The Good, The Bad & The Ugly Paramedic Student Handbook: GBU Paramedic, #1

By Tammie Bullard

Are you mentally ready for the reality of making an ambulance your everyday office?

 

Is it your hope to end every shift without second guessing your actions or inactions?

 

Do you want to follow the crowd, or create your own professional approach with intent?

 

Becoming a newly qualified paramedic or EMT is like a juggling act. With hands and minds full of ambition, fresh ideas, hard earned expertise and newly acquired knowledge, it can be challenging to maintain the high standards that you're desperate to deliver. Even the best of intentions will be difficult to deploy, without recognising what's important, or why. This book is your guide to growing good habits, so that little of the bad and even less of the ugly can creep in along the way.

 

While training and education deal with standalone skills, minimal time remains to devote to the biggest learning curve of all. Putting everything together into one professional, compassionate and satisfying package. If you're looking for checklists to tick, flick and forget, this is not the book for you. But if you prefer to craft an individual brand of outstanding emergency care with intent, everything you need is right here.

 

Nothing clinical will be covered. No tips or tricks on specific techniques. It's all about attitude to the human-centered skills that will set you up for success, ready to hit the ground running. A self-development style handbook, for students at any stage of preparation for a prehospital career. 

 

• Work on ways to bring out your best in providing nothing less than you would expect for your loved ones.
• Think through the things that may prove inwardly challenging, before they arise in reality.
• Fine tune your focus and create proactive plans to avoid unnecessary incidents or unwanted events.
• Design a mindset that matches your moral compass, and satisfies those who depend on your dedication.

 

Through its friendly, conversational and easy to follow format, The Good, The Bad & The Ugly Paramedic Student Handbook puts you firmly in the driving seat of your own destiny toward the job of your dreams.

 

Book #1 in the GBU Paramedic series for prehospital care providers.

• Language: English
• Publisher: Resounding Impact Publishing
• Release date: Feb 23, 2021
• ISBN: 9780648880868

Tammie Bullard

Tammie is an Australian author with a passion for professionalism and best patient care. Through a background in paramedic practice and extensive academic study, along with clinical teaching, training, precepting and lecturing roles, she aims to put it to good use. Her approach to the prehospital environment and its unique challenges is inclusive, non-confrontational and realistic, with the simple goal of encouraging every reader to stay proactive in making their chosen career successful, safe and satisfying. After deciding to become a paramedic, while living in a remote country town, she started as a volunteer, before diving headfirst into the world of paramedic practice. Throughout her academic journey from undergraduate to postgraduate qualifications in intensive care paramedicine, and a master's degree in critical care, her enthusiasm has steadily increased, along with the prerequisite study debt and collection of textbooks. Tammie's emergency ambulance experience ranges from paramedic, preceptor and trainer, to clinical support as a single responder. Through university lecturing and co-ordination roles, she has been fortunate enough to teach, and continually learn from, paramedics in every Australian state, either in person or online. For the duration of her career, at every level, Tammie has remained fascinated by recurring cultural chatter around the question of what makes a "good" paramedic. Without professing to know the answer, over a decade's worth of scribbled notes, from countless conversations with medics and students have been gathered together in the shape of this book. Written to provide an effortless ongoing tool for self-reflection in every paramedic with a desire to excel in this rewarding role.

Book preview

Striking Up A Rapport

If you are a new paramedic or on your way toward becoming one, then you have chosen an enormously exciting career. Full of unknown shocks and surprises, tragedy and triumph, stress and satisfaction ahead. Books that you have read up until now will be mostly educational, instructional and informative in all things clinical and practical, as they should be. But this one is different. 

Over a decade of working and teaching in the world of prehospital care have highlighted one resounding factor above all else, the strength of every student’s desire to have a heads up on what really happens. In decades gone by, a shroud of mystery existed, the kind that created excitement and anticipation. But, in more recent years, unlimited access to ideas, opinions and experiences floods every student paramedic’s focus. Social media platforms, reality shows, podcasts, video streams, memoirs and more feed that natural need to know.

Excessive for some and never enough for others, but full of insight, be it good, bad or ugly. 

In the same way that it provides some sense of preparation, this can become blindsiding. Too much time among others’ mindsets, through such a crucial and impressionable phase, may also form a false sense of self. Without doing, seeing or being involved in the intricacies of emergency prehospital care, it is difficult to decide which approach, attitude or aspect of advice will work best for you. And you are the one who matters the most. To the patients you want to care for, the profession you want to represent, the employer you want to work for, the loved ones you want to make proud and the conscience that you want to convince.

With a lifelong journey in your sights, you must choose with intent which type of paramedic you want to be. Those that you follow in feeds, listen to at length, watch their words of wisdom or read about regularly can influence one way or another, but you have to do you. Remain true to your thoughts, moral compass and personal code of ethics. Listen and learn by all means. Never stop searching for the nuggets of gold that will add value to the essential service you plan to provide. But this book is designed to put you in the driving seat, right from day one.

Almost all of the precepting, mentoring, teaching, training and writing I do is we focused, an intentional approach to providing a team-based thought process. So that each individual, myself included, can appreciate the bigger picture surrounding every situation, then make conscious choices about how and where we want to stand. Taking the same approach, the tone of this book brings all of us together into one inclusive group.

Out in the wider world of prehospital care, some of the not-so-nice things about being new could tempt you into following the crowd to fit in faster. Although all prehospital care providers are at different stages, every single one had to start somewhere, even those portraying an image of being a naturally born pro.

A more authentic alternative is the advantage that you are opting to take. Through reading this book, you can create individual and purposeful approaches to every aspect of your future career. The very fact that you are taking such steps to set yourself up with intent speaks volumes about your integrity and potential. It is a privilege to join you on this journey to becoming a paramedic through chapters that will provide food for thought in the following ways.

Simple paragraphs styled to inspire positive paramedic practice.

Most of them bite-sized, but some bigger to break down the ideas.

Short, although not always sweet, but straight to the point.

Insight into the effects of attitude on patients and public perception. 

Steps to aim for excellence rather than leaving every outcome to chance. 

Suggestions for actions or inactions that you may choose in the future. 

Words on why it matters to patients, your profession and your overall level of self-satisfaction.

So, scribble in it, fold the edges of pages over, mark chosen chapters with sticky notes, highlight some sections and cross out others. In audio or eBook format, use your device’s mark-up tools or find a pocketbook to gather your thoughts. Every time you pick up the pages, they could provide a different perspective. Either evolving alongside as you develop good practices or reminding you of what matters most, when you find yourself struggling to stay on track.

You will notice an overriding theme that threads throughout. Ongoing advice to set yourself up for a consistent approach. It might not sound like much, but it’s a big deal, often overlooked in every industry, no matter how fresh or firmly planted the provider. Forming some level of forethought, or applying the benefit of hindsight to as many situations as possible, may drastically reduce the effort and stress that you will need to expend on daily decisions.

Your career is going to be jam-packed full of demanding choices, some with a brief period to process thoughts, but most in an on-the-spot, rapid-fire format. Nothing can be done to change this. You are no doubt prepared and probably looking forward to expecting the unexpected. But, if you are forced to stop, think, and process every minor moment, every time it re-arises, your mind is bound to tire. Leaving less energy and focus for the prehospital patient’s major mayhem and mishaps that require your undivided attention.

Suggestions for creating consistent catchphrases, regular reminders, proactive plans, organised overview, systematic structure, predictable performance, memorising the mundane and regulating your reactions come up time and time again. So often, that a break between chapters is strongly advised. Otherwise, it risks becoming more monotonous than motivating. It’s a long book after all, full of insight and ideas offered by others as well as lessons learned the hard way through making mistakes of my own.

After reading any point that piques your interest and resonates with the reality of things you have seen, heard or done, put the book down. Think about how to apply a purposeful approach. Write notes on how it may look or feel, why it could be beneficial and ways to build your own proactive alternatives instead. Then put it into practise whenever you can.

When progressing through the pages, remember that it’s okay to agree or disagree with any of the words. Either way, if you’re proactively planning a purposeful approach due to your reactions to everything you read, then that is precisely the intent. I cannot tell you how to behave, it is entirely up to you, but I can put a collection of words out there to get you thinking.

From a comfortable place of reading, you’ll be able to picture yourself in some of the positions of discomfort described. During placements and eventually shiftwork, you might consider specific snippets that come to mind. When lying in bed at night, you may find yourself re-visiting real-life events that stop you from sleeping soundly, so re-visiting a chapter could help in reflecting, reassessing, then moving on. Chatting with colleagues could raise issues that resonate, or not, with your reading. Agreeing and disagreeing throughout is both expected and encouraged. After all, paramedics are picked by recruiters for their autonomy, independence and critical thinking abilities, so now is a great time to fine-tune yours. 

Rest assured, I have no desire or drive to prove myself through knowledge or controversy, so none of this aims to convince, contradict, impress or infuriate. It is simply intended to motivate a mindful attitude in a career that demands decisive action. Reflective practice will be your go-to tool in setting you up for success and, the more you deliberate over the details now, the less likely you are to fall into a comfortable habit of going with the flow. At the centre of your prehospital preparation, the star of the show is you. So, set the stage now, with intellect and intent.

Let others continue to train you in the techniques, tips and tricks of paramedicine, but only you can tell what makes you, and your conscience, tick. Attitude is entirely within your control, so be proactive in delivering nothing less than you would expect for loved ones of your own. Grow good habits now, so you have less bad to break and ugly to undo in your future paramedic practice.

Preparing The Equipment

Before we take off on the track toward setting standards and styling our approaches, there are four things that we will need to bring along the way. 

Time

External pressure and internal drive to do our best can push us into rushing ahead. But, just like the tangible skills we have trained in, they cannot all compete for our attention. There are twenty-five separate chapters in this book, each revolving around one specific concept or area of focus, full of suggestions, attitudes and approaches to consider.

So, the best way to tackle each topic is one at a time and, tempting though it may be to devour the entire book in one sitting, especially for faster readers, look at it as an emergency services style of meal. 

The breakfasts, brunches, lunches, afternoon snacks, and dinners that we delight in are enjoyable and satisfying on days off. We might participate in the preparation, then let the cooking aroma sink in. Leisurely chew as we take in every taste and flavour, then sit back and wait while our bodies process and digest before absorbing the best bits and excreting the unwanted waste.

Compare this to a busy shift, with little to no breaks, when we force ourselves to fill up with food on the run, cramming in everything possible en route to the next call. Not noticing the nice things in our lunchboxes, no time to salivate over savoury and sweet treats, never able to remember what we have even ingested.

We can swallow the book whole if we’re hungry for more. But, for a fulfilling and worthwhile experience, being prepared to go back and thoroughly chew on each chapter will prove a valuable, proactive process in shaping our styles of paramedic practice. 

An Open Mind

This is where we get a sense of whether we’re excited to read on or already beginning to feel buyer’s remorse. Life is way too short to read books that our brains don’t buy into. So, we absolutely must be willing to maintain an open mind if we want to gain any value from the time we spend reading. 

It may be best to temporarily forget everything that we think we know about ideas and attitudes in paramedicine. Of course, we’ll need to remember the skills that we have learned so far, including anatomy, physiology, pathophysiology, pharmacology and overall logistics. But the rest? Now is a good time for us to start from scratch to establish a real sense of individual style.

Memes about paramedics praising or punishing patients and behaviours. Demonstrations of driving that depict almost every road user as selfish or obstructive. Social media posts that build-up or knock down the reputations of others. Books devoted to calls deemed inappropriate for an ambulance. Movies that glamourise the drama and destruction. Online pages or groups with threads full of comments or complaints. Peer discussion that dictates what needs to be changed and why. Conversations overheard on placement about an organisation’s politics. Documentaries that divulge emotional reactions of paramedics in real life. Have they helped us form opinions on the good, the bad and the ugly of prehospital care before we have even settled in? 

If so, it is probably too early to hold fully formed opinions, and we don’t want to miss out on seeing both sides of every story.

We may be new to this role but are undoubtedly bringing a broad range of life experience along with us. So, we can give ourselves credit, as intelligent adults, and chances to develop independent and well-informed opinions on the job.

If we do everything possible to keep an open mind now, we will already demonstrate some of the most outstanding traits of a good paramedic. Sharp sighted situational overview, absence of judgement, critical thinking skills, lack of bias, strong rationale and educated decision-making processes. To any person still reading at this point, welcome aboard.

A Methodical Mask Mindset

One of the tools to keep each of us and those we intend to care for feeling safe, respected, calm and reassured is a confident demeanour or expression, like a mask. Something alluded to often throughout this book. Not the type to hide behind, but the kind that buys us time and a little mental space when we face difficult circumstances. 

If we imagine walking into horrific scenes that shock the senses, having a default expression to wear gives us an instant shift in perspective. Terrible sights, smells, and sounds will undoubtedly occur. But when instinct kicks in and forces our faces into shock or disgust, knowing how to pull this back into line is vital, reducing the likelihood of offending or insulting the dignity of others. 

Feelings of outrage, upset, confusion, overwhelm or even anger are inevitable in this role, all of which may be outwardly obvious when patients and family members look to us for reassurance. A tried and tested mask can help us hone in on what we know, squashing almost all of the doubt or emotion that rushes to meet us.

The key behind the mask is in its method rather than its appearance. Almost a physical and mental re-boot. So, we can imagine it in whichever ways we prefer. As long as the picture we see before us is a face fixed into the professional, impartial expression that comes from having focus. 

Although the concept may never have made itself evident until now, it is nothing new for most. It merely describes the expression that we wear in other aspects of life, personally and professionally, the one that makes it clear that we mean business.

If we face a multi-trauma call and become distracted by the damage, we can start with A to E because it is familiar and effortless to follow. When trying to obtain IV access in challenging situations, we apply what we know using naturally recalled methods. If we have to resort to a surgical airway, relying on preparation gives us a clear path to follow, despite the enormity of undertaking this type of task.

Should we find ourselves facing violent threats, knowing how to request urgent assistance, or escape, will help us make smarter, quicker decisions amid immense pressure. On extremely upsetting calls, having a way to maintain our composure is likely to prevent us from breaking down. Avoiding floods of tears, which could render us incapable of providing much-needed care and comfort to those involved in the call.

Moulding the mask is best done through repetition, sound knowledge and planning. 

Having structured ways of preparing for skills and laying out equipment so that we still manage in poorly lit, confined workspaces against noisy, dramatic backdrops. 

There may be occasions when we are forced to rely on colleagues or bystanders to rummage through bags and hand us equipment. It will be easier to keep things coming when we can picture exactly what we need, and where to find it, when we need it the most.

We can create catchphrases for ourselves to use in stressful situations as an instantaneous tool, or play them on repeat, in the mind, during times of crisis. Rather than find ourselves forced to scramble around in adrenaline-fuelled thoughts, for random hints of reassurance. 

Familiarity is formed with equipment and where it is stored, from infrequently used items in the ambulance, to the habitual positioning of keys, radios and mobile phones. Training our brains in reliable, rapid recognition, so we can reach for something vital without wasting valuable time. 

First, we need to get comfortable with donning and doffing the methodical mask by testing it out in the mirror. It may sound silly or feel foolish, but it could also work. 

Think of a daunting scene and make a shocked expression.

Imagine a relevant skill or procedure from training.

Mutter a decisive right or okay out loud.

Watch the face set itself with a focus now that the brain knows what to do. Try to keep the shocked expression even when picturing the skill. It’s hard to do both at once isn’t it?

It is almost a sub-conscious switching between expressions. This is the mask that naturally falls into place when we have a plan of action. It is also the expression that patients hope to see from any paramedic tending to an emergency.

Exercises like this can elicit annoyance or even disbelief in their design. Some of us cannot stand, nor see the value, in role-play or pretend, in any aspect of education. But it has to be worth a try if the only alternative is winging it when the need arises. 

Phrases like flying by the seat of my pants or I’ll work it out as I go have an incredibly short shelf life. They may appear to roll off the tongue in those we admire, but they have a sneaky habit of tripping us up. Particularly those in pressurised roles, such as first responders. The culture of appearing casual and cool is a hot-bed of disaster. Instead, we can do ourselves a favour and get so smart about building habitual, replicable, consistent, and easy-to-reach practices that we get to feel, and look, calm in any crisis. No matter the extent of the chaos we will encounter. 

The multiple mentions of developing plans, processes and systematic approaches throughout this book provide the materials to make this methodical mask. But it’s up to each of us to put them into practice.

An Understanding Of The Bluff

Every first responder learns to bluff, to