17 Ways to Become an Awesome EMT in 2012

Want to become more awesome in 2012? Here are 17 places you can start:

1) Start Checking Out Your Rig Each Morning

Most organizations have a policy in place that states that oncoming EMS crews should complete a thorough checkout process. The reality is that very few of us check out our rig at the beginning of each shift with the proper attention that the task deserves. We know we should, but we get caught up. The signs of an incomplete rig checker are subtle but recognizable. If you open your cabinet or kit on a call and note (for the first time) that you are low or absent a needed supply, you’re not checking out your rig well enough. If you need to look in two or three paces to find what you are looking for, you aren’t checking out your rig well enough.

When you complete a detailed rig inventory, you aren’t just confirming that everything that is supposed to be there is still there. You are hard-wiring into your brain the exact location of everything that you might need. Once you’ve done this over and over again, you’ll find that you are able to collect necessary equipment in a fraction of the time. When you can grab equipment without even looking, your patient care efficiency will go way up. You’ll become a better caregiver. So grab that list and open those cabinets.

2) Look -Up Every Prescription Medication That You Don’t Recognize

The patient’s medication list is a wealth of information about their medical history. It contains vital information about possible causes of the their current condition. It hides details about how the patient will respond to acute medical conditions and it gives clues to how they will respond to your subsequent treatments. If you don’t understand what those medicines are and what they do…you’ll miss all of it.

If you’re caring for folks and you don’t understand the medications on their med list, you might as well wear a blindfold. You’re missing that much.

In today’s information age, there’s no excuse to not have some sort of medication reference in your phone or in your pocket or in your work bag. Carry it and use it. Every time you sit down to write a trip report and you write a medication down that you aren’t completely familiar with, look it up…right then. Don’t wait till later. Just pull out your reference and learn the medication. Google it if you need to. Once you start this habit, you’ll be surprised by how quickly you start to understand these lists in a much more detailed way.

3) Stand Up and Claim Your Mistakes

This can be one of the hardest new habits to learn. Partly because we’re all so afraid of admitting that we made an error. Winston Churchill once said that success was the ability to go from mistake to mistake without losing our enthusiasm. It’s absolutely true in medicine. We can’t grow as patient care providers without making errors. In 2012 commit to avoiding errors whenever possible and owning every error that you make. Be brave. Be fearless. (But don’t be reckless.)

4) Learn Every Patients Name and Use It for the Duration of Your Care

In all but a few rare exceptions, asking your patient’s name is an excellent first step in your patient assessment. Airway, breathing, circulation and a large majority of the cranial nerves can be assessed by simply taking your patient by the wrist and asking their name.

Once they say their name, the next step is a little harder. Remember their name. This takes a conscious effort at first. Once you get in the habit, it’s easier. Now that you remember their name, use it. I think you’ll find that your patient rapport increases dramatically (almost effortlessly) once you stop calling your patient honey, sweetie, dear, sirs, ma’am, pal, friend or partner, and start calling them by their name.

5) Learn Your Protocols

I mean better than you already do. When I was an EMT-Basic, I all but ignored my county protocols. I figured protocols were things that paramedics needed to worry about. Once I became a paramedic and started reading my protocols I realized that I should have read most of them back when I was an EMT.

Your protocols are the rule book. I’m not an advocate of always following the rules, but before you can break the rules properly, you need to know the rules. Learn them. Know them. Then you can start refining your care around them.

6) Pay Attention to Research

I already mentioned that this was the information age. There’s really no excuse to be ignorant of current research in EMS. If you don’t know where to start, start with the research section of EMS World. Then check out the news and features at EMS1. Keep an eye on podcasts like The EMS Educast and The Research Podcast. When you’re ready for the big leagues, check out Rogue Medic’s blog. (Wear your seatbelt.)

Half a dozen things you’re doing right now will change in the next five years. Want to know which six things are going to be obsolete? Start paying attention to research.

7) Develop a Specialty

Think of the most talented, well respected EMS practitioner you know. I’ll bet I know something about them, even though I’ve never met them. I’ll bet that they’ve taken their knowledge in at least one area of medicine far beyond the expectations of their job.  Think I’m wrong? Ask them.

Sooner or later, every EMS caregiver who’s eager to learn and improve will find some area of medicine that interests them to a degree that they seek out more information. Once they tap into the subject they’re compelled to keep going. They become specialists.

It could be cardiology and it could be limb splinting. It could be airway management and it could be extrication. The subject isn’t that important, the idea that your knowledge does not need to be limited by your scope of practice is critical. Find an area of medicine that fascinates you and dive in. Don’t worry about whether or not the information is applicable to your patient care. Learn for the sake of learning.

Before you know it, you’ll be a specialist.

8.) Use the Information in This Blog (Or Stop Reading It)

Yes, you read that correctly. This might be the only time you’ve ever heard a blogger tell you to stop reading his or her blog, but I’m serious. If you’ve been reading my blog for a while and you still haven’t encountered anything that you can take to work and use to your benefit, stop reading.

I’m not writing this stuff for my own information. I’m writing it for you. If you don’t actually use any of it in practice, then it’s worthless. You can stop reading…I won’t take it personally.

If you aren’t using and applying the information you see here your wasting our time. Find those useful little gems that resonate with you and go to work and actually try to be a better EMT. Or find someone else’s blog to read who might be more useful to you.

9) Listen to (At Least) One Podcast in Your Rig While Posting (Or On Duty)

There are so many awesome podcasts out there in our field. If you have an iPod or an MP3 player or any other device that plays digital audio, you have no excuse to not listen. Download a few and see what you like. Make that down time useful.

You can hear some of the most lucid thinkers in EMS talk about the latest issues that affect you and your industry if you simply tune in. I recommend The EMS Garage, The EMS Educast, The EMS Leadership Podcast, EMS Office Hours, and Confessions of An EMS Newbie. They’re all awesome.

You can learn a bunch from regularly listening to any one of them. In the age of MP3 Players, Ipods and smart phones, there are no longer any excuses for wasting your time in your car listening to commercials on the radio. Pick a podcast you like and start listening. You won’t believe how much good information you’ll have packed into your brain by next year.

10) Start Teaching Something

It’s time. If you already teach a class, such as Red Cross First Aid or AHA CPR, great. You can skip this one. But if you haven’t taken the time to give back to the community by teaching the EMS information you already know, 2012 is your year.

It’s hard to describe how much teaching can expand your knowledge and experience. Once you know that other people are going to learn vital skills based on your knowledge you will feel compelled, like you never have been before, to dial in your own knowledge.

Teaching opportunities are everywhere. Hopefully you can find a way to teach your specialty to other people. Educators like Mike Smith and Tom Dick have built their careers on finding something they are passionate about, becoming the leading authority on the topic and then teaching it to other people.

Maybe in 2013 I’ll see you on the speakers list for EMS World or EMS Today.

11) Bring Yourself to Work

You might be thinking, “Steve, I’m required to show up at work.” True. That’s not what I mean. I mean that this year is the year for you to find that unique contribution that only you can make to the world of EMS. When you begin your career, you mostly copy the styles and techniques of your preferred instructors. You do what you can to be like them.

Now it’s time to break that mold and ask yourself what your style is going to be. What are your techniques? How can you make this job uniquely your own. What can you do to make the people you work with think to themselves, “Wow, I’ve never seen anyone do it like that before.”

There is a unique something that you were meant to bring to the world of prehospital emergency care. No one can tell you what it is. You have to figure it out on your own. When you find it, don’t tell anyone…just show them.

12) Start Doing Full Head-to-Toe Patient Assessments

I know you’ve been faking it. I know this because most EMT’s fake it. Regardless of how good or talented they are, most EMTs don’t have a good, smooth, thorough head-to-toe assessment that they can perform with confidence in front of other people.

And the really sad thing is that it isn’t that hard to do. You just have to start doing it. Do it and then do it again and then do it again. As you practice detailed head-to-toe assessments again and again you will quickly reach a level of proficiency that far exceeds that of the vast majority of your colleagues.

More importantly, you’ll become a better caregiver to your patients. Commit right now to making 2012 the year when you quit faking it and start doing solid patient assessments

13) Learn a Thorough Neurological Assessment And Do It Whenever It’s Appropriate

You can add this one to your new-found head-to-toe assessment when the need arises. A neurological assessment is how we figure out if the patient’s body is talking to the patient’s brain correctly. Just like a physical assessment, it starts and the head and ends at the feet. A good neurological assessment includes motor, sensory and cognitive assessments. If your assessment includes questions like, “Can you feel me touching here?” or “Squeeze my hand.” or “Where are you right now?”, you’re already doing some neurological assessments.

Once you have a systematic, head-to-toe, neurological assessment, do it on every potential spinal injury, stroke, overdose, poisoning and head injury patient. (That’s a good start.) I’ve never seen two caregivers who use the exact same neurological assessment. Develop your own. It will get better over time. Do it often. It will help define you as a quality caregiver in 2012.

14) Find One Glaring Mistake or Outdated Treatment in Your Protocols and Vow to Violate It

I know this one is going to be a little controversial. I’m not telling you to give inappropriate care to your patient. I’m also not giving you a license to not know your protocols. (See number five.) But I can guarantee, beyond doubt, that there are some things in your protocols that are out of date, useless and possibly harmful to your patients. Find one of those things and commit to not doing it in 2012. Make sure to write a variance report when you’re done.

15) Stop Eating Roadside Junk Food

It’s killing you. Just stop. This year, start bringing your food in a little cooler. As an industry tasked with protecting the health and safety of others, we are ridiculously fat and out of shape. Don’t be the next post-difficult-call-cardiac-arrest story in the national news. Drop the trans-fat and eat an apple.

16) Stop Having Tantrums On Your Way To Calls

Yes, you do. We all do it. The dispatch happens and we immediately start rationalizing why this shouldn’t be our call. “Isn’t Medic 36 closer to this? Are they still out at the hospital. Those guys spend way too long at the hospital. This nursing home calls for the dumbest reasons. Why can’t PD transport their own drunks?” When we’d rather be doing something else, there’s always a reason why we shouldn’t have to run the call we’ve been assigned.

Just decide to commit yourself to the call from the moment that you are dispatched. You can’t feel good about the job you do if every time you get assigned a call you go into angry / frustrated mode. You’d be surprised how much energy you can expend with these habitual negative tantrums. Let go of it. Shrug it off like a heavy weight. If the job is worth doing then decide to just do it. You’ll be amazed at how much better you feel.

So that’s it. There’s your recipe for how to have an awesome 2012. We’re just far enough into 2012 to have abandoned all of those ridiculous resolutions that we committed to on January 1st. Now you can make some real worthwhile commitments. Pick a few and get started.

“Wait!” you say… “You promised us 17 ways to become awesome.” Indeed I did. You’ll have to wait until next time to get the 17th tidbit. It’s just good enough to warrant its own post. …And you can find it right here.

Comments

  1. I think it’s important to note that items 1 and 3 are related.

    If you start at 7 am and get a call at 7:02 am and you’re missing something, it’s the prior crew’s fault for not restocking or letting you know about it.

    If you start at 7 am and at noon you realize you’re missing something, then it’s your fault for not doing a proper checkout. Ultimately it’s the on-duty crew’s responsibility to ensure that they are properly stocked, and you can’t do that without doing a unit checkout.

    Similarly, 5 and 14 are related. You have to know your protocol to know where the wiggle room is and know where the outdated interventions are.

  2. Excellent post! I’ll be retweeting this and advertising it to my crews.

  3. Rick Thompson says:

    Hey Steve, can you post a link to your best advice for the head-to-toe? This seems to be one of my biggest pratfalls on my journey to practicing als!

  4. Medic Minx says:

    Very well written article.

    @Joe: Agreed. My start time is 0700 & I’ve jumped on off crew’s late calls (early for me) as early as 0630 & have discovered the hard way what I’m missing. I arrive early mainly because I try to make sure the person I’m relieving may get off on time, but also to perform a thorough truck check. It takes me sometimes hours to complete my check, & quite frankly it is ridiculous. I’m noted to keep a surplus of overly used items…18 & 20ga caths, tourniquets, 4×4’s, etc. I’m also notorious for hiding my supplies because most of the time the people I relieve don’t re-stock.

  5. Ingrid Bouldin says:

    This is the best EMS article on every-day, every-shift advice I’ve ever had the good fortune to stumble upon in many, many years! And I’ve been doing this for twenty plus years, both BLS and primarily ALS.

    Well-written, concise, practical advice that is suggested in the right amount of words with sage wisdom obviously backing it. I’ve been training ‘newbies’, maintaining ‘the seasoned’ for decades and I wish I’d had this article in hand to supplement and reinforce everything I’ve been trying to impress upon everyone, alike. I hope you don’t mind if I distribute this and share it. Perhaps the more visual learners will get more out of this excellent article than just listening to my ‘strong suggestions’.

    @ Joe and Minx – my truck checks start at 0530 for the 0600 shift. I feel your pain but of course it’s a necessary evil and falls heavily on the benefits mentioned in the #1 spot. This too is something I have a very hard time impressing upon any crew and it’s the first golden rule I teach to newcomers. Boy, do they ever listen once they’re the one caught down.

    Long as I’ve been doing this, I still had a thing or two to learn myself…like the uh,… temper tantrum part…….

    Thank you for the good read, excellent advice and I give you the EMS pat on the back for a job well done!

  6. this is probably the most valuable and worthwhile career/professional info I’ve seen info in a long time. Thank you.

  7. Great stuff Steve.

  8. I must be awesome. Cuz I do all those except the podcasts.

  9. Andrew Przepioski says:

    Even though a full head-to-toe isn’t a treatment, I think it isn’t indicated for every patient. I believe a master would look for pertinent positives and negatives based on the patient’s chief complaint or your differential diagnosis. There are a couple of circumstances were I can imagine a full head-to-toe would be appropriate e.g. en route to the hospital after everything is done and ready, and the only thing left is for you to stare blankly at the patient or do a full head-to-toe; otherwise it’s a waste of your time and the patient’s time.

    A mistake I think people make when they do a focus assessment is they tunnel vision on location. Like I said, pertinent positive and negatives. Shortness of breath is an easy example: anxious facial expression, nasal flaring, pursed lips, platysmal indrawing, sternocleidomastoid use, excessive chest wall movement, intercostal retraction, etc. People seem to tunnel in on the chest only.

    Instead I’d recommend people practice it with friends, family, or co-workers.

    For neurological exams, I think the MEND exam is a pretty good one.

  10. Steve Whitehead says:

    @Joe It’s true. And it’s an operational issue many of us face. At our department, off going crews give a hand-off report to the oncoming crew. If the hand-off is inaccurate we at least have the ability to call each other out. Some folks don’t even get that courtesy.

  11. Steve Whitehead says:

    @Brian, Thank you.

    @Rick, Mastering the head to toe assessment: http://theemtspot.com/2010/02/08/mastering-the-head-to-toe-assessment/

    @Minx, It’s unfortunate that you have to go through such measures… I’m glad you do.

  12. Steve Whitehead says:

    @Ingrid, Thanks for your input and your complement.

    @Annon, That’s nice of you, thanks.

    @Brandon, Thanks Brau.

    @Bet, You are most certainly awesome. But you only need one thing to become even more awesome. Yeah!

  13. Steve Whitehead says:

    @Andrew, I agree that not every patient needs a full head-to-toe exam. However, It’s amazing how quickly sometimes can become never in our practice. I think most EMTs do far fewer full head-to-toe exams than they should. Instead we do some sort of focused assessment regardless of history and mechanism, and we do those poorly as well. We could all do better by defaulting back to our head-to-toe as our primary form of assessment. (Because we miss a lot.)

    I love the MEND exam and I think it’s a great place to start learning your own neuro exam. (Humm, that might make a good post….)

  14. Andrew Przepioski says:

    I work interfacility transport, and I remember transporting one patient to the ER (it was a CODE 2 call) whose chief complaint was shortness of breath. I was very stressed, and I missed a lot in my physical exam and history taking when I gave my report and the ER asked me questions (for example I knew he had a lobectomy cause of SAMPLE, but I didn’t know which lobe, and I didn’t know why). After that, I tried working on my history taking skills by asking more than what we were taught in EMT school based off questions facilities commonly ask me, or if I was blessed with common sense that day and asked. Not every nurse listens to my report and says “Great report”, but I’ve noticed an increase in nice feedbacks on my reports. Perhaps if I practice doing a full head-to-toe on the patient, tell them I want to get an overview of their body like when you visit your doctor, my physical exam will improve. So starting tonight, I will give doing a full head-to-toe on each of my patients letting them know it’s to gain an overview of their body and possibly practice, haha.

  15. Great post! I just read a little bit of it but I can’t wait to read it all!

  16. Slick Jim says:

    I’m bookmarking this article for when I become an EMT! It’s got me more pumped than ever before.

  17. Scott P says:

    I have found that when trying to learn something (or to teach something) the best way is to: Learn it, Do it, Teach it.
    It shouldn’t be hard for us to find our specialty, we all know that one section in the book when we were in class that we were just like “All-right were covering __________ Today” Taking that one area we love and exspaning our knowledge to the point where we feel comfortable teaching others is great for everyone.

    You were brutally honest when it came to owning up to our mistakes, which I think its dead on, when you own up you feel bad about it and that serves as motivation to prevent that mistake again

    Steve, This is your best article yet. Keep up the great work.

  18. Jenn Hughes says:

    I’m a newbie AEMT about to start working for my county EMS service. Even though the pay is less than the private companies, I’m excited because no expense is spared in the area of pt care and because it’s the county and they’re not concerned about making a profit, all of the policies and resources are geared towards doing things The Right Way. Not The Cheap Way and all of the “facetime” is spent on the pt instead of primarily in the paperwork and “pushing the button.” This means, I’ll be establishing all of my habits, all muscle-memory, all my routines and approaches to this field in an environment more conducive to establishing the RIGHT ones in the first place. That makes it WORTH that lower pay scale because for only 2 bucks an hour, I’m getting a better education than my peers did who are going to work for Newman’s or AMR, right out of the gate. $2 to not pick up bad habits your first year on the job? In my mind, you can’t beat that.

    So as you can see, it’s really important to me to start getting it right and DOING it right from day `1. I’m taking this article to heart: if I can start out doing these things (maintaining my psychomotor exam-level Pt assessment habits, poring over those protocols NOW and using them NOW, listening to podcasts), I’ll be ahead of the game before I’m expected to be a pro.

    Thank you for this!

  19. Jenn Hughes says:

    P.S. I plan to make phamacology my “specialty.” I’m fascinated by mechanisms of action, pharmacokinetics, pharmacodynamics, etc. I want to be the gal they call and say “You ever hear of this stuff? It’s Lah moe…I’ll spell it out for you. L-A-M-O-T-R-I-G-I-N-E. Could this stuff be giving her a seizure if she’s taking it with some ultram pn medication her mother gave her?”

  20. Matt Garrett says:

    First off great site and great post. I am a fairly new EMT and find this to be a great resource. In this post you mentioned to get a specialty. Even before reading this I have wanted to specialize in assaults due to the fact that the area I volunteer in (and possibly work someday) has a lot of them. (i.e. Shootings, stabbings, beatings, sex assaults etc.) However, I was wondering if anyone knew where I could start to find some good literature on these various topics as they relate to EMS. Thanks, appreciate all the feedback.

  21. Garrett J says:

    Thanks for writing this article! I’m an EMT-B student currently and learning everything I can as I go to end up making myself a better EMT… Thank you!

  22. were is number 17

  23. Hi guys i really like these comments I’m starting college in 5 days time to do a access course to go on to uni to do paramedic science if anyone knew of some voluntary work in London it would be great for me to do or if someone had some ideas for me to get some good books to learn it would be a great help any Advice would be gratefully received my e mail is josephmcdonagh4@hotmail.com

  24. My first class starts tomorrow. The break protocol because its outdated one is already on my heart. I was planning on being a midwife for 9 years, so waiting at least 1 minute to clamp and cut an umbilical cord. Preferably waiting until after the 5 minutes apgar score. Immediate clamping causes a newborn to not recieve 40%! of its blood supply. In trauma if I had a choice to allow someone to lose 40% o f his blood suppy. It would feel like attempted murder

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