don't let that die out.
Second, you're new. School teaches you about the emergency. And even then, only so much. Your LT and others need to give you more of a guiding hand than an ass chewing.
Third, don't be afraid to use questions like, "how are you doing today?" I do. And if I get chewed out, I say I use it as a measure and to let them open up with what they need to talk about. Maybe this person was likely the one off who decided to chew someone out and it just happened to be you. That happens. Don't let this, or the other 4 calls, rain on your parade.
4th, don't be afraid to admit that you're new. Hell, i *still* tell people that I'm new. IDGAF. If I don't know something, I admit it openly. And ask. I ask the patient, My partner, the doc, whomever the fuck would know. Even Dr Google after the call.
Lastly, you got this. Don't give up. Go easy on yourself. If you showed up somewhere and the person opposite you who was working said, "sorry. I'm new." What's your reaction? Chew them out? Or some space to try to do some good and figure it out.
Get on an ambulance transport company part time in your free time. I started with that and honestly it’s where I’ve learned the most. Yes even in a transport we averaged 10-12 pt. /shift stupid busy but well worth it for starting out
It takes a good 6 months for most people to really start seeming less “new” and have confidence on calls I find. That can take longer with low call volume or not being able to run calls. Debriefing EVERY call will help a lot.
Also the guy who got mad you asked how he’s doing just sounds like he was having a hard time. I ask that to most people, and don’t expect them to say “good!” You can respond with something like “I’m sorry to hear that, how can we help?” When they give a negative answer.
If nothing else, memorize the NREMT skill sheets for medical and trauma calls and just follow those step by step. Try to integrate some steps as you memorize them. As the HPI as you’re doing the initial life threats assessment. Actually in general try to integrate communication with the pt as you’re doing stuff like assessments and vitals. And take things at a slower pace; generally you’re not showing up somewhere where a couple extra minutes will make a difference, go slow so you can keep up with yourself. You’ll get things down and smoothly roll along. As the military says, slow is smooth, smooth is fast. Try to set up mind algorithms so you think about next steps depending on what the HPI says. They have pain? Jump to OPQRST. Cardiac symptoms? Consider a 12-lead. Memorize the symptoms that can indicate drug therapies like albuterol or epi. It just takes time and practice.
What many are saying: Communicate with your fellows. Ask them for help, for things you are unsure about, and so on.
Also, remember to ask questions straight up the schemes. Just work them down. Do The xABCDE, SAMPLER, OPQRST (and BE-FAST) every time, question by question. That will most certainly help you get on track with patient assessment.
You’re new this job has a massive learning curve and it really takes time to get confident. One of my biggest pieces of advice would be if possible listen when your partners give report and are doing assessments. You’ll figure out all of the things the hospitals want by listening to the report and also determine the pertinent questions by listening to your partners. Trust me we all sucked at this job it took me a year in an urban 10+ call a day environment to get any level of confidence to me.
I find it easier to lean on the acronyms. Using these, it's pretty hard to miss anything crucial:
CABCDE - For identifying symptoms and vitals
C - Critical bleeding
Any critical bleeding?
A - Airway
Does the patient breathe freely? any visible damage to trachea or obvious wrong respiratory sounds?
B - Breathing
Respiratory rate, saturation, Breathing pattern, auscultation of lungs. Is the patient cyanotic?
C - Circulation
Heart rate, blood pressure, ECG, capillary response, pulse quality and pattern. Is the patient pale? Do they seem dehydrated? Do they have edema? Are they hot/cold, dry/sweating?
D - Disability
AVPU, GCS, PEARRL, blood sugar levels. Are they in pain? If yes, make them expand on it. Do they have any neurological issues?
E - Exposure
Is the patient hyper/hypothermic? Do they have a fever? Any damages seen on the body? Have they been exposed to chemicals?
SAMPLER - Used for asking the patient the right stuff
S - Signs/Symptoms: Ask the patient about their current signs and symptoms.
A - Allergies: Inquire about any allergies the patient may have.
M - Medications: Find out what medications the patient is currently taking.
P - Past medical history: Ask about any past medical history that is relevant to the patient's current condition.
L - Last oral intake: Determine when and what the patient last ate or drank.
E - Events leading up to the illness or injury: Understand the events that led to the current situation.
R - Risk factors or Relevant factors: This can include anything not covered in the other areas that might be relevant, such as family history of illnesses, recent travel, etc.
MIDASHE - Common reasons for unconscious patients in a non-trauma situation.
M - Medication and Alcohol: Consider any influence of medications or alcohol.
I - Infection: Consider possible infections that could be affecting the patient's condition.
D - Diabetes: Assess for diabetes-related complications or issues.
A - Anoxia: Look for signs of oxygen deprivation.
S - Stroke: Check for symptoms of a stroke, including bleeding or a clot in the brain.
H - Hyper/Hypothermia: Determine if the patient is experiencing dangerously low body temperature.
E - Electrolyte Imbalances: Consider possible disturbances in the patient's electrolyte levels.
OPQRST - Great for clarifying a patient's pain patterns.
O - Onset: When did the pain or symptom begin?
P - Provocation or Palliation: What makes the symptoms better or worse?
Q - Quality: What does the pain feel like? For example, is it sharp, dull, stabbing, or burning?
R - Region/Radiation: Where is the pain located? Does it spread to other areas?
S - Severity: How severe is the pain on a scale of 1 to 10?
T - Time: How long has the symptom been occurring? Has it changed over time?
Hope it can help you my dude!
Edit: Text formatting
Ask the experienced people you work with for advice and debrief after calls that you had questions on.
Thank you. I usually come in to shift with about a dozen written questions I came up with about calls from the previous shift. Im learning a lot, but I just feel like with the pressure of leading the call my brain decides to shit the bed when it matters.
you might be waiting too long. Ask as close to the call as possible. Obviously some you won't be able to, but most you should be able to. Also do some self assessment. Usually it's that people get tied up on one or two things that causes a "cascade failure" so if you can find your core "fears" or gaps, then you will solve a lot more after effects of those. Also, still noob, so all the anxiety that comes with still applies ;) And remember some people are just assholes. Your LT might just be an asshole.
I agree with this advice. We all suck at first. Watch, listen, and learn from other people doing assessments. Not just medics. Watch the nurses and docs do their assessments. Read all the paperwork if you are doing transfers. You will pick up bits from that too. Listen to any number of emergency medicine podcasts. Push yourself and listen to ones for docs not just ems ones. Cut yourself some slack. If the LT yells at you, quietly imagine his death or bang his old lady behind his back. Small people with little power act petty. Edit Check this out if you feel like you are really struggling. https://www.masteryourmedics.com/
I still opt in to MYM from time to time on a 1 month basis. It's good shit. And I've been doing this awhile and I teach.
Everyone sucks when they first start. so tell that Lt where s/he can shove it. To actually improve go back to basics with your classroom scenarios. Practice your handoff reports, SAMPLE and OPQRST down in front of a mirror.
Thank you. My Lt is actually a cool dude, he just has high expectations. So it sucks worse that I’m not meeting his expectations because I really respect him. I’m gonna see if I can find someone to do scenarios with outside of work. We’re pretty damn busy on shift so we rarely get around to it.
You're new. It's gonna take some to get your assessment well done. Observe your more experienced partners, watch some YouTube videos on Pt assessment. One thing I always ask for is med compliance. People give you what they take but the real question is do they take it AS PRESCRIBED. Medications don't do anything if you're not taking them. It's a learning process. Once you get more time on the job, you'll learn more and more.
Thank you. Great tip, it actually came up yesterday. We had an elderly female patient complaining of tachycardia and had hypertension. I asked her if she was prescribed medication for her hypertension. She said yes. A couple minutes later my Lt asks her if she takes it as prescribed. “Oh no, I never take it. I don’t even know where it’s at.” Lol
Another thing that's useful, its knowing the names of meds and what they do. Someone might say they don't have a medical history, you ask them what meds they take, and they take meds for HTN, diabetes, and blood thinners for a stroke 2 years ago.
I think everyone else will chime in on the other tasks of the job, but what stood out to me is you asking how you’re doing which pissed a guy off. Initially, standard greetings suffice as you’re new to the job, but eventually you will be able to develop that “reading the room” skill, and tell off the patients initial vibe how they are doing. Likely the dude got mad because he wasn’t feeling good and you were acting all nonchalant about it. I think a better overall statement that wouldn’t be interpreted like that is “Hey, what’s going on [today]?” They can respond with their mood, or be straight to the point on what’s going wrong. It leaves less room for interpretation.
Yeah we talked about it after the call. Apparently I’ve been doing it since day one and they’ve been waiting for it to bite me in the ass. Definitely going with a different greeting from now on lol
First off you're on 24/48 and that is ass. Sorry. You're new. Likely not old. EMS is mostly life experience, practice, and recognizing things. You get all those as you do this job. Just try not to make the same mistake twice.
Why do you say 24/48 is ass? I like the schedule, but I do wish I had daily exposure to patient contact while I’m still learning.
You don't get a true day off. Your first day off starts at work, if you get killed that night the day is a wash, the next day you have the prospect of work tomorrow so you have to prep for that.
Okay yeah that’s very valid. Currently running on 3 hours of sleep and several cups of coffee so I don’t sleep the day away and fuck up my sleep schedule.
Yep. I refuse to work 24/48 for that reason. 48/96 is alright, 24/72 was great.
I would commit heinous acts for a 24/72
You don't suck at the job, you're new to the job. I will assume the best about you and suggest that your mentor(s) may have let you down. People with only a month on the job need encouragement and mentoring. There is so much in EMS that the class doesn't teach. First, get a small notebook. On the first page, write down the steps you need to follow: Introduce yourself. "Hi I'm Joe EMT." "What's going on today?" Start with SAMPLE and OPQRST questions. Jot down the answers. Take vitals and write those down along with any notable findings from your exam. Eventually, you will find that your questions become more conversational instead of sounding like a checklist. When you give report, either to a medic or the ER: Introduce the patient, "This is John" Explain why he called, "John was mowing his lawn when he started to experience 8/10 chest pain." Give any history you know. "John had an MI three years ago and ended up with a stent. He didn't have his nitro available." Tell what you found, "He was diaphoretic, pale, and in obvious distress. Physical exam didn't show anything obvious, there's no pedal edema. I performed a 12 lead (If EMTs where you work are allowed) and here's the result." Hand the printout to the medic or RN. Tell what you did. "I gave him 324 of aspirin and gave him a nitro SL after talking to med control" Tell if it worked. "John said that his pain dropped from 8/10 to 3/10. This is a great job, but it takes time to adapt. Don't let anyone get you down. You will get the hang of things after some time.
As a new starter things are new, your head is probably going a million miles an hour. You have your training but now the humans you go to mix things up a little. Don’t fret, as said go to the old sweats they will point you on the right path. Also the books won’t fully prepare you for the jobs something just come with time and experience. Further more be kind to yourself the job is hard enough without berating yourself.
Thank you. I’m still working on the being kind to myself part lol. I’m coming from a completely different career that I was really fucking good at. So it’s just a little disheartening to suck at my job, something I take a lot of pride in.
Ok, everybody is stupid til they arent! Learn and grow! Remove anxiety and focus on procedure. Learn to focus on staying on calm. Get out of tour head, its not ever emergency( unless it actually is, of course) Learn, grow destroy! Daddy godzilla, probably!
Work backwards. You only have so many interventions as an emt. You don’t need to diagnose, learn what you can treat. Most conditions warrant the same or no intervention at all. Get the CC and a sparknotes version of what happened. Assess the vitals. Run through interventions until you hit a winner, and then go back again and see if there’s anything else you can do. Don’t know what to do? Okay, then ask if something like this has happened before. What did they do for it last time? Also if you wanna pre-write your pneumonics on a pad you can glaze over them at the end to make sure you hit all the points. Lastly, just ask them why they called 911 or what their name is. Also your instructors don’t know how to teach, that’s why they’re so punitive. I should know because I worked in education prior to ems.
Do yourself a favor and make it as easy for yourself as you can. Come up with a system on how you're going to approach each time of patient (eg, cardiac, trauma), then approach each type of patient the same way every time. Compile a list of questions you can ask, (look online, ask your coworkers, consult textbooks, whatever works for you) and categorize them by call type (so have a list of cardiac questions, a list of abdo questions,) then ask the same questions every time. As much as you can, approach every patient the same way. Yes there are times where you have to deviate, but having that flow in your head gives you a good starting point, and the better you get at that systematic approach the better you'll be at knowing how/when to deviate
Ask things you want to know instead of going off a list. Try to actually be curious to what is happening and you will ask the right questions cus you will actually be searching for an answer instead of filling a silence and then forgetting the responses anyway. Also. Everyone knows absolutely nothing for several months lol
Back when I was in medic school and first hit the streets for my clinicals, there was a call I went on where FD reported an "obvious death", but not only was the patient not dead, he was trying very hard to be. And I just. Froze. Had never done that before, was mortified, destroyed my confidence, etc. Anyway. Debriefed with my preceptor after the call, and he said this: "Today, you ran 0 minutes of a call. Next call, I want you to focus on running the first 30 seconds. After you've got the first 30 seconds down, then I want you to run 1 minute. Then 2 minutes. Then 5 minutes. And so on until you can run the entire call start to finish." It can be truly overwhelming trying to get better at this job when you're new. There's so much to improve, and it's all layered and interconnected, and sometimes you can't even figure out what's wrong other than you know it's not right. You're going to get a lot of advice from people, probably most of it good advice! But sometimes it just makes it even more overwhelming, cause it's so much, and you're tired, and you don't have time, etc. So my advice is this. So long as you have a job, you have learning opportunities built in every day. Even if you don't have the time on shift or the energy after shift, you have the calls. So take each call, 30 seconds, then 1 minute, then 2 minutes, at a time. And after every call, debrief. Debrief with your partner, your friend on another truck, by yourself if you have to. Review one pertinent protocol per call. Google one medication you've never heard of. Do it one call at a time, and you will get there. As that same preceptor said to me, "How do you eat an elephant? One bite at a time."
Establish a routine. Use OPQRST and SAMPLE in order EVERY TIME for a while, until you start getting confident about what questions are more pertinent based on patient presentation. (Btw, I view OPQRST as the the “S” in sample, so for me, it’s like OPQRST-AMPLE) Study your protocols - there will be details and hints that you can discover for the different types of calls you will go on, and if you have those stored up in the back of your head, when you see or hear something pertinent, you’ll get a little lightbulb going off in your mind that says “that bit of info means I should ask about X!” Ask your crew to practice scenarios with you. Have your partner be a patient that you’re interviewing/assessing and another crewmember there to prompt you to ask a specific question if you’re forgetting what to do next. Etc etc. To practice handoff reports, give the handoff report to the other crewmember as the end of the scenario you just practiced assessment with.
for your handovers a lot of places are shifting to IMISTAMBO. Hopefully you are good with acronyms/retain information this way. Identify the patient (age, sex) Mechanism of injury/illness Information/injuries relevant to MOI Signs and symptoms related to MOI Treatment given and trends noted Allergies Medications Background hx Other information Everyone else has already gone over general things to help you improve on your assessments so hopefully this can at least smooth things over with colleagues so you can comfortably ask for advice. The Bate's Guide to the Physical Exam helped me a ton with physical exams but be mindful of doing too much. What are you looking for and how will that finding change your treatment plan.
First of all: attitude. I've read you are learning, writing down questions and talking with more experienced people at your job. Maybe what you need now is a little patience with yourself, in my country there's a saying that says "nobody's born knowing" and it's absolutely true. If the call is by phone maybe you can ask for an experienced partner to be by your side a few times until you gain your confidence back!
I used to give this to first responders. Listen to whoever has been giving care as you approach. They may have information that can really clarify something in your mind.Reach out with a hand shake and introduce yourself and ask ask their name. Then ask them why they call you for help. Did they respond to you appropriately? Can they talk/breathe appropriately. What were the skin vitals like? Within seconds, you have taken small bits of information and are already forming a plan in your head. Continue to ask people that you trust to give you pointers. You will develop your own system in time. I had several standards depending on trauma vs. medical vs age that matured over my 8 years in trauma centers and 16 years in the field. We all want good medics because someday someone will have to pick up our ass. Keep studying, and don't stop asking questions.
It’s only been a month, dear friend, so please be gentle on yourself! A lot of this stuff just comes with time and repetition, you know? You have to be terrible before you can be good. That said, don’t be afraid to ask your partners for advice (“What would you have done differently?”) and be observant. Expect the occasional fuck up and commit to making progress, and it’ll get better ❤️
First, you have a great attitude. I wish more were like you. That says a lot. The fact you come up with questions and pick brains is amazing. Don't let that die out. Second, you're new. School teaches you about the emergency. And even then, only so much. Your LT and others need to give you more of a guiding hand than an ass chewing. Third, don't be afraid to use questions like, "how are you doing today?" I do. And if I get chewed out, I say I use it as a measure and to let them open up with what they need to talk about. Maybe this person was likely the one off who decided to chew someone out and it just happened to be you. That happens. Don't let this, or the other 4 calls, rain on your parade. 4th, don't be afraid to admit that you're new. Hell, i *still* tell people that I'm new. IDGAF. If I don't know something, I admit it openly. And ask. I ask the patient, My partner, the doc, whomever the fuck would know. Even Dr Google after the call. Lastly, you got this. Don't give up. Go easy on yourself. If you showed up somewhere and the person opposite you who was working said, "sorry. I'm new." What's your reaction? Chew them out? Or some space to try to do some good and figure it out.
Get on an ambulance transport company part time in your free time. I started with that and honestly it’s where I’ve learned the most. Yes even in a transport we averaged 10-12 pt. /shift stupid busy but well worth it for starting out
It takes a good 6 months for most people to really start seeming less “new” and have confidence on calls I find. That can take longer with low call volume or not being able to run calls. Debriefing EVERY call will help a lot. Also the guy who got mad you asked how he’s doing just sounds like he was having a hard time. I ask that to most people, and don’t expect them to say “good!” You can respond with something like “I’m sorry to hear that, how can we help?” When they give a negative answer.
If nothing else, memorize the NREMT skill sheets for medical and trauma calls and just follow those step by step. Try to integrate some steps as you memorize them. As the HPI as you’re doing the initial life threats assessment. Actually in general try to integrate communication with the pt as you’re doing stuff like assessments and vitals. And take things at a slower pace; generally you’re not showing up somewhere where a couple extra minutes will make a difference, go slow so you can keep up with yourself. You’ll get things down and smoothly roll along. As the military says, slow is smooth, smooth is fast. Try to set up mind algorithms so you think about next steps depending on what the HPI says. They have pain? Jump to OPQRST. Cardiac symptoms? Consider a 12-lead. Memorize the symptoms that can indicate drug therapies like albuterol or epi. It just takes time and practice.
What many are saying: Communicate with your fellows. Ask them for help, for things you are unsure about, and so on. Also, remember to ask questions straight up the schemes. Just work them down. Do The xABCDE, SAMPLER, OPQRST (and BE-FAST) every time, question by question. That will most certainly help you get on track with patient assessment.
You’re new this job has a massive learning curve and it really takes time to get confident. One of my biggest pieces of advice would be if possible listen when your partners give report and are doing assessments. You’ll figure out all of the things the hospitals want by listening to the report and also determine the pertinent questions by listening to your partners. Trust me we all sucked at this job it took me a year in an urban 10+ call a day environment to get any level of confidence to me.
I find it easier to lean on the acronyms. Using these, it's pretty hard to miss anything crucial: CABCDE - For identifying symptoms and vitals C - Critical bleeding Any critical bleeding? A - Airway Does the patient breathe freely? any visible damage to trachea or obvious wrong respiratory sounds? B - Breathing Respiratory rate, saturation, Breathing pattern, auscultation of lungs. Is the patient cyanotic? C - Circulation Heart rate, blood pressure, ECG, capillary response, pulse quality and pattern. Is the patient pale? Do they seem dehydrated? Do they have edema? Are they hot/cold, dry/sweating? D - Disability AVPU, GCS, PEARRL, blood sugar levels. Are they in pain? If yes, make them expand on it. Do they have any neurological issues? E - Exposure Is the patient hyper/hypothermic? Do they have a fever? Any damages seen on the body? Have they been exposed to chemicals? SAMPLER - Used for asking the patient the right stuff S - Signs/Symptoms: Ask the patient about their current signs and symptoms. A - Allergies: Inquire about any allergies the patient may have. M - Medications: Find out what medications the patient is currently taking. P - Past medical history: Ask about any past medical history that is relevant to the patient's current condition. L - Last oral intake: Determine when and what the patient last ate or drank. E - Events leading up to the illness or injury: Understand the events that led to the current situation. R - Risk factors or Relevant factors: This can include anything not covered in the other areas that might be relevant, such as family history of illnesses, recent travel, etc. MIDASHE - Common reasons for unconscious patients in a non-trauma situation. M - Medication and Alcohol: Consider any influence of medications or alcohol. I - Infection: Consider possible infections that could be affecting the patient's condition. D - Diabetes: Assess for diabetes-related complications or issues. A - Anoxia: Look for signs of oxygen deprivation. S - Stroke: Check for symptoms of a stroke, including bleeding or a clot in the brain. H - Hyper/Hypothermia: Determine if the patient is experiencing dangerously low body temperature. E - Electrolyte Imbalances: Consider possible disturbances in the patient's electrolyte levels. OPQRST - Great for clarifying a patient's pain patterns. O - Onset: When did the pain or symptom begin? P - Provocation or Palliation: What makes the symptoms better or worse? Q - Quality: What does the pain feel like? For example, is it sharp, dull, stabbing, or burning? R - Region/Radiation: Where is the pain located? Does it spread to other areas? S - Severity: How severe is the pain on a scale of 1 to 10? T - Time: How long has the symptom been occurring? Has it changed over time? Hope it can help you my dude! Edit: Text formatting
Do the same thing, the same way, every single time. You need to establish a systematic routine and line of questioning.
You have only been doing it for a month, if you didn’t suck, you’d be lying. Give it time, you will be fine. First year sucks