Career Change: Complete

[zion zig zag]

Everyone is different, but what I've found works the best for me after 15 years of paramedic/flight/ambo/er nurse stuff is this, as callous as it sounds is........

When I rolled up on horrible shit with tattered bodies laying around in the ditches, I go in to the "I don't give a shit about these people" mentality. Why? Well, because then you are the calm one on scene, not panicking and freaking the hell out running in circles. You think clearly, you do your job better because of it. Emotion has little or no use in EMS, it's best to put up the mental armor. The worst calls are the ones where one EMS person is freaking out and then that escalates and percolates into everyone on the scene, destroying any chance at efficiency and good patient care.

Same with the ER. Patient comes in not doing so hot, take a step back and chill out, slow down, think, and try to help others do the same. No reason to raise your voice or even hurry. Just slow down and be deliberate and THINK.

You'll get some gnarly tunnel vision on your first bad scene call. When you're driving up, just go through your job duties in your head, calm down, focus on your duties for that particular scene.

Good luck. EMS work is a blast.

This is good advice. I become almost robotic on bad scenes, super detached.

[Trackhead]

This is good advice. I become almost robotic on bad scenes, super detached.

You're sort of a robotic tool anyway, so............

[emtnate]

Sweet reply, TH.
Just wanted to clarify what I said about seeing each patient as an individual: I won´t sit down and dry tears when it´s cooking around me while at the ER, but it´s easier to do your job well when you focus on the problems at hand. Not freaking out is a big plus, and being the calm one is extremely valuable in pressing situations.

Exactly, you're only one person - your partner may or may not be equally or higher trained depending on your system. You can't do everything for everyone at once. Stay calm, stay detached and your training will come through.

(Still nice to be able to sit down with a patient after a traumatic incident, but everything has its time)

I check up on some cases from time to time, especially if someone is still in the ER when I come back later in the shift. For real serious cases our local hospitals are good about following up with us. It's nice, because the last city I worked in we only found out more about a case if it went to audit with the MD.

Edit: My wife brings up another good point. Watch what you bring home on you. What's on or in your uniform, nasty stuff you might have stepped in (including the ER floor, ever seen anyone walk around a hospital barefoot? ) Wash your uniforms separate from regular clothes or at the station. Think twice about hugging the loved ones when you come home. I got sick frequently when I started in the field, now it's rare that I come down with something. I'd hate to pass something on that I've become immune to.

[divegirl]

Awesome!! And Congrats!!

[BeanDip4All]

Wow, go away for a hike and come back to find that this thread exploded into awesomeness. So many seasoned voices to learn from here, I feel so lucky! I actually printed the past two pages out, took notes from what everyone said and bulleted your points on the back of my EMT binder.

So hey- for my first day, any "stuff" you can suggest I purchase?

I was thinking of getting my own stethoscope and possibly sphygmomanometer. Also one of those EMS field guide books like [ame="http://www.amazon.com/EMS-Field-Guide-Intermediate-Informed/dp/1890495301/ref=sr_1_2?ie=UTF8&s=books&qid=1245215799&sr=8-2"]this one[/ame].

Are there certain brands of stethoscopes that anyone can recommend? Anything else I should pick up now? I was thinking maybe some EMS boots like this, but probably am going to wait until after Thursday and find out what the dress code is like (Thursday they told me to wear business casual as I am just doing paperwork, touring, getting my IDs, etc).

Also, $319 for EMS boots?!?! holy cow. One thing I've noticed just from shopping around is that any product with the word "tactical" in the description is like a 20% markup.

[AKPogue]

I was thinking of getting my own stethoscope and possibly sphygmomanometer. Also one of those EMS field guide books like this one.

Are there certain brands of stethoscopes that anyone can recommend? Anything else I should pick up now? I was thinking maybe some EMS boots like this, but probably am going to wait until after Thursday and find out what the dress code is like (Thursday they told me to wear business casual as I am just doing paperwork, touring, getting my IDs, etc).

Also, $319 for EMS boots?!?! holy cow. One thing I've noticed just from shopping around is that any product with the word "tactical" in the description is like a 20% markup.

I have bought tons of crap and from what I have learned is to wait after your first day and see what they have there for you. No reason to go out and buy a sphygmomanometer. If the company you are working for doesn't have one you need to leave that company because it would be beyond negligent to not have one. Littman stethoscopes seem to be the standard.

Call up the company you are working for and ask what they recommend.

You definitely don't want to go cheap on boots but you need to find one that fits you. It can be hard to find the right boot online. See if there is a store in your area.

[arild]

Edit: My wife brings up another good point. Watch what you bring home on you. What's on or in your uniform, nasty stuff you might have stepped in (including the ER floor, ever seen anyone walk around a hospital barefoot? ) Wash your uniforms separate from regular clothes or at the station. Think twice about hugging the loved ones when you come home. I got sick frequently when I started in the field, now it's rare that I come down with something. I'd hate to pass something on that I've become immune to.

Heh, this isn´t much of an issue for me, as my immediate plans don´t include ambulance work (but it may likely happen - sometimes the ER RNs have to tag along on ambulance trips to FUBAR scenes), and our scrubs are picked up and tossed at the hospital anyway. Also, our equipment stays on the job (most of it is hospital property anyway). I´ve gotten home once or twice and realized I had blood sprayed on my forehead (arterial and venous bleedings), and it´s time for a good, healthy shower.

Don´t want to fuck up a pretty cool thread, but I´m curious as to what your routines are if you get blood spray directly on skin on your job in the US (without any open wounds yourself in the area of impact)?
We do a thorough soap handwash, then hand desinfectant (70%etanol and glycerol). If the case is open wounds etc, there´s screening and shots involved, as if with accidental used syringe "stabs". Hep, HIV, MRSA +++

[grrrr]

You will probably need to supply your own boots. Many places offer a uniform allowance for boots. Hopefully, you will have a uniform allowance for your regular uniforms instead of being tossed something from the back room...because inevitably it will be a size XXL (no chinstrap). You don't need the $300 Haix boots, but find something comfortable and well built. I've had comfortable duty boots that lasted 4 months. I've got a pair of timberlands now that are 2 years old. If you have to shop online, Galls has a bunch of deals on clearance boots, if you can find something that fits. Otherwise, there are stores (particularly in Cali) that specialize in fire/EMS gear.

I'd hold off on supplies until you've had the intro, and ask when you're there if they suggest anything. Many EMT's like to get a holster for gloves/scissors/pocket guide. Another thing you'll want to consider is a personal response bag for your car/home. Now that you know what to do, you will find it sucks to come upon a car wreck and not have your stuff.

[emtnate]

So hey- for my first day, any "stuff" you can suggest I purchase? ...

Definitely buy your own stethoscope.

1. You don't know who's ears they've been in.
2. If you ever grab the one off the truck in haste and the earbuds had fallen off, you will regret it quickly.

I have hearing problems from 6 years of sirens and truck engines, and way too many shows without earplugs when I was in high school and college. Littman's are the only brand I can hear well out of. I do not like the kind with dual lumens. I find they rub on each other during the transport making it more difficult to hear breath sounds. I use the Classic II.

Other tools I carry:

• ALS Field Guide (on a smartphone) - helps with figuring out why people are on certain home meds.
• Leatherman Tool
• Trauma Shears
• AA Maglite

I also keep a few hand tools in my locker that I grab if we get a fire. If I get hired on the city as a paramedic, I'll be adding bullet proof vest.

As for boots, $319 is too expensive. I always wear steel-toes, it gives you a place to rest the backboard while taping the head down and gives protection when your parter isn't around to grab the cot wheels from slamming down. I like the ones with zippers on the side around the engine house. They paid a little over $100 for them.

Don´t want to fuck up a pretty cool thread, but I´m curious as to what your routines are if you get blood spray directly on skin on your job in the US (without any open wounds yourself in the area of impact)?

If it is just a body fluid spray without any broken skin, then it is not considered an exposure. We just wash with soap and water and go about our business. Unless it gets in your mouth or mucous membranes. This happened to me when I was a lifeguard, and it was no fun at all.

[bigsugar]

Lots of good advice here in this thread. In my experience the aspect I struggle most with is the tunnel vision that can come with the truly sick/injured patient(s). Time and experience and training all help, but (as stated previously by others in this thread) emotionally removing yourself from the situation is key. Slow down, think, and chill the fuck out. Makes all the diference in the world.

Oh and good luck with the whole not getting jaded thing.

Good luck. Have fun.

[hutash]

I have been of the web a few days and missed this...Well Done C. I never had, (nor have) any doubt that you wouldn't rock the heath care field.

Some good advice here. Burn out is a huge problem in all heath care fields, and we all have different ways of dealing with it. Find what works for you. One of the best bits of advice here is to find a mentor. It is very helpful to find somebody who has been through "it" before just to be able to phone up, or chat with at the end of a shift.

As for stethoscopes, just buy a good quality one that will last. Getting to know a cheap one works better then using an expensive one you have not used before. The advantage of a better quality one is that you will have it for years (I still have my Littmann from vet school) The Littmann nurse scope is a great all around scope. The cool kids all get dog tags with their name on them and attach it to their scopes, at least all the young vets do.

[babybear]

congrats!! I went the opposite way- ski patroller and EMT to the wall street job. now I'm addicted to the current paycheck but would go back to that field any chance I got. Good for you and best of luck!!!!

[woodstocksez]

My exciting news is that today I got a job offer as an EMT!

It's official: So long, Wall Street, and hello, Healthcare.

This is just such an happy moment I couldn't refrain from posting it up. It's with an ambulance company in the East Bay, and after six months or so I'll be running ALS calls as well, so East Bay'ers- watch out, soon I could show up if you call 911.

...

Beers on me for all!

Congratulations on success in the first steps along your new career path.

I'll be sure to request BeanDip as my emergency responder when my middle son inevitably starts breaking bones (technically, I guess we're South Bay now, but plan to be East Bay in the near future). (I'll wait for my free beer until then.)

[mtnmedic]

The more time you get on the road the less crap you will keep on your belt. You don't need all the holders and gadgets. I would say work a few weeks and see what everyone else is using and what you really need. Grab a decent stethascope, nothing out of control. You'll probably lose your first one anyway, everyone always does. As for boots, I have been wearing these for years and love them.

Lots of good advice going on here. Take it slow and remember that you start learning from here on out, it never goes like the book says.

[AbsolutStoli]

congrats courtney!! way to go after it and not second guess yourself. scary is not bad, just lets you know that youre alive. im not a huge bobby flay fan, but its his quote in my sig, i think its pretty appropriate for our situations.

hows cali treating you?

[BeanDip4All]

Well, yesterday was my first day and it was pretty cool. We have a full gym in the ambulance bay which is really awesome. Although it sounds like we post the entire shift, so I guess people just use it before and after their shifts? Also, everyone at the company seems genuinely nice and it does seem to have a very "family" vibe.

There was one other new-hire and myself, which apparently there were 75 applicants for 2 positions, and we were the chosen two. Wow. But then the thing that freaked me out yesterday was that the very first thing we did was have to take freaking 200 question exam!! Agh!! I was killing myself, I wish I had studied. It was on DNRs and legality questions, and then a section on how to read the Thomas Guide. Also a bunch of skills questions and we had skills testing.

So I passed the test, but am getting pretty nervous for the next couple weeks of training. Basically we have 3-10 shifts with our FTO which we can either pass or fail. And if you fail, then you don't get an offer of employment, and you are SOL. So our boss tells us that 50% OF ALL TRAINEES FAIL THE TRAINING! Agggggh. No pressure there. He tells us that things we can do other than really nailing our skills are to be early every shift, look neat in our uniforms, study the (300 page each) different protocols for the four different counties our firm operates in, volunteer to wash the rigs and do dishes, stay late, and be a good team member. 50% failure rate!

I called my FTO this morning to schedule my training and she sounds really nice. Although she works 24 hour shifts! So next week I am doing three 24 hour shifts with her starting Monday at 7:00am. I asked if I should bring pajamas, and she said "Well, if we get a call we have to be on the rig driving out in under 3 minutes, so I normally don't change, but if you think you'll have time to doso go for it." Fack.

I haven't stayed up 24 hours straight in a very long while. This is going to be interesting. Nothing like throwing myself headfirst into the fire.

Also a kind of fun detail is they are sending us to an 8-hour EVOC course (emergency vehicle operators) which takes place on a TRACK. Heh. Cool. But still... lots of pressure to pass the training.

[irul&ublo]

So hey- for my first day, any "stuff" you can suggest I purchase?

Depending on where in the East Bay you're working, you might want to get some kevlar underwear

[grrrr]

Yeah, welcome to sleeping in the uniform. Just hang your class B shirt by the bed and sleep in an undershirt, uni pants and socks. Boots and shirt on for calls. Don't know how busy your rig will be...some folks actually get to sleep at night, some not so much. My partner is still riding the rig, and she never goes anywhere without her no-doze. Usually a good idea not to plan must-do things for the day after your shift, as you will sometimes need to go back to bed.

I had one shift where we ran all night, then we went out on an inbound isolette call in foggy weather. We we're waiting for the helo to land, so I told the driver I was laying down on the bench for a few minutes. Woke up an hour later with dispatch trying to call us and find out what happened to us...my driver was passed out snoring in the driver's seat and the helo had turned around. woops.

You've proven yourself pretty well up to now, you will do fine on the training! Throw your life into it for the next few weeks, it will be worth it. Good luck!

[zion zig zag]

When I was new I'd sleep in t-shirt, socks and underwear. I can't stand sleeping in socks so those went first. Then I was always hot so the t-shirt went next. Now I'm down to just the underwear. Our SOP's give us 2 minutes to be on the rig and I can get dressed and take a leak in that time.

[emtnate]

welcome to 24 hour shifts. I'd rather work 12s because of the sleep schedule getting messed up, but I take what I can get. I just sleep in shorts. We also have 2 mins to go in route, I don't have a problem slipping on pants & boots and getting the shirt buttoned up in time.

There are days when we're up the whole shift, you'll learn to catch a meal,nap, or bathroom break whenever you get a chance.

Good advice about not making too many plans the day after a shift. The day I tore up my shoulder skiing was right after a rough 24+ shift. I was exhausted, but there was a foot of fresh, epic for southern michigan.

[zion zig zag]

I love the 24 and the time off it affords me. I'd slit my throat if I had to go back to a regular schedule. I still make plans for the next day, you get used to it.

[BeanDip4All]

First 24 hr shift. got to sleep from 1:30am-3:30am. did not make it to the rig in 3 minutes when we had a call in the early morning.

We went into a board and care for the mentally ill at 4:00am that smelled completely rank and kept making me gag. Plus whatever smell it was vaporized into my clothes for the rest of the day. I drove the entire way home this morning with the windows down, despite sitting in CA smog/traffic for an hour. Even thinking about that smell now I feel sick.

had a guy with fungus of the groin keep scratching and scratching and then waving his hand around the rig, another guy with a dirty diaper on who kept scratching that then sticking his feces-smelling hand out at us.

TOENAILS!!!! GAH. wtf is with all the GROSS, gross extra-long, rotted, pointy toenails!!! omg disgusting. plus when you lift the gurney into the ambulance their claw like feet are right in your face.

patient with d-cub w/ MRSA who didn't tell me he had MRSA when i was doing my SAMPLE.

3 people over 300lbs. I can't lift the gurney. I am SO sore already and i just got off shift an hour ago. arms hurt. worried i am going to fail my training because i can't lift the gurney high enough (i am 5'3 and i could only lift it to my waist). need more practice or more strength or better technique.

my insane FTO wants me to work her next THIRTY SIX HOUR shift starting tomorrow at 7am and going till thursday 7pm. Good fucking god.

i think (hope) i will get used to all of the above. but wish i had more time to decompress/sleep/study/take 5000 showers/practice assessments before having to go do it all again (but 10 hours longer) starting tomorrow at 5am.

you know, honestly? maybe this is just a dumb newbie thing, but i was surprised people weren't more thankful for the care we were giving them. not many of them seemed all that appreciative. wasn't expecting them to bow down and sing our praises or anything, but i never expected patients to be so... grumpy. one patient called my FTO a dyke and complained she didn't want a lesbian touching her. (my fto wears a rainbow flag pin).

oh yeah. and the back of ambulances are fucking HOT. maybe i acclimated to nice temperate SF city and now that i am shlepping 300lb people around the east bay greenhouse smog i can't take the heat, but damn i was sweating like a pig in the back of the rig.

so, nap, dog walk, chilling, studying and then ready to do 36 hours again. have to step up my game- not feeling really great about my performance today.

[pappag]

Now THAT is a sweet blog.

[Anxious Mo-Fo]

Groin fungus... now you've got my attention.

[BurnHard]

Now THAT is a sweet blog.

WORD!
WOW. Talk about stress... Who needs to watch TV EMS shows, I'm gonna keep following BeanDip's blog!

Keep your spirit up! You're gonna kill it!