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Patient Care

What’s Your Motivation?

In 1989 I was an undergraduate college student in upstate New York. I’d been an EMT for a couple of years. I decided I wanted to increase my knowledge and skill set and get some ALS training.

I was an intern with Town of Colonie EMS Department (TOCEMS). I was riding as a third crew member during my internship when we had a dispatch for an 18-wheeler that had rolled over, with the driver in cardiac arrest. My unit arrived at the same time as everyone else—multiple fire units, several ambulances, two ALS fly cars, the chief, and tons of police. A huge crowd gathered around the victim, and we began CPR and associated modalities. The chief took command and quickly assigned roles. He called out, “Barry’s doing the tube!”

I thought to myself, Holy cow! I’ve only done endotracheal tubes in the OR. This would be my first time in the field, and in front of six other veteran paramedics and my chief! Nervous as anything, I worked my way through the crowd, readied my laryngoscope, and dropped a 7.0 tube on the first try.

I was proud of myself. Had I not been successful, I would have felt quite embarrassed in front of everyone. In those days we did CPR in the ambulance during transport and worked the patient all the way to the hospital. This patient was pronounced a few minutes after arrival at the ER. A patient died, and all I could think of was how pleased I was that I performed that skill correctly.

Reflecting back on this call 30 years later, I question my mind-set and wonder for whose benefit we perform our EMS skills. Perhaps some are for our own gratification or our partner’s approval rather than the needs or outcome of the patient.

Known Landmarks

The two are not mutually exclusive. You can please yourself and your partner and care properly for the patient. The patient’s needs always come first, of course; anyone who would perform unnecessary interventions on a patient just to show off has no business in EMS. You can rightly “celebrate” a successful difficult IV or securing a challenging airway but try not to lose sight of who it is for.

EMT and author Courtney Marino noted that “there are certain types of calls that are recognized in the EMS world as the big ones”—your first full arrest, delivering a baby, first stabbing or gunshot wound. “It’s not that your station mates want to celebrate the death or tragedy you might have just witnessed… [it just] marks your evolution in the field and helps to plot the map of your experience, all the while assuring you that you’re not alone: These landmarks are known landmarks.”1

We cannot control the calls we respond to. We can control our motivations, mind-sets, and responses during and after these calls.

To help reflect, when you employ an EMS skill, ask yourself the following questions:

  • Is it medically necessary?
  • Is it good for the patient?
  • If I am having difficulty, am I confident enough to ask for help?
  • Am I celebrating the success of the skill over the success of the patient?
  • Do I look for excuses if I am not successful with a skill, or do I problem-solve on behalf of the patient?

Newer providers should be especially mindful of what’s motivating them—admiration, approval, or praise from their partner, or patient need? If the stronger motivation is wanting to avoid strong or inappropriate criticism because a skill wasn’t done quickly enough, well enough, or perhaps even required a second or third try, that requires a hard look at the mentoring culture of the agency. Is it a culture of coaching or one of criticism? Are you inherently satisfied with your level of performance, or are you relying on others to affirm you?

At the end of the call, the true professional is harder on themselves than any partner or colleague could be. A suggestion is to be reflective and ask for constructive feedback from others. This is a good way to grow, and when your partner knows you’re inviting the feedback, it creates a stronger climate. According to Pennsylvania EMS Program Manager Aaron Rhone, “Coaching should be used to develop specific competencies, improve work outcomes, and introduce new skills or systems.”2

Colorado medic Nick Nudell wrote, “Paramedicine is at a point where it would benefit from developing a culture of mentorship that extends across age and experience groups. The evidence in not just healthcare but also paramedic research supports the benefits that come from a formalization of mentorship. There is untapped knowledge available among our peers that will improve our organizations and also, as a result, our profession and the care we provide each patient.”3

As emergency medical providers, we provide services and skills most of the public can’t. This job is hard enough without the weight of possible criticism or self-aggrandizement affecting our advocacy for the patient. We should be proud of ourselves when we deliver a patient to the hospital in better shape than we found them. If we don’t, we owe it to ourselves and the patient to figure out what we can do better in the future and approach the next call with a better mind-set.

References

1. Moreno C. Dealing With Trauma: An EMT On Coping Mechanisms. Huffington Post, 2014 Sep 29.

2. Rhone AM. Mentoring vs. Coaching: The Differences & the Impacts on EMS Leadership. J Emerg Med Serv, 2018 Jul 18.

3. Nudell N. Methods in Mentoring: Mentoring Models. EMS World, 2019 Mar 22, www.emsworld.com/article/1222438/methods-mentoring-mentoring-models.

Barry A. Bachenheimer, EdD, FF/EMT, is a frequent contributor to EMS World. He is a career educator and university professor. Active in EMS since 1986, he is currently a firefighter with the Roseland (N.J.) Fire Department and an EMT with the South Orange (N.J.) Rescue Squad. He is also an instructor at the National Center for Homeland Security and Preparedness in New York. Reach him at bbachenheimer@albany.edu.

 

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