…. Answered
I asked for the questions and I got them, in spades. I put the challenge out there; What’s the hardest 
question you’re willing to ask about the life and job of an EMT? As usual, I started out with high expectations and then was blown away by the awesome response.
In fact I got so many great questions I needed to divide this post into two parts. So here are my answers to some tough reader questions about the life and work of an EMT. Thanks for asking them.
I’ll post the second installment next time.
1. How do you deal with smells, blood, guts, disfigurement and dead bodies?@BrownCoatEMT via Twitter
I’ve never been real great with smells. I’ve come close to puking but never full-on hurled on a call. some people go so far as to carry Vick’s vapo-rub to put on their lip. They say it helps. Me, I just decide to bear it. Though there have been moments that if I’d had the Vick’s jar, I’d have used it.
Disfigurement and death are different. I try to explain to non-medical folks that medical people look at bodies like mechanics look at cars. I don’t know how to fix cars so when I look at a broken car all I see is the damage. But a mechanic thinks about what he needs to do to fix it.
Same deal with injured people. I see an injury and my mind goes in to fix it mode. I’m consumed with what needs to happen next. Even a dead body sends me into an assessment mode, looking for criteria for obvious death. I just don’t find I think too much about the blood and disfigurement.
I do think about tragedy and sad situations (usually after the call is over.) I think it can be powerful to live closer to tragedy than most people. It makes us appreciate what we have. It certainly does for me.
2.) How can you get a service to realize that it is more important to get real High Quality new paramedics instead of just passing everyone who applies because they need numbers on the road?
Medic999 via blog
It can be frustrating to try to get EMS managers to recognize the concept of Talent Flow
The same is true for disengaged workers. Unfortunately you tend to attract more of what you have and keep them for longer than you want.
As much as that might seem obvious to you and me, ambulance service providers have a hard time maintaining high standards of entry and performance when faced with few qualified candidates for employment. Try to get involved in the hiring process and interject the talent flow concept as much as possible.
Work with your administration on solutions to running a full schedule when employee volume is lower and try to get the organization to think farther ahead in the hiring and training process so there isn’t a last minute rush to fill seats with partially trained personnel.
Agencies that struggle with hiring talent also tend to have a difficult time letting go of low performers as well. Another bad practice that compounds the problem.
3.) Can you ‘learn’ how to be a great paramedic or is it just something that is inside of you?
Medic999 via blog
There are some aspects of being a great EMT of any certification level that can be learned and a few that can’t. Being highly competent is certainly learned. All the skills and knowledge that go along with high performance need to be learned.
And then there are some things that an individual needs to bring to the table. When I wrote What Makes A Good EMT I discussed several vital elements. Strategy, tactics, performance … all those things can be improved with good training. But the first three elements, attitude, motivation and tolerance for repetition, the candidate needs to bring those to the table.
4.) Why do EMT’s have such a twisted sense of humor?
@Medic61 via twitter
Sigmund Freud first coined the term gallows humor in a 1927 essay and described its function this way,
“The ego refuses to be distressed by the provocations of reality, to let itself be compelled to suffer. It insists that it cannot be affected by the traumas of the external world; it shows, in fact, that such traumas are no more than occasions for it to gain pleasure”.
I think Sigmund was a very smart dude and I’d say that explains my occasional use of inappropriate humor fairly well.
In his book Lone Survivor
I’ve found that gallows humor can be an effective protective mechanism for things that are more traumatic or tragic than we are ready to cope with at that moment. It doesn’t mean that we won’t get around to more effective coping mechanisms, just not at that moment.
But it can have some negative consequences as well. We have to take great care not to express inappropriate humor in environments where others more close to the tragedy will accidentally be exposed to our antics. They are, by definition, inappropriate and need to be expressed in a guarded and careful way.
They also can be disrespectful to the patient and we need to always value the patient’s dignity whether they are present or not. I’m never OK with humor that is disrespectful or devalues the patient’s existence. I don’t think that ever serves any real purpose.
5. How can a new EMT start to be proactive on calls without getting in the way of everyone else?
@hopelessromantic via twitter
I remember that feeling. First, let go of the idea that you’re getting in the way. You’re a trained EMT and you have some valuable things to contribute to the patient care equation. Next, get in there and start contributing. If you get in the way people will tell you. Most of the more seasoned personnel would probably like to see you get a bit more aggressive.
Here are a few specific tips. Get the kit in your hand. Before you ever get to the scene think about where the kits are kept and make sure to have at least one of them in your hand first. Next, try to be one of the first two people to the patient’s side. Kneel next to the patient and get a BP cuff and a stethoscope in your hand so when it’s time to get some vitals, you’re the obvious person for the job.
Listen to the interactions of other caregivers with the patient. Do as many assessments as they will let you. (i.e. lung sounds, pupils, skin signs, head-to-toe) If you don’t understand why a question was asked, remember it and ask the attendant about it afterwards. Get feedback after the fact about what you did well and what you could do better.
As you get more comfortable in your EMT shoes you’ll find yourself more easily engaging the patient and anticipating what needs to happen next. You may even surprise yourself and start directing care. But when you look over our shoulder and find that new EMT, hiding in the corner, remember how they feel and get them in the mix.
6. Why are we here and what’s the meaning of life?
Medic999 via blog
Wow, when I asked for hard questions you didn’t hold back. And that really is the question isn’t it? This is a question that everyone has to answer for themselves, but if you’re asking my opinion, I think you can find the answer here: Matthew 25:41-16
7. I am 54 and going to EMT-I school in Jan. Is that to old? I am wondering if I have lost my mind.
Medic322 via blog
54! Brother you’re in your prime! Don’t be telling me 54 is old. The older I get the younger 54 seems. But seriously, you’re going to find you have some serious advantages over your college age counterparts in EMT class.
Your years of life experiences are going to lend themselves to your success in the field. If you haven’t been in school for a while you may feel a little shell shocked by the volume of information thrown at you in EMT class, but I predict your transition to field operations will be substantially easier.
Scene delegation, patient rapport skills and call management all lend themselves to your considerable life experience. Good luck in your new career.
Now it’s your turn: Those are my answers, but more importantly, what are your answers? where do you think I’m right and where am I dead wrong? Leave a comment and let everyone know? I’d really like to hear what you think.
(Update: You can find questions 8 – 15 answered in this follow-up post)
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Great article! Wow, the questions are fantastic. For a new person like myself that is just finishing the medical review process, these are helpful to learn.
I noticed under #4 that the Sigmund Freud link goes to your site and is a dead link… i’m guessing you wanted Wikipedia?
Steve
aka maclifer
Agreed! Fantastic article and questions. I especially like number 3 and 5. All too often, the weaker, more shy EMT’s feel left out and as a result, end up leaving the field. This may also be due to poor mentoring though. Not everyone is the ‘in your face’ type. I know that I’m not, and I’ve been in the field since 1992 (whether folks want me in it or not). Great advice. Thanks!
I can relate to your perspective on some of those tough questions. Interesting how many lay people have a morbid fascination with the darker side of our profession i.e the disturbing cases. In my earlier days, it didn’t effect me much. I tended to de-humanise the situation and concentrate on the clinical need, blocking out the sad reality of human suffering. After years on the job, I have found it harder to deal with human suffering…maybe it is maturity, perhaps I have more empathy or maybe it’s the cumulative effect of avoidance? The quality question is also interesting. I think we need to stop hiring folk who are fundamentally wired wrong…the people who are in it for self importance and power with a really bad attitude and huge sense of entitlement.
6. Why are we here and what’s the meaning of life?
42.
I mean, duh? :-p
These were all excellent questions and answers. I especially liked question 5 (my own question). I hope to start implenting your advice now as an observer/student and even more so when I’m an actual EMT trying to help out the new guy. Thanks again!
@Stephen Fixed the link. Thanks for the heads up brother.
@Theresa. I’m glad you found the advice useful. Tanks fo coming by and adding your two cents.
@Graeme I have had a similar experience. I actually wrote about that very dynamic last summer.
http://theemtspot.com/2009/05/19/coping-with-grief-and-tragedy/
Thanks for your addition.
@CBEMT I don’t understand.
@HopelessRomantic It sounds like several people liked that question and identified with it HR. Thanks for asking it.
Steve, I have to say I’m sorely dissapointed.
http://en.wikipedia.org/wiki/Phrases_from_The_Hitchhiker%27s_Guide_to_the_Galaxy#Answer_to_Life.2C_the_Universe.2C_and_Everything_.2842.29
Happened across the site, Nice Job!!
I liked this post alot, I think my favorite question was the old number 5. Liked your answer alot too. I was the shy guy for awhile, until I finally asked one of the Paramedics “When you get here, what is it you want me doing?” His answer was “Whatever you feel you have to do, I am not taking care from you so much as doing my part of it”.
I think everybody has a part to play, new EMT’s also have new book knowledge that us older EMT’s do not. If you have something to contribute, do it. I use to be concerned that I would be “interrupting” if I asked a question, until I asked a patient “what was the last thing you had to eat or drink”, and was told “Drano”. The Paramedic looked at me and we went in a new course of questions/actions. Obviously don’t talk over someone, but if you have something to ask or interject, don’t be afraid to do so.
When you are on scene, you are part of a team (the size of which varies), do whatever you can to help. Sometimes I am simply getting a blanket, othertimes I am doing chest compressions etc. We all need to cover each other and remember the questions others didn’t ask, forgot about or considered irrelevant. As well as perform the actions someone else hasn’t gotten to yet (O2/CMS/PERL). I’d rather see a new EMT jump in and start an O2 tank and have me say “No” than nobody on scene starting one. Nothing says you can’t ask a question while I am concentrating on vitals.
@Tundra “I use to be concerned that I would be “interrupting” if I asked a question, until I asked a patient “what was the last thing you had to eat or drink”, and was told “Drano”. The Paramedic looked at me and we went in a new course of questions/actions. Obviously don’t talk over someone, but if you have something to ask or interject, don’t be afraid to do so.”
This is so true. I’ve had my butt saved many times because the other people on scene felt comfortable interjecting questions and ideas. Some paramedics get real uptight about that, but I think they’re hanging themselves out there. We should be encouraging everyone to come together as a team, not intimidating other caregivers when they join in.
im a new emt student and haven’t volunteered or had any experience on the field. i feel completely nervous and scared about life as an emt and for some reason i feel like im the only one who feels that way…. Did you have doubts on being an emt and if so, what convinced you that emt/paramedics was the career for you ?
I was on a call once, and our patient had chest pain, but was stable and so we were just talking on the way to the hospital. He had been under a lot of stress within the last year – his youngest daughter died suddenly and his wife was just involved in a MVA and dealing with PT. We got on the subject, and he looked at me and said, “Ya know, people always wonder why we’re here… what’s our purpose? I think it’s simply just to help one another.”
If my purpose in life is simply to improve the life of another human’s, that’s meaning enough for me.