All Shifts Are Not Created Equal

Strengths and weaknesses; we all have them and we all know everyone else does too. Some people flaunt theirs and other do what they can to hide them. Some are out in the open for all to see while others are deep-seeded and difficult to find. There are still others who hold on with the faintest of hopes that they’ll eek by and never get caught with their pants down and those who think they are God’s gift to mankind.

Look at our field, EMS. Do we have those people, I mean both extremes? Do you know any? Do you work with any? I’ll bet that everyone says that they do to both counts.

So the next batch of questions come in; what have you done about it? Have you said anything to a superior? To that person? Have you tried to eliminate the problem or help it? Are you trying to be proactive in your approach with the patients' interests at heart or are your hands tied?

I went through EMT class when I was 17 and a senior in high school. I passed my written and practicals before I turned 18. It took me about a year before I felt truly comfortable with my knowledge and skill base. At that time I felt that I could handle anything thrown in front of me. I loved being an EMT. I was aggressive. I wanted calls that would challenge my skills. Seems normal, right? I got in to Paramedic school when I was 19 and finished when I was shy of my 21st birthday. It too took me about a year or so to feel truly comfortable with my skills as a Paramedic.

It wasn’t long after I got out of Paramedic school that I began to realize I wanted to see things done “my way.” It was the correct way, or so I thought, and that everyone else should be doing it that way. On one hand I like helping and teaching others how to do things, imparting my knowledge to them (hadn’t gotten all the experience just yet). I liked teaching others. I liked precepting EMT and Paramedic students. Here I was only 21 and already doing that. I wanted to do my part in helping others succeed at good patient care. Then as the years crept by I got more in to educating and making sure that others did things the right way; not necessarily “my” way, but the proper way.

Everywhere I’ll go I always run across some who seemingly have no clue. Their hearts are in the right place and they like being a part of something like EMS but if put out on their own in a busy, not necessarily messy, cardiac arrest or multi-systems trauma that they soon would be overtaxed. These are the people who would either freeze on the spot or would be so focused on one thing that they overlook the obvious which could be detrimental to the patient’s outcome.

Have I been there? Yep. So have a lot of people and they should have no problem admitting it. I haven’t seen everything but I’ve seen and done a lot. I have learned to slow down and take a look at the overall picture of a scene, regardless what it is, prior to moving forward. For example, on car wrecks I’ll always look at the outside of the vehicle first so I know what kind of damage has been done before I look inside at the patient and the interior compartment. I know there’s always urgency but not to the point of overlooking things.

So, what do we do about these “weaker” people? Do we discard them? Do we put them on shift with someone who will carry them? Do we keep them as warm bodies in cold seats? Do we educate them in hopes of rehabilitating them in to productive members of our EMS crews?

Usually these “weak" people are easily identified. They usually hang back and are the followers, not the leaders. They do not direct. They seem pensive. They may be terrific “hands” on a scene but if placed by themselves they will not function adequately or at a substandard rate. Mind you, I understand that not everyone is suited to be a "leader" and that's perfectly fine. But often the people who need the help, need the experience, get pushed aside by the leaders of the pack, the more aggressive ones who want to make sure things get done. There are times when that's needed but others when things can be slowed down to allow them to be a part of the call, do some skills, have a hand in direct patient care, and be let to feel more comfortable with their surroundings and skills as we the leaders watch from an arm's length and are there to jump in at any given moment if things go south.

How do we handle them? How can we? More times than not they’re placed with partners or shifts that can absorb their skills in to their own and they become that needed set of hands to do work, not necessarily the thinkers on the call. The “weaker” ones are placed with the “stronger” ones to balance out in hopes that they may, by course of osmosis, absorb the necessary skills and knowledge to be productive, to function normally like most others do, to properly and adequately care for the patient and protect themselves and the crew at the same time. Big tasks to be asked of all, all at once, and handled by a group that routinely do each and every day without a bat of an eye.

I’ve found that bringing inadequacies to some people offends them. It makes them feel inferior like saying, “you suck at being an EMT,” when they probably humped it to get through class. Do it tactfully. Offer suggestions. More and more I’m critiquing runs after the fact with the crews not only because I have to do internal a & r but because it helps everyone in a smaller group discuss what they saw, what they did, what part they took in the call, and ask / answer questions. If a single person has a problem or I saw something that wasn’t right I’ll ask that person on the side what they saw, what they did, what they thought of the run, and then offer constructive criticism.

Find out what their weaknesses are, if possible. Is it knowledge? Is it skills? It might be something as simple as letting them "get their hands dirty" on a call. They may not feel comfortable doing some skills or handling a particular piece of equipment. It might be that a certain type of call intimidates them or scares them.

I’m not the smartest Paramedic out there as I learn things all the time, even after 23+ years in EMS. I still miss subtle signs. I too focus in on one thing and miss the obvious. It’s happened to all of us at one time or another.

If you see someone who has problems or questions things, help them out. Don’t let their questions go unanswered. The longer they linger the longer they may go and not properly treat a patient because they’re afraid of doing the wrong thing. In the end they’ll leave EMS because they feel inadequate and that they don’t know how to help people. Answer questions. Ask questions. Practice with these people, with crews; do training the right way and don’t make a pencil exercise out of it. Talking about things and actually putting your hands on are two completely different things. They’re not the same. Hopefully with help, education, perseverance, and determination by both sides these “weak” people will become the stronger ones and help the next batch of “weak” people.

Listen, learn, educate, and help. Such a vicious cycle but we’ve all been there before.