The Back of the Medic

Well, week two of my Paramedic Academy is complete. As of today, I have realized something extremely important: I really need to refresh my initial patient assessment skills.

Me? Yeah.

Why? Really? Yep. I do assessments all the time. I have patients I work up all the time. Not that I don’t ask and obtain pertinents from my patients. I just don’t do it in a consistent manner. Right now, while I am in the academy, I need to remain consistent, which can only help me in my EMS work outside of school. I don’t plan on this being a “only while in the academy” habit. I want this to be a permanent part of my providing an excellent level of care to my patients.

I’m not the only one that needs to improve skills and get rid of bad habits. The experience levels in my class vary significantly, but the common denominator among all my classmates is assessment skills. Each of us has weak points. Mine became blatantly obvious to me when I was given a baseline assessment of my patient assessment skills. We got absolutely no feedback on our assessments. But I knew where I screwed up. I left that baseline skills assessment and I literally beat myself up over it. I thought long and hard about my performance, and realized that improvement is what we are all there for. To ensure our BLS skills are strong, to works to make us strong paramedics. Those vital primary assessment questions assist us in determining the course we will be taking in caring for our patients.

Remember the following acronyms?

• OPQRST
• SAMPLE
• OPASTE

Wait? What? OPASTE? I remember the first two, but this is the first I heard of the latter acronym. I guess my age in EMS is showing. If you haven’t heard of it before, it is for respiratory emergencies, and stands for:

• Onset – When did it start?
• Progression – Is this acute or chronic?
• Associated with pain – Does it hurt to breathe? Where?
• Sputum – Is there a cough? Is there sputum (i.e. productive cough)? What color is it?
• Talking – How much effort is it taking for them to speak?
• Exertion (or Exercise) tolerance – Are these respiratory symptoms making those normal levels of exertion more difficult? Or impossible?

I have gotten out of the habit of using the first two acronyms. I need to get back to those true basics. I have written them down again and again, to pound them into my head. I’ve begun to put it into use as of today’s assessment lab.

Even if you don’t use OPQRST or the other acronyms, are you consistent in your patient assessments? This is a little heads-up to all EMS folk, working full-time, part-time, or not. Practice, practice, and re-practice those assessment skills. Most importantly, to be a better EMT (or Paramedic!). But also for those who are considering getting into a paramedic program. It will bite you in the rear end either way if you don’t.

Day two, as well as my first week of the Paramedic Academy are over. We are still working on the administrivia (computer access, calendars, reading requirements, testing – FISDAP, etc), as well as reminders of our BLS skills. It makes sense to ensure EMT skills are solid before moving to the new paramedic skills. Today was another day of BLS skills assessment and review. Airway (OPA, NPA, BVM) on adult and pediatric patients, suctioning, more CPR, AED use, and becoming familiar with the Zoll ECG/Defibrillators we will use in the Academy. We got a brief refresh on cardiac function, and scientific basis for CPR using the new guidelines. More c-spine work was also in one of the skills stations, including that lovely device that doesn’t see a lot of use – the Kendrick Extrication Device (K.E.D.).

Personally, I haven’t used a K.E.D. on a patient in years. I also got to be a patient placed in c-spine. We each can be (and are) patients when needed for other students to practice or demonstrate skills. That brought back memories of being stuck on a board waiting for c-spine clearance in an E.R. years ago!

I did impart a few gems on many of the guys in my group on some things to make our patients more comfortable. For example, we use Laerdal StifNeck Select collars, both in my company, and in class. For some patients, they can be very uncomfortable on the medial (sternal) end of the clavicle (collarbone for the uninitiated). Padding it with a few 4 x 4 gauze pads can do wonders to make a patient more comfortable if they, like me, have that end of their clavicle protrude out a bit. And if the patient has a clavicle fracture, but they need to be placed in a cervical collar, pain from the collar pressing on a fracture can be eased by padding (As well as a paramedic administering pain medication.). Frankly, I was happy to get off that board.

I have 8 chapters to read this weekend… time to get on it.

Well, my first day of the academy was completed without any issues.

I was a bit surprised that I was performing CPR on a mannikin by 1030 hours  (Class began at 0900 hours). As paramedic “candidates”, we are obviously expected to have our EMT basic scope of practice knowledge and be able to apply it. Any EMS skill learned prior to any particular day in class, whether learned years ago, or the day before, if fair game to be required to demonstrate. So, there I was, pushing hard and fast on a mannikin, working to ensure that my switch-off with my partner at the moment happened in under 10 seconds.

Aside from that, we learned the requirements of upkeep of the academy grounds, uniform requirements, proper respect of our instructors and guest lecturers (Call out “Instructor on Deck”, and stand up), how to answer questions when asked in class (yep, there is a specific way), learned about our SIM mannikin (No pens allowed near him, for example), worked on some ambulance operations, more about homework and workloads, uniforms, and more. It was a lot to take in on day 1, but it was a great start!

Last night was the first night I opened the textbook package. It is 2 large volumes, plus 2 large workbooks. There is also an ECG book, but we won’t be using that until March or April. Chapters 1 and 2 are now digested. Chapter 3 during lunch today.

With my acceptance into the Paramedic Academy, this next year will mean incredible change for me. It means my life will boil down to school, work, and sleep (In that order of priority). If you are reading this, and you are a paramedic already, you know exactly what I mean. If not, this is a quick boil-down of my life for the next 4 months while I am attending the classroom portion of the program (There is actually still classroom time in the next 2 semesters, but not nearly as much):

• I will be in class 24 hours a week.
• I will also have 48-60 hours of study each week.
• I will also be working my “dayjob” 32 hours each week.

There are 168 hours in a week. Subtracting 24, 48, and 32 hours from that, leaves 52-64 hours to cram in sleep, exercise, housework, running a business, grocery shopping, etc.

Unfortunately, management at my “dayjob” has been less than supportive of my effort, since it doesn’t benefit them directly. There is a program here called “Career Development Program”, which allows staff to pursue a degree or certificate, even if it doesn’t relate to their current job or the needs of the department. This pays for registration/tuition, books, and some misc fees. However, my direct and second level management don’t want to authorize it. Nice. It really doesn’t matter that they support this. They have known that I was applying to the Academy. My guess is, they figured I wouldn’t make the cut, and it would be a moot point for them to prepare for me to be in school three days a week. Well, I did make it. And I am attending. I WILL get my paramedic, with or without their assistance. I purchased my books last week, and will pay my registration fees this Wednesday, as soon as I receive the permission code from the college to do so. I may not eat for the next 2 weeks, but hey, I’ll lose more weight.

So, based on my study and workload this semester, please understand if I don’t answer calls or text messages M-W-F from 0800-1700, as my phone will be either shut off completely, or set to absolute silence mode. And I may not respond as quickly to text message and emails.  I will respond after class and after work. But I need to triage the emails, text messages, voicemail, etc. The best method to reach me will be email, BTW.

Note to my family, friends, DMAT, and others: Thank you for your support! It means everything to me to know how much encouragement I have received from you.

A few things:

I added a countdown timer to my site, which is currently showing the time left until the Paramedic Academy starts. People have been asking me when I begin this new direction… Look to the right.

Once the Academy starts, I will put the countdown until I expect to be finished with the semester.

My activity level on this blog may change. Might go up, might go down. I really won’t know until I am in the thick of it all.