Episodes
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Kelly Grayson is a very experienced paramedic, educator, speaker and author that serves the EMS community.
You can follow him here:
(10) Kelly Grayson (@AmboDriver) / X
(20+) Facebook
You can find his books on Amazon
Amazon.com: On Scene: More Stories of Life, Death and Everything In Between (A Paramedic's Stories of Life, Death and Everything In Between Book 2) eBook : Grayson, Steven "Kelly" : Kindle Store
En Route: A Paramedic's Stories of Life, Death and Everything In Between: Grayson, Steven Kelly: 9781537770819: Amazon.com: Books
Kelly talks about how he was cocky for many years when he first started as a paramedic. Paramedics often go one of two routes: God’s gift to paramedicine or bringing their text books around in fear every day
Kelly re published En route and On Scene the way he meant to release them in the first place in 2023
A lot of us go through the “God’s gift to paramedicine” phase of our career when we are overly-confident when we are new
Kelly tells a moving story about an elderly woman and how not everyone wants to be saved
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Nick talks about a difficult RSI intubation and his struggle to overcome the feeling that he didn’t do his best
We talk about how intubation success was such a critical point as a paramedic that everyone would have judged you on in the past
We talk about the direct laryngoscopy vs the new video techniques
Advice for the newbies:
Brent: You’re going to struggle with burnout. You need to recognize it early. Prepare for that possibility.Nick: The things that affect you are different for everyone. Certain things you think may not affect you will actually become a problem for you later. You can’t choose the things that you will struggle with. Always treat the patient well and don’t blame them for the problem they are having. It is not all about you. Treat people with respect and give them options. Let them save face.
Mark: Recognize that your happiness is up to you. Don’t expect the company or organization to give you your happiness or your wellbeing. If you see yourself getting less happy, you don’t owe the organization anything. You make the decisions that affect your life. We can’t blame the environment we choose. Make a change if you need to.
The mountain will always be the mountain. We have better gear than we did before but that doesn’t make the challenge itself that much easier. EMS is tough field and that will always be the case
Knowing when to step away is also important
Nick’s metaphor: Event horizons are the edge of a black hole. If you were in space and you passed into an event horizon you probably wouldn’t even notice. But from the outside, you would just appear to disappear. Event horizons appear in our careers as well. You may not really understand you are at that point of terminal burnout but looking back you might be able to pinpoint that point of no return that you crossed.
Where is the event horizon on a call? That point of no return where the outcome is assured.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Episodes manquant?
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Nick talks about a difficult traffic accident and how something that seems like not a big deal but actually affected him – we can’t choose the things that affect us
Is there something protective in the fire or law enforcement world that helps with longevity? Is it the wider variety of calls?
EMDR (eye movement desensitization and reprocessing) is a form of psychotherapy that Nick had some great results from utilizing and highly recommends to those strugglingWorking together as a tribe is a key aspect of a functional scene. Everyone has their roles, their strengths and they complement each other
When things would go bad, Nick would take all the responsibility on himself but share the successes with everyone
Nick talks about an officer that was vulnerable enough to go into the details about a difficult call where he ended up struggling for his life and how this inspired him to get some help and talk about past trauma as well
It is important to recognize your need for help before it becomes a big problem
Our experience on the panel leads us to believe that we are more likely to respond in anger as men in EMS – maybe that prevents us from seeking help sooner
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Why did Nick switch to law enforcement? He burned out on medicine
What does he miss the most: The team mentality. The fire crews that he grew close to. He felt certain they could handle whatever call came their way
We talk about the struggles working a 48-hour shift with a rural fire department but also having to manage the expectation from the private ambulance company that you run calls in a much wider radius to include the city when needed
Sleep deprivation is a big factor in burnout
Nick talks about his heavy caffeine intake and how he started having runs of dysrhythmia that later required a cardiac ablation for atrial flutter
What does Nick not miss? Getting up to run calls. The tiredness. The anger and helplessness
I remember getting to my absolute wits end on those 48-hour shifts and having to call our supervisor and tell them we were done running calls because we were so tired
Nick talks about how he could feel that stress and sleep deprivation damaging him in real time, like if his hand was on fire
The stress level of running those calls an hour from the hospital with no other paramedic on scene and having to perform high level skills has not been matched as a PA in the ED
Nick talks about how, even in law enforcement, his fear of the next call is not equal to what it was as a paramedic
Brent talks about a time when Nick was so angry he started stabbing his seat belt
Don’t blame the patient for their medical emergencies and don’t take your frustrations out on them
Nick talks about losing his temper on an innocent dispatcher after a hard night
Why do we see more resiliency and less burnout on the fire side?
Maybe the team mentality on the fire department, ability to move to slower shifts, debriefing
We all tend to get support after that horrific call that makes the news, but a bigger problem might be the micro-traumas that we all undergo day in and day out
Resiliency needs to be built into the system – you are going to get burned out and have a tough day at some point and it needs to be prepared for
We don’t typically lie to ourselves that we are “okay,” we may genuinely feel okay. It’s later that situations and calls may affect us
Status code 4 is a non-profit for first responders that is doing some great work – Look them up if you need more support
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Mark (paramedic) | Brent (fire officer and EMT) | Nick (former paramedic and current police officer)
Mark has worked in urban and very rural 911 ambulances and does part time EMT education now
Community paramedicine is an emerging field and can vary a lot from region to region. Paramedics are flexible providers, so the potential is hugeBrent has stuck with firefighting from his early days as a recruit all the way to becoming a fire officer
Nick has transitioned from EMS to law enforcement in the last several years
The history of the spine board is a good lesson for new people: The way we practice medicine is a constantly moving target. Best practice is not always based on good data. We used to put EVERYONE on a spine board, but this has turned out to likely be doing more harm than good
Even though logically something might make sense, it doesn’t mean it always does in reality. Backboards and epi are big examples of this
Mark talks about the history of backboards and how this practice came to be
An important point to remember in emergency medicine: If you have nothing really wrong with you, we are more likely to harm you than help you with treatment. This is because nothing comes without risk and if there is truly nothing to treat, the scale weighs entirely to the risk side.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Nate talks about a motorcycle crash he stopped at on his way home and how he was critical in saving an injured patient and how he became close with the family who still talk to him today. Even though the patient ultimately died, the impact he made on that family was immense.
Patients remember us
We need to remember we treat a person not a complaint or a room number
The balance is finding the human connection while not over-empathizing and taking on burdens that are not yours to bare
We talk about moral injury vs burnout – I do agree that we do not need to blame the individual for their burnout. It is certainly caused from many factors outside of their control factor BUT I like to place the responsibility for overcoming burnout on the individual because no one is coming to save us. Looking to blame external factors doesn’t help us in the long run
Mental health struggles are not always obvious to us in people we spend time with
Casey talks about how the cooperate leaders are actually trying to do the right thing for the front-line workers in spite of what we might think about them
What advice for yourself 5-10 years ago?
Nate: Slow down. Listen to those with experience. Bring your love of the job to someone else, especially new people.
Kash: Remember that you don’t have to do everything on your own. EM is a team sport.
Aaron: Enjoy teaching the newbies. You can make or break their experience based on your affect.
Casey: Journal your days in EMS. The babies you deliver. The skills you perform. Something to look back on can be very valuable.
We mean a lot to new people and students so remember the influence you have on people
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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The paradigm around rapid sequence intubation is evolving and becoming much safer with more education and procedures.
Sometimes in emergency medicine slow is better. We need to stay mindful and calm in chaos and this requires us to detach and be above the fray and walk slowly instead of run. This will actually increase effectiveness and efficiency.
Nate recounts his EMT rides with myself and a great paramedic partner I had named Justin
Nate actually paid in EMT school to do more third rides so he could learn from the crews that were good at teaching
Crews can make or break an EMT students experience
Nate talks about how you really have to love EMS. The things we see are difficult, the shifts are long, the pay is not great. Something has to get you through
What affects one person may not affect another.
Casey talks about how it can be tough when things don’t affect you at all. That can be a form of struggle as well.
We talk about some of the hardest things to see in EMS, the cries of a mother or father at the loss of a child.
I talk about, how as an ER PA, I am a little more insulated from the death and the conversations with family than I was as a paramedic.
Nate talks about looking for the good differences you make with people. His job is not to save a life but to prolong lives.
Be intentional about marking those good moments
Casey talks about how a patients family remembered him long after a call
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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EMS varies significantly from state to state so you get a wide range in the abilities of EMT’s and paramedics nation wide
Case reviews are moving to an educational rather than a punitive model
There is no true national standard for EMT’s and paramedic’s which further complicates things
The regions that EMS is practiced in vary a ton as well. Skills may need to be performed much more frequently in an urban area vs a very rural area
Senior, experienced providers should use opportunities to show the newbies how to do skills rather than perform them themselves
One of the hardest parts of being a paramedic is standing back and delegating instead of doing the actual skills
EMS still falls under the department of transportation which is the department it was founded under
Standardization nationwide for EMS practice is difficult for multiple reasons, a big one is EMS needs and patients can vary a lot from region to region. Call volumes are very different from region to region.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Meet our new panel
Kash (EM physician)
Casey (Paramedic)
Nate (EMT)
Why emergency medicine?
Kash: Likes to see results in the short term rather than manage long-term problems. Decided on EM and even an EMS fellowship before starting med school after getting his EMT
Aaron: When in PA school you really need to be at least considering primary care but I decided it was not for me. A day in primary care tended to really drag for me while emergency medicine makes the day go by quickly
Nate: Initially wanted to be a firefighter but enjoyed the medical side more and eventually got his EMT. He loves the diversity of the patients and the chance to help people. He loves critical care transport with the increased knowledge he has gained
Nate: Learn to slow down.
Kash: Don’t just do something, stand there.
Fix the underlying issue. Don’t just blindly treat numbers. Fix the why, don’t just react.
Casey talks about a scenario where slowing down was critical to catching important details during an RSI. Sometimes the whole team gets so focused on individual tasks that simple things (like low O2 sats) can get missed.
Checklists can be critical to making sure the simple doesn’t get missed
We all need to have humility
I address the video that got taken out of context after people thought we were directly comparing EMT’s to CNA’s. That was definitely not the intent.
Nate talks about how he is proud and protective about what we do in EMS
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Matt talks about our reliance on technology and how sometimes it is nice to remember that to assess a patient it is actually really simple without using technology
Andrew: I am mostly paid to not get tricked into missing something big.
Standards in medical education changing when there is emphasis on getting people through programs
Keep holding high standards for your students
Advice for the newbies:
Andrew: You won’t fail if you are trying your best and making the best decisions you can and caring for the patient
Aaron: Take care of yourself before you take care of patients
Matt: Ask for help if you need it.
Julie: Be content with where you are at
Sarah: Progress further in medicine if you can do it
Schasny: Don’t listen to the naysayers. Zero to hero is possible because everyone is different
You can learn from all providers, even if they haven’t been in the field long. Sometimes experience can be greatly varied even with only a short amount of time in the career
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Imminent baby delivery stories
Burnout tips: avoid the overtime. Sometimes the extra money is not worth the additional life stress.
Make sure you get off on time and make that transition to home life.
Andrew uses audio books so he has something to look forward to while driving to and from shift.
Patients are often not even the source of our stress, it’s operational difficulties, interpersonal difficulties and decision fatigue.
Decision fatigue is a big issue we face in our home lives after a significant portion of our day being in fight and flight mode
We talk about driving lights and sirens to every call and the dangers associated with this to the crew and public
This likely doesn’t save lives in any meaningful way that justifies the danger
There is a big push to decrease the emergent responses
We talk about the hazards with emergent returns, the confusion other drivers may have, the danger for the patient and crews.
Road rage isn’t worth engaging in, remember that the bar to obtain a drivers license is very low and many of the meth-using patients we take care of will drive as well. You never know what kind of person is in that other car.
I bring back up the discussion of “Where is God is emergency medicine?”
We see the whole spectrum of life and death. We see people come back from the brink of death that logically shouldn’t and those that succumb that logically shouldn’t.
We talk about strategies to compartmentalize and move on to the next patient
Schasny talks about the traumatic life and medical experiences she has come through and how they have changed her view on religion
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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The team mentality at all levels in the ED is key to a harmonious, efficient and effective environment
In EMS, this can be difficult on a given scene when you may not know the other responders all that well and it can be easy to get offended when no offense was meant
Developing a thick skin is important in emergency medicine. You can’t allow negative emotions of others to affect you all day long.
Patients can be really mean. This is just a fact that can be expected so you can make a plan to deal with it.
One of the cool things about being an emergency medicine provider is that we are the provider that the patient has access to any time of day or night. We are not a expert in any one specialty and that is okay.
Sarah talks about a rough shift in the fast-track part of the ED
Andrew talks about the first code he ran as a medical student and the impact it had on him
It is an honor to be there at a patients last moments and to help their families through it.
It is very easy to forget the human side of emergency medicine. Ask yourself how you would act if it was your family, you were taking care of.
Slow down. Focus on making a connection.
I naturally fall out of making that human connection, so I have to be intentional about connection it or I won’t happen.
Paramedics and EMT’s have a tendency to measure success and contentment by the acuity of the calls they run. I would venture to say we need a better metric: human connection. If you can connect with your patients, this will prevent burnout in your own life and improve your patient care as well.
Strategies for avoiding burnout: music on shift, nebulizing coffee to neutralize bad smells and planning trips
Crazy stickers for comedic relief
We talk about the inaccuracy of pain scales and alternate pain scales
Schasny talks about a patient with an ingrown toenail that got up and left after hearing multiple traumas and code blues announced overhead.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Meet our new panel
Matt (EMT) Julie (RN) Sarah (paramedic) Schasny (paramedic) Andrew (EM physician)
Advice for the newbies: Don’t panic, it is not your emergency
Find the balance of detachment while still making sure the patient feels cared for and understood
Part of avoiding burnout is taking some time to access the human side of youself in caring for a patient while also not taking the emotional stuff home with you
You don’t know it all when you are new. You have just been deemed safe enough to do the job.
Knowing where your limits are is important when you are new
Don’t be afraid to ask more questions of those around you in the beginning
Being a new paramedic has its own challenges as there really is no one to consult or provide direct feedback after a treatment
Some ER physicians are not familiar with EMS protocols so have some grace for this situation
In the ED, we must remember that EMS crews have a ton of operational problems to overcome on calls AS WELL as treating the patient for an emergent condition.
Confidence and experience only come by running call after call. You must see a lot of patients.
Medicine is an art not an exact science
Multitasking as an ER provider is just rapidly changing between focuses but is a huge skill you have to develop
Be in the chaos but staying organized is key to this “multitasking”
Another difficulty as a new ER provider is figuring out the order in which to complete the tasks you have to do
Controlled drowning. New people need to be allowed to feel the pressure and the stress while still having a backup so they don’t experience this for the first time by themselves.
Find a method to not let tasks get forgotten.
I talk about overwhelm when I was a new PA
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Keep asking “why” do get to a full understanding of what is going on
As providers we do want questions asked of us if someone is not sure about something we ordered
Tracey has found techniques to avoid burnout despite 24 years in emergency medicine, she says it is very individualized how you overcome burnout
Belligerent patients do cause burnout and the job to be very difficult in general
Taking intentional time to connect with your patients will help overcome burnout
Tracey has advice to give patients grace
Adam: purpose in life is important to avoid burnout. He believes he is called to be here.
Exercise, spend time with family, move your body, work less or even work more now to work less later
Force yourself to be social on days off, even if you might not feel like it. This will often help your mental well-being.
Owning your mistakes is key to avoiding burnout
Understand we will make mistakes and even when everything goes perfect, we cannot save the patient every time
We really aren’t built to see a lot of the things we have to see in emergency medicine
Be patient with the patients we deal with. They are going through something that we are not and have concerns we may not know about. They are scared, they are frustrated.
You need to have a sense of humor and the ability to compartmentalize
Compartmentalization helps to move on to other tasks that need to be done
Kate tells a story about compartmentalization
It is okay to set boundaries with patients that push on the limits
Deescalating belligerent patients is a skill that can be learned
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We talk about EKG interpretation
Adam talks about the power of teaching
Ongoing learning is key to performing well in emergency medicine and medicine in general
We discuss confidence in emergency medicine and The Dunning-Kruger effect:
People with limited competence tend towards an overestimation of their abilities
It is very dangerous at the top of this curve before you recognize your limits
Most of us feel this effect when we are new to a new level or field
Building confidence depends on the individual
I talk about my own overestimation of my abilities as a new EMT
Your partner on the ambulance can really encourage or limit your interaction with the Dunning-Kruger Effect
Even Adam, who admittedly doesn’t lack confidence, took about 3 years as an attending to gain confidence
For Kim, it took about a year to really build confidence, but also notably in a busy system. However, she still wanted time before taking students. She did that at about the 3 year mark.
As a PA, I think experience teaches you where your limits are.
Adam often talks through complicated problems out loud while working in the ED
Kim makes a great point about experienced EMT’s lacking the background knowledge and the “why” behind treatments. This “why” is critical to learn in medicine
Adam tells a story about how the “why” is so important. You cannot blindly treat a number. You must take into account the whole clinical picture.
Doing nothing is the right answer sometimes.
I tell a story about a paramedic, Amanda, and how doing nothing was the right answer for a patient.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Stress exposure in school is very helpful for real life practice
A good analogy for lay people: EMT is like CNA, AEMT is LPN, paramedic is RN. This helps people understand the progression of levels of care better
Paramedics need to be learning provider type assessments on rotation not nursing assessments
Kim talks about the zero to hero debate: Experience matters not just in emergency medicine. The main difference is the individuals drive and education
Kim talks about a hypoglycemic patient when she was a new paramedic
Kate talks about the difficulty in bringing up possible concerns with providers and how important it is for the providers and advocating for patients
Adam discusses listening to EMS and the patient and the importance of what the patient looked like before they got to you.
Understanding your EMS system is important as an ED provider
We talk about the value of interpreting lab work in the field
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We meet our new panelists
Kate (EMT)
Kim (Paramedic and educator)
Tracey (Former paramedic and current PA)
Adam (Former paramedic and current EM physician)Kate talks about how the public doesn’t know the difference between EMT’s and paramedics
Tracey talks about a humbling experience in her early career where she did not know where her equipment was in the ambulance
Kim talks about changes in paramedic and EMT education. Historically you retain 20% of the information in a lecture format. That has been increased to 80% retention with new techniques like switching to simulation and active learning techniques
Putting the responsibility on the students to perfect their skills is something they will have to maintain in the field as well
Switching to competency-based education from hours based has been a huge change
Simulation based training is very valuable. It teaches you techniques and de-escalation techniques that you can’t learn from text books
We talk about medical scenarios outside of work and how our skills come into play
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Be willing to speak up. Sometimes you might be the only person to notice something important.
We need resiliency in this field. We are all still learning, so stand up and advocate for your patient.
Regardless of your level of care, you need to advocate for your patient.
The hierarchy is largely in your mind. Don't be afraid to approach someone with a perceived higher status than your own.
Take ownership over patient care
Confidence varies in how long it takes to develop
Be willing to be uncomfortable, it is how you will continue to learn
Be willing to make mistakes
EMS to in-hospital care can be a steep learning curve even as an EMT
We talk IV’s and IO’s, staples, “foley buddies and “no no zones” discussion
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Nate (EMT) shares his story and the issues he has been dealing with.
Nate overdosed on medication and ended up in inpatient psych care which helped him immensely.
He still feels grief from time to time but does have happiness more now.
Nate wants people to know that these struggles are real and you are not alone. Don’t be afraid to talk about it. Seek counseling and therapy.
The field we work in makes us prone to dealing with mental stress and health.
Dark humor is a method we use to move on to the next patient or next call.
Our job is to help the body heal itself, sometimes this doesn’t work and we can’t get caught up in the times when it doesn’t work. We must be comfortable outside of that control.
We can’t save everyone.
A bad partner or burned out partner on the ambulance can really ruin your experience. We all need to be willing to teach in a tactful nonjudgmental way.
Sometimes doing nothing is the right answer if a patient needs an OR and a rapid transport is necessary
If you want to support the show, follow the links below for some great health and fitness products.
My favorite protein:
https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMSMy favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor u
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We meet our new panel:
Eric (EM Physician)
Shelby (EMT)
Nate (EMT) and returning guest
Sam (Prior EMT, ER RN)
DeTessa (ER RN)
Part of the fun part of the ER is getting to start from scratch and figure out the puzzle
Stories do change as the patient talks with different providers
We are not equipped to diagnosis or resolve chronic problems in the ED, we can’t provide every answer for every symptom
The mindset of the public of what the ER is vs reality is often quite different
We do need to understand that waiting for your ER work up can be very difficult as a patient, especially when you are in pain.
We need to have grace for this patient perspective
We talk about GSW patients and chaos that is present on scene and in the hospital
If you want to support the show, follow the links below for some great health and fitness products.
My favorite protein:
https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMSMy favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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