Contemporary Concepts in Paramedic Practice
Introduction
I operate as a paramedic, and at my station, we often work in shifts in teams of four individuals; one driver, two paramedics, and a senior medic. As part of the larger emergency medical services team, our participation in the provision of care is paramount because we are usually among the first responders in many medical emergencies, as noted by Anderson, Vaughan, and Mills (2017). With all sorts of teaching moments and stories from those more experienced than us, our workplace is ever productive and exciting. Newcomer paramedics are often deployed during the day and only operate at night once every seven days. When I began operating as a new paramedic at the current station, I was more of an assistant to an older and more experienced paramedic, and this was part of the tradition in order to inculcate other newcomers like me and me into the system, and bringing us up to speed with how the department was running. It so happened that my first day at work was on a Friday night, and it was quite an experience. This paper will outline details of my clinical experience on that Friday night. In order to cover all areas of my experience on that day, I will use the Gibbs reflective cycle.
Description
My shift started at 5 p.m. on a Friday evening. Ecstatic at beginning my new posting, I arrived one and a half hours earlier in order to get acquainted with the work and members of staff. I was getting myself acquainted with my new workstation and what would become my office for a long time (ambulance). EMS members of staff operate as one family, and it is a tightly-knit group of professionals that are solely committed to their work. The team that we were supposed to replace had not yet returned from the field. They actually returned late at 19:43 hours, and by this time, we had already started ours. In my line of work, there is no such thing as a typical day, as I later came to know. Every day brings new situations, new patients, new settings, having different complications, or medical challenges.
I was taken through the orientation process by my older colleague, and we started by inspecting the ambulance and ensuring that everything that we required for our shift was available and in good condition. This process involved checking whether we had sufficient medical supplies, whether our radios were working, and whether our tools were in good condition. After inspection, we were now required to remain on standby, waiting for phone calls alerting us to attend to any emergency. Our standpoint was an office adjacent to one of the major hospitals in the state. At immediately 9:30 p.m., a call was dispatched, and we drove to the scene immediately.
We arrived at the local nursing home within minutes of the dispatch call. We were supposed to attend to a patient that was reportedly having a serious altered mental status. Upon reaching the destination, I was required to pull the stretcher out of the back of the ambulance while my colleagues headed towards the entrance of the facility. I wrestled with a stretcher out of the back and started walking towards them, and the older paramedic stopped and asked me whether I had remembered to carry the bags. I had obviously forgotten, and he laughed softly and sent me back to the ambulance as my colleague took on the stretcher. Being my first night out, my body was experiencing mixed reactions with both terror and excitement, featuring in equal measure. I did not know what to expect from the other side, and as much as I was curious to assist the patient, I was equally apprehensive. My confidence was only strengthened by the fact that I was in the presence of arguably the most experienced individual in the department at the time.
Carrying the two red bags in hand, I jogged a little in order to reach where my colleagues were. I found them already having gone past the receptionist, and they were in the lobby waiting to get into the elevator. Two minutes later, the lift arrived, and we went up two floors. Every nursing home has its own style and culture, and therefore one often encounters challenges because you never know what to expect from employees operating in nursing homes. Nonetheless, in this instance, there was an elderly woman who apparently had received my colleagues at the reception. She was wearing a navy blue scrub, and she was the one leading us to where the patient was situated. As such, we assumed that she was an attendant or a nursing assistant within the facility. She directed us to where the patient was located, and with an unflustered and slow gait, she turned and left, having uttered one sentence, “This is Mercy, today she has been acting weird.” My colleague, Jordan, scoffed and pushed the door wide open. Inside the room, the patient was seated on the bed, and there was a young security guard seated in a chair directly opposite to her.
Apparently, Mercy had been unresponsive the whole afternoon: She refused to talk to everyone. As my old colleague started saying hello to the patient, Jordan asked me to hand over the bags and set them on the floor. The veteran paramedic then requested for the blood pressure cuff from Jordan and asked me to watch carefully as he began the usual routine procedures. He also asked for the pulse oximeter and the stethoscope and attached each of the three tools to the patient. Jordan continued taking measures, and the older paramedic started running his assessment. A few moments later, the older paramedic started engaging the patient directly, “Hello, my name is Michael, and I am a paramedic. What is the problem today?” Mercy respondent by murmuring some words that none of us could either understand or interpret. Michael then proceeded by asking the patient to squeeze his hand as he placed his left hand in her right hand. The patient responded and squeezed Michaels’ hand. “That is very nice Mercy, can you now smile for me?” Mercy glared at him at first, then smiled.
We were all focused on the patient, and therefore it was easy to see that whereas her right side responded beautifully to her smile, her left side did not move an inch.” Thank you very much that is very encouraging of you,” said Michael. Michael then turned to all of us and told us that we needed to move with speed. He looked at me specifically and told me that the patient was probably on the verge of suffering a stroke. Michael then sat next to the patient and informed her that she was in danger of a very serious condition and that it was important that she accompanies us to the hospital. Michael asked the patient whether she understood any of what she was being told, and she responded in the affirmative. Michael then held the patient by the hand and asked her if she could stand up, which she did with ease. Within minutes, we were in and out of the nursing home, having already identified what was troubling the elderly patient. We rushed her to the hospital, and she was booked immediately in the E&A Department, with doctors attending to her condition as we wheeled the stretcher back to the ambulance, ready for the next call.
Feelings
I remember vividly that I almost asked Michael to repeat what he had just said. As we walked towards the elevator, my heart was beating one million times faster. This was my very first call, and for it to feature a patient with stroke, it was not the kind of start that I was expecting. Michael’s pronouncement was awesome and horrible at the same time. Awesome because we knew what was troubling the patient and therefore understood what needed to be done, and horrible because there is nothing worse than stroke. Here I was, escorting an elderly woman so close to death, and yet she did not even understand the thin line that she was trending on. Our stretcher was of no use because the patient was physically capable of walking. She, in fact, seemed the type to decline the offer of being wheeled in one.
Like any other newly employed young and energetic individual, I was eager to demonstrate my prowess and help individuals that would require my services. In any case, it is what I had trained for, and it is one of the reasons why I signed up for this line of work. Therefore, when I reported on that day for work, I was certain that my day would be just like any other. But to be in an elevator with a woman who was on the verge of death without even her knowledge was something different altogether. I was clearly not prepared for such incidents, and now I understood why the department had this policy of welcoming new paramedics and placing them under the tutelage and watchful care of experienced veterans such as Michael. I looked at my colleagues, and none seemed to be apprehensive or even worried about the situation. I am sure it is not that they did not care, but probably they had been used to such incidences. My journey back to the ambulance felt like it took me a full day. I wanted us to fly and rush the client to the hospital to avert what was evidently a precarious situation.
Evaluation
Everything that happened on this day was perfect in my eyes. From the time I arrived at our station, my colleagues were really helpful and open to assisting me with the culture of the workplace. And even when we got our first call of the day, my colleagues were really helpful, almost literally holding my hand and helping by guiding my footsteps along the path. Throughout the journey to the nursing home, I was being briefed of what usually happens when we reach the destination. Michael informed me that upon arrival, a paramedic must ensure that the scene is safe, and this is done by conducting a rapid assessment. This is what Michael and Jordan were doing when we reached the scene. The vital signs were being taken to assess the situation of the patient in order to establish or rule out some of the common challenges that often affect older people. I saw how my colleagues treated the patient with kindness and professionalism. This was a huge learning experience and a positive one, for that matter. Everything went well, and there were no mishaps.
I always wondered why the EMS members of staff are always efficient in what they do. I realized that it revolves around the kind of culture developed around their work and their work ethic. Everyone deployed in the field knows what to do when to do it, and how to do it. It is like Michael and Jordan were communicating through osmosis. The coordination was spot-on. The outcome was a near-perfect result for the patient that we reached just in time to take her to the hospital before the worsening of her condition. Michael’s style of engaging the patient was quite effective – the language used and the methods adopted were highly effective. The nurse assistant had stated that Mercy was unresponsive to their instructions and attempted communication, but from Michael’s engagement, there was nothing to indicate anything of the sort. Perhaps it is the approach used that really mattered in this context. Effective communication is vital in the provision and promotion of effective care. Being a veteran, Michael had developed great interpersonal skills, and his easiness with Mercy was evident and quite effective.
Perhaps one of the most overlooked aspects of our success in the activities that we did on that day and which we have always done in many other similar days is the aspect of teamwork. We needed each other to accomplish what we did on that day. We could not operate without our efficient and colleague driver and the expertise of Michael and my other colleague Jordan, who had served for one year before my arrival. It would have been a tall order had the patient become problematic with only one paramedic on site. Our success on that day and on many subsequent days has been pegged largely on the fact that we operate as a team and therefore complement each other and support each other to accomplish the main objective of assisting our clients to become well. Supposing our patient became comatose during the evaluation process, it would have been a challenge for anyone to carry her to the ambulance to seek further medical services. The significance of the team cannot be underestimated.
Conclusion
My experience during my first day at work was quite special, although I did not expect that together with my colleagues, I will be attending to a patient on the verge of suffering stroke. I cannot give a positive ending to what transpired on that day because the patient was later transferred to another bigger and more specialized hospital after becoming comatose a few days later. In fact, word went around that we had done such a good job at diagnosing the patient’s condition earlier on, and this aided the interventions that followed. Any delays in our actions would have resulted in an unfavorable situation for Mercy and for us. Our quick response was indeed timely and vital, for it gave her a fighting chance.
Faced with the same situation today, I would be able to take charge owing to the experience that I have gained over the duration that I have been practicing as a paramedic. Being my first day at work, this experience was special and unique in itself because I never expected, and it never occurred to me that my work would also involve responding to such cases. It is excusable because it was only my first day at work. Before this day, I always had the idea that my work would largely involve responding to accidents and similar incidences, and this experience taught me to always get prepared to respond to any kind of challenge. I learned that I needed to develop my interpersonal skills, and even though that would come with experience, I saw it important to dedicate some time to developing my interpersonal skills since I would be engaging with clients directly as I saw Michael do on that Friday evening. What was possibly a tense situation was easily diffused by Michael, and within minutes, the patient became verbal and started responding to his prompts.
Besides the need to improve my interpersonal skills, my experience on my first day at work shaped the rest of my encounters in subsequent days, weeks, and months. My day started with Michael taking me through the paces of inspecting our ambulance and ensuring that everything we needed for our shift was available. I later came to learn that this process is considered so vital that it can determine whether one survives or not and, therefore, should be carried out with the highest levels of concentration. And even though the inspection process may appear trivial at first, going to the field without certain tools or equipment would be catastrophic in instances where such materials are required to help one overcome the life-threatening challenges. While we were inspecting the ambulance, Michael had me draw a checklist, and as I later came to learn, the idea was to help me memorize the items that are required before beginning our work. In addition, I also learned that inspecting the scene to ensure that it is safe upon arrival is also of paramount importance because, in certain situations, paramedics may respond in a hostile environment, thus risking their lives and of the patients, they are meant to attend to.
Action Plan
Based on my interactions on my first day at work, and after seeing firsthand the significance of effective communication on patient care, I committed to improving this aspect of my practice in order to enhance my overall contribution. I consulted with Michael and Joseph, the head of the department, on ways through which I would improve in this area. Even though it had not been identified as an area of deficiency, I just felt that I needed to operate at the same level as I saw Michael do.
List of References
Anderson, G. S., Vaughan, A. D., and Mills, S., 2017. Building personal resilience in paramedic students. Journal of Community Safety and Well-Being, 2(2), pp. 51-54.