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.
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....
A peek inside a PSAP
My EMT course is being taught through Atlantic Training Center, using facilities at the Morris County Public Safety Academy. The Academy not only supports Police and Fire academies for the county, it's also co-located with the Morris County Office of Emergency Management (OEM) facilities.
Although not formally part of the EMT course, my class was exceedingly lucky to have a quick tour of the 911 emergency dispatch center and the Emergency Operations Center (EOC), thanks to Scott DiGiralomo, Director, Department of Law and Public Safety/Emergency Management Coordinator. A mere 2 years old, the center is a technological marvel, reminiscent of any major Hollywood movie depicting high-tech command-and-control centers, from space flight operations to military war rooms. As my actual career has been in the high-tech and telecom industries for 25-plus years, I found the technical aspects quite fascinating, from real-time video feeds from around the county (including the helipad at Morristown Memorial Hospital, used by our county airborne paramedics), to GPS-enabled tracking of emergency services personnel and equipment.
The amazing job these emergency dispatchers perform really can't be understated. For those that are curious, I've linked to a YouTube video that gives you just a small taste of the complex multi-tasking these individuals perform, minute by minute, staying on-line with callers for as long as necessary with simultaneously coordinating with a host of dispatched resources. They truly are one of a kind, and probably don't get half the recognition that they deserve.
Be still my beating heart...
Well, actually... don't!
There's no doubt that we've got to master the signs and symptoms, and associated interventions, of both respiratory and cardiac emergencies. Every situation we face starts with assessing the ABC"s -- Airway, Breathing, and Circulation -- as these represent true emergencies, where it really can be a matter of life-or-death.
Respiratory and cardiac emergencies are very closely related, as issues in one area can have a detrimental, even fatal, impact to the other.
While the heart is responsible for pumping blood through the lungs for oxygenation, and then moving the oxygenated blood itself to the tissues and organs throughout the body, it is itself a muscle that also requires oxygenated blood to effectively pump. So any disruption in how the body is obtaining and utilizing air through the upper and lower airways (including the lungs) can cause issues for the heart as well.
And things roll downhill quickly from there on... Because having to perform CPR means that someone is having a really, really, really bad day....
Taking a breather
With the first set of EMT written and practical tests behind us (Ashley, our Cadet member, and myself both scored very well...thanks to all who offered their well wishes!), our classwork moves on to a more focused set of lectures on medical emergencies, and their associated care and treatment options.
While we are told not to diagnose underlying causes of illness, in practice, EMTs play a very key role in uncovering critical signs and symptoms of those underlying medical issues through our history-taking activities (the aforementioned "million questions"), which we provide to medics and hospital staff as part of our transfer of patient care. The questions also guide us in developing an index of suspicion for what may be happening with our patient, allowing us to be more aware of the risks for cardiac, respiratory or neurological issues that may develop while we are in transport.
Classwork this week focused on the various causes of respiratory distress. If you love to read a good detective story, this set of coursework is for you. The textbook almost reads like a good mystery novel, filled with similar signs and symptoms for many different potential causes of dyspnea (or shortness of breath).
And only by combining the practical lung sound skills we're learning to listen for, with other vital signs (including pulse rate and blood pressure), key medical history, and signs and symptoms from our observations and the patients own behaviors and expressed issues, can we reach a clear index of suspicion on key underlying possibilities to be aware of.
... and we try not to drop them along the way.
Two weeks of class are under my belt, and I'm feeling kind of good. There is certainly a lot of material being covered, and a whole bunch of practical exercises so we can practice skills until they become second nature. Ashley even described the practical exercises as "fun," even while they are designed to get you to think critically about patient care, teamwork and communication.
Class is in session!
And so it begins, not with a whimper or a bang, but rather with a 2-and-a-half hour orientation session last night. 24 hopeful future EMTs, split about 50/50 between men and women, from squads around Morris, Union and Somerset counties.
I'm taking my EMT course through Atlantic Training Center at the Morris County Public Safety Academy in Parsippany, although there certainly are many other training organizations offering EMT courses in New Jersey.
The key message last night was pretty simple: Becoming an EMT is hard work. Be prepared to put in the time, study, practice and study some more. Classroom lectures, reading assignments, online lectures and quizzes, in-class written and practical exams... plus 10 hours of clinical rotation in a hospital emergency department or with the Mobile ICU (MICU, aka paramedics). Clearly, this is not something you can coast through with some last minute cramming.
One instructor explained that they weren't there to help us pass the course. Their goals were to turn out the best EMTs possible, and while they'd be more than happy to help us when we need it or when we ask for help, but ultimately this has to be something that we, as students, really wanted to succeed at.
The goal, as he explained it, was to teach us to "act, not react".
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: