New Paramedic ALS nerves.

[LoadingMe]

Hello,

As the title explains I am a brand new paramedic working 911 calls at my Fire Department. In the past I worked 911 but never really did much transporting to hospitals. The last Fire Department I worked at I was an EMT and they did not transport to the hospital. We would show up on scene and just gather vitals and help transfer the patient to the oncoming ambulance that showed up on our scene to transport our patient. Prior to becoming a paramedic I was functioning as an EMT and I would get nervous on calls that required ALS interventions but once the call got going and we were in the back of the ambulance working it started to sub-side because the eyes were not on me. I've only probably being doing legit 911 transport calls as an EMT now for about a year. Just recently about a couple weeks ago is when I obtained my paramedic license and it didn't hit home that I was going to be the leader now and eyes would be put on me. We have had a few close calls that turned out to be nothing. One call coming out as a pregnant female not breathing. When the tones dropped for that call I was beyond nervous. My heart was racing and I was constantly worried about messing up and being looked at as the paramedic that kills people. While I was in school I knew the material. I hate to say this but I barley studied in medic school. I mainly just studied the ALS AHA guidelines and my drugs and of course ECG's. I passed my psychomotor skills on my first try and pass the written exam first try at 80 questions. I feel book smart but when it comes to the street I am not sure if I am that leader that needs to be. I am a very introverted person and its hard for me to have "confidence." I'm a pretty low self esteem person and I am always constantly worried about what I may say wrong or what someone may think of me. I am always worried now about performing a procedure wrong or being completely stumped on something as simple as seeing V-tach on the monitor and forgetting to shock it because of how nervous I would be and get tunnel vision. It really demoralizes me because I really do enjoy the medical field but I do not think I am cut out for the emergency setting. Ever since I obtained my medic I am constantly worried about the tones dropping and it being a serious call such as a bad trauma (gun-shot, MVC, etc), cardiac arrest, pediatric calls, anaphylaxis shock, etc. In a calm setting I can tell you everything I would do for this but in a real life situation I get tunnel vision due to my nerves and always and I mean always second guessing myself. I always feel stupid and think to myself I should have never even passed medic school.

Its always been a goal of mine to go to PA school and specialize in sports medicine more specifically orthopedic. I obtained my paramedic to bridge to nursing because it always me to work full-time but this really doesn't matter for this thread. I'm just not sure if I am cut out for this because all other medics I have talked to say they never got nervous and think its crazy how nervous I actually get. They keep trying to convince me to stay but I believe that is because they just don't want to lose a medic because they would get back on the box. I just don't know. I wish I wouldn't get so damn nervous.

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[Apollyon]

Never nervous is bull****. But, nervous is not scared. It's apprehension. What's that saying - "We are what we repetitively do". Muscle memory is real.

Good BLS beats bad ALS 8 days a week. The best mistake is the one you don't make. You're appreciated for what you can contribute, not what you can't. What this means is, just go down the list. Follow the protocol. When you get to needing the IV, don't miss it. If the pt needs BiPAP, that's a tube you didn't miss. However, if the pt needs a tube, don't miss it.

Back in 1978, if I recall, the NY Medical Journal published "Loeb's Laws of Medicine":
1. If what you're doing works, keep doing it
2. If what you're doing isn't working, stop
3. If you don't know what to do, don't do anything
4. Above all, though, never let a surgeon to your patient!

I was saved at least twice by cookbook medicine. You gotta be a clone, not a droid. Sometimes, you have to improvise. But, the structure is there.

Just by doing it, you'll get more comfortable. Your superiors know you've got it, or else, they wouldn't have cut you loose.

You got this.

 

[LoadingMe]

Never nervous is bull****. But, nervous is not scared. It's apprehension. What's that saying - "We are what we repetitively do". Muscle memory is real.

Good BLS beats bad ALS 8 days a week. The best mistake is the one you don't make. You're appreciated for what you can contribute, not what you can't. What this means is, just go down the list. Follow the protocol. When you get to needing the IV, don't miss it. If the pt needs BiPAP, that's a tube you didn't miss. However, if the pt needs a tube, don't miss it.

Back in 1978, if I recall, the NY Medical Journal published "Loeb's Laws of Medicine":
1. If what you're doing works, keep doing it
2. If what you're doing isn't working, stop
3. If you don't know what to do, don't do anything
4. Above all, though, never let a surgeon to your patient!

I was saved at least twice by cookbook medicine. You gotta be a clone, not a droid. Sometimes, you have to improvise. But, the structure is there.

Just by doing it, you'll get more comfortable. Your superiors know you've got it, or else, they wouldn't have cut you loose.

You got this.

Hello Apollyon,

Thank you for kindly responding to my post and giving me your advice. I do greatly appreciate it. I guess at times it's hard for me to tell the difference on whether I am actually scared or just nervous. I believe in muscle memory and I guess as time goes on the more ALS calls I run the better it will become or at least that is what I hope for.

Not really sure how else to respond to your points other than to say how much I agree with them and how grateful I am to have read them. Thank you sir again. I just need to get out of my own head and stop worrying about performing the wrong procedure and doing more harm than good. I have to realize that not every patient presents the same and how the book wants you to believe. Thank you sir.

 

[seanm028]

I felt the same way. I had been an EMT for a while and I had taken some college classes, so I was pretty cocky going into medic school. I passed the tests without having to study very much and was generally an arrogant a**hole. That all changed when I graduated and hit the streets. I remember a few calls with my heart in my chest, thinking how dumb I was for not trying harder in school, back when I had a safety net in the form of a preceptor. I will never forget the first critical patient I had who didn't have a textbook presentation, nor will I ever forget the relief I felt when I wheeled him in to the ED and he still had a pulse. Fortunately, I had an FTO who gave me a lot of straight talk. He told me I needed to work on leadership and confidence or I wouldn't cut it. Which sounds great, but how does one "work on leadership and confidence?" In my experience, the answer has been through exposure. Running a code seemed terrifying until I did it half a dozen times. Giving direction to everyone else on scene seemed terrifying until I did it 20 or 30 or 40 times. Deciding when to activate a trauma alert or a STEMI alert seemed terrifying until I did it a few times. In the meantime, I had my nose in the protocol book constantly (and I think people expect this from new medics). I made it a point to re-read at least 1 or 2 protocols each shift, quizzing myself throughout the day until I was confident that I had developed muscle memory. On the way to calls, if my partner didn't need me for something else, I would review the protocol for the dispatched nature, just to be sure. It took probably 6–12 months of this habit, but eventually, I started to feel less panicked when I came to work. Now, almost 8 years after medic school, I feel generally prepared and calm with any call that is thrown at me. That's not to say that I know everything — I certainly don't, and I still make it a habit to consistently review protocols and medical literature — but I feel I can handle situations without killing any patients. I still get stumped on some of the more complex calls, but I can systematically move through an assessment and treatment plan until either the problem is corrected or I transfer care to the hospital.

Bottom line, it's completely normal to be terrified as a new medic. Every good medic is terrified at first. If they say they aren't, they're either lying or they're dangerous. Keep studying, keep working on developing muscle memory, and no matter what you do, DO NOT try to duck out of the scary stuff! You'll get your confidence soon enough.

 

[dowaitlisted]

It took me 2 years to feel comfortable enough to go on 95% of calls. I still get the pucker calls, but they are much fewer and further in between. Volume, volume, volume. The more runs you make, the more patients you take care of, the easier it will get.

I didn't BLS anything but BLS transfers for the first year and a half that I got my medic.


EDIT: You got this. I'm always a PM away.

 

[N2B8TR]

Old thread I know but maybe you are feeling more comfortable now? I worked for an extremely busy EMS program so it took about 6 months before I felt like I was stable, and wasn’t afraid to pick up some overtime, and close to a year before I had an established routine and felt ok in the job. Start teaching on the side and help with simulation (if your program offers that) and that will definitely start to help and increase knowledge. Hope all is going well.