Remember Their Faces

One of the easiest routes to take when dealing with the incessant 911-caller, often endearingly referred to as our frequent flyers, is to show them to their seat in the ambulance and ignore them thereafter.  Generally, these are the callers that - to many of us - regardless of the hour, it is never the right time for them to call.  Typically, these patients are homeless, under-educated, have poor coping mechanisms, a combination of all three, or more.  And sometimes, they fall under none of those categories.

It is simple to assume that because of their seemingly unfortunate circumstances, they won't complain about your lack of understanding, compassion or clinical intervention, and that no one would care even if they did complain.  But is this what we trained for?  Look, I'm not going to say that I've never been frustrated by those callers.  Perhaps, however, we can take the opportunity, instead of berating them for calling just as we're about to get off shift (because obviously every time they call we're about to get off shift), to speak to them, listen to them and truly make the attempt to empathize with them; to appreciate their story just as you'd want someone to hear yours.

One of the most eye-opening, and to some extent, absurd things I've ever heard was "wow, I can't believe you actually treated that patient," referring to one of our regular clients who I found to have an altered mental status, an irregular heart beat, and hypotension.  This wasn't said to me insultingly as if I had over-treated the patient; rather, it was said in true disbelief because so many paramedics and EMTs would have ignored or completely missed the fact that this familiar face was acting differently than he normally does.  That is, because he's a regular, many would have walked him to the ambulance and potentially not even assessed him, dropped him off in the emergency department waiting room and never recognized that the patient was unstable.  Why? Strictly because he was homeless, an alcoholic and called 911 often.

This presents two stunning issues with the current state of EMS: (1) Many of the newer generation of employees only care about themselves, which unfortunately leads to the second issue, (2) they can't empathize with the patients and therefore do not always provide appropriate patient care.

Just the other day I was reminiscing with a friend of mine about a patient we often saw in the ER where we both previously worked.  We admired his persistence to stay afloat, despite multiple co-morbidities causing him to drown slowly.  We chuckled about the fact that he knew the ER so well that we'd recurrently find him in the staff kitchen area getting snacks and juice.  My friend also recalled that one time when the patient was in the ER she asked him why he was homeless.  He told her that his wife left him, he felt lost, found the bottle and drank himself into homelessness.

His story is not so far from the truth for many of our frequent flyers.  In fact, according to Crane et. al. (2005), homelessness later in life is often a result of relationship breakdown, disputes with neighbors, death of a close family member, loss of accommodations or financial troubles.  In addition, alcoholism and mental illness are common contributing factors (Crane, et. al., 2005).  Furthermore, Mojtabai (2005) explains that while mental illness is not a primary reason for homelessness, it certainly increases vulnerability, which has been noted in research for many years.  And according to HomeAid, a non-profit organization that works to provide housing for homeless individuals, homelessness can be linked not only to the above causes, but to domestic violence, divorce or other family disputes.

So, clearly, many of our homeless patients do not consciously choose to be homeless.  Some do, but many of them do not.  And regardless of socioeconomic status or living arrangements, we have a job to do, and that is to care for our patients fairly and responsibly.  Unfortunately, however, I'd guess that many paramedics and EMTs see the homeless frequent flyer as an inconvenience and not as someone, a person,  they can learn from.  Simply put, they don't inquire as to why the patient is homeless because they don't care. 

As I alluded to above, perhaps this is a result of the newer generation of paramedics and EMTs being born into the "me me me" generation; the offspring of the baby boomer generation, or generation me (Stein, 2013).  That is, the newest group of our EMS providers were brought up to believe that they are IT.  Stein (2013) explains that this group, now in their early 20's are three times more likely to be diagnosed with narcissistic personality disorder compared to the generation now in their 60's or older.  By definition, this generation lacks the ability to empathize with others (PsychCentral, 2014).  Thus, this group of newer EMTs and paramedics lack the ability to care for another individual as is required to be effective EMS providers.

I always tell my coworkers and trainees that we have two primary jobs: patient care and patient advocacy; neither are mutually exclusive of the other.  To provide good patient care, one must be a good patient advocate, and to be a good patient advocate, one must do good patient care.  And to do both well, one needs to listen to their patient and to care about what their patient has to say.  To treat their patient as they'd like to be treated themselves.  Or to treat their patient as they would like their family members or close friends to be treated.

Every time I've asked a patient about their homelessness, the answers vary, but are all, nevertheless, equally tragic.  One patient told me he was homeless because he ran away from his home because he was being sexually assaulted on a regular basis, and not just by his parents; his parents prostituted him to make money.  Another got a divorce, lost his children, home and everything, turned to alcohol and drank himself onto the streets.  Others have cited inability to control mental illness or physical disability.  Again, regardless of their reasons for being homeless, or even the fact that they are homeless, they are people who are in need, and so should be cared for. 

Perhaps one of the greatest struggles we, as paramedics, have is identifying with our patient.  Being able to feel what they feel, think what they think and see what they see is not easy for many of us, especially when the patient is the only representation of such an unfortunate life.  However, homeless people are not the only ones who have been sexually assaulted, involved in domestic violence or diagnosed with a mental illness.  In fact, many of our coworkers, family members and friends have been diagnosed with or qualify for a diagnosis of a mental illness, have been in abusive relationships or have been sexually assaulted.

While you may never know who these people are, or that you even know them, they exist in your world.  They are part of your life.  They are your way to identify with a patient you may otherwise care nothing about.

For a few years before I started working at my current place of employment, I volunteered with an organization dedicated to educating people about mental illness in order to decrease the stigma that surrounds it.  I had the opportunity on a number of occasions to share my story of a life with depression.  I shared my story to empower those incapable of sharing their own and to encourage those too afraid to seek help to reach out and speak to someone about their struggle.  I shared my story to give people a relatable and unsuspecting face of mental illness. 

Now, I share that publicly (again, not for the first time, so no worries about the gasps or jaw drops that may have just happened) to provide my coworkers - those I know and those I don't know, those who work for the same company as I do, and those who I'll never meet because they live elsewhere in the world - a face or representative for the mentally ill patients you encounter, some of them homeless, and many of them not.

Sharing is not for everyone, and I know that, and I don't expect a revolution of paramedics offering their own personal stories to coworkers in order to convince them to treat their homeless or mentally ill patients with respect.  For those who do share, I commend your bravery.  For those who cannot, I understand your struggle and your pain.  I understand your desire to keep your personal life personal and your private experiences private.  There are many reasons to share your story, and many reasons not to.  So, for those who are not comfortable sharing, in this forum, I speak for you. 

I speak for the unimaginable number of individuals who die by suicide each year.  For the multitude of people who are diagnosed with a mental illness each year.  And for the millions who live each day with an undiagnosed mental illness for fear of seeking treatment because of the undeniable stigma that exists.  For those of you who know me, let me be the face you see.  For those who don't know me, let me be the voice you hear.  Although, you really don't need to go too far to find a face; use your own face, your parents' faces, your siblings' faces, your friends' faces.  Or simply, look your patients in the face, speak to them, and remember their faces.

I ask but one thing: recognize that you are not alone in your struggles, and that your patients, too, should not be alone in theirs.  Mental illness does not discriminate against age, gender, race, religion, ethnicity or socioeconomic status, so certainly we, as healthcare providers, shouldn't either.  Regardless of who your patient is, where they come from, or how many times they've called this month, treat them as you would like to be treated.


References:

Crane, M., Byrne, K., Fu, R., Lipmann, B., Mirabelli, F., Rota-Bartelink, A., ... & Warnes, A. M. (2005). The causes of homelessness in later life: findings from a 3-nation study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(3), S152-S159.

HomeAid (n.d.) What is HomeAid?  Retrieved from http://www.homeaid.org/About-Us

Mojtabai, R. (2005). Perceived reasons for loss of housing and continued homelessness among homeless persons with mental illness. Psychiatric Services, 56(2), 172-178.

Staff, PychCentral (n.d.). Narcissistic Personality Disorder. Retrieved from http://psychcentral.com/disorders/narcissistic-personality-disorder-symptoms/

Stein, J. (2013, May 20). Millenials: The me me me generation. TIME.

 

I have been changed...

As I've mentioned in previous posts, often I have been asked why I chose to become a paramedic; why I remain a paramedic.  The answer I frequently provide, jokingly, of course, is because I am selfishly selfless.  The looks I get after giving that answer are generally perplexed.  So, let me explain.  I enjoy helping people.  I feel it is my calling to render aid to those in need.  Thus, when helping someone else, I get the warm and fuzzies; I am selfishly helping others.  However, how selfish is it really?

According to a Psychological Reports article from 1996 by Francine Grevin, paramedics show the highest rate of burnout among all other healthcare professionals due to "dealing with life and death emergencies in hazardous environments and chronic exposure to human tragedy" to name a few.  That is, we see graphic things in austere environments.  Grevin (1996) comments that such astonishingly high rates of stress lead to burnout, drug and alcohol abuse, and work-related and family problems.  Furthermore, Drewitz-Chesney (2012) explains that paramedics experience higher rates of PTSD than police officers and firefighters for the same factors listed above, which can be severely detrimental to personal and family lives.

So, I ask again, how selfish is it really of those of us who chose to become paramedics because we get a good feeling from helping others?

My co-workers and mentors in EMS always told me that EMS changes people, but, naively, I chose to ignore what they had to say and pretend that I was invincible and couldn't be changed.  My mind, and thus behavior, could not be altered by the effects of EMS. 

But I find myself wondering how invincible I truly am, or was.  I have seen, over the years, friends get married and get divorced and get married again and get divorced again.  I have seen relationships blossom and relationships die.  I've seen the spark of happiness in a new employee's eyes and the look of horror and defeat in their eyes just years, or even months later.  But I have also seen marriages and relationships flourish in EMS for whatever reasons; maybe strong coping skills, resilience or a sense of coherence (a view of the world that recognizes the meaning and predictability of it), as Streb, Haller and Michael (2014) suggest.

My parents recently asked me if I actually have feelings, if I have the capacity to love another human being, trust another human being.  And honestly, that got me thinking.  Do I think I have that capacity, of course.  I have grown to truly love many of the people I work with, if for no other reason because of the common bonds we share, because of the tragic images that will forever remain stained in our brains.  For the sounds of gunfire that will forever ring in our ears.  And for the stench of a dead body that will forever remain in our nares.  We share that.  We get that.  Not many other people can understand what we understand.

I've recently found myself at events with friends of mine from my pre-EMS life.  They do and forever will have a special place in my heart.  But every time I see them, I find myself thinking about how much THEY have changed.  How little we have in common because they're all different.  Although, I can't help but think that maybe they're all the same, and I have changed.

For example, the things we used to discuss no longer interest me.  It's no longer intriguing to hear about so-and-so and whatever mishap has happened in their life.  It no longer piques my interest to hear about so-and-so and their 60-, 80-, or 100-thousand-dollar-a-year job.  Or about their children who are constantly misbehaving, or their children who are perfect angels.  It no longer makes me smile when they talk about how inexpensive their ridiculously priced haircut or shirt or suit or shoes cost.  All I hear in my head is how petty the discussions have become. 

Why should I care that you are cooking a 10-course meal for people who just moved into the neighborhood when I have to walk into homes in the middle of the night and see malnourished children who have never, and likely will never experience a 10-course meal?  Why should I care that your pool man or housekeeper didn't show up today, even though they were supposed to, when I see people who are the pool man and the housekeeper both for their family and yours?  Why should I care that your kid can read at 1 year old when I see 50 year olds who never had the luxury of attending school, and still have no idea how to read?  Why should I care about your debate between this name brand pair of shoes and that name brand pair of shoes when I have patients who couldn't dream of such shoes or having a debate about such shoes?  Or where you're going to eat for dinner tonight when I see people who don't even have enough money to put food on their own table, in their stomachs and their childrens' stomachs, not to mention eat off the dollar menu at McDonalds??

Do I feel this way because I have changed or do I feel this way because they have changed?  If it's me, is this a good change or a bad change?  Is it bad that the conversations and people who used to interest me rarely do so now?  Is it a problem that with whoever one of us has changed, a distance has grown between us?  I can't answer that question for myself or anyone else.  What I can say is that things that once were run-of-the-mill, important, life-altering questions and decisions no longer seem to be; in fact, many seem unimportant and petty.

This previous line of questioning brings to mind a song from the epic Broadway play Wicked: "For Good".  A line from the song "Because I knew you...I have been changed for good".  I think of my career in EMS in a similar way; however, to define the word good appropriately in context, I have to figure out if EMS has changed me for the better, or forever; both of which sufficient definitions for the word good.

I know that over the years in which I have been in EMS, the way I view the world has changed.  The things that used to have meaning, don't necessarily carry the same weight as they used to.  The people and interpersonal relationships I've known no longer have the same significance.  The context of the world has changed in my mind.  Certain things, materials, individuals and experiences don't have the same relevance as they once did.  However, the world is still a meaningful place for me.  So, have I changed for the better, have I changed forever, or both? 

I'd venture to say that to those who once knew me, my world, my attitude and my ability to express and receive emotion, I have changed...not for the better.  But does that make me a worse person?  No, it makes me a person more familiar with what may or may not be as important in MY world as it may or may not be in someone else's world.  It makes me an individual who recognizes that the world and the environments in which we live are ever-evolving, dynamic and, to some degree, predictable.  It makes me a person who is more aware, both of my self and my surroundings.

But, again, to those who once knew me, it makes me appear more distant, withdrawn and, perhaps, less compassionate.  The truth is, externally, I may not convey compassion, I may not be the model of kindness and caring, but I am compassionate and I do care and I am kind.  I just express my sense of caring in a less exaggerated fashion to things, material and individuals who aren't experiencing true tragedy or dilemma.  I don't appear compassionate to those suffering from a bump in the road versus a life-changing, sentinel event.  That, however, does not mean I don't care; it just means my view of what is important has changed.

So, relating back to relationships outside of my EMS family, I can understand why people say I have changed, because I have.  But, because they don't know what I do, how I do it, or even the circumstances under which I do it, they don't get it.  And they never will. 

To reference my last post regarding burnout, which is very much related to this post, paramedics and EMTs might find it easier to confide in and express emotion to others who have experienced the same or similar incidents as they have, that's just human nature.  Is it something to become offended by?  No.  It is just a reality that those who aren't in the EMS family must learn to understand and accept.  It is also why having people with whom you can relate is so important for those of us in EMS, because most of the time, we won't find it at home.  And at home, our behavior, emotions (or lack thereof), and point-of-view may not be favorable, even if we can no longer control it or provide reasonable explanations for it. 

But there is a reason.  In fact, there are as many reasons as there have been patients under our care.  Every patient has a story, and every story affects the story of my life, of our lives, of any EMS provider's life.  Those stories have changed us for good.  Those stories make all of us question whether or not we pursued a career in EMS for selfishly selfless reasons, or for selflessly selfless reasons.  While we may gain a stronger sense of self throughout our careers, to others who knew us before, we appear to lose some of ourselves.  Maybe we do lose some of ourselves, but that which we lose, we gain in other areas of our lives and we do become better people forever, potentially just more difficult to understand.


Citations:

Drewitz-Chesney, C. (2012). Posttraumatic stress disorder among paramedics: exploring a new solution with occupational health nurses using the Ottawa Charter as a framework. Workplace health & safety, 60(6), 257-263.

Grevin, F. (1996). Posttraumatic stress disorder, ego defense mechanisms, and empathy among urban paramedics. Psychological reports, 79(2), 483-495.

Streb, M., Häller, P., & Michael, T. (2014). PTSD in paramedics: Resilience and sense of coherence. Behavioural and cognitive psychotherapy, 42(4), 452-463.

Burnout...The Other Silent Killer

Burnout is a terrible thing that we all learn about in paramedic school.  It's usually discussed in the first couple of chapters of the paramedic book, but never again, really.  Burnout sucks.  When you get to the point that showing up at work makes you cringe and you start developing creative excuses for calling out or going home early, you're getting there.  When you lose focus and forget about why we do what we do, and allow that to change the way you do things, speak to people and think, you've probably gotten there.

Recently, I hit what others have told me was my "first burnout".  A burnout that, thankfully, is easy to overcome.  I've been asked by other paramedics, many of them newer than me, how I stay focused, appear calm, and always try to do what is best for my patients...basically, how am I not burned out.  My answer is usually that appearances are deceiving.  I've learned over the year to develop the paramedic version of a poker face.  That is, I don't show my emotion.  I don't allow my patients, their family members or my crew to see the stress in my head.  I keep it in my head.

As to how I strive to deliver par or above par patient care, the answer is simple.  Our patients, whether homeless, smelly, mean, nice, poor, wealthy, or what have you, are someone's family member.  They are a brother, sister, father, mother, aunt, uncle, cousin to someone.  They are someone to someone.  And we have been put on this earth, for at least this moment, to care for them.  So how do I stay focused, appear calm and attempt to do what is best for my patient?  I put myself in their shoes, or, better yet, I put a friend, or my parents, siblings, cousins, family members, in their shoes and remember that I have to respect my patients the exact same way I'd expect...and demand...a paramedic treat my family member.

But, I also explain that it is our responsibility to do what is best of the patient because that is our job.  We were not hired, nor did we attend school and ultimately get licensed to practice as paramedics and EMTs to sit on our asses and do nothing while our patients writhe in pain, wretch from nausea, cry due to depression, clutch their chests because of chest pain, or struggle to breath as a result of COPD; we got hired to act upon our callings to save lives and treat people in their time of need.  We come to work every day (for many of us, just three days a week...THREE out of seven), to be compassionate, to speak to our patients, to listen to our patients when they speak to us, and to treat our patients when they need us.

The practice of medicine is taking an interesting turn.  We've seen medicine all over the place (especially in the United States) move away from patient-focused medicine to finance-focused medicine.  Medicine has shifted away from a practice to a field in which we can be sued for making human errors.  From a field where good judgment, clinical gut, hands-on-diagnostics to a field where every test must be employed to cover ourselves from legal liability.  Ultimately, however, medicine is still and always will be about the patient.  If we fail to focus on our patients, on what they tell us, on their signs and symptoms, the minutia we find, what they feel like, sound like, smell like or look like, we will fail at providing patient-focused medicine. 

Again, we went to school to learn how to interact with other humans, to be humans who are capable of helping other humans when the need arises.  We went to school to do this, so, why not do this?  Why not give it your all, for three days a week?  Why become bothered and frustrated when someone makes you have a bad day.  For all intents and purposes, they called 911, so by definition, they're having a bad day!  That's why they made your day worse; why they're being rude or short with you.  They're sick!

So how do I try to continue to treat patients to the best of my ability even if I don't feel like it?  Because not feeling like it is not a legitimate excuse; it is an excuse that simply represents laziness, the inability to convey compassion.

Sometimes We Miss Things...and Have to Start All Over Again

A wise paramedic once told the young paramedic student me "I can stop you from killing someone ten times faster than you can kill them".  At the time, it didn't really mean anything to me.  I thought how could he read my mind and know what I'm going to do before I do it.  Now, I understand exactly what he meant.  It is my responsibility as a preceptor and field training officer to be ten steps ahead of whomever I am precepting.  Further, it is my responsibility to pay attention to my students, partners or new employees at all times, even when I am or appear to be doing something else.  By paying close attention and thinking way ahead of their game, I can stop my students, partners or new employees from killing someone ten times faster than they can actually kill someone. 

But, when a preceptor doesn't follow behind a new employee's or student's assessments, it's impossible to be ten steps ahead of them; in fact, the preceptor will likely be ten steps behind, if even that close.

The call that taught me this lesson was about two months after I finished paramedic school.  My partner at the time - a phenomenal EMT, and now an excellent paramedic - was in paramedic school.  I trusted him.  We worked together for a few months at that point, and I was confident in his abilities as an EMT and a paramedic-to-be.  I guess I should add that I still trusted him after this call because what he showed me, I otherwise might not have learned and he certainly learned from his error.

We were called to a person down at an intersection approximately 15-20 minutes from the closest hospital (which is a fairly far transport for us).  Of course, en route to the call, I was both nervous and excited.  But I also wasn't really sure how to feel because we had been dispatched to this type of call at this type of location so many times before and found nothing.  So, part of me tried to convince my (new paramedic) self that no one would be there, but the other part of me wanted nothing more than to feel prepared for whatever I might find. 

Although, even as a paramedic, I knew that no amount of classroom training could adequately prepare me for the real people I would treat and the real situations I would encounter as a paramedic.  I knew that I would have to learn through real patient contacts, through treating real people.  Feeling real pulses and listening to real breath sounds.  Touching the skin of a real ill person to assess their temperature and condition.  Looking into the real eyes of a patient in distress.

Anyway, we arrived on the scene to find an elderly gentleman sitting in a wheelchair.  The man appeared completely out of it and he was being held up by bystanders.  My partner excitedly asked if he could lead the call.  How could I say no?  He did a great initial assessment, ABCs intact.  The patient had an altered mental status and had a contusion to the back of his head indicating some type of trauma.  We quickly immobilized the patient and left the scene.  Even though my partner lead the call on scene, as the paramedic, it was still my responsibility to ride in the back with the patient.

We loaded the patient into the ambulance, and, well, that's when I started to panic a little bit.  You see, as a new medic, I thought it was my job to figure out why my patient had an altered level of consciousness, so I started sweating.  I knew my partner had checked ABCs, pupils, c-spine, lung sounds...what was I missing?!  I didn't know.  I couldn't think.  I wasn't sure what I was missing, but I just couldn't move forward with my assessment.  In my head, I was panicked.  My heart was racing, and the beads of sweat poured down my forehead.  I felt my brain trying to work, but the wheels weren't turning the way they were supposed to. 

I stuck to the basics.  Oxygen, supplemental ventilations as needed, IV fluids, cardiac monitor, EKG, vital signs...over and over again. 

Still, no clue.  So what did I do?  I started over. 

Wiping the sweat out of my eyes, I looked at my patient and asked "sir, what is your name".  With slurred speech, the patient answered.  Okay, I thought, airway intact, the patient is obviously breathing, and has a pulse.  I made a mental note of the slightly garbled words and continued.  I assessed the patient's breathing:  in...out...okay...breathing intact, but slow.  Okay, my patient is breathing slowly, has altered mental status...could it be drugs?  Pupils!  What do the pupils look like?  Pinpoint.  I called out to my partner..."hey man, did you notice that the patient's pupils are pinpoint?".  His response: "oh yea, I forgot to tell you".  Oops.  By the way, pulses were equal, regular and strong, so circulation was intact.

Now that I recognized the patient's respiratory effort was depressed, and the patient had constricted pupils, I had an idea regarding how to fix it.  Narcan!  I gave the patient narcan and while my patient's breathing improved, his mental status did not. 

Okay...what else am I missing.  At that point, with a patient so severely altered, my next step was to expose the patient to assess for further trauma.  No injuries found, but I found a necklace indicating my patient has diabetes.  But his blood glucose level was 130...so, I thought to myself: could that still be the issue.

And then I remembered a time when I was working with my previous partner and we had a completely obtunded diabetic patient, profusely diaphoretic, as is classic with a hypoglycemic episode, and a stable blood sugar also in the 130 range.  We administered IV dextrose and the patient awoke.  My partner at that time explained that normal blood glucose levels vary depending on the patient's compliance with medication, diet, etc. 

So, I gave this altered elderly male patient some IV dextrose.  He awoke, and explained to me that he has chronic back pain and takes opiate pain medication for relief.  Whew...problem solved.

After this call, and many other similar calls, patients with altered levels of consciousness became one of my favorite calls to tackle.  As I explain to my students and new hires...and whoever else will listen, part of our jobs as paramedics is to be like detectives.  We may run into a scenario with which we are unfamiliar, but we need to search for clues, follow all leads and rely on experience and gut to forge our path toward developing some sort of explanation.  That explanation can dictate our treatment plan, and potentially save our patient's life.  So, when at first the scenario is perplexing, sometimes, starting from square one is the way to go.

It's Been a WHILE

Well, it's been a little over three years since I last posted on this blog.  I guess I got so wrapped up in being a new paramedic that I completely forgot to record my experiences here.  So, to catch you up, I am still a paramedic but also function in the role of a field training officer.  Field training officers are the first point of contact for new employees once they've been released from the classroom portion of their new hire onboarding process.  The new employees do third-rides and one-on-one rides with us for a minimum of four weeks.

Anyway, as you can imagine, a lot has happened over the last three years and I will do my best to include past and present experiences in the blog posts to come.  For now, I'll summarize the last three years of my career.

Since I became a paramedic, I have run nearly 4000 calls, about 25 of them have been cardiac arrests or obvious deaths, almost 200 calls for legitimate respiratory distress, 120 chest pain/cardiac-related calls, and 80 major traumas, including shootings, stabbings, assaults, and car wrecks.

Thankfully, through those calls, whether serious or not serious, medically necessary or not medically necessary, I can say I have learned a lot.  When training a new employee, one of the most important points I like to make is that as paramedics and EMTs, we can learn from everyone and everything.  We can learn from the patient who isn't breathing, the patient who's bleeding out, the patient who has threatened to kill us, the patient who has actually kicked, punched, slapped, spit at or tried to wrestle us.  We can learn from the patient who's complaining of toe pain, or the one who doesn't really have a complaint and just needs a warm place to sleep for the night. We can learn from the patient with chest pain and an abnormal EKG, or the one's who have extremely diminished lung sounds, or none at all.  We can learn from the bodies left behind at the scene of an accident, or the patients who survived the accident.  We can learn from everyone and everything!

Often, my new employees chuckle when I mention that they can learn from those patients with lower acuity complaints, but there really isn't anything funny about it.  I can honestly say I've learned from those patients.  Whether I've learned some aspect of patient care, or something about documentation, or how I, as a human, relate to other humans, I've learned something.  And, when I, or any other EMS provider feels they've learned all there is to learn, it's time to leave the profession.

In fact, one of the things that has kept me in EMS is the knowing that every single day can present a learning opportunity.  I'm thankful that I have not yet, and hopeful that I will not in the future take for granted this wonderful aspect of my journey through prehospital medicine. 

Well, this post is long enough for now.  Next time I will write about some interesting cases I have been confronted with since I became a paramedic.