Mental Strategies for Rookie Paramedics and EMTs

It’s your first month on the truck and, so far, you have been very lucky. Your biggest problem is lamenting that you’re getting mostly basic injuries and common medical transports. Then, out of the blue on a random Tuesday, the tones drop and, within seconds, you’re rushing to an unconscious 4 year old who isn’t breathing. No matter how well you did in school and no matter how many times you’ve read the protocols; nothing has quite prepared you for what you’re about to experience. You pull up on scene to find fire and 1 police officer already there. Inside the house, parents and a neighbor are wailing, first responders are trying to tell you everything they know, and there is a lifeless little boy in front of you. You’re the highest level of care on scene, and so everyone is looking at you to fix the problem. You feel the adrenaline pumping so hard that you get this surreal feeling, like this is some weird dream. It isn’t, though, and you’re in charge of all of this. What do you do?

Being that you are probably the most certified on your ambulance or on scene, you need to take control and how exactly do you do that with little to no confidence or beginners jitters?

The short answer: Fake it until you make it. Let’s face it, you spent at least a year in school and passed registry so I am going to bet that deep down inside, you know what you are doing. You know to start by assessing ABCs and you know that if you’re in a code situation, you attack it via CAB. Your mind is going to be thinking through all of the fears you have: What if I screw up? What if he dies because I don’t know what I’m doing? What if I do something wrong and make things worse? These thoughts are all NORMAL. They happened to all of us. They WILL happen to you.

When you haven’t done a certain thing enough to be confident that you can do it well, you will NOT have confidence. WHEN YOU ARE NOT CONFIDENT, YOU WILL FREAK OUT. When you freak out, you will get tunnel vision and have the potential to make mistakes. Don’t stick your head in the sand and ‘hope’ this doesn't happen to you. Expect it, prepare for it, and just realize that the first step in becoming great at something is to have some practice at it.

When you find yourself freaking out, and your brain is running in a thousand directions, here is what you do:

1. Think basic

   If you’re toned out to an apneic patient, you should be running the algorithm in your head before you’re even on scene. Prepare for the worst while you’re driving. Think to yourself “Its going to be a code, and i’m going to be nervous, so I’m just going to focus on ABCs and then if they are dead, I’m going to start CPR, make sure its done correctly, and then make sure I have a patent airway. I’ll have my partner get a line and, THEN, we’ll figure out what’s wrong and fix it.

2. Focus on the patient, not yourself

   If you look at all the questions and fears we talked about earlier, they all have one thing in common: they are fears for YOU. The way to counteract this is to stop thinking about you. Zoom in on the patient and use your algorithms and critical thinking to stabilize the patient. Your first goal is stabilization and to get them to the ED. The best paramedics think of every patient as a family member. If it was your child, you wouldn’t be thinking about how this call would look on your career, you would 100% be zoomed in on stabilizing this patient. That’s what you have to do all the time and its the best way to get good faster.

3. Get good at post-call review

   After every call, ASK THE DOCTOR what you could have done better. Explain the call to your mentor or someone you respect and see what can be improved! I promise that no matter how well you handle the call, after you've done it a few times, you're going to find ways you could have done better. By using the experience and expertise of others to your advantage in post-call review, you will become better FASTER.

During your first year, you are also going to over-analyze EVERYTHING! You may think, “why did I do this instead of that” or “crap, I probably should have done something in addition to what I've already done”.  I can tell you from experience that you are only over analyzing every detail because you genuinely care and want the best for your patient. Nothing, and I mean nothing is “textbook” in the beginning. Sometimes you are going to be like “what on earth is that rhythm?” A first year medic is going to be afraid of missing that MI, so he/she is going to see bad things on a 12 lead ALL THE TIME! In school, you’re taught to expect this perfectly normal sinus rhythm. In real life, though, in most patients over 45, you’re never going to see that perfect sinus rhythm. There are going to be all of these oddities, and it will take you a year to realize which oddities become your new “normal.” Expect it. Count on it. Do your best for your patient and err on the side of caution, and realize that when you get it wrong, that you are GOING to get it wrong until you get your compass needle acclimated to real life. Don’t beat yourself up.

Recently I was on a call and nothing made sense. The gentleman was short of breath and weak, but his lungs were clear. I did a 12-lead and it was so aberrant. I had one of my coworkers meet me en route to the hospital to give me his opinion and when he opened the door I said, “look, I know he has a pacemaker, but I don’t see it and I don’t understand why it looks so abnormal.” He said, “you just answered yourself” and shut the door. After the call I confronted him and explained that I didn't understand what he was trying to say. He explained, “You know the answer. You answered it when you were giving me a brief. You just need to find your confidence and stop second guessing yourself.”

You are your own worst enemy. When you first become a medic or EMT, you can be afraid to treat your patients because you’re afraid you will screw something up.”What if I misinterpreted rhonchi for rales and gave an albuterol treatment and sent a patient into flash pulmonary edema?” Or “what if I gave Nitroglycerine to a patient who had chest pain, but really it was radiating from his abdominal cavity and he had a AAA?” Most doctors will tell you that anything done in the field can pretty much be reversed in the emergency department. That isn’t a golden ticket to go cause mayhem, but quit being so hard on yourself and breathe. When you relax, high stressed situations will go much more smoothly. Remember to not be afraid to consult medical command when you are stumped. I used to call medical command for everything. I think that at one point, I called medical command more than my mother and as sad as that may be, I even had medical command numbers saved in my favorites on my phone. You shouldn’t be afraid to ask for help when needed, whether it’s from medical command or a back up unit.

Throughout this article, I spoke about confidence. You may also hear it from your coworkers and friends. Confidence, confidence, confidence. Where do you get some if you have none? Confidence and respect go hand in hand. Neither can be bought, both have to be earned, and without confidence you won’t get respect. In order to gain confidence you need to practice. Take classes, watch videos, read books, and ask questions when you don’t understand something. No question is a dumb question and every person can teach you something different. Maybe your IV skills stink, but a coworker can show you a trick that he or she learned that makes them easier. Or maybe you have a difficult time intubating and you can gain a few pointers or someone can even tell you what you're doing wrong. Criticism is only going to make you better in the long run.

In order to succeed as a paramedic you’re going to need to get confident, and you’re only going to get confident through practice, study, and EXPERIENCE. It may not be today, tomorrow, next month, or even in six months, but it will happen. Don’t give up and remember to ask for help when you are stuck. If you are struggling with confidence, try not to look lost in front of family or patients because it will make things harder. It is okay to overanalyze everything because you just want to help. You are not the only one who is experiencing all of this. There are a ton a new medics and paramedic students who are scared, but you are a professional and you will do your best. And remember: ALL OF THIS IS NORMAL. You’re a medical professional, you’re the best person on scene and someone needs you. Excellence is not optional. When you’re in the weeds, go back to basics, do your best, and focus on the patient.

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