Point of View: Overcoming the Age Factor

As a 14-year-old, I started volunteering with the First Aid Service Team (FAST) at the local American Red Cross. The primary function of the FAST program was to train young people in basic first aid and CPR, and to set up and staff first aid stations at various community events in the area. This was my first real look at the field of EMS. While most of the situations we encountered were relatively minor and only required a Band-Aid or icepack, we were occasionally in the right place at the right time and had the opportunity to assist the fire department medics with sick patients.

As a high school senior, I wasn't sure what I wanted to do after graduation. I knew I wanted to do something fun, something exciting and something that mattered. At 18 years old, in the middle of my senior year, I applied to be a volunteer with the local fire department. The testing process was fairly extensive, with a basic knowledge exam, a physical ability test, an oral board interview, a psychological evaluation and finally a drug screen. It was several weeks before I was officially offered a position and started the 44-hour Washington State First Responder class, the minimum certification required at that time.

My first year as a volunteer was a tough one. I was told that state law indicated that because I was not an EMT, I could not be the sole provider in the back of an aid car with a patient (an additional EMT had to be present), and I was not 21, which prevented me from driving a department vehicle. This didn't stop me from doing everything I could to get out on calls. I was assigned to a combination career/volunteer station, so volunteer-only responses were not all that common. Occasionally, during a working structure fire or other resource, emergency volunteers would backfill the remaining apparatus in the station and be available for subsequent alarms. For the next six months or so, I went to the fire station whenever I could to ride with the on-duty career staff. This was the best way for me to go on more calls and obtain more patient contacts. The following fall I was sponsored into the EMT-Basic class offered by King County EMS at the newly constructed City of Seattle Joint Training Facility.

It wasn't long before I found that maintaining proficiency in EMT skills was going to be difficult as a volunteer with an irregular schedule and limited patient contacts. I applied for a full time EMT position with a nearby ambulance company, and before I knew it, I was cleared from the field training program. It's hard to explain to a non-EMS person how you are able to be woke up in the middle of the night and drive to someplace you've never been to take care of someone you've never met. Our EMT programs do a great job giving us experience taking vital signs, obtaining patient history, administering oxygen and immobilizing and packaging people for transport. The one thing they can't give us is what I learned as a young EMT can be most important…life experience.

No matter how good your EMT school and field training programs may have been, the real test comes when you hit the street for the first time. I distinctly remember my first call after training. Not because it was a memorable call, but because it was the first time I realized what I had gotten myself into.

We pulled up on scene behind the fire engine, and I jumped out of the driver's seat to grab the gurney. We loaded up the patient, my partner got a report from the captain, and then it happened. I positioned myself back in the driver's seat, and my partner looked at me through the pass-through and said "Alright, we're set. You can head for the hospital." My response… "Ok…where's that?"

You will undoubtedly encounter situations that you have never even imagined that will require you to think critically and make split-second decisions in less than ideal conditions. Rarely do things happen the way the EMT book says they should. As a 19-year-old just out of high school, I remember those late-night calls for the assault victim with scene unsecure, the intoxicated person, and the 66-year-old male who "states to be pregnant with the baby Jesus." It was eye-opening to see some of the things that happen after dark. You really do learn to see the world differently through the windshield of an ambulance.

It's not easy starting out as a young provider. You are often put in situations where there is no right answer. What do you say to someone who tells you he wants to die? People will give you a hard time. It goes with the territory and separates the people who can do this job from those who can't. Patients will ask if you are old enough to drive; other EMTs will ask if you are allowed to stay up past 10 p.m.; people will make references to things that happened before you were born and laugh when you stare blankly at them. The key is to stand your ground, let the little things go and focus on what's most important--quality care for patients. Just do your job.

There are senior members in every organization who want to be recognized for the time they have put in and their experience and knowledge. They have learned from their mistakes and the mistakes of others over the years. Working with an experienced provider is an excellent opportunity for a new provider to learn. Ask questions, clarify what you don't know or are unsure about, and take time to discuss the call with your partner. They may have picked up on something you didn't that you want to be aware of next time.

It is also important to note that new providers have a lot to offer even the most seasoned EMS provider. I remember one of my first shifts at the fire department after EMT school, when my lieutenant pulled me aside and said, "I've been an EMT for 30 years and a lot has changed in that time. You are now the most current of all of us. If you spot something we miss on an EMS call, speak up. We're all on the same team and we value your input."

New EMTs see things from a fresh perspective and have fewer bad habits to cloud judgment and patient assessment on scene. Sometimes, we need to think outside the box and get out of the mindset that there is only one way to get from point A to point B.

The way you interact with your patients is another tell-tale sign of age and maturity, and is the foundation of quality and effective patient care. Many of your elderly patients, for example, will take offense to slang terminology and "teenage" lingo. Calling a 75-year-old man "dude" can cause a significant breakdown of communication and make it even more difficult for you as a provider to gather the information you need to treat the underlying medical issue.

As an EMT preceptor, I teach my students to always address people by their appropriate title. If they ask you to refer to them by first name, fine, but never assume. Treat every patient like they were your own mother or father. It is also extremely important to involve your patients in their own care and never talk about them like they are not there.

As a young provider, the best way to earn the respect and confidence of your co-workers is to step up to the plate and admit what you don't know. A good partner will bend over backwards to help you be successful, but only after you have proven that you are deserving of his support and mentorship. I remember EMT school instructors saying, if you can't hear that blood pressure, try it again and then admit you couldn't hear it and ask another provider to try. Never, ever make up a blood pressure. This is a perfect example of personal accountability. Now and then, I have EMT students whom I suspect are having a hard time and, rather than admitting it and asking for help, they guess and go. If you don't know, ask. Practice what skills you struggle with, and periodically read up on things you don't know a lot about.

I am now 23 years old and recently accepted a promotion to field supervisor for a private ambulance service, where I oversee the day-to-day operation of 12 BLS and three critical care transport units used in both a secondary 9-1-1 and inter-facility capacity. Six years ago, I never would have guessed I would accomplish as much as I have in my young EMS career. I am proud to be a part of such an important system that so many people depend on, and I couldn't imagine doing anything else.

Josh Pelonio, EMT-B, is a field supervisor and preceptor with Rural/Metro Ambulance and has been a volunteer EMT with Eastside Fire & Rescue in King County, WA, since 2006.

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