The end of the beginning
A journey of a thousand miles begins with a single step
-- Laozi, Chinese philosopher (also known as Lao Tzu)
I've had a couple of weeks now to reflect upon the completion of the EMT course, and my successful certification by the state of New Jersey. I want to again thank my wife and son for their patience with me, and to everyone that offered their support and well wishes.
The experience was both easier and more challenging than I had expected. In all honesty, the course material wasn't particularly difficult to understand, even with the use of medical terminology sprinkled throughout. The hands-on and practical skills weren't particularly difficult either, whether it was applying trauma bandages, inserting airways, performing CPR, or just moving and lifting patients.
On the other hand, I was challenged to overcome an initial desire to simply 'help' a patient with what appeared to be an immediate discomfort or pain, and rather to slow down and assess the entire situation, looking for those more hidden issues that actually posed a greater life risk. It took a bit of time for me to not just understand the importance of this, but to actually internalize it to the point that it became natural to slow down rather than speed up in times of crisis.
Not that I was always perfect at it.
Tom Petty Had it right....
The waiting is the hardest part.
Last night I took the NJ State certification exam, and to be honest, I found it easier than the class final.
75 hopeful future EMT's were given up to 2 hours to complete 100 multiple choice questions, which spanned the entire gamut of course materials from operations to anatomy, pediatrics to geriatrics, medical injuries to trauma care.
So I was either really well prepared or clueless.
Results can come in as little as 48 hours, although the State only promises "3 to 6 weeks".
My wife asked me this morning if I was relieved it was all over, to which I snorted and responded, "This isn't the end of the journey, it's just the start."
Now I'm just waiting to hear the word "Go!"...
One behind, one ahead
There are challenges at every step to becoming an EMT. Some are easily overcome, such as learning to take a pulse or blood pressure reading, move a patient to or from a stretcher, or take off a pair of gloves without getting glitter all over yourself (yes, that is from an actual practical skill session...).
Tougher challenges include the mental ones, becoming comfortable with assessments and how to build rapport with patients, especially the ones who might not be able to fully communicate what ails them, yet is reliant upon you as an EMT to keep them safe, and get them to more skilled medical hands.
And then there is the final exam of the EMT course.
And terrified that it's going to be twice as challenging. So send your good wishes my way... I'll take all I can get. ..
The toughest lesson
Today was our final practical exams, a requirement for graduation from the EMT course. Designed to test our knowledge and understanding of all things EMT, covering medical and trauma assessments along with key skills including airway management, bandaging and splinting, CPR and AED usage, and pharmacological interventions such as EPI-Pen and Nitroglycerin administration.
And although the final practical exams were designed to test the skills I have gained over the past 4 months, in the end it taught me perhaps the most important lesson of all -- a reminder that being humble and keeping an open mind may just be the most important EMT skills I can master.
While the EMT course has been challenging, especially for someone who has been out of the day-to-day experience of classes, studying, and test taking for almost 30 years, I felt that I had done pretty well for myself. My quiz and exam grades were always high, and while there was a lot of memorization to accomplish, my own life experiences often helped to put class material in context and perspective. Eighteen months as a driver for the squad gave me an additional sense of how to interact with patients, and the experience of having observed other squad EMTs actually putting some of these skills in action in the course of our calls might have even offered me an edge in some scenarios.
Through the class, the practical exams had gone extremely well, with several instructors telling my that I appeared to have that special quality that would make me a good EMT. I passed through all the practical exams without requiring remediation or a second (and final) attempt to demonstrate a critical skill.
And then there was today. Final exams. And on the fourth and final skill station, I made a huge mistake, one that I won't quickly or easily forget.
A grim way to Learn
One of the clear benefits of doing practicals in class is that it gives us a chance to learn from our mistakes. And overall.... as EMT students, we make lots of mistakes.
Most of them are small, like not thinking to put a sheet down on a Reeves stretcher to make it easier to move a patient to the ambulance stretcher later one, or tying bandages in such a way that the un-padded side of a splinting board ends up against the patient.
But then there are the big mistakes. The deadly ones. The ones where, as a student, you sit at the end of the exercise wondering "Do things really go bad that quickly in real life?" [The answer, by the way, is unfortunately 'yes'].
The bad news, unfortunately, is that all these scenarios represent real-life situations that various instructors have personally faced. As one told us, "After 25 years as an EMT, I still learn something new on just about every call."
Keeping eyes on the goal
I saw the picture above the other week, and it has stuck with me....
While the EMT course can be a lot of work, my push to excel is driven from within. Coursework and certification alone won't make me a good EMT.
What will make me a good EMT is never settling for giving my patients anything less than my very best efforts.
[Thanks to @insomiacMedic for the image]
From beginning to end
As we come to the last few weeks of the EMT course, it seems that we are also coming full circle, revisiting early class materials on the lifecycle of human development.
One of the more interesting aspects of our current study is the process of childbirth, and the EMT skills that support it.
Needless to say, this has made for some humorous practical skill sessions,mostly involving EMT students trying not to laugh as their peer is arm deep in the abdomen of the mother (delivery) mannequin, trying to emulate the birth process by pushing the baby mannequin out (with appropriate grunting sounds made entirely by accident in most cases).
Having just wrapped up the third exam, it feels like a great weight has been lifted from my shoulders. With a little more than a 40 hours remaining (a month of weekends, in my case), the end of the EMT coursework is within sight.
Most of our remaining classes are really going to be review, helping us to fine tune our skills at patient assessment and interventions for both trauma and medical emergencies. In talking with some of my fellow students, everyone seems to be more comfortable than we were just a few weeks ago, having recognized that by breaking down how to approach patient care in to a logical and consistent manner, we've grown both comfortable and confident in our own skills and ability to handle many different situations.
Of course, the instructors aren't going to just make it easy for us. The scenarios and situations they're starting to give us are more complex, often involving a mix of injuries and medical conditions, and requiring us to build upon our index of suspicion skills and determine which are serious life threats to be dealt with quickly, and which ones could have little or nothing to do with the situation at hand.
For example, just because a patient presents with high blood pressure and is known to be diabetic doesn't necessarily mean that either of these two conditions are linked to an underlying issue that we must treat. Where our initial scenarios were clearly set up so we could demonstrate an understanding of diabetic emergencies (and associated treatment options), instructors now want us to be able to treat our patients holistically, and not get overly focused on one specific piece of information at the expense of something more critical.
And I got a real-life lesson in this just the other week....
As class heads in to our third quarter, the materials and skills shift from understanding medical emergencies and associated Nature of Illness (NOI) to traumatic injuries and their associated Mechanism of Injury (MOI).
Trauma is generally considered the gorier part of EMS, and deals with direct bleeding, fractured bones, and other physical injuries to the body that generally result from the application of an outside force on the patient. As such, there are a wide number of practical skills involved in providing interventions to our patients, including proper techniques for bandaging and tourniquet application.
But trauma isn't always obvious. Car accidents, sports injuries, slips and falls can all cause traumatic injuries to bones, muscles and internal organs, often with no visible external injuries. Some of these internal injuries are treated almost exactly the same as internal bleeding caused by medical issues, such as acute abdominal pain due to appendicitis, or altered mental status due to stroke. .
But the effects of the MOI are supposed to guide us to an index of suspicion that there may be more going on with our patients, concerns that may require more care and a deeper assessment for injuries that just simple pain or confusion would appear to warrant.
So we get a bit more touchy-feely with our fellow students, and start learning to look for DCAP-BTLS.
Jon Alperin, one of our MFAS volunteers, shares his journey to becoming an NJ certified EMT.
from the Start
Here is Jon's journey, presented in time order: