It. Is. Finally. Over.
You're excited to be a graduate of paramedic school and now you're starting your first few shifts as a paramedic. Except... now you realize that once you go out on calls, it's up to you. There is no preceptor to hold your hand, and your partner may be less than helpful. Here are five things you should know now that you're out on your own (so you don't end up like the kid in the picture).
1. You need to have plenty of resources
No one can remember everything. Some apps are free, some apps cost $10 or $15. Medical apps are worth the little bit of money you spend on them if you use them correctly and to their full potential. You spend more on dumb stuff. Get over the sticker shock. They have dosing charts, calculators, clinical sign and symptoms reminders, normal pediatric vital signs, etc. Take the time to get to know these apps so you can actually refer to them when the time comes. Also, have a PDF copy of the protocols or guidelines that you work with in an easy to access place on your phone.
Another thing you can do is write out notes and plans in a notes style app. I have a couple that I use (mostly the notes app on my iPhone). I write in here how a specifically mix all the infusions that I may come across such as Ketamine, Levophed, Epi, Amiodarone, Cardizem, Magnesium, etc. There are tons of medications that you can infuse on a pump in your ambulance if you stop and think about them. Write yourself instructions in your notes app so that when the time comes, all you have to do is read the idiot proof instructions you already have prepared. You could even make yourself graphs, charts, or include pictures to help.
< Here is a screenshot of what I regularly refer to or play around on.
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2. You should have a written or prepared plan for high stress situations
Have you ever truely been the lead provider in charge durign an RSI or DSI? At some point, you will have to. Have you thought about what medications you will use? Your protocols / guidelines probably allow you freedom to choose several different avenues of anesthesia. Figure out a plan for what medications you will use for which patients, why you would use those medications, and how you will administer them (get very specific). You might be noticing a trend here... Be prepared and write out your plans. This can apply to assisting in childbirth, intubating, running a code, caring for a crashing cardiac or respiratory patient, etc.
3. Know how to read an ECG correctly
Oh I forgot... You just graduated from paramedic school! You must be better than anyone else in the world at ECG interpretation.... I thought the same thing when I graduated paramedic school. I was wrong, and so are you. Perform a simple self test of your baseline knowledge (I got this one from Tyler)...
1. Take a black piece of paper.
2. Draw out 12 boxes like a 12 lead
3. Label what each box should be
4. Draw what each complex should look like in each box.
How did you do?
Do you know which leads should be mostly positive, negative, biphasic, have specific waves? Do you fully understand R wave progression? How about axis deviation? That stuff is just the absolute basics. Now try and draw subtle ischemic changes according to which coronary arteries are blocked. How about a Posterior MI? De Winters T waves? Wellens sign? Progression of hyperkalemia? How about Hypokalemia? Can you spot an MI in LBBB, LVH or using Sgarbossa criteria or Smith modified Sgarbossa criteria?
4. Know how to use all the equipment in your ambulance thoroughly
Everyone sucks at the IV pump when they first start (if your ambulance does not have an IV pump by 2017, quit). Learn how to set up infusions, piggy back infusions, drive lines, etc.
Know all the functions on your cardiac monitor. Know how your monitor expects you to place the limb leads (this is important). The Zoll I work with expects the limb leads on the limbs. The local hospital has a machine that expects the limb leads on the core. Know your equipment because it can change the way the 12 lead looks. Figure out how to pace someone, perform sync cardioversion, defibrillate, use the pacer magnet, set BP timers, use the invasive blood pressure monitoring devices, figure out how to zero an art line transducer.
Know how to use your suction the right way. Look up S.A.L.A.D. (suction assisted laryngeal airway decontamination).
Hopefully your service has done away with longboards, how are you with the scoop stretcher?
Not knowing how to use your glucometer is a sure way to look stupid....
If you only learned how to place an IO line into the tibia, your teacher shorted you some valuable information. Placing an IO into the humerus gives you the ability to infuse with the reliability and distribution of a central line! Learn proximal humerus placement!
5. You need to have a study plan
Everyone has a plan to study medicine after paramedic school... Most people never do it. They go off of the already outdated medical information they learned from their dusty paramedic instructors (this goes for any medical profession). There are all kinds of recommendations for your first year. Try reading a recent copy of Rosen's emergency medicine over the course of your first year. For a paramedic, you will find lots of terms and measurements that you are not familiar with. If you educate yourself on these things, you will be way ahead of most first year paramedics. There will be lots of chapters that you will think 'this does not apply to EMS at all.' The more restricted to EMS paramedics keep their knowledge level, the more useless we will be as a practitioner as our scope of practice continues to expand. Don't be ignorant. Educate yourself about every aspect of emergency medicine.
If you don't want to study that book, study topics. Shock should be your first topic.
Distributive
Hypovolemic
Obstructive
Cardiogenic
Figure out how to detect, diagnose, and treat these forms of shock appropriately.
Once you graduate paramedic school, your real education can begin! For good or for bad, you will be defining your own practice of medicine. I am still surprised to this day the amount of new paramedics I meet who cannot do simple things like medication math or properly interpreting an ECG. Don't be that person! Try to have goals like the ones I've outlined here, and make your practice one of evidence based medicine!