New-Medic Blues

Your stomach turns and your hands are moist as you drive into work. You go over the protocols in your head, and worry because you can’t remember if you need orders to give steroids to a patient in anaphylactic shock. A few months ago, you finished paramedic school and last week completed your ambulance service’s field training program. Now you have an EMT-Basic partner and are on a new platoon where you don’t know many people. It’s your first day as a released paramedic.

At the station, you greet your new partner, and the offcoming shift wishes you luck. As you check out the ambulance, your hands are shaky, and you wish you hadn’t had your morning cup of coffee. Now you wonder what the first call will be, and you’ve pulled out your protocols to find the answer to your steroid question. You aced your medic class and quickly completed your field training, but now you can only think of how much you don’t know instead of how much you do.

A little more than an hour into your shift you get your first call for difficulty breathing at a nursing home. On the way, you think about all the potential causes of respiratory distress—CHF, COPD, pneumonia, pulmonary embolism—and what you’ll do for the patient. Your hands are really shaking now, and you wonder how you’ll be able to start an IV.

You arrive to find an 80-year-old female in bed, who appears to be in moderate distress. The staff tells you they noticed she was having difficulty breathing a few hours ago during her scheduled vital signs check, and she hadn’t gotten any better since. The patient has dementia and isn’t able to answer your questions, so you obtain what history you can from the staff while your partner obtains vital signs. The patient has a history of MI, CHF, hypertension, pneumonia, GERD, urosepsis and depression, and takes the appropriate medications. She has a heart rate of 110 and sinus tachycardia, a blood pressure of 140/100, SpO2 88% on 2 LPM from the nasal cannula applied by the staff, and a respiratory rate of 32, with rhonchi and crackles in the lower and middle lobes. You move the patient over to the stretcher and decide to start an albuterol treatment. Your first thoughts while moving the patient to the ambulance are whether her distress is caused by CHF or pneumonia, and whether she would benefit from nitrates and furosemide. Your next thoughts turn to how the veteran medics you’ve worked with in the past would know exactly what to do, since they have treated patients with similar presentations a hundred times before.

You start an IV en route to the hospital and notice that your hands have stopped shaking. The rest of the call is uneventful. The patient’s vital signs don’t change significantly; she seems to be moving more air when you listen to her lungs again, and her SpO2 increased to 96% with the albuterol treatment and increased oxygen. You move the patient to the bed at the hospital and give your report to the nurse. Now you wonder if you made the right choices, if you were aggressive enough, and if the more-seasoned medics would have treated her the same way.

No matter how thorough your paramedic training or field training program, it is scary when you are on your own for the first time. Even if your mentors and trainers feel that you are ready, there is nothing that teaches like experience.

“Even though they said we were ready, I still wasn’t secure in my abilities,” says Justin Jackson, who was released as a paramedic with New Castle County (DE) EMS within the past year. “I knew I could do it, but there were a lot of things that I had not done enough on my own to feel confident.”

Evan Tsurumi, who recently began working as a paramedic in the Bronx area of New York City, had similar feelings. “As EMT-Bs, we always looked up to the medics. Now, BLS, firefighters and police officers all look at us as the last line of defense, and it was intimidating at first.”